Multi-drug resistance and characteristic of integrons in Shigella spp. isolated from China

Objective To investigate the characteristic of integrons and the relationship between integrons and antimicrobial resistance in Shigella spp. Methods Ninety Shigella strains (83 S. flexneri and 7 S. sonnei) were isolated from the stools of patients in China. Susceptibility to 8 antimicrobials was tested for all isolated strains. PCR, RFLP and sequencing analysis of integrons were applied to all of them. Results High prevalence of multi‐drug resistance (95.6%) was identified. Of the isolates 79 (87.8%) carri...     

沙门菌质粒DNA上整合子的分析

目的分析沙门菌质粒DNA上整合子的分子特征。方法用全自动细菌分析仪Mieroscan WalkAway40和纸片扩散法,对32株沙门菌进行抗生素敏感性测定,提取细菌质粒DNA,PCR扩增Ⅰ类整合子、Ⅱ类和Ⅲ类整合酶,对扩增产物进行序列分析。结果12株细菌含有一个Ⅰ类整合子,整合子大小分别为1000bp和1700bp。1000bp整合子含基因盒aadAl,1700bp整合子含基因盒dfr17-aadA5,未检测到Ⅱ类和Ⅲ类整合酶。结论整合子在沙门菌中广泛存在,整合子是介导和传播细菌耐药性的重要分子机制。     

志贺菌属整合子的耐药贡献与稳定性研究

目的分析志贺菌属整合子对耐药性的贡献及其稳定性。方法对志贺菌属1类、2类整合子的耐药基因盒分别克隆、转化DH5α,观察阳性克隆菌对多种抗生素敏感性的变化。将整合子阳性克隆菌与多重耐药志贺菌进行质粒接合实验,并测定耐药性的改变。对10株耐药谱不同、携带整合子不同的志贺菌属细菌进行无抗生素压力下连续多次传代实验,检测其耐药性及整合子的变化。结果志贺菌属1类整合子耐药基因盒dfrA17-aadA5阳性克隆菌对链霉素和甲氧苄啶的最低抑菌浓度(minimal inhibitory concentration,MIC)分别提高了8倍和32倍;2类整合子耐药基因盒dfrA1-sat1-aadA1阳性克隆菌对链霉素和甲氧苄啶的MIC分别提高了64倍和32倍;整合子阳性克隆菌经质粒接合传递后对抗生素的MIC无改变。1株携带2类整合子的志贺菌属菌株经过多次传代培养后丢失整合子及其耐药性。结论志贺菌属整合子-耐药基因盒系统可引起特定抗生素的耐药性,对质粒接合传递耐药性无影响。志贺菌属的2类整合子可发生丢失。     

血液中分离大肠埃希菌的Ⅰ类整合子分析

目的:分析从血液分离大肠埃希菌中I类整合子的流行情况。方法:对15株大肠埃希菌进行PCR扩增I类整合子,将扩增产物测序并分析其中的基因盒。结果:6株细菌含有I类整合子,整合子大小分别为600bp、1700bp,600bp整合子含基因盒dfr2d,1700bp整合子含基因盒dfr17-aadA5。结论:整合子在从血液分离大肠埃希中流行。     

食品中大肠埃希菌耐药性与整合子的关系研究

目的研究食品中大肠埃希菌的整合子携带情况及其与耐药性之间的关系。方法PCR检测细菌总DNA中1、2、3类整合酶基因，确定细菌携带整合子的情况。阳性菌株进一步检测整合子的可变区，分析插入基因盒的序列。结果50株大肠埃希菌中19株携带1类整合子，2株携带2类整合子，集中分布在对4种以上抗生素耐药的菌株中。插入基因盒主要是dfr和aadA类基因盒，各种基因盒组合中最常见的是dfr17-aadA5。结论细菌的多重耐药性与整合子携带高度一致，但是单个菌株的耐药谱与整合子的耐药基因盒缺乏对应关系。     

整合子在鲍曼不动杆菌多重耐药机制分析

目的:调查我院鲍曼不动杆菌耐药性;了解整合子类型以及整合子携带耐药基因盒特征。方法:收集我院临床分离鲍曼不动杆菌。细菌鉴定及药敏由MicroScan Walk Away 40仪器完成,整合子分类检测及开放阅读框扩增由PCR法完成。开放阅读框扩增产物经琼脂糖凝胶电泳及凝胶回收试剂盒回收纯化后进行DNA测序分析,测序结果在Genebank上作比对。结果:62株鲍曼不动杆菌有11株呈多重耐药,阳性率17.7%,11株鲍曼不动杆菌对氨基糖苷类药物阿米卡星,妥布霉素,庆大霉素均耐药,其余菌株较敏感。11株鲍曼不动杆菌中均检出整合子;进一步分类鉴定显示均为Ⅰ类整合子,未检出Ⅱ类和Ⅲ类整合子。开放阅读框可变区扩增产物为(0.3～2.5)KB不等条带,测序结果证实11株Ⅰ类整合子含有6个不同耐药基因盒:blam-1,orfX,aacA4,catB3,dfrA1,aadA1。其中7株均出现catB3,aacA4和dfrA1组合。结论:与其他报道相比较,我院鲍曼不动杆菌多重耐药率相对较低,但耐药鲍曼不动杆菌携带整合子率较高,且均为Ⅰ类整合子;其整合子基因盒含有多种耐药基因编码,其中aacA4,catB3和dfrA1耐药基因组合在本地区占优势。     

泛耐药鲍曼不动杆菌整合子Ⅰ和ISCR1结构及基因分型研究

目的研究从临床分离的鲍曼不动杆菌的整合子Ⅰ和ISCR1的分布及结构情况,并对其进行基因分型。方法分离自临床的57株鲍曼不动杆菌,PCR检测整合酶Ⅰ、整合子Ⅰ、ISCR1以及ISCR1可变区,PCR产物进行限制性片段长度多态性(RFLP)分型并进行测序分析可变区携带的耐药基因盒,ERIC-PCR进行基因分型。结果 49株整合酶I阳性,其中47株整合子I扩增阳性,RFLP分为2型,测序结果为aacA4-catB8-aadA1和drf17-aadA5。3株ISCR1以及ISCR1可变区扩增均阳性,可变区经RFLP分为1型,测序结果为orf513-qnrA1-ampR-qacEdeltal,ISCR1阳性菌整合子I均阳性,经ERIC-PCR检测将57株鲍曼不动杆菌分为27个基因型。结论Ⅰ类整合子广泛存在于鲍曼不动杆菌中,ISCRI携带率较低,氨基糖苷类、甲氧苄啶类和β-内酰胺类耐药基因盒较常见,ERIC-PCR可用于临床鲍曼不动杆菌的分子流行病学研究。     

Risk factors and outcomes of imipenem-resistant Acinetobacter bloodstream infection in North-eastern Malaysia

Objective

To determine the risk factors and outcomes of imipenem-resistant Acinetobacter baumannii (IRAB) bloodstream infection (BSI) cases, since there is very little publication on Acinetobacter baumannii infections from Malaysia.

Methods

A cross sectional study of 41 cases (73.2%) of imipenem-sensitive Acinetobacter baumanii (ISAB) and 15 cases (26.8%) of IRAB was conducted in a teaching hospital which was located at North-Eastern state of Malaysia.

Results

There was no independent risk factor for IRAB BSI identified but IRAB BSI was significantly associated with longer bacteraemic days [OR 1.23 (95% CI 1.01, 1.50)]. Although prior use of carbepenems and cephalosporin were higher among IRAB than ISAB group, statistically they were not significant. There was no significant difference in term of outcomes between the two groups.

Conclusions

Although statistically not significant, this analysis compliments previous publication highlighting the importance of appropriate empiric antibiotic usage in hospital especially carbepenems and need further evaluation with bigger subjects.     

Association of doripenem resistance with OXA-type carbapenemases in Acinetobacter baumannii isolates

Objectives:

To evaluate the in vitro activity of doripenem in Acinetobacter baumannii (A. baumannii) clinical isolates that possess different OXA-type carbapenemases, and to evaluate the roles of these enzymes in the development of carbapenem resistance.

Methods:

This retrospective study was conducted with 25 A. baumannii isolates at Sakarya University Training and Research Hospital, Sakarya, Turkey from June to October 2014. Antibiotic susceptibility testing was carried out using the Vitek-2 automated system (bioMérieux, Marcy l’Etoile, France). Minimum inhibitory concentrations (MICs) were determined using Etest strips (bioMérieux, Marcy l’Etoile, France). Quantitative polymerase chain reaction was performed in a Fluorion Instrument (Iontek, Istanbul, Turkey).

Results:

Isolates were divided into 5 groups based on their susceptibility profiles and OXA-type carbapenemase positivity. Group 2 isolates whose MIC of both meropenem and doripenem are in the range of 4-32 µg/mL were negative for both bla_OXA-23 and bla_OXA-58. Group 3 isolates whose MIC of meropenem and doripenem is in the range of 4-32 µg/mL, bla_OXA-23 is positive, and bla_OXA-58 is negative. Group 5 isolates whose MIC of meropenem is >32 µg/mL, and that of doripenem is in the range of 16-32 µg/mL were positive for both bla_OXA-23 and bla_OXA-58.

Conclusion:

The bla_OXA-23 and bla_OXA-58 gene combinations may confer resistance with a much greater MIC of both meropenem and doripenem. However, the presence of bla_OXA-58 alone was not correlated with doripenem resistance.The rise of antibiotic resistance is an increasingly important threat, particularly for infections caused by Acinetobacter baumannii (A. baumannii). The use of carbapenems to treat A. baumannii infection has resulted in outbreaks of infection with carbapenem-resistant Acinetobacter spp.1 We are now faced with more problematic drug-resistant pathogens that threaten to move us into what some consider the post-antibiotic era of infectious diseases. Regardless, a potential strategy is to focus on the relation of molecular characterization of the isolates and the response to antimicrobial theraphy.2 Carbapenem resistance in Acinetobacter spp. has been ascribed to the recruitment and production of carbapenem-hydrolyzing class D β-lactamases (CHDLs), and to a lesser extent metallo-β-lactamases. In A. baumannii, the CHDLs can be intrinsic (OXA-51-like), or acquired (OXA-23-like, OXA-24-like, and OXA-58-like).3 Although these enzymes weakly hydrolyze carbapenems, they can confer strong resistance when bla_OXA genes are overexpressed, as a result of their association with mobile elements, such as ISAba1, which carries a strong promoter.4 The bla_OXA-23 gene, in association with ISAba1 is spread by A. baumannii worldwide, and is the most prevalent OXA allele in isolates from Turkey.3,5 However, the carbapenem against, which antibiotic resistance emerges according to OXA gene status is unknown. The purpose of this study was to evaluate the in vitro activity of doripenem in a collection of A. baumannii clinical isolates that possess different OXA-type carbapenemases, and to evaluate the roles of these enzymes in the development of carbapenem resistance.     

铜绿假单胞菌整合子及其基因盒与耐药性的相关性研究

目的 调查致呼吸系统感染的铜绿假单胞菌中整合子的存在情况,研究整合子中基因盒与耐药表型的关系.方法 测定97株铜绿假单胞菌对抗菌药物的敏感性;应用简并引物PCR方法扩增整合子5'保守区的Ⅰ类、Ⅱ类和Ⅲ类整合酶基因,对阳性产物用限制性内切酶Hinf Ⅰ作限制片段长度多态性(RFLP)分析,并进行整合子分类;对整合酶阳性标...     

健康学生大肠埃希菌第1类整合子的鉴定及特征

目的：探讨健康学生肠道大肠埃希菌携带第1类整合子的分布及所含基因盒的特征。方法：常规方法分离大肠埃希菌;纸片扩散法对10种抗生素进行耐药性监测和分析;PCR鉴定第1类整合子阳性株;PCR产物测序并对结果进行分析。结果：从97份标本中鉴定出大肠埃希菌76株,其中25株（32.8%）为多重耐药,耐药谱为复合磺胺-氨苄西林-四环素-红霉素-链霉素。25株中有14株(56.0%)鉴定出1类整合子,1 800 bp 10株, 750 bp 4株。PCR产物测序得知1 800 bp整合子携带aadA1-dfrA14-orf基因盒,传递对氨基糖苷类-磺胺类抗菌药物的耐药性;750 bp整合子携带dfrA14基因盒,传递对磺胺类抗菌药物的耐药性。结论: 不同种类的1类整合子存在于健康人大肠埃希菌中,携带耐药基因盒,决定多重耐药性。      

产志贺毒素大肠埃希菌中国分离株第1类整合子-基因盒的特征

目的：探讨产志贺毒素大肠埃希菌中国分离株携带第1类整合子的特征及所含基因盒的种类。方法：采用纸片扩散法对8株产志贺毒素大肠埃希菌中国分离株进行抗生素耐药性监测;制备细菌转接合子,采用PCR技术鉴定第1类整合子,并对PCR产物测序及结果分析。结果：4株产志贺毒素大肠埃希菌对复合磺胺、四环素、氨苄西林、环丙沙星表现多重耐药,其中2株同时对链霉素和壮观霉素耐药。PCR检测第1类整合子1 000 bp 2株,PCR产物测序1 000 bp整合子携带腺苷酰基转移酶(aadA1)基因盒并存在于7 800 bp可接合质粒上,与sul 1和qacEΔ1基因连锁,分别传递着对链霉素、壮观霉素、复合磺胺和季胺盐类消毒剂的耐药性。结论: 产志贺毒素大肠埃希菌中国分离株可接合质粒上第1类整合子携带的aadA1耐药基因盒是该菌株对氨基糖苷类抗生素耐药产生和扩散的重要原因。     

Evaluation of anti-resistant activity of Auklandia (Saussurea lappa) root against some human pathogens

Objective

The antimicrobial activity of the ethanol extract of the Auklandia (Saussurea lappa)root plant was investigated to verify its medicinal use in the treatment of microbial infections.

Methods

The antimicrobial activity of the ethanol extract was tested against clinical isolates of some multidrug-resistant bacteria using the agar well diffusion method. Commercial antibiotics were used as positive reference standards to determine the sensitivity of the clinical isolates.

Results

The extracts showed significant inhibitory activity against clinical isolates of methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, Extended Spectrum Beta-Lactemase, Acinetobacter baumannii. The minimum inhibitory concentration values obtained using the agar dilution test ranged from 2.0 µg/µL-12.0 µg/µL. In the contrary the water extract showed no activity at all against the tested isolates. Furthermore, the results obtained by examining anti-resistant activity of the plant ethanolic extract showed that at higher concentration of the plant extract (12 µg) all tested bacteria isolates were inhibited with variable inhibition zones similar to those obtained when we applied lower extract concentration using the well diffusion assay.

Conclusion

The results demonstrated that the crude ethanolic extract of the Auklandia (Saussurea lappa) root plant has a wide spectrum of activity suggesting that it may be useful in the treatment of infections caused by the above clinical isolates (human pathogens).     

Immunochromatographic Methods in Malaria Diagnosis

Background

Malaria remains a major cause of morbidity and mortality in India. This study was carried out to evaluate the use of parasite lactate dehydrogenase (pLDH) test in diagnosis of malaria.

Methods

Blood slides of 400 patients who presented with fever including 104 patients with clinical features suggestive of malaria were studied. The results were compared with microscopy and another immunochromatography test (ICT) based on detection of histidine rich protein-2 antigen [Pfhrp-2] secreted by Plasmodium falciparum.

Result

In this study the sensitivity and specificity for detection of Plasmodium vivax was 100% while for Plasmodium falciparum the values were 96% and 100% respectively.

Conclusion

ICT is useful for diagnosis of malaria caused by Plasmodium falciparum in field but microscopy of a well-prepared blood smear must not be omitted in a laboratory setting.Key Words: Malaria, Immunochromatography     

多重耐药革兰阴性杆菌I类整合子结构与功能分析

目的探索I类整合子在多重耐药的革兰阴性杆菌中的功能作用,并对其基因结构进行研究,为阐明革兰阴性杆菌的耐药机制和抑制耐药性的产生提供理论依据。方法选择温岭市妇幼保健院2009年7月～2011年10月的多重耐药革兰阴性杆菌80株,其中铜绿假单胞菌40株,鲍曼不动杆菌40株,使用K—β纸片法和双纸片协同实验对细菌的耐药性和超广谱β-内酰胺酶（ELSBs）的产生情况进行考察。对耐药且产ELSBs的细菌进行筛选．使用聚合酶链式反应（PCR）扩增实验、电泳法、整合酶Souhen杂交实验对耐药细菌体内的I类整合子存在情况、整合子基因结构、基因位置进行考察。结果药敏结果显示,40株铜绿假单胞菌中多重耐药且产ELSBs的菌株为27株,40株鲍曼不动杆菌中多重耐药且产ELSBs的菌株为28株。对多耐药且产ELSBs的菌株通过PCR扩增实验进行的I类整合子存在情况的考察结果显示,40株鲍曼不动杆菌和40株铜绿假单胞菌中I类整合子的阳性率分别为57．5％和55．O％。I类整合子的保守区和可变区PCR扩增与测序分析结果显示,保守区内含有qaeEal-F和sul1-B这两种特征性基因片段,可变区内以长度为0．15、1．00、2．00、2．30kb的基因片段出现频率最高．0．15kb含有保守区内基因结果,其它基因片段依次为aadA、aaeA4、catB8这3种基因盒。结论I类整合子与革兰氏阴性杆菌耐药性的产生有着密切的关系,qaeEal-F和sull一B为I类整合子基因保守区的特征性片段。两者同时出现则可确证该细菌体内含有I类整合子。I类整合子基因可变区内含有aadA、aaeA4、catB8三种出现频率最高的基因盒且长短为0．15kb的基因片段含有保守区的基因结构,这3种基因盒和保守区基因片段的存在是导致细菌间耐药性平行转移的重要因素。     

Prevalence of Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) and the Distribution of Class 1 Integron in Their Strains Isolated from a Hospital in Central China

Objective The aim of our study is to investigate the prevalence of Carbapenem-resistant Klebsiella pneumoniae (CRKP) and the genetic characteristics of the class 1 integron in CRKP on multi-drug resistance. Methods Clinical Klebsiella pneumoniae strains were collected from multiple departments of a hospital in central China. CRKP strains were identified among the isolates, and antibiotics susceptibility of CRKP strains was analyzed. The polymerase chain reaction (PCR) was adopted to amplify the class 1 integron variable area. The integron genetic structure was analyzed with enzyme digestion and DNA sequencing technology. The relation between class 1 integron and drug resistance was analyzed statistically. Results Totally 955 strains of Klebsiella pneumoniae were isolated from varied sites of the hospital, and 117(12.3%) of them were identified as CRKP, with a separation rate of 8.9% (26/292) in 2013, 11.3% (38/336) in 2014 and 16.2% (53/327) in 2015, which shows an increasing trend by year. 44.4% (52/117) of CRKP strains were separated from specimen of ICU, and 61.5% (72/117) were from sputum. Over 95%CRKP strains were resistant to ampicillin/sulbactam, aztreonam, imipenem, meropenem Ceftazidme, Cefotaxime,Cefepime,and Piperacillin, while relatively low resistant rates were found in Tigecycline (12.8%) and colistin (35.9%). The class 1 integron was detected in 77.8% (91/117) of CRKP strains. Class 1 integron of CRKP was significantly correlated with the antibiotic resistance to the tobramycin, gentamicin and amikacin (all P<0.01). The gene cassette analysis of variable area of class 1 integron showed that aadA2 accounts for 64.8%(59/91), aacA4-catB8-aadA123.1% (21/91), and aadA2-dfrA2512.1% (11/91). Conclusions CRKP has an increasing trend in a clinical setting in China, and most of them were resistant to multiple antibiotics. Class 1 integron in CRKP has strong ability to capture the genes resistant to aminoglycosides antibiotics from environment, with the aadA2 gene as the most popular one.     

Seroprevalence of Borrelia burgdorferi in North Eastern India

Background

There is paucity of data on Lyme disease in India. A seroprevalence study of B burgdorferi infection was carried out in North-Eastern states of India to assess the same.

Methods

Sera from 500 individuals of North-Eastern states of India were tested for IgG antibody by enzyme linked immunosorbent assay using commercial kits containing recombinant antigen.

Result

Out of 500 persons, 65 (13%) were positive for B burgdorferi specific lgG Females showed higher positivity rate as compared to males (15.86% vs 10.95%). Higher prevalence rate was observed in the age group of 15-30 years in both sexes (11.48% in male and 18.69% in female). Arunachal Pradesh showed higher seroprevalence rate (17.8%) as compared to other North-Eastern states (8.46-9.6%).

Conclusion

Seropositivity to B burgdorferi suggests infection by the organism and presence of Lyme disease in these areas. Further population and vector biology studies are required to find out the exact species involved in transmission of the organism.Key Words: Lyme Disease, Seroprevalence, Borrelia burgdorferi     

Multidrug-resistant acinetobacter infection and their susceptibility patterns in a tertiary care hospital

Background:

Antibiotic-resistant Acinetobacter nosocomial infection is a leading problem. It acts as an opportunistic pathogen to cause a wide spectrum of infection including nosocomial pneumonia, meningitis, endocarditis, skin and soft tissue infections, urinary tract infection, conjunctivitis, burn wound infection and bacteremia. Multidrug-resistant Acinetobacter infection creates a great problem in hospital setting.

Materials and Methods:

The clinical specimens obtained from ICU and different surgical and medical wards were investigated using standard microbiological techniques to know the distribution of and their resistant profile. Antimicrobial resistance was studied using the modified Kirby Bauer disk diffusion technique following the CLSI protocol.

Results:

Major infections found in different medical wards, surgical wards and ICU were due to Acinetobacter baumannii (74.02%), A. lowfii (14.2%), A. haemolyticus (7.79%), A. junii (3.8%) among Acinetobacter spices. Acinetobacter showed increased resistant against majority of commercially available drugs imipenem (5.2%), meropenem (9.75%), piperacillin-tazobactum (18.2%), netilmicin (16.24%), amikacin (14.29%), ceftazidime (74.1%), gentamicin (70.13%), ofloxacin (42.21%).

Conclusion:

A. baumannii was found to be associated with UTI, RTI, septicemia, bacteremia, and meningitis and wound infection. A. baumannii displayed higher resistance to more number of antibiotics than other nosocomial pathogens from ICU.     

Aortic Artery and Cardiac Valve Calcification are Associated with Mortality in Chinese Hemodialysis Patients: A 3.5 Years Follow-up

Background:

This study was to investigate the relationship among aortic artery calcification (AAC), cardiac valve calcification (CVC), and mortality in maintenance hemodialysis (MHD) patients.

Methods:

All MHD patients in Shanghai Ruijin Hospital in July 2011 were included. To follow up for 42 months, clinical data, predialysis blood tests, echocardiography, and lateral lumbar X-ray plain radiography results were collected. Plasma FGF23 level was measured using a C-terminal assay.

Results:

Totally, 110 MHD patients were involved in this study. Of which, 64 (58.2%) patients were male, the mean age was 55.2 ± 1.4 years old, and the median dialysis duration was 29.85 (3.0–225.5) months. About 25.5% of the 110 MHD patients had CVC from echocardiography while 61.8% of the patients had visible calcification of aorta from lateral lumbar X-ray plain radiography. After 42 months follow-up, 25 (22.7%) patients died. Kaplan–Meier analysis showed that patients with AAC or CVC had a significant greater number of all-cause and cardiovascular deaths than those without. In multivariate analyses, the presence of AAC was a significant factor associated with all-cause mortality (hazard ratio [HR]: 3.149, P = 0.025) in addition to lower albumin level and lower 25-hydroxy Vitamin D (25(OH)D) level. The presence of CVC was a significant factor associated with cardiovascular mortality (HR: 3.800, P = 0.029) in addition to lower albumin level and lower 25(OH)D level.

Conclusion:

Lateral lumbar X-ray plain radiography and echocardiography are simple methods to detect AAC and CVC in dialysis patients. The presence of AAC and CVC was independently associated with mortality in MHD patients. Regular follow-up by X-ray and echocardiography could be a useful method to stratify mortality risk in MHD patients.     

IgM Chlamydia Trachomatis Antibodies in Cases of Melasma

Background

Melasma is an acquired photosensitive hypermelanosis in sun-exposed areas, especially seen in females. The exact cause of this disorder is not known. Association of melasma with chronic pelvic inflammatory disease (PID) has been described earlier. Chlamydia trachomatis is an important etilogical agent in acute and chronic PID and photosensitivity has been described in almost 50% cases of chronic lymphogranuloma venereum caused by 1.1, 1.2 and 13 serovars of C. trachomatis.

Method

Blood of 38 cases of melasma in women and 31 healthy females was tested for the presence of C. trachomatis IgM antibodies by ELISA.

Results

The average age of the patients was 35.6(range 19-51) years and that of controls was 38(range 24-55). 7(18.42%) and 5 (13.16%) of the patients of melasma were positive and borderline positive for IgM antibodies respectively. None of the healthy controls were positive. The difference was statistically significant.

Conclusion

Melasma in women is most likely due to photosensitivity to C.trachomatis in cases of chronic pelvic inflammatory disease.Key Words: Melasma, Chlamydia trachomatis infection