Background:The study was conducted to analyze previous six-year prevalence data of HIV infection in the Northwest region of India and predict future trends for a couple of years.Objectives:The study was conducted to aid SACS and NACO to plan and arrange resources for the future scenario.Materials and Methods:All the attendees of ICTC, Jaipur, from January 2002 to December 2007 were included and variables like age, sex, marital status, occupation, place of residence, pattern of risk behavior and HIV serostatus were studied. As per the strategy and policy prescribed by NACO, tests (E/R/S) were performed on the serum samples. Data was collected; compiled and analyzed using standard statistical methods. Future trends of HIV-prevalence in north-west India were anticipated.Results:The overall positivity rates among attendees of ICTC, were found to be 12.2% (386/3161), 11.8% (519/4381), 11.1% (649/5867), 13% (908/6983), 14% (1385/9911) and 17.34% (1756/10133) in the years 2002, 2003, 2004, 2005, 2006 and 2007 respectively. Future trends for the next couple of years depict further increase in prevalence without any plateau.Conclusion:Epidemiological studies should be carried out in various settings to understand the role and complex relations of innumerable behavioral, social and demographic factors, which will help, interrupt and control the transmission of HIV/ AIDS.

Background:Proteus species cause a variety of community- and hospital-acquired illnesses. Synthesis of β-lactamases is the predominant mechanism for resistance to β-lactam antibiotics. Among the β-lactamases, extended spectrum β-lactamases (ESBLs) and AmpC β-lactamases are the most common.Aim:The objective of this study was to determine the occurrence of ESBL and AmpC β-lactamases in Proteus species among various clinical isolates at a tertiary care hospital, India.Materials and Methods:This study was done to identify various species of Proteus from clinical samples (n = 3922). Antimicrobial susceptibility was performed by Kirby–Bauer disc diffusion method. ESBL production was detected by modified double-disc synergy test and indirect modified three-dimensional tests and AmpC β-lactamase production by AmpC disc test and modified Hodge test.Results:Proteus species were isolated in 5.4% (101/1876) specimens. Three Proteus species isolated were Proteus mirabilis 62.4% (63/101), Proteus vulgaris 29.7% (30/101), and Proteus penneri 7.9% (8/101). ESBL producers confirmed by both tests were of 88.1% (89/101). Only AmpC β-lactamase was produced by four isolates. Coproduction of ESBL and AmpC β-lactamase was observed in 58.4% (52/89) of isolates. Twelve isolates were non-β-lactamase producers. Multidrug resistance (MDR) was found in 95.1% (96/101) of isolates, 50.5% (51/101) were possibly extensively drug resistant and none were pan drug resistant. None of the isolates were resistant to piperacillin-tazobactam. P. penneri isolates exhibited high resistance to most of the antibiotics.Conclusions:A high prevalence of ESBL and AmpC β-lactamases was found that concurrently showed MDR. Phenotypic methods for the detection of β-lactamases are easy and simple and can be implemented in routine diagnostic laboratories along with susceptibility testing. These data will assist the clinicians in the management and control of infections.

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Objective: Rapid diagnosis of genital tuberculosis (GTB) is essential as it is an important cause of infertility among women. Diagnosis can be done by imaging techniques, direct visualization by endoscopy, serology, histopathology, culture and polymerase chain reaction (PCR) tests. Laparoscopy detects macroscopic changes only; histology is only suggestive and not confirmatory unless acid fast bacilli (AFB) are demonstrated in the lesion but sensitivity is poor in paucibacillary disease. Culture methods are the gold standard but slow growth of most pathogenic mycobacteria delays the diagnosis. PCR can rapidly detect even few copies of DNA with high sensitivity and specificity.Aim: Comparative evaluation of AFB smear examination, culture in Middlebrook 7H9 media and IS6110 based real-time PCR assay for the detection of mycobacteria in various female genital samples. Materials and methods:A total of 555 female genital samples like endometrial and fallopian tube biopsies, menstrual blood and vaginal discharge were processed by modified Petroff's method. The deposit was used for detection of mycobacteria by AFB smear, culture on Middlebrook 7H9 media and IS6110 based real-time PCR.Results: Out of 555 samples, 25.22 % (140/555) were positive by the combination of all the methods used. Overall positivity by real-time PCR alone was 23.78% (132/555), by culture 8.28% (46/555) and 2.70% (15/555) by AFB smear examination. Out of total positives, 94.28% (132/140) were positive by PCR alone, 32.85% (46/140) by culture and 10.71% (15/140) by AFB smear. Eight (5.71%) culture positive samples were negative by smear and PCR, six of these were nontubercular mycobacteria (NTM) and two samples had PCR inhibitors as confirmed by spiking with positive DNA. Contamination was observed in 25/555 (4.5%) which were reported negative by culture but three of these were PCR positive. AFB smear results were available in 1 hour, PCR in 1 day and culture in 4 to 6 weeks. Conclusion:PCR was found to be the most rapid and sensitive (94.28%) method, 9-fold more sensitive than smear examination and 3-fold than the culture for detection of mycobacteria. Results were available in 4 to 6 weeks time for culture but in only 1 day by PCR. IS6110 PCR can detect only MTB and not the NTM. Use of multiplex PCR with genus and MTB specific primers will increase the sensitivity of test but care needs to be taken to prevent false positivity due to cross contamination and false negative due to PCR inhibitors.

Background:Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are global health concerns. Due to shared routes of transmission, co-infection is common. Their co-existence can cause severe liver complications and immunological impairment in infected individuals.Aim:To find the prevalence of HBV co-infection in HIV patients and to assess the pattern of liver enzymes and CD4 T-cell counts in HIV monoinfected and HIV/HBV co-infected patients.Materials and Methods:A total of 342 consecutive confirmed HIV positive treatment naïve patients were tested for hepatitis B surface antigen (HBsAg). Clinical staging was done according to Centers for Disease Control and Prevention classification guidelines. Liver function tests were performed by an autoanalyser. CD4 T-cells were estimated by FACS Calibur.Results:Hepatitis B virus co-infection was detected in 8.7% of HIV positive patients as compared to 1.42% in the HIV negative control group (P < 0.05). Majority of the HIV monoinfected and co-infected patients were below 38 years. HBsAg positivity was higher in males (9.4%) and the route of transmission was heterosexual. Categorical data revealed significantly higher proportion of alanine aminotransferase and aspartate aminotransferase (AST) in the co-infected patients compared to the monoinfected patients (P < 0.05). The HIV/HBV co-infected patients had significantly lower CD4 T-cell counts (P = 0.03) and significantly higher AST, alkaline phosphatase and serum bilirubin values (P = 0.023, P = 0.029, P = 0.009 respectively) than the monoinfected group. Males had 1.33 times higher risk than females for co-infection (odds ratio = 1.33; 95% confidence interval 0.57–3.10).Conclusion:The prevalence of co-infection was high. Raised levels of liver enzymes and lowered CD4 counts were seen in co-infected patients. These findings underscore the importance of HBV screening of all HIV positive individuals before initiating antiretroviral treatment.

Resistance to broad spectrum β-lactams mediated by Extended Spectrum β-lactamases (ESBL) and AmpC β-lactamases enzymes is a growing threat worldwide. AIMThe aim of the study was to detect the prevalence and antimicrobial susceptibility of ESBL and AmpC β-lactamase producing Escherichia coli and Klebsiella pneumoniae isolated from various clinical samples. MATERIALS AND METHODSA total of 288 isolates comprising of 180 Escherichia coli and 108 Klebsiella pneumoniae isolated from various clinical samples were included. ESBL was detected by Phenotypic Confirmatory Disc Diffusion Test (PCDDT) and Double Disk Synergy Test (DDST). AmpC detection was done by AmpC disk test. RESULTSOut of 180 Escherichia coli and 108 Klebsiella pneumoniae isolates 91 (50.5%) and 63 (58.3%) were confirmed to be ESBL producers by PCDDT and 81 (45%) and 57 (52.7%) by DDST respectively. AmpC was detected in 35 (19.4%) of Escherichia coli and 33 (30.5%) of Klebsiella pneumoniae isolates. Co-production of ESBL and AmpC was detected in 6 (3.3%) Escherichia coli and 11 (10.2%) of Klebsiella pneumoniae isolates. Majority of ESBL producers were from blood in both organisms. Multidrug resistance (MDR) was seen in 79.1% of ESBL Escherichia coli and 63.5% of ESBL Klebsiella pneumoniae isolates. MDR was seen in 28 (96.5%) of AmpC producing Escherichia coli and all AmpC producing Klebsiella pneumoniae isolates. CONCLUSIONIt is essential to report ESBL and AmpC beta lactamase production along with routine susceptibility, which will aid the clinicians in prescribing antibiotics. Strict adherence to the hospital antibiotic policy and good infection control practices would go a long way in curtailing the menace of drug resistance.

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Diffuse cutaneous leishmaniasis (DCL) is characterized by the presence of a large number of lesions at several anatomic sites (head, limbs and trunk). The lesions include papules, nodules and areas of diffuse infiltration that do not ulcerate and reveal abundant parasites on histopathological examination. DCL and human immunodeficiency virus (HIV) co-infections are seldom reported. We report two cases of DCL in HIV positive patients without visceral involvement. DCL is emerging as a new opportunistic infection associated with HIV/acquired immunodeficiency syndrome.