Publications by authors named "Nidhi Singla"

52 Publications

Aspergillus candidus eumycetoma with review of literature.

J Mycol Med 2021 Apr 3;31(3):101135. Epub 2021 Apr 3.

Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, India.

Objective: Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissues with involvement of underlying fasciae and bones, usually affecting extremities. In India, among mycetoma, the eumycetoma constitutes about 35% of cases. Hereby, we report the first case of eumycetoma caused by uncommon fungus, Aspergillus candidus.

Case Report: A 61 year old female presented to the Department of Dermatology with history of swelling of right foot associated with multiple firm nodules of approx. 1.5 × 1.5 cm each over dorsum of foot with discharging sinus containing white color granules. Biopsy of lesion on right foot on direct KOH examination revealed septate hyphae. Histopathology examination showed a histiocytic granuloma with fungal elements. Culture on Sabouraud Dextrose Agar grew white mycelial colonies which were identified to be Aspergillus species phenotypically. Genetic sequencing using Internal transcribed spacer gene, beta tubulin gene and Calmodulin gene was done and the isolate was identified to be Aspergillus candidus. Lesion was excised and patient was started on itraconazole.

Conclusion: Timely identification and starting of antifungal treatment can help in reducing morbidity due to eumycetoma to a large extent. As newer and newer species of fungi are emerging as significant causative agents of human infections, it is pertinent to report such findings from epidemiological point of view.
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http://dx.doi.org/10.1016/j.mycmed.2021.101135DOI Listing
April 2021

Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016).

Infect Disord Drug Targets 2021 ;21(3):445-451

Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India.

Background: Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases.

Objective: To study the epidemiology of Nocardia infections in a tertiary care center.

Materials And Methods: This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram's stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture.

Results: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods.

Conclusion: Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.
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http://dx.doi.org/10.2174/1871526520666200516161940DOI Listing
January 2021

Clinicoepidemiological and Genotyping Correlation of Pediatric Scrub Typhus from Chandigarh, India.

Indian Pediatr 2020 04;57(4):314-316

Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India.

Objective: We studied the clinical phenotypes and prevalent genotypes of Orientia tsutsugamushi in our area using indirect immunofluorescence assay (IFA).

Methods: We prospectively screened all febrile children presenting to our hospital over three years. From among children who were scrub typhus positive by ELISA we selected a sample of convenience for IFA testing to determine the genotypes of O. tsutsugamushi using four strains namely Boryong, Gilliam, Karp and Kato.

Results: Of all scrub positive patients (n=77), we tested 14 samples using IFA and all 14 samples were IFA positive. Karp genotype (n=7) was most prevalent followed by Kato (3), Boryong (1) and Gilliam (1) genotypes; 2 patients were positive for mixed genotype. There was high prevalence of organ dysfunction among IFA positive children. Three most common organ dysfunctions included hematological derangement in all, liver involvement in 10 (71%), and encephalopathy and shock in 4 each.

Conclusions: Karp was the most prevalent genotype of O. tsutsugamushi in our area.
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April 2020

Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases.

Acta Cytol 2020 23;64(5):406-412. Epub 2020 Mar 23.

Government Medical College and Hospital, Chandigarh, India.

Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations.

Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation.

Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture.

Conclusions: Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy.
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http://dx.doi.org/10.1159/000506432DOI Listing
September 2020

Molecular identification of species complex isolated from clinical samples and its antifungal susceptibility patterns.

Curr Med Mycol 2019 ;5(4):43-49

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Background And Purpose: More than 300 species are grouped into approximately 23 species complexes out of which around 70 are involved in human infections. The nomenclature of these species has undergone considerable changes in recent years. These species cause localized infections in individuals while inducing systemic infections mainly in immunocompromised patients. The present study was conducted to identify species in clinical isolates by molecular methods and determine their in vitro minimum inhibitory concentration (MIC) patterns to address the lack of data in this domain in Northern India.

Materials And Methods: For the purpose of the study, isolates obtained from various clinical samples were sent to the Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands, for molecular identification. The MIC testing was performed using the microbroth dilution method as per the Clinical and Laboratory Standards Institute reference method (M38-A2).

Results: was isolated from 33 patients (i.e., 1, 1, 2, 14, and 15 cases with endophthalmitis, sinusitis, pulmonary involvement, onychomycosis, and keratitis, respectively). These 33 isolates belonged to three species complexes, namely species complex (FSSC; n=13), species complex (FFSC; n=13), and species complex (FIESC; n=7). The species identified within FSSC, FFSC, and FIESC included (n=6)/ (n=6)/ (n=1), (n=7)/ (n=5)/ (n=1), and SC species (n=6)/ SC species (n=1), respectively. The MIC results showed that all isolates had a lower MIC against amphotericin B than against the other antifungal agents.
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http://dx.doi.org/10.18502/cmm.5.4.2149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034782PMC
January 2019

Isolation of and Species from Clinical Samples in a Tertiary Care Hospital in North India.

Infect Disord Drug Targets 2021 ;21(1):84-89

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Introduction: The members of the tribe Proteeae, Morganella and Providencia are being increasingly recognized as important pathogens. The spectrum of disease caused by them is wide and in reported cases, the mortality is high. Previously both of these pathogens were considered to be rare pathogens as the potential to cause nosocomial transmission and infection was not much studied. But their phenomenal evolution and increase in multidrug-resistance (MDR) strains of these pathogens are posing a major threat toward public health throughout the world.

Methods: This present study was carried out from July 2018 to December 2018 on all the pus and body fluid samples that were received in the Department of Microbiology. Samples were processed as per the standard Microbiological guidelines and also were analyzed for their antimicrobial susceptibility profile as per Clinical Laboratory Standards Institute.

Results: Out of 8425 samples received, 2140 were culture positive, amongst which 19 samples (0.89%) were positive for Providencia species (9) and Morganella morganii(10). The male : female ratio of these 19 patients was 2.8 : 1 and maximum patients (13) belonged to 20-60 years. As far as risk factors are concerned, maximum patients were diabetics (7) followed by abnormal liver function tests (6), concomitant UTI (6), history of invasive procedure (5), prior exposure to antibiotics (5) and urinary catheterization (4). About 6 were polymicrobial infections. Antibiotic susceptibility patterns revealed that Providencia strains were sensitive to ampicillin- sulbactum (77.7%) and amikacin (77.7%), while all Morganella strains were 100% sensitive to tobramycin and piperacillintazobactam.

Conclusion: This study heralds in need for more research in this area as infections caused by these two pathogens are on the rise. Moreover, resistance to antimicrobials is also an increasingly common problem thus delaying the treatment and prognosis of the disease.
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http://dx.doi.org/10.2174/1871526520666200128162646DOI Listing
January 2021

Rapid Intestinal Uptake and Targeted Delivery to the Liver Endothelium Using Orally Administered Silver Sulfide Quantum Dots.

ACS Nano 2020 02 24;14(2):1492-1507. Epub 2020 Jan 24.

ANZAC Research Institute , Concord Repatriation General Hospital , Concord , New South Wales 2139 , Australia.

Quantum dots (QDs) are used for imaging and transport of therapeutics. Here we demonstrate rapid absorption across the small intestine and targeted delivery of QDs with bound materials to the liver sinusoidal endothelial cells (LSECs) or hepatocytes and following oral administration. QDs were radiolabeled with H-oleic acid, with a fluorescent tag or C-metformin placed within a drug binding site. Three different biopolymer shell coatings were compared (formaldehyde-treated serum albumin (FSA), gelatin, heparin). Passage across the small intestine into mesenteric veins is mediated by clathrin endocytosis and micropinocytosis. 60% of an oral dose of QDs was rapidly distributed to the liver within 30 min, and this increased to 85% with FSA biopolymer coating. Uptake into LSECs also increased 3-fold with FSA coating, while uptake into hepatocytes was increased from 40% to 85% with gelatin biopolymer coating. Localization of QDs to LSECs was confirmed with immunofluorescence and transmission electron microscopy. 85% of QDs were cleared within 24 h of administration. The bioavailability of C-metformin 2 h post-ingestion was increased 5-fold by conjugation with QD-FSA, while uptake of metformin into LSECs was improved 50-fold by using these QDs. Endocytosis of QDs by SK-Hep1 cells (an LSEC immortal cell line) was clathrin- and caveolae-mediated pathways with QDs taken up into lysosomes. In conclusion, we have shown high specificity targeting of the LSEC or hepatocytes after oral administration of QDs coated with a biopolymer layer of FSA or gelatin, which improved the bioavailability and delivery of metformin to LSECs.
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http://dx.doi.org/10.1021/acsnano.9b06071DOI Listing
February 2020

Biofilms: Fungal perspective.

Indian J Pathol Microbiol 2019 Jul-Sep;62(3):514-515

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_20_18DOI Listing
December 2019

Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India.

J Fungi (Basel) 2018 Apr 6;4(2). Epub 2018 Apr 6.

Mycology Unit, Medical School and IISPV, Universitat Rovira I Virgili, 43201 Reus, Spain.

Mucormycosis is an emerging opportunistic fungal infection. Increasing immunocompromization, widespread use of antibacterial and antifungal agents (such as voriconazole prophylaxis), carcinomas, transplantation and lifestyle diseases such as diabetes are the main contributors to this situation. The predominant clinical manifestations of mucormycosis vary from host to host, with rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal infections being the most common. In India, the prevalence of mucormycosis is approximately 0.14 cases/1000 population, which is about 70 times the worldwide-estimated rate for mucormycosis. The present study was undertaken over a period of five years (January 2009-December 2014) to determine the prevalence of mucormycosis. The samples suspected of mucormycosis were examined by direct KOH wet mount and cultured on Sabouraud's dextrose agar without actidione and on blood agar as per standard mycological techniques. Histopathological correlation was done for most of the cases. Antifungal susceptibility testing was performed by the EUCAST reference method. We identified a total of 82 cases of mucormycosis out of a total of 6365 samples received for mycological culture and examination during the said time period. Out of these, 56 were male patients and 27 were females. Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections. The fungi isolated were (17), (12), (9), (8), (5), (4), (2), (1), (1) and (1). The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. Most of the patients (50) recovered, but 25 died. The rest of the patients left against medical advice. "Nip in the Bud" should be the mantra for clinicians/surgeons for a favorable prognosis. Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management.
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http://dx.doi.org/10.3390/jof4020046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023269PMC
April 2018

Sepsis Due to Chryseobacterium gleum in a Diabetic Patient with Chronic Obstructive Pulmonary Disease: a Case Report and Mini Review.

Jpn J Infect Dis 2017 Nov 11;70(6):687-688. Epub 2017 Sep 11.

Department of Microbiology, Government Medical College and Hospital (GMCH).

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http://dx.doi.org/10.7883/yoken.JJID.2016.567DOI Listing
November 2017

Dengue: An Analysis of Epidemiological Pattern Over a Six Year Period.

J Clin Diagn Res 2016 Dec 1;10(12):DC12-DC14. Epub 2016 Dec 1.

Professor and Head, Department of Microbiology, Government Medical College Hospital , Chandigarh, India .

Introduction: Dengue is an arboviral infection transmitted among humans by , the urban vector and as a maintenance vector in sub-urban and rural areas. The diagnosis is routinely established by detection of NS1 antigen and/or by IgM antibodies testing. Dengue infects 50-100 million cases per year worldwide with atleast half million serious cases needing hospitalization. Therefore, it is necessary to keep the surveillance ongoing to timely look out for changes occurring in disease pattern over a geographical area.

Aim: To study the epidemiological patterns of dengue virus infection in our region over a period of six years.

Materials And Methods: The present retrospective study was undertaken in the Department of Microbiology, Government Medical College Hospital, Chandigarh during time period January 2010 to December 2015 on 10,774 serum samples from patients clinically suspected to be suffering from dengue infection. Samples were selected as per World Health Organization (WHO) criteria. All the samples were processed for the presence of dengue IgM antibodies by μ anti-body-capture Enzyme Linked Immunosorbent Assay (ELISA), MAC ELISA and/or NS1Ag by ELISA as per the instructions of the manufacturer. The data was analysed from the data sheets available.

Results: During the time period, a total of 10,774 samples were processed and 2,449 (22.7%) samples came out to be positive for dengue virus infection. Marked seasonal variation was noted with 0-2 cases presenting during month of January to July but positivity peaked in post monsoon season in October (>70%) and tapered till December every year. The adult age group (16-45 yrs) showed maximum positivity (83.5%) with males affected more than females.

Conclusion: The present study clearly shows that our region is endemic for the dengue virus infection and there is need to continuously monitor the transmission of the disease in the community, to plan effective measures, to control the spread of dengue virus infection timely.
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http://dx.doi.org/10.7860/JCDR/2016/22482.9011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296428PMC
December 2016

Saksenaea erythrospora, an emerging mucoralean fungus causing severe necrotizing skin and soft tissue infections - a study from a tertiary care hospital in north India.

Infect Dis (Lond) 2017 Mar 4;49(3):170-177. Epub 2016 Oct 4.

c Medical School and IISPV, Universitat Rovira i Virgili , Reus , Spain.

Background: Saksenaea erythrospora is an emerging and recently described pathogenic fungus mainly causing invasive cutaneous infections. Globally, very few human cases, caused by S. erythrospora, have been reported. In India, among the genus Saksenaea, S. vasiformis was the only reported pathogenic species, until recently when a case of fungal rhinosinusitis was reported to be caused by S. erythrospora. We observed five human cases of necrotizing skin and soft tissue infections caused by S. erythrospora following traumatic implantation over 1-year study period.

Methods: The study was conducted for a year observing the causative role of Saksenaea species in primary cutaneous necrotizing infections. The clinical entities were diagnosed by both microbiological and histopathological examination of the skin biopsies. The final identification of fungal strains was done by comparing internal transcribed spacer (ITS) and D1-D2 domains of the LSU (larger subunit) of the nuclear ribosomal RNA (rRNA) sequences with those of type strains of the different species of Saksenaea.

Results: Out of total 23 cases of necrotizing skin and soft tissue infections, 5 were caused by S. erythrospora. Intramuscular injection into the gluteal region was the predisposing factor in four patients, while upper limb involvement, following medicated adhesive tape application, was seen in one patient. All patients were treated with liposomal amphotericin B (LAMB) along with extensive debridement of necrotic tissues. Four patients responded well however one died.

Conclusion: Saksenaea erythrospora is an emerging mucoralean fungus isolated in India among patients undergoing inadvertent I/M injections entailing necrotizing fasciitis at the local site.
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http://dx.doi.org/10.1080/23744235.2016.1239027DOI Listing
March 2017

Phaeohyphomycosis Caused by Rhytidhysteron rufulum and Review of Literature.

Mycopathologia 2017 Apr 15;182(3-4):403-407. Epub 2016 Sep 15.

Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.

Phaeohyphomycosis is caused by a heterogeneous group of mycelial dematiaceous (phaeoid) fungi, which produce melanin pigment. This condition is often confused with chromoblastomycosis. Rhytidhysteron is a dematiaceous fungus, which has been recently found to be causing human infections. Till date only three cases of infection with Rhytidhysteron rufulum have been reported in the literature. All three cases have been from North India. Hereby, we present another two cases where Rhytidhysteron was isolated. Both the patients belonged to Chandigarh (India) and presented with subcutaneous lesions. The isolates were confirmed by ITS sequencing. Both the patients were immunocompetent and gave no history of trauma or any other predisposing factor. Phaeohyphomycosis are often missed due to lack of knowledge regarding the fungi causing the infections and there is need for clinical, pathological and microbiological correlation for effective diagnosis and treatment in these cases.
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http://dx.doi.org/10.1007/s11046-016-0064-xDOI Listing
April 2017

Fusarium sacchari, a cause of mycotic keratitis among sugarcane farmers - a series of four cases from North India.

Mycoses 2016 Nov;59(11):705-709

CBS-KNAW Fungal Biodiversity Centre, Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, The Netherlands.

The two most common filamentous fungi causing mycotic keratitis are Aspergillus and Fusarium spp. Around 70 Fusarium spp. are involved in causing human infections. In this study, four cases of keratitis in sugarcane farmers in India are being reported, caused by the sugar cane pathogen Fusarium sacchari, a species of the Fusarium fujikuroi species complex. Fusarial keratitis was established by potassium hydroxide/Calcofluor white wet mounts and fungal culture of corneal scrapings on conventional media. Final identification was done by genetic sequencing at CBS-KNAW, Utrecht, The Netherlands. The antifungal susceptibility testing was done using broth microdilution method as per CLSI document M38-A2. Four cases of F. sacchari keratitis were identified. Three of them had trauma with sugarcane leaves, whereas one sugarcane farmer reported trauma by vegetative matter. The morphological similarities among various Fusarium species warrant use of molecular methods for identification of cryptic species. A wide distribution of sugarcane farming could be the possible explanation for emergence of F. sacchari keratitis in India.
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http://dx.doi.org/10.1111/myc.12518DOI Listing
November 2016

Changing Epidemiology of Mucoralean Fungi: Chronic Cutaneous Infection Caused by Mucor irregularis.

Mycopathologia 2015 Oct 14;180(3-4):181-6. Epub 2015 Jul 14.

Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India,

Introduction: The fungi pertaining to order Mucorales usually cause an acute form of clinical disease called mucormycosis. A primary chronic presentation in an immunocompetent patient is a rare form of mucormycosis. Mucor irregularis is known for causing chronic cutaneous infections geographically confined to Asia, mainly in China. We describe a case of primary chronic cutaneous mucormycosis caused by M. irregularis from a new geographical niche in India, highlighting changing aspects of its epidemiology.

Case Presentation: The patient was a farmer with a history of skin lesions over the lower limb for the past 6 years. The biopsy taken from the lesions showed pauci-septate hyphae with right-angle branching on KOH wet mount as well as special fungal stains. On fungal culture, greyish-white cottony mycelial growth of Mucormycetes was obtained. The strain was finally identified as M. irregularis on macro- and microscopic features on 2 % MEA and DNA sequencing. The antifungal susceptibility was done using EUCAST broth microdilution method and was found to be susceptible to commonly used antifungal agents. The patient was started on oral itraconazole and saturated solution of potassium iodide (SSKI). While undergoing treatment for 2 months, he was lost to follow-up, however, after a year when he recently visited the hospital; the disease got completely healed with no new crops of skin lesions.

Conclusion: Mucoralean fungi should also be suspected in cases with chronic presentation, in immunocompetent host, as there is emergence of such fungi in new endemic areas, particularly located in Asia. The role of other antifungal agents apart from amphotericin B for the treatment of chronic mucormycosis needs to be explored.
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http://dx.doi.org/10.1007/s11046-015-9908-zDOI Listing
October 2015

Antimicrobial susceptibility pattern of vancomycin resistant enterococci to newer antimicrobial agents.

Indian J Med Res 2015 Apr;141(4):483-6

Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh 160 030, India.

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http://dx.doi.org/10.4103/0971-5916.159309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510732PMC
April 2015

Dengue in pregnancy: an under-reported illness, with special reference to other existing co-infections.

Asian Pac J Trop Med 2015 Mar;8(3):206-8

Departments of Obstetrics & Gynaecology, Government Medical College Hospital, Chandigarh, India.

Objective: To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.

Methods: A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes.

Results: Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.

Conclusions: Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.
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http://dx.doi.org/10.1016/S1995-7645(14)60316-3DOI Listing
March 2015

Mycological Profile and Antifungal Susceptibility of Fungal Isolates from Clinically Suspected Cases of Fungal Rhinosinusitis in a Tertiary Care Hospital in North India.

Mycopathologia 2015 Aug 24;180(1-2):51-9. Epub 2015 Feb 24.

Department of Microbiology, Government Medical College and Hospital, Sector 32, Chandigarh, India.

A prospective observational study was conducted for 18 months to analyze the mycological profile of clinically suspected cases of fungal rhinosinusitis requiring endoscopic sinus surgery and test antifungal susceptibility of the isolates according to Clinical and Laboratory Standards Institute guidelines. Per-operative biopsies (n = 126) from 106 patients were processed by standard mycological procedures. Out of 126 samples, 59 (46.83 %) had fungal elements on KOH mount examination. Fungal growth was obtained in 76 (60.32 %) samples, of which single fungal organism was isolated in 68 samples and more than one fungal species in eight samples. The most common isolates belonged to the genus Aspergillus (n = 53, A. flavus being most common) followed by mucormycetes (9), Candida species (7), Penicillium species (5), Alternaria species (5), Fusarium species (1), Curvularia species (1) and black yeast (1). Two hyaline septate fungal isolates could not be identified. Aspergillus species were susceptible to amphotericin B (n = 46), itraconazole (n = 48), voriconazole (n = 52), posaconazole (n = 53), caspofungin (n = 51), anidulafungin (n = 53) and micafungin (n = 53). All mucormycetes isolates (n = 9) were susceptible to amphotericin B, posaconazole and itraconazole. Filamentous non-Aspergillus, non-mucormycetes isolates (n = 15) were susceptible to amphotericin B (n = 12), itraconazole (n = 13), voriconazole (n = 15), posaconazole (n = 15) and echinocandins (n = 15). Amongst the 07 Candida species, 05 isolates of Candida tropicalis were susceptible to amphotericin B, posaconazole, echinocandins and 5-flucytosine; one isolate of Candida albicans had the same susceptibility but was resistant to 5-flucytosine also, and one strain of Candida species was susceptible to all the nine antifungal drugs.
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http://dx.doi.org/10.1007/s11046-015-9873-6DOI Listing
August 2015

Determination of Extended-Spectrum β-Lactamases and AmpC Production in Uropathogenic Isolates of Escherichia coli and Susceptibility to Fosfomycin.

J Lab Physicians 2013 Jul;5(2):90-3

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Background: Urinary tract infection due to Escherichia coli is one of the common problem in clinical practice. Various drug resistance mechanisms are making the bacteria resistant to higher group of drugs making the treatment options very limited. This study was undertaken to detect ESBLs and AmpC production in uropathogenic Escherichia coli isolates and to determine their antimicrobial susceptibility pattern with special reference to fosfomycin.

Materials And Methods: A total number of 150 E. coli isolates were studied. ESBL detection was done by double disc synergy and CLSI method. AmpC screening was done using cefoxitin disc and confirmation was done using cefoxitin/cefoxitin-boronic acid discs. In AmpC positive isolates, ESBLs was detected by modifying CLSI method using boronic acid. Antimicrobial susceptibility pattern was determined following CLSI guidelines. Fosfomycin susceptibility was determined by disc diffusion and E-test methods.

Results: ESBLs production was seen in 52.6% of isolates and AmpC production was seen in 8% of isolates. All AmpC producers were also found to be ESBLs positive. ESBLs positive isolates were found to be more drug resistant than ESBLs negative isolates. All the strains were found to be fosfomycin sensitive.

Conclusions: ESBLs and AmpC producing isolates are becoming prevalent in E. coli isolates from community setting also. Amongst the oral drugs, no in-vitro resistance has been seen for fosfomycin making it a newer choice of drug (although not new) in future. An integrated approach to contain antimicrobial resistance should be actually the goal of present times.
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http://dx.doi.org/10.4103/0974-2727.119849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968637PMC
July 2013

Salmonella typhi isolation in a pregnant woman: determining the importance.

J Clin Diagn Res 2013 Sep 10;7(9):2100-1. Epub 2013 Sep 10.

Associate Professor, Department of Microbiology, Government Medical College Hospital , Chandigarh, India .

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http://dx.doi.org/10.7860/JCDR/2013/6118.3417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809696PMC
September 2013

Trends in the antibiotic resistance patterns of enteric Fever isolates - a three year report from a tertiary care centre.

Malays J Med Sci 2013 Jul;20(4):71-5

Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, 160030 India.

Background: The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center.

Methods: The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips.

Results: Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%).

Conclusion: In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773355PMC
July 2013

Epidemiology of Candida blood stream infections: experience of a tertiary care centre in North India.

J Infect Dev Ctries 2013 Sep 16;7(9):670-5. Epub 2013 Sep 16.

Government Medical College Hospital, Chandigarh, India.

Introduction: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients.

Methodology: In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed.

Results: During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole.

Conclusion: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.
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http://dx.doi.org/10.3855/jidc.2623DOI Listing
September 2013

Composite pheochromocytoma-ganglioneuroma of the adrenal gland: A case report with immunohistochemical study.

Urol Ann 2013 Apr;5(2):115-8

Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Composite tumors of the adrenal medulla consisting of pheochromocytoma and ganglioneuroma are rare tumors accounting for less than 3% of all sympathoadrenal tumors. These tumors display more than one line of differentiation in which normal and neoplastic chromaffin cells are capable of differentiating into ganglion cells under the influence of nerve growth factors. To the best of our knowledge, we report the second case with a composite tumor of the adrenal medulla in a normotensive patient from India.
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http://dx.doi.org/10.4103/0974-7796.110011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685741PMC
April 2013

Excited state behavior of pyrrole 2-carboxyldehyde: theoretical and experimental study.

Spectrochim Acta A Mol Biomol Spectrosc 2013 Aug 10;112:125-31. Epub 2013 Apr 10.

Department of Physics and Materials Science & Engineering, Jaypee Institute of Information Technology, Noida, Uttar Pradesh 201 307, India.

Photophysical and photochemical dynamics of excited state proton transfer reaction have been reported for Pyrrole 2-carboxyldehyde (PCL). Experimental and theoretical observations yield all possible signatures of intramolecular and intermolecular proton transfer in an excited state. Dual emission (~325 nm, ~375 nm) on photo excitation indicates the existence of more than one species in an excited state. Computed reaction pathway and two-dimensional potential energy profile in the ground state reveals a single minimum corresponding to normal form (E). Dual minima in excited state energy profile shows the existence of two species, one normal and other zwitterionic (Z*) species. A large Stokes shifted emission at ~375 nm in hydrocarbon medium reveals the existence of zwitterionic species due to Excited state intramolecular proton transfer (ESI(ra)PT). Excited State Intermolecular proton transfer (ESI(er)PT) is observed in a hydroxylic environment around 430-490 nm. pH variation in hydroxylic medium suggests the formation of anion (A((-))) from Z*.
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http://dx.doi.org/10.1016/j.saa.2013.03.091DOI Listing
August 2013

White light generation by carbonyl based indole derivatives due to proton transfer: an efficient fluorescence sensor.

J Phys Chem A 2013 Apr 21;117(13):2738-52. Epub 2013 Mar 21.

Department of Physics and Materials Science & Engineering, Jaypee Institute of Information Technology, Noida 201307, Uttar Pradesh, India.

The motivation of the present work is to understand the optical, chemical, and electrical aspects of the proton transfer mechanism of indole (I) and some carbonyl based indole derivatives: indole-3-carboxaldehyde (I3C) and indole-7-carboxaldehyde (I7C) for both powder form and their liquid solution. Structural information for indole derivatives (isolated molecule and in solution) is obtained with density functional theory (DFT) and time dependent DFT (TD-DFT) methods. Calculated transition energies are used to generate UV-vis, FTIR, Raman, and NMR spectra which are later verified with the experimental spectra. The occurrence of different conformers [cis (N(c)), trans (N(t)), and zwitterion (Z*)] have been interpreted by Mulliken charge, natural bond orbital (NBO) analysis, and polarization versus electric field (P-E loop) studies. (1)H and (13)C NMR and molecular vibrational frequencies of the fundamental modes established the stability of Nc due to the presence of intramolecular hydrogen bonding (IHB) in the ground state (S0). Computed/experimental UV-vis absorption/emission studies reveal the creation of new species: zwitterion (Z*) and anion (A*) in the excited state (S1) due to excited state intramolecular and intermolecular proton transfer (ESI(ra)PT and ESI(er)PT). Increased electrical conductivity (σ(ac)) with temperature and increased ferroelectric polarization at higher field verifies proton conduction in I7C.
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http://dx.doi.org/10.1021/jp310331nDOI Listing
April 2013

Human cervicofacial mycetoma caused by Streptomyces griseus: First case report.

J Microbiol Immunol Infect 2015 Dec 5;48(6):703-5. Epub 2013 Mar 5.

Department of Pathology, Government Medical College Hospital, Chandigarh, India.

Streptomyces griseus causes subcutaneous mycetomas in felines and dolphins; however, human mycetoma caused by S. griseus has not previously been reported. Hereby, we report a case of a 50-year-old female presenting with swelling in the left upper cervical region and the left cheek that lasted for 6 months. The fine needle aspiration (FNA) performed on the swelling yielded purulent material; on microscopy, actinomycosis was diagnosed. On culturing, the pus grew S. griseus. To the best of our knowledge, this is the first reported case of human mycetoma caused by S. griseus.
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http://dx.doi.org/10.1016/j.jmii.2012.12.002DOI Listing
December 2015

Evaluation of NS1Ag and IgM antibodies against dengue, importance for epidemiological surveillance.

Asian Pac J Trop Med 2013 Mar;6(3):251-2

Department of Microbiology, Government Medical College Hospital, Chandigarh-160030, India.

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http://dx.doi.org/10.1016/S1995-7645(13)60035-8DOI Listing
March 2013

Outbreak of Salmonella Typhi enteric fever in sub-urban area of North India: a public health perspective.

Asian Pac J Trop Med 2013 Feb;6(2):167-8

Department of Microbiology, Government Medical College Hospital, Chandigarh, India.

Outbreaks of enteric fever are a major health concern not only due to significant human morbidity and mortality but also fear of spread of multidrug resistant strains. We report an outbreak of enteric fever caused by Salmonella enterica serotype Typhi in a suburban area, in city Chandigarh of North India. Twenty-seven strains of S. typhi were isolated from blood cultures over a period of two weeks with 18 of these 27 patients residing in the same area. Maximum cases were in the age group 5-14 years (10 patients, 55.5%) while 4 (22.2%) cases were children under 5 years. All the strains showed similar resistogram being resistant to ampicillin and nalidixic acid, intermediate to ciprofloxacin and sensitive to chloramphenicol, ceftriaxone, cefotaxime, cotrimoxazole and azithromycin on disc diffusion testing. Minimum inhibitory concentration of ciprofloxacin was determined by agar dilution method and was found to be raised (≥ 2 μ g/mL). This nalidixic acid resistant S. typhi outbreak report warrants the necessity of implementing stringent sanitation practices in public health interest.
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http://dx.doi.org/10.1016/S1995-7645(13)60017-6DOI Listing
February 2013

Admission surveillance cultures among patients admitted to intensive care unit.

N Am J Med Sci 2012 Dec;4(12):648-50

Department of Microbiology, Government Medical College Hospital, Chandigarh, India. E-mail:

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http://dx.doi.org/10.4103/1947-2714.104317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530322PMC
December 2012
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