Background: Bacterial meningitis is still one of the major causes of mortality and morbidity among all groups in developing countries. The mortality and prevalence of common pathogens has reduced in developing countries with implementation of successful vaccination against the pathogens. Laboratory surveillance of pathogens is crucial in formulating the empirical treatment guidelines and to identify the targets of immunization. The present study was undertaken to evaluate the clinical profile, bacterial pathogens and their antibiotic sensitivity pattern of the pathogens.  The outcome of the cases was recorded and followed for six months to detect any neurological sequelae.Methods: A one year prospective cross sectional study was done and all suspected cases of acute bacterial meningitis (ABM) were screened and confirmed by diagnostic criteria. Clinical features were recorded and entered into the case sheet. CSF culture was done and biochemical analysis and cell counts were performed. All the data was entered in Microsoft excel and analysed.Results: A total of 547 cases were screened and 282 confirmed with 164 males and 116 females. 282 pathogens were isolated with 266 bacterial and 12 fungal isolates. Gram negative bacterial pathogens were predominant than gram positive. Streptococcus pneumoniae was the common isolate in the study followed by others like S. aureus, Coagulase negative staphylococci and Acinetobacter sp., Escherichia coli, Klebsiella pneumoniae and meningococci. Candida albicans and Cryptococcus sp. were fungal pathogens. Community acquired meningitis was commonest cause and seen in 51-60 years of age. Gram positive pathogens exhibited maximum sensitivity to vancomycin and linezolid whereas Gram negative pathogens to carbapenems.Conclusions: There is an overwhelming need to formulate policies in the management of cases of ABM. The rationale use of antibiotics is necessary to prevent the development of antibiotic resistance. Hence minimizing the emergence of antibiotic resistance and its spread is necessary, which can be achieved by regular prevalence and antibiotic susceptibility studies.

Background: A rise in HIV/AIDS is observed in resource poor countries like India despite successful implementation of control programmes. Most of these deaths recorded in cases of AIDS are because of opportunistic infections [OI] and other malignancies. The reason may be attributed to the effective destruction or decrease in CD4 cells which play a pivotal role in immune system. OI cause substantial morbidity and hospitalization, economical loss to the society and shorten the survival time of HIV patient. The objective of this study was to evaluate the different type of infections and identify the frequent pathogens affecting the HIV patients who are attending a tertiary care hospital in India. The clinical profile of these patients was studied and proportion of CD4 counts with respect to their type of infection and pathogen is also evaluated.Methods: A prospective cross sectional study was conducted for one year period. Clinical samples were collected from all the newly diagnosed cases of HIV and performed various staining techniques and cultured on appropriate culture media.  All the isolates were identified as per standard guidelines. Serological evaluation for IgM antibodies for toxoplasma was done by ELISA. CD4 counts were estimated by FACS.Results: Tuberculosis was the commonest (67%) OI in HIV cases, followed by candidiasis (61.5%), respiratory tract infections (50%), gastro intestinal tract infections (44%) and meningitis (38%) in our study. The mean CD4 cell counts in the study was 267.11cells/µl. The commonest fungal pathogen was C.albicans and Cryptosporidium parvum the parasitic pathogen. The mean CD4 cell counts were lesser in parasitic infections when compared to bacterial and fungal infections. Six cases of P.jiroveci pneumonia were identified in our study. Mortality was recorded among the HIV cases with CD4 cell counts <50 cells/ µl.Conclusions: Early diagnosis and prompt treatment of OIs contributes to increased life expectancy among infected patients, delaying the progression to AIDS. This study helps the clinicians in proper guidance to come up with right diagnosis and early response to manage the patients in resource poor countries like India.

Prevalence of ICU infections varies between 45% to 58% 10 and incidence rates between 30 to 35%. 11,12 Factors associated with increased risk of infections in ICU are ABSTRACT Background: Infections still remain as one of the major cause of mortality in low and lower-middle-income countries as reported by Global Burden of Diseases study. Intensive care units (ICU) are a major source of infections in tertiary care hospitals. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. A hospital based epidemiological study was to determine the risk factors; bacterial isolates, antibiotic sensitivity and outcomes in ICU patients. Methods: This prospective study was done at Narayana Medical College and Hospital for 12 months from 1 st February 2015 to 31 st January 2016. All the risk factors were noted. Patient's outcome noted as death, recovery and transfer to palliative care. Data entry and analysis performed in Microsoft excel, p valve < 0.001 was considered significant. Results: Three hundred and thirty patients were included in the study (age: 56.16±15 years, 57.6% males). 159 (48.2%) were direct admissions, 103 (31.2%) were transfers from other hospitals. Major cause of admission was neural (29.1%) followed by cardiovascular (21.8%). HTN (52.4%) was major co-morbidity followed by type-2 DM (47.3%). 51.9% culture positivity (n = 539) was observed with sputum 83.6% and blood 24.2%. Gram-negative pathogens were predominant which includes Acinetobacter baumanii (13.8%), Escherichia coli (20%), Klebsiella pneumoniae (14.3%), Pseudomonas aeruginosa (9%), Enterobacter aerogenes (5.1%). Candida Sp and MRSA, VRE were isolated. In the study 255(77.3%) recovered, 38(11.5%) progressed to death and 37(11.2%) transferred to palliative care. Higher mortality was noticed with Acinetobacter baumani (81.6%). Conclusions: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs. Sarvepalli AK et al. Int J Adv Med. 2017 Feb;4(1):156-161 International Journal of Advances in Medicine | January-February 2017 | Vol 4 | Issue 1 Page 157 intrinsic risk factors associated with the patient, invasive medical devices, overcrowding and animate objects which act as reservoirs for bacterial isolates. Higher incidence and prevalence of infections in ICU are associated with higher age, higher APACHE-2 score (Acute physiology and chronic health evaluation) and associated co morbid conditions. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. Reports on the emergence of metallo β-lactamase (MBL) and carbapenemase-producing gram negative bacterial isolates, methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE) are posing a serious threat in outcomes of patients in ICU. KeywordsThe present study was sought to determine the prevalence of infections, clinical risk factors, bacterial isolates and antibiotic profil...

Background: Malaria a protozoal disease caused by Plasmodium species. As per WHO global report 2015, it is distributed in 100 countries throughout the world. The worldwide prevalence of malaria is around 200-300 million cases with an estimated economical loss of 0.5-1 billion per annum. India contributes to 70% of cases and 69% of deaths in south east Asian region. Malaria in India is caused mainly by two species P. vivax (Pv) and P. falciparum (Pf). The present study was done to evaluate the clinical profile of malarial cases with associated complications and hematological profile in these cases. This study will provide insight into the common species distribution and their clinical presentations with hematological profile.Methods: The present study was conducted at Narayana general hospital and medical college for two years from March 2014 to February 2016. Study was conducted on 400 confirmed cases of malaria with 200 males and 200 females. Clinical presentations with signs and symptoms were noted and laboratory parameters of cases were noted.Results: 127 cases of vivax, 243 cases of falciparum and 30 cases of mixed infections were identified. 41-50 years (33.3%) age group was predominantly affected. Fever was the most common symptom (100%) followed by chills (83%). Pallor was the most common sign (76%) followed by splenomegaly (71%). Cerebral malaria was seen in 42 cases, severe anemia in 82, ARDS in 4 and circulatory collapse in 1 case was identified. ESR, PT, BT and APTT were raised in both falciparum and vivax malaria. Severe thrombocytopenia was identified in 100 cases with petechia and minor bleeding manifestations.Conclusions: To conclude falciparum malaria was more common than vivax malaria in our study with more cases of severe anemia, splenomegaly, cerebral malaria, and severe thrombocytopenia. BT, PT, APTT were raised more in cases of falciparum than vivax malaria. In cases of mixed infections of vivax and falciparum, clinical profile and laboratory indices were more presenting as falciparum than vivax malaria.