Introduction: Tuberculous meningitis (TBM) is a manifestation of extrapulmonary tuberculosis (EPTB) caused by Mycobacterium tuberculosis (MTB). The central nervous system is involved in about 1%-2% of all current tuberculosis (TB) cases and about 7%-8% of all EPTB. if not treated early, TBM leads to a high rate of neurological sequelae and mortality. Objective: This study aimed to assess the diagnostic performance of the GeneXpert MTB/rifampicin (RIF) assay in patients with TBM. Methods: A total of 100 suspected TBM cases were enrolled from various departments at tertiary care hospital, Bhopal, Madhya Pradesh, India, and classified as definite, possible, or probable TBM. The clinical samples were tested for microbiological and other cerebrospinal fluid (CSF) testing. Results: Out of 100 cases, 14 (14%) were classified as definite TBM, 15 (15%) were having probable TBM, and 71 (71%) were having possible TBM. Out of a total of 100 participants, all were negative for acid-fast bacilli (AFB) staining. Of the 100 cases, 11 (11%) were positive by mycobacterium growth indicator tube (MGIT) culture, of which only four (36.36%) were positive by GeneXpert MTB/RIF. GeneXpert MTB/RIF detected three (3%) cases that were negative by MGIT culture. Ten (90.9%) of the 11 MGIT-positive culture isolates were found to be RIF sensitive while one (9.1%) was found to be RIF resistant. Three cases tested positive/sensitive by the GeneXpert MTB/RIF but negative by MGIT culture. Six (85%) of the seven GeneXpert MTB/RIF positive cases were RIF sensitive while one (15%) was RIF resistant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 36.36% (95% Confidence Interval (CI) (10.93% to 69.21%)), 96.63% (95% CI (90.46% to 99.30%)), 57.14% (95% CI (25.50% to 83.85%)), 92.47% (95% CI (88.70% to 95.06%)) and 90% (95% CI (82.38% to 95.10%)) for GeneXpert MTB/RIF assay, compared with MGIT culture as the reference standard. Conclusion: Our study found that the sensitivity is lower when compared to culture, so using GeneXpert MTB/RIF alone is not recommended. Overall performance of GeneXpert MTB/RIF assay is noteworthy. The GeneXpert MTB/RIF assay is a potentially accepted test for obtaining an earlier diagnosis, and if it tested positive, the treatment should begin immediately. However, culture must be performed in GeneXpert MTB/RIF negative cases.
Objective The primary objective of this study was to assess the diagnostic performance of multiplex polymerase chain reaction (mPCR) for the detection of Mycobacterium tuberculosis complex (MTBC) in presumptive pulmonary TB patients, in the setting of a tertiary level teaching hospital in central India, in comparison to liquid culture using BACTEC mycobacteria growth indicator tubes (MGIT) 960 TB system as the gold standard. The secondary objective was to assess the performance of mPCR for Ziehl Neelsen smear negative samples and ascertain the utility of this assay in smear negative samples. Materials and Methods Sputum or bronchoalveolar lavage samples were collected from patients who were adults, aged 18 years or older, presenting with presumptive pulmonary TB, and subjected to three microbiological investigations, that is, Ziehl Neelsen staining, mycobacterial culture using mycobacterial growth indicator tubes in the BD BACTEC MGIT 960 instrument, and the mPCR. Statistical Analysis For statistical analysis, 2 × 2 contingency tables were prepared and analyzed separately for all samples and for smear-negative samples using GraphPad and MedCalc tools. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of mPCR were calculated by taking MGIT culture as the reference standard. Results For all samples (n = 114), sensitivity of mPCR for the detection of (MTBC) was 93.48% (95% confidence interval [CI]: 82.10–98.63%), specificity was 95.59% (95% CI: 87.64–99.08%), positive predictive value (PPV) was 93.48% (95% CI: 82.54–97.75%), and NPV was 95.59% (95% CI: 87.87–98.48%). For smear negative samples (n = 80), sensitivity was 80.00% (95% CI: 51.91–95.67%), specificity was 98.46% (95% CI: 91.72–99.96%), PPV was 92.31% (95% CI: 62.80–98.84%), and NPV was 95.52% (95% CI: 88.57–98.33%). Conclusion In this study, we were able to demonstrate the good performance characteristics of the mPCR for the detection of MTBC from clinical samples of patients with presumptive pulmonary tuberculosis, with MGIT liquid culture as the reference standard. It may be concluded that mPCR can be considered equivalent to MGIT culture in terms of clinical decision making and yield of positivity, owing to the good sensitivity and specificity for the detection of MTBC.
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectives Primary Objectives: Secondary Objectives: Methods Cross-sectional hospital-based study of 1-year duration 2020-2021. All samples sent to the microbiology laboratory with clinical suspicion of Candida infection and fulfilling the inclusion criteria were considered as sample size for the study period. The study population was the clinically relevant Candida isolates for which antifungal susceptibility testing was done and fulfilling the inclusion criteria. Study duration was for 1-year and was held at AIIMS, Bhopal. The data collected was entered in MS EXCEL and latest WHONET software and analyzed by WHONET software to generate antibiogram for Candida. Results are summarized in percentages and frequencies. Results Total 110 Candida isolates were included in the study for antifungal susceptibility testing and WHONET entry after fulfilling the inclusion criteria. The commonest isolate across all samples processed and included was C. tropicalis 40% followed by C. glabrata 15.5%. A total of 43.6% Candida species were isolated from urine samples followed by 29% from blood samples and 10% from sputum samples. In all 54.5% of yeast isolates were from ICU followed by 40% from ward patients and at least 5.45% from OPD. The commonest isolate across all locations was C. tropicalis 40% followed by C. glabrata 15.5%, C. albicans 14.5% and C. parapsilosis 11.8%. The predominant isolates were under the age category 19-60 years, 69% followed by 26.4% >60 years of age. The percentage susceptibility of C. tropicalis isolates showed >90% susceptibility to tested antifungals. The percentage susceptibility of C. glabrata isolates showed susceptibility to echinocandin but reduced susceptibility to fluconazole. For Candida albicans overall no azole or echinocandin resistance was noted. For Candida parapsilosis overall no azole or echinocandin resistance was noted. C. krusei showed 100% susceptibility to anidulafungin, caspofungin, micafungin, and voriconazole by BMD. C. guilliermondii percentage susceptibility available for caspofungin 33.3%. A total of 80% of the isolates were from patients with community-acquired infections and 19% Candida species were from health care-associated infections. Among the community-acquired infections C. tropicalis was the commonest 37.5% followed by C. albicans 17%, C. glabrata 16%, and C. parapsilosis 12.5%. Among the HAI commonest isolate was C. tropicalis 47.6% followed by 14.3% each of C. auris, and C. glabrata. C. auris all isolates showed elevated MIC fluconazole(≥64 μg/ml), voriconazole (≥1 μg/ml), and caspofungin (≥1 μg/ml). Conclusion The study conducted just over a year period in the department of microbiology of AIIMS Bhopal has been instrumental in generating cumulative antifungal antibiogram for Candida species.
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives To disseminate and discuss a rare case of rhino sinusoidal Lasidiploidea theobromae in a known diabetic. Method A case study was prospectively done since 2021 following a hospital visit of a 56-year-old male patient presenting with rhino sinusitis mimicking mucormycosis. Ethical approval and patient consent were obtained for this study. A detailed account of case progression from the date of first hospital admission to the final cure was noted. A 56-year-old male from Madhya Pradesh, in central India, presented to the outpatient department of Otolaryngology (ENT) -Head and Neck Surgery. The patient was a known case of diabetes for 5 years. He presented with a headache for 10 days, throbbing pain over the left cheek and upper teeth with nasal discharge and crusting for one week. Nasal crusting and sample from left maxillary meatus were sent suspecting rhino sinusoidal mucormycosis. Mycological evaluation by KOH wet mount showed melanized hyphae and short fragments appearing broad pauciseptate. After 10 days, a grey fluffy growth was observed at 37°C and 25°C on SDA with chloramphenicol. On SDA with cycloheximide there was no growth. LPCB mount of the growth showed some hyaline hyphae with immature hyaline conidia and at places brownish dark walled single septate conidia. Phenotypic identification was inconclusive. Debridement surgery was done and amphotericin B was initiated. The patient was discharged after 10 days with the mention of routine follow-up. The isolate was sent to PGIMER Chandigarh Mycology Reference Center India for species confirmation. After almost 3 months the species was confirmed as L. theobromae. Results After almost 1-year clinical improvement was observed. Conclusion This study addresses the diagnostic dilemma both for the clinicians as well as clinical mycologists. Also, it emphasizes the need for molecular diagnostic workflow in such a scenario.
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