There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

No abstract

Salmonella enterica subsp. arizonae is a common gut inhabitant of reptiles, with snakes as the most common reservoir. Though human cases due to this organism are exceedingly rare, it may infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Gastroenteritis is the most common presentation; others include peritonitis, pleuritis, osteomyelitis, meningitis, and bacteremia. We report a fatal case of S. enterica subsp. arizonae gastroenteritis in a 3-month-old child with microcephaly, with a review of earlier cases and problems encountered in identification of this rare human pathogen. CASE REPORTA 3-month-old female child presented to the Emergency Unit at Ram Manohar Lohia Hospital, New Delhi, India, with a history of fever and cough for 20 days and diarrhea with mucus and blood for 15 days. There was no history of similar illness in other family members or in the community. On admission, the child, who had microcephaly, appeared highly irritable and had tachypnea and bilateral crepitations. The spleen and liver were just palpable, and there was a rash all over the body. The patient was diagnosed as having pneumonia with persistent diarrhea. A fecal sample was sent for routine culture and microscopic examination, and the patient was empirically started on broad-spectrum antibiotics (ampicillin, cefotaxime, and amikacin). Investigations revealed a hemoglobin level of 11.0 g%, a total leucocyte count of 11,500/ml, and an erythrocyte sedimentation rate of 100. A urine culture was sterile, and cerebrospinal fluid biochemistry and cytology showed no abnormality. The chest X ray showed infiltration in both lungs, while the skull X ray was normal.The routine microscopic examination of feces did not reveal the presence of any protozoan or helminth. While fecal cultures grew a non-lactose-fermenting motile organism, the routine biochemical tests (indole, triple-sugar iron agar, citrate, urea, mannitol, and motility) for this isolate were obfuscating.

Urinary tract infections (UTIs) in pediatric population are associated with high morbidity and long term complications. In recent years, there is increased prevalence of Escherichia coli (E. coli) strains producing extended spectrum β-lactamase, Amp C, and Metallo β-lactamase, making the clinical management even more difficult. This study was aimed to detect the serotypes and to determine antimicrobial susceptibility profile of E. coli isolates from urine samples of children <10 yrs old. A total of 75 pure E. coli strains isolated from patients with symptoms of UTI and colony count ≥105 organisms/mL were included in the study. Antibiotic sensitivity pattern showed maximum resistance to nalidixic acid (98.7%), followed by ampicillin (97.3%), amoxi-clavulanate (96%), and fluoroquinolones (92%) while most of the isolates were found sensitive to piperacillin-tazobactam (13.3%), nitrofurantoin (5.3%), and meropenem (1.3%). 48% of the strains were ESBL producer (extended spectrum beta lactamase). 44% strains were typable withantisera used in our study and the most common serogroup was O6 (33.3%) followed by O1 (15.1%) and O15 (15.1%). To conclude, judicious use of antibiotics according to hospital antibiotic policy and infection control measures should be implemented to prevent spread of multidrug resistant organisms.

examination were normal, hemoglobin (Hb) was 6.2 gm% and TLC was normal. The thyroid proÞ le and reproductive hormonal proÞ le, including prolactin levels, were normal, with a normal chest X-ray. Mantoux test was positive at 25×25 cm and ESR was raised-48 mm in Þ rst hour. IgG ELISA for TB (Tuberculosis) was high positive, i.e., greater than 400 U/ml (Immuno Vision's M. tuberculosis IgG Avidity ELISA test kit [USA], supplied by Amar Diagnostics, Mumbai, India). Sputum and urine examination did not reveal any AAFB. She was vaccinated with BCG at birth.Since invasive procedures could not be undertaken in this particular patient, her menstrual blood was sent for AFB examination. Mycobacterial culture facilities were not available and hence, not done. The sample was homogenized, centrifuged at 3000 rpm for 15 minutes and smears were made from the deposit. After dehemoglobinizing the smear, it was stained by Zeihl Neelsen (ZN) stain, using 3% acid alcohol as a decolorizer. On examination under oil immersion, straight to slightly curved, beaded, acid and alcohol fast bacilli (AAFB), with morphology suggestive of Mycobacterium tuberculosis were seen (Fig. 1). Two consecutive samples in the same menstrual cycle were also positive for AAFB.The patient was diagnosed as a case of genital tuberculosis and anti-tubercular therapy (ATT-category I) was started, according to RNTCP guidelines.[1] After one month of treatment, when patient came for follow-up, she HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeÞ ciency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Using optimal methods, 15% of third trimester pregnant women in India are GBS colonized. A multivalent vaccine containing 6 CPS types (Ia, Ib, II, III, V and VII) would encompass ~87% of GBS carried by pregnant women in India.

No abstract

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.