Acquired immunodeficiency syndrome and related opportunistic infections are a significant cause of morbidity and mortality in susceptible population. This study aims to negate the paucity of data regarding the relation between CD4 levels, prevalence of enteric parasites, and the outcome of treatment with HAART (highly active antiretroviral therapy) and Cotrimoxazole in Kerala, India. Multiple stool samples from 200 patients in a cross-sectional study were subjected to microscopy and Cryptosporidium stool antigen ELISA. Parasites were identified in 18 samples (9%). Cystoisospora and Cryptosporidium spp. were seen in 9 cases (4.5%) and 5 cases (2.5%), respectively. Microsporidium spores and Chilomastix mesnili cysts were identified in 1 case each (0.5% each). Seven cases of Cystoisospora diarrhoea recovered after treatment with Cotrimoxazole. Diarrhoea due to Cryptosporidium spp. in all 5 cases subsided after immune reconstitution with HAART. This study concludes that a positive association was seen between low CD4 count (<200 cells/μL) and overall parasite positivity (P value < 0.01). ELISA is a more sensitive modality for the diagnosis of Cryptosporidium diarrhoea. Chilomastix mesnili, generally considered a nonpathogen, may be a cause of diarrhoeal disease in AIDS. Immune reconstitution and Cotrimoxazole prophylaxis remain to be the best therapeutic approach in AIDS-related diarrhoea.

Context:Rubella is a mild self-limiting disease all over the world; nevertheless, it is of significant public health importance due to its teratogenic effect of congenital rubella syndrome. Rubella vaccine is currently not included in the national immunization program in India. Rubella-specific IgG in the unvaccinated population is a marker of previous rubella infection. Rubella IgG estimation in children will provide data for initiation and necessary modification to the immunization strategy.Aims:In this background, this study was conducted with an aim to know the age-specific susceptibility of acquiring rubella infections and future risk of congenital rubella syndrome (CRS) among girls.Settings and Design:This was a community-based, observational study.Participants and Methods:The study was conducted at a randomly selected rural area Mavoor Panchayath of Kozhikode District, Kerala, among adolescent girls. The estimation of rubella-specific IgG antibody was done by quantitative enzyme-linked immunosorbent assay method. IgG titer value of >15 IU was taken positive, 8–15 IU as equivocal, and <8 IU as negative.Statistical Analysis Used:Statistical analysis was performed using Statistical program for Social science version 16 for Windows. Chi-square test was applied to find out significant difference and Fisher's exact test wherever applicable.Results:The data and blood sample collection was done from 250 girls. The mean IgG titer was 151.93 ± 128.78 IU, and as per the criteria, 68.3% were positive, 28.5% were negative, and 3.2% were equivocal. At this age, majority (68.3%) of the girls get protection by natural infection without any vaccine. Some girls (32%) may remain susceptible to infection during adulthood and pregnancy.Conclusions:Natural rubella infection was widely prevalent among child population and at this age. An immunization policy recommending rubella-containing vaccine is highly desirable to prevent rubella and CRS.

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CONTEXTAcute Bacterial Meningitis (ABM) is a medical emergency requiring immediate diagnosis and treatment. The bacterial pathogens responsible for ABM may vary with time, geographic distribution, age and preceding medical and/or surgical conditions of the patient. Information regarding the changing trends in terms of aetiology and antibiotic susceptibility in a particular region is essential for the correct and timely management of ABM. AIMThis study was done to determine the bacterial pathogens responsible for ABM in adults and study their antibiotic susceptibility pattern. SETTINGS AND DESIGNA cross-sectional study was carried out on clinically suspected cases of ABM at Government Medical College, Kozhikode, for a period of one year. METHODS AND MATERIALSSamples of Cerebrospinal Fluid (CSF) collected aseptically from clinically suspected cases of ABM were centrifuged and subjected to culture, Gram staining and antigen detection by Latex Agglutination Test (LAT). Antibiotic susceptibility testing was performed on all the isolates. Cases of post-traumatic meningitis and meningitis developing after neurosurgical procedures were also included in the study. RESULTSCSF samples were collected from 165 clinically suspected cases of ABM and processed. The bacterial pathogen could be identified by centrifuged Gram stain in 21 cases (12.7%), by culture in 16 cases (9.7%) and by LAT in nine cases (5.4%). Streptococcus pneumoniae was the predominant pathogen isolated in 7 cases (43.8%) followed by Pseudomonas aeruginosa in 4 cases (25%), Acinetobacter baumannii and Coagulase negative staphylococci (CoNS) in two cases each (12.5%) and Staphylococcus aureus in one case (6.25%). Drug resistance was common among Gram negative isolates in three cases (50%). CONCLUSIONStreptococcus pneumoniae remains the most common aetiological agent of ABM in adults. Multidrug resistant Gram negative bacilli are also important emerging causes of ABM. This study shows the importance of centrifuged CSF Gram smear along with culture for the accurate diagnosis of ABM in developing countries. LAT can be used as a simple, rapid and convenient test to establish the bacterial aetiology in ABM.