Hepatitis C virus (HCV) is a heterogeneous virus with multiple genotypes. It has a slowly progressive course with a fatal outcome. Chronic infection with HCV is a major cause of liver cancer. Diagnosing the disease early at an early stage is necessary so as to prevent its progression to chronicity. Screening for anti-HCV IgG antibody can be done by a number of immunoassays but at the same time it becomes difficult to differentiate between acute and chronic infection. To overcome this problem nucleic acid testing for detecting HCV ribonucleic acid (RNA) can be used as themainstay for diagnosing the infection.
Probiotics aremicro-organisms that confer health benefits to the host. There is a growing body of evidence documenting the immune-modulatory ability of probiotic bacteria. The need for probiotic formulations has been appreciated for the health benefits in “topping up your good bacteria” or indeed in an attempt to normalise the dysbiotic microbiota associated with immunopathology. This review will focus on the use of probiotics in clinical practice, particularly related to neonatal practice, including explanations of what they are and how they work. Evidence for the health benefits of consuming probiotic bacteria are examined in several clinical conditions. Lastlywe have tried to solve the debated question that “should probiotics be used as standard of care in neonatal practice?”
1. Probiotics are enterally administered live “good’micro-organisms that colonise the gastrointestinal tract tomodulate the functions of the innatemicrobial community and immune system.
2. Thismay result in significant health benefits; for example enteral probiotic supplementation significantly reduces both severe necrotising enterocolitis and all-causemortality in preterminfants.
3. There is a debate on routine enteral probiotic supplementation for all preterm infants. Others advise caution pending results fromlarge clinical trials designed to address issues regarding safety and efficacy in the smallest, most vulnerable newborn population.
4. Probioticsmay also reduce atopic eczema in high-risk infantswhen administered to themother during pregnancy and to the infant post-natally and improve feeding tolerance in neonates.
The closely related origins of the skin and the gastrointestinal systemmake for a fascinating grouping of diseases with concomitant involvement of these two important organ systems. The dermatologicmanifestationsmay precede clinically evident gastrointestinal disease and help in early diagnosis, saving unnecessarywastage of time and resources. In this overview, we review the cutaneousmanifestations of various hereditary, neoplastic and inflammatory gastrointestinal diseases including the various polyposis syndromes, hereditary colorectal cancers, inflammatory bowel diseases, etc. Dermatologic manifestations of acute and chronic hepatic and pancreatic diseases have also been discussed. This review underscores the importance of collaboration between dermatologists and gastroenterologists for better and efficient management of the affected patients.
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Kaur S, Vaishnavi C, Kapoor P, Masoodi I. Retrospective assessment of fecal myeloperoxidase activity in Clostridium difficile associated diarrhea. J Gastrointest Infect 2013; 3 (1):28-32.
Background & Objective: Immune defense cells such as polymorphonuclear (PMN) leucocytes and monocytes are present in the colonic mucosa and aid in local inflammatory response. Myeloperoxidase (MPO) abundantly present in immune defense cells gets released upon neutrophil activation. Clostridium difficile is an anaerobic bacteriumresponsible for nosocomial diarrhea and severe colitis.
Methods: A retrospective study was undertaken to quantify the presence of colonic inflammation by evaluation of fecal MPO activity as an adjunct to C. difficile diarrhea. A total of 560 patients with nosocomial diarrhea and 123 healthy subjects with no diarrhea formed the basis of our investigation. C. difficile was investigated either by stool culture (n=351) or by C. difficile toxin (CDT) assay (n=209) using purified anti-toxin A and anti-toxin B. MPO activitywas measured using dianisidine hydrogen peroxidase.
Results: MPO was positive in 76.8% of patient samples. Chi square test for MPO analysis showed that it was significantly distributed over positive and negative values. A total of 115 stool cultures were positive for various organisms, of which 91 were also MPO positive. There were 38 C. difficile culture positive of which 34 were also MPO positive. MPO activity in relation to CDT assay showed that 43% were positive for both CDT and MPO. When control samples were analyzed, MPO was positive in 11.7% with C. difficile growing in 4/30 (13%) of the cultured samples. CDT was negative in the remaining control samples.
Interpretation and Conclusion: High levels of MPO may signal the acuity of the disease and indicate inflammation. Fecal MPO is a simple, inexpensive and objective tool for assessing the degree of acute inflammation in the intestine.
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Garg N, Rishi P, Goad J, Bharrhan S. Antibacterial and immunomodulatory effect of cell free supernatant of Lactobacillus plantarum against Shigella flexneri. J Gastrointest Infect 2013; 3 (1):33-40.
Background & Objectives: Shigellosis is endemic throughout the world causing great deal ofmorbidity andmortality. Emergence of antibiotic resistance and lack of vaccine against Shigella, necessitates exploitation of alternative strategies to combat Shigella infection. The present studywas undertaken to evaluate the effect of cell free supernatant (CFS) from Lactobacillus plantarum (L. plantarum) against Shigella flexneri (S. flexneri).
Methods: The effect of CFS from Lactobacillus plantarum against S. flexneri was studied in terms of agar well diffusion assay, time kill assay, adherence inhibition andmacrophage functions.
Results: It was found that CFS inhibits S. flexneri as indicated by zone of inhibition and continuous decrease in the CFU/ml for 16 hours of incubation period. A decrease in the number of Shigella cells adhering to mouse intestinal cells was also observed in the presence of CFS. Cell free supernatant could significantly decrease the levels of malondialdehyde (MDA) and nitrite. Levels of lactate dehydrogenase (LDH) and Tumor necrosis factor-α (TNF-α) were almost restored in the presence of CFS. The study revealed correlation between LDH and MDA levels, as well as between nitrite and TNF-α levels suggesting the immunomodulatory effects of CFS in addition to its antibacterial property against Shigella.
Interpretation and Conclusions: Regular intake of probiotic food supplements may prove to be beneficial against enteric infections due to sustained release of antimicrobials.
Rajoo Singh Chhina,
H. S. Pannu,
Background & Objective: Liver disease in pregnancy can have serious consequences. We studied the profile of liver disease in pregnant women and its correlation with outcome of pregnancy during the hospital stay in a tertiary care hospital.
Methods: Pregnantwomen with liver disease admitted in the departments of Medicine, Gastroenterology and Obstetrics & Gynaecology between January 2011 and June 2012 in a tertiary care hospital of North India were evaluated for various parameters.
Results: Out of 2663 pregnant women, 92 patients (3.45%) were diagnosed to have liver disease. Acute viral hepatitis (AVH) was found in 42 (45.6%) and pregnancy specific liver disease in 39 (42.4%) patients. Hypertensive disorder of pregnancy including HELLP Syndrome (Hemolysis, Elevated liver enzymes, Low platelet count) was seen in 27 patients (29.3%). Four patients had leptospirosis and hepatitis E co-infection. Overallmaternal and perinatal mortality was 7.6% (7/92) and 25% (23/92) respectively.
Interpretation and Conclusion: Acute viral hepatitis (45.6%) was the most common cause of liver disease in pregnancy in our study.
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Sharma M, Kaur S. Inhibitory potential of Lactobacillus species isolated fromfermented dairy products against Escherichia coli and Staphylococcus aureus. J Gastrointest Infect 2013; 3 (1):45-50.
Background & Objectives: Probiotics exert a strong antagonistic activity against many microorganisms including food spoilage organisms and enteropathogens. Lactobacilli find increasing acceptance as probiotics by showing its beneficial effects. Keeping in view the benefits of probiotics in literature, the present study was planned to isolate Lactobacillus spp. from different fermented dairy products and to study the inhibitory potential against biofilm forming bacteria viz. Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus).
Methods: Lactobacillus spp. were isolated from different fermented dairy products and characterized. The antimicrobial activity of each Lactobacillus spp. was checked by agar well diffusion and overlay methods. The strains showing inhibitions in these assays were further used to detect biofilminhibition against E. coli and S. aureus by microtiter plate biofilm assay method.
Results: A total of 21 samples were studied of which pure growth was observed in 67% and mixed growth was observed in 33% of the samples. Of 18 isolates obtained, 45% belonged to Lactobacillus plantarum (L. plantarum), 33% were Lactobacillus acidophilus (L. acidophilus) and 22% comprised of Lactobacillus fermentum (L. fermentum). Ten isolates showed inhibition against E. coli and 9 isolates showed inhibitory activity against S. aureus in agar well diffusion assay and overlay method. In microtiter plate biofilm assay, the absorbance values were less in the wells where E. coli and S. aureus were mixed with the Lactobacillus broth.
Interpretation and Conclusions: The Lactobacillus strains showing inhibitory activities against the pathogens can be used as probiotics or as starter culture in food fermentations after confirming other attributes.
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Pandey V, Shubhada C, Ajantha G, Kulkarni R. Comparison of enterococcal colonization of gut in hospitalized and non-hospitalized patients. J Gastrointest Infect 2013; 3 (1):51-54.
Background & objectives: Enterococci are Gram-positive diplococci especially known to cause hospital associated infections. Intrinsic and acquired drug resistance is an important character of this organismand it is ranked next to E. coli in hospital associated infections.1 Hospitalization and use of antibiotics increases their number, making the hospitalized patients prone to develop infections posing a therapeutic challenge to the treating clinicians. Astudy was, therefore, undertaken to compare enterococcal colonization in the outpatient and inpatient subjects.
Methods: Stool/rectal swab samples from 109 hospitalized and 58 outpatients were collected and evaluated for presence of enterococci. Standard biochemical and physiological tests were used for identification. The antibiotic sensitivity test was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results were analysed statistically.
Results: A total of 109 rectal swabs / stool samples from IPD cases and 58 stool samples from OPD group yielded 90.8%(99 of 109) and 37.9%(22 of 58) growth of enterococci respectively. Of the 109 IPD cases, all were receiving antibioticswhile only 32 of 58OPD patientswere receiving antibiotics. All isolateswere sensitive to vancomycin. The carriage of enterococci in IPD cases was significantly higher compared to the OPD cases.
Interpretation and Conclusions: Enterococcal colonization increases with hospitalization and use of antibiotics. The cliniciansmust be aware of this phenomenon so as to avoid hospital associated infections by enterococci, especially in the light of their intrinsic and acquired drug resistance.
Background & Objectives: Enteric fever is a major challenge in developing countries and perforation peritonitis is a major cause of morbidity and mortality. The main aim of this study was to compare and evaluate the various operative procedures performed in enteric perforation and to find out the ideal operative procedure (if any) in the treatment of enteric perforation with peritonitis.
Material & Methods: The study was conducted over a period of 3 & 1/2 years (2 years retrospective and 1 & 1/2 years prospective) on 150 patients presentingwith enteric perforation. All patientswere treated as a surgical emergency and given broad-spectrum antibiotic coverage, naso-gastric aspiration, fluid and electrolyte management prior to surgery. Patients were kept on regular follow-up for the next 6 months after treatment.
Results: In our study, 93%of the procedures belonged to one of the two categories i.e. ileostomy or primary closure. Ileo-tranverse bypass and resection-anastomosis were done in 4% and 3% of the patients respectively. The total mortality was 11% & the incidence was more in ileostomy group (17.9%) as compared to the primary closure group (6.7%). The difference in mortality between the ileostomy and primary closure group reached least statistically significant value (p<0.1).
Interpretation and Conclusions: Aggressive resuscitation and early surgery is the key to successful management of enteric perforation. Primary closure should be the treatment of choice in enteric perforation. Ileostomy should be done if there are major risk factors for post-operative fecal fistula formation.
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Jain S, Bakshi RK, Walia G. Seroprevalence and risk factors of hepatitis B and hepatitis C virus infections among patientswith chronic liver diseases. J Gastrointest Infect 2013; 3 (1):61-63.
Introduction & Objectives: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide. Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HBV infection and among people at high risk for parenteral infection.
Material & Methods: This study was conducted from January- December 2011 during which 170 blood samples were collected frompatients suffering fromchronic liver diseases (CLD) (chronic hepatitis or cirrhosis) admitted in Medicine Department. Five ml venous blood sample was collected and processed in Department of Microbiology. HBsAg was detected by using Hepacard Test and anti HCV was detected by using HCV Tridot - rapid visual test (J. Mitra & Co. Ltd.).
Results: Among 170 patients with CLD, HBsAg seropositivity was 28% (47/170) while anti-HCV seropositivity was 41% (70/170). Co-infection of HBsAg and anti-HCV was 3.5% (6/170). In patients with alcoholic hepatitis/ cirrhosis, seropositivity of HBsAg & anti-HCV was 19.4% & 29.0%respectivelywhile in patientswith non alcoholic chronic hepatitis/cirrhosis, it was 23.1% & 48.1% respectively.
Interpretation and Conclusion: Seroprevalence of HBsAg & anti-HCV in patients with CLD was 28% and 41% respectively whereas co-infection of HBsAg & anti-HCV was 3.5%.
Clostridiumdifficile (C. difficile) is responsible for nosocomial diarrhoea and is themajor cause of pseudomembranous colitis. Incidence of C. difficile associated diarrhoea (CDAD) has increased in recent years and is associated with high mortality of 24-38%. Forty nine stool samples received were screened for the presence of C. difficile toxin A & B by ELISA, out of which 10 samples were positive for both the toxins. Therefore, CDAD needs to be diagnosed early in hospital settings so that cases can be treated early and spread can be prevented.
Clostridium difficile infection (CDI) is an important cause of infectious nosocomial diarrhoea. Widespread use of antibiotics has led to a dramatic rise in the incidence of CDI. However, a majority of the CDI cases are either misdiagnosed or undiagnosed because of low clinical suspicion or the use of diagnostic tests with low sensitivity. Although occurrence of diarrhoea in a patient who has recently received antibiotics is an important clue to the diagnosis of CDI, presentation of CDIwith non-diarrheal symptoms like fever, pain abdomen or abdominal distention is known. We report a case of a 65 years old male who presented with acute abdomen in surgical emergency, was diagnosed to have CDI, and was successfully treated with vancomycin.
We report a case of primary psoas abscess caused by Nocardia in an immunocompetent patient who presented with low back ache with pain radiating to both legs. A suspicion of nocardiosis was made based on Gram's staining and modified acid fast stain ofmaterial obtained by ultrasound guided aspiration. The patient showed remarkable recovery after treatment with co-trimoxazole. Quick identification by simple Gram's staining and modified acid fast staining helped in timely diagnosis and treatment of the patient.