Meningococcal meningitis in Ludhiana.

A retrospective study was carried out at Dayanand Medical College & Hospital, Ludhiana (Punjab) during the period from January 1985 to June 1990 to know the incidence of meningococcal meningitis. Meningococcal etiology was established in 170 (49.41%) cases out of 344 cases of bacterial meningitis. Out of 170 cases of meningococcal meningitis, 74 (43.52%) were positive only by smear examination, 90 (52.94%) were positive both by smear as well as culture and there were six (3.52%) cases which were positive only by culture. The organisms were sensitive to most of the common antibiotics including penicillin, chloramphenicol, ampicillin and sulphadiazine.     

Seroprevalence of melioidosis in diabetic patients in Taiwan.

Diabetes mellitus is a major predisposing factor for Burkholderia pseudomallei infection. This study surveyed serum samples from 356 Taiwanese patients with diabetes mellitus for anti-flagellin antibodies against B. pseudomallei. Antibody titer to B. pseudomallei was positive in 3.0% (11/365) of diabetes mellitus patients. All seropositive individuals were aged > or =60, indicating that elderly and diabetic adults are at high risk of B. pseudomallei infection. In this study, diabetic females, who were usually housewives, had a seropositive rate of 81.1%. However, the incidence of melioidosis in males (usually working outdoors) was 93.7% based on clinical cases. We suggest that exposure of males and females to B. pseudomallei in this study was via different routes of infection.     

Pathophysiological mechanism of lung injury in patients with leptospirosis

AIMS: Acute lung injury (ALI) is a serious clinical problem. We investigated the pathogenetic mechanisms of ALI caused by leptospirosis. METHODS: The study included five cases of leptospirosis. We monitored the arterial pressure (AP) and heart rate (HR) and analysed the AP and HR variabilities for assessment of autonomic functions. Histopathological changes in the lung, brain, kidney, and liver were examined. In addition, we identified the expression of inducible nitric oxide synthase (iNOS) using immunohistochemical stain. RESULTS: Five patients associated with leptospirosis died of ALI. Before death, severe hypotension and bradycardia occurred. Spectral analysis of AP and HR variabilities indicated decreased sympathetic drive with increased parasympathetic activity. Pathological examinations revealed alveolar haemorrhage and necrotic lesions in various organs. Immunohistochemical stain disclosed iNOS activity in multiple organs. Biochemical determinations indicated hypoxia, hyperglycaemia, increased nitrite/nitrate, methyl guanidine and other factors. CONCLUSIONS: These changes suggest that leptospirosis causes severe hypotension and bradycardia accompanied by autonomic dysfunction. Finally, multiple organ failure and damage ensued. The pathogenesis of lung and organ injury may involve iNOS and NO production.     

Release of granzymes and chemokines in Thai patients with leptospirosis

The plasma concentrations of granzymes are considered to reflect the involvement of cytotoxic T-cells and natural killer cells in various disease states. Interferon (IFN)-gamma-inducible protein-10 (IP-10) and monokine induced by IFN-gamma (Mig) are members of the non-ELR CXC chemokine family that act on T-cells and natural killer cells. This study revealed that the plasma concentrations of granzyme B (but not granzyme A), IP-10 and Mig were higher in 44 Thai patients with definite or possible leptospirosis than in healthy blood donors. These data suggest that activation of cell-mediated immunity is part of the early host response to leptospirosis.     

Seroprevalence of hepatitis C in human immunodeficiency virus infected patients

Prevalence of antibodies against hepatitis C virus (HCV) was evaluated using Ortho and Abbott HCV Elisa assays and the Abbott EIA Neutralization assay in 150 human immunodeficiency virus (HIV)-seropositive patients and compared with the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers. Overall prevalence of hepatitis C virus antibodies was 29.3%; significant variations were seen across human immunodeficiency virus risk factor subgroups: prevalence was 10.2% in homosexual men, 12.0% in bisexual men, 73.5% in intravenous drug users, 13.3% in blood transfusion recipients, and 16.6% in frequent travellers. Seroprevalence was higher in the 20 to 40 year-old age group and in patients stage II or III according to the Center for Disease Control classification. Prevalence of hepatitis B virus and hepatitis D virus markers (75.7% and 17.5% respectively) was analyzed according to hepatitis C virus marker status; patients with HBcAb were more likely to have antibodies against hepatitis C virus than their HBcAb-negative counterparts. Further studies are needed to investigate the influence of coexposure to human immunodeficiency virus and hepatitis C virus on liver lesions. Data from this study show that coinfection or coexposure is common.     

Serological follow-up of patients involved in a localized outbreak of leptospirosis

Eighteen patients involved in a localized outbreak of leptospirosis were subjected to a serological follow-up study over a 5-year period. Four distinct sets of sera from all patients and a fifth sample obtained from 10 of them were examined by the microscopic agglutination test (MAT) for demonstration of leptospiral antibodies. The test was carried out by using live leptospires from reference strains of 17 Leptospira interrogans serovars known to occur in Italy. In all cases, the highest titers of agglutinins were recorded against one or more of the three Australis group serovars tested (australis, bratislava, and lora). The highest antibody levels were reached soon after the acute phase of infection in some patients but only after some months in others. Titers then tended to recede with varying rapidity, but titers against the Australis group serovars were still detectable in some patients after 5 years. Coagglutinins against serovars of other serogroups were detected, generally at low levels, in the early sets of sera of most patients, but tended to disappear in the late-set sera. Specific immunoglobulin M (IgM) and IgG against the three Australis group serovars were determined in most serum samples from 16 patients by solid-phase enzyme immunoassay (EIA). In general, EIA titers were considerably lower than MAT titers, but there was a certain patient-to-patient variability in both the IgM/IgG ratio and the evolution and persistence of the two immunoglobulin classes. Since all the evidence indicated that the initial outbreak from a single source, the observed patient-to-patient variability in the progress of both MAT and EIA titers appeared to be attributable to factors inherent in the individual patients. Cross agglutination absorption tests, aimed at retrospectively determining to which of the Australis group serovars the outbreak-specific infecting strain belonged, were performed with six serum samples from different patients. Most absorbed sera seemed to originate from an australis or lora infection, but it was not possible to discriminate conclusively between the two serovars.     

Nephropathy in leptospirosis

Renal involvement is common in leptospirosis. Bacterial invasion, inflammatory process, haemodynamic alterations and direct toxicity of bacterial products are thought to be responsible for the development of nephropathy. Pathologically, all renal structures are involved. Interstitial nephritis is the basic lesion, and is observed even in patients without clinical renal manifestations. Tubular necrosis is the important pathological counterpart of acute renal failure. The clinical spectrum of renal manifestations includes mild urinary sediment change, hypokalemia, tubular dysfunction, decreased response to fluid load and acute renal failure (ARF). ARF reflects the severity of leptospirosis, is catabolic and is commonly associated with cholestatic jaundice. Severe renal failure may be complicated by multiple organ involvement. Renal failure with hyperbilirubinemia represents a severe form of renal dysfunction with oligo-anuria and prolonged clinical course. Mild renal failure is usually anicteric and non-oliguric and without complication. Besides antibiotic treatment, early and frequent dialysis is life saving. ARF with major organ failure has unfavorable outcome. Plasmapheresis and continuous venovenous hemofiltration improve hemodynamics and are beneficial for the patients with acute renal failure and multiorgan involvement. Recovery of renal function is usually complete in most patients.     

Incidence of anaerobes in throat infections and their sensitivity pattern in Ludhiana

Of 175 throat swabs processed, anaerobes were isolated from 16 (9.14%) patients. Isolation of anaerobes from healthy controls was 2 out of 25 (8%). Peptostreptococci and Bacteroides species were the commonest isolates followed by Peptococci and Propioni-bacterium. All of these isolates were sensitive to Metronidazole. Clindamycin, Erythromycin and Tetracycline also showed good response.     

Seroprevalence of Helicobacter pylori infection in patients with hepatitis B.

Helicobacter pylori infection has been investigated extensively in immunocompromised hosts, such as those with acquired immunodeficiency syndrome (AIDS) and organ transplant recipients. However, few reports on H. pylori prevalence in individuals with chronic HBV infection are available. The aim of this serological study is to investigate H. pylori prevalence in patients with hepatitis B. Ninety-six consecutive hospitalised patients with chronic hepatitis B were studied, together with 104 age-matched healthy individuals of similar socioeconomic status and with no evidence of hepatitis B virus infection or liver diseases. Serum samples from both groups were tested for specific IgG antibodies to H. pylori, using enzyme-linked immunosorbent assay (ELISA). Of the 96 patients with hepatitis B, 55 (57.3%) were positive for serum IgG anti-H. pylori, significantly greater than in the control group of 104, where 44 (42.3%) were positive (P < 0.05). In addition, the seroprevalence of H. pylori in the 45 patients who were positive for hepatitis B envelope antigen (HBeAg) and/or HBV-DNA was 75.6% (34), compared to 41.2% (21) in the 51 patients who were negative (P < 0.005). An increase in H. pylori prevalence is present in patients with chronic hepatitis B. Further study is needed to determine whether eradication of H. pylori will benefit these patients.     

Demonstration of lipoprotein anomalies in leptospirosis. Prospective study in 10 patients

Abnormalities of lipid metabolism have never been shown in human leptospirosis. A prospective study of plasma lipids was performed in 10 consecutive patients with leptospirosis. Significant increase of triglycerides with low levels of the high-density lipoproteins and cholesterol fraction was observed in 8 patients. Electrophoresis of lipoproteins showed a fusion of beta and pre-beta lipoproteins and a marked decrease of alpha lipoproteins. The respective role of bacteria, liver and kidney could be suggested to explain these abnormalities of lipoproteins in leptospirosis.