Diarrhea is a major public health problem in developing countries resulting in heavy economic burden. Various pathogenic bacteria affect the gastrointestinal tract and produce abdominal cramps, nausea, vomiting and diarrhea. These bacteria are mainly acquired through contaminated water and food. The important ones among them are Vibrios, Escherichia coli, Staphylococcus, Salmonella, Shigella, Bacillus cereus, Campylobacter, Clostridia, Yersinia, Klebsiella and Aeromonas. Proper sewage disposal and other sanitary hygiene such as proper hand washing must be maintained in the community in order to prevent diarrhea, as ingestion of fecal contaminated water is the primary route of transmission of the pathogens. Safe drinking water is another requisite to fight against the problem of diarrhea. Adequate chlorination of water easily kills organisms such as that of cholera and safeguards against bacterial diarrhea. Salads prepared from materials washed in contaminated water or handled by unhygienic hands are also important vehicles of transmission of pathogenic bacteria. Reheating of refrigerated food kept at room temperature for a very long time also perpetuates spores and may lead to food poisoning. All these preventive measures when taken into account can help to reduce the burden of diarrheal episodes. However despite preventive measures if diarrhea occurs, restoration of fluid and electrolyte balance in the form of oral rehydration therapy is of paramount importance in the management of the illness.

Diarrhea is a major public health problem in developing countries resulting in heavy economic burden. Various pathogenic bacteria affect the gastrointestinal tract and produce abdominal cramps, nausea, vomiting and diarrhea. These bacteria are mainly acquired through contaminated water and food. The important ones among them are Vibrios, Escherichia coli, Staphylococcus, Salmonella, Shigella, Bacillus cereus, Campylobacter, Clostridia, Yersinia, Klebsiella and Aeromonas. Proper sewage disposal and other sanitary hygiene such as proper hand washing must be maintained in the community in order to prevent diarrhea, as ingestion of fecal contaminated water is the primary route of transmission of the pathogens. Safe drinking water is another requisite to fight against the problem of diarrhea. Adequate chlorination of water easily kills organisms such as that of cholera and safeguards against bacterial diarrhea. Salads prepared from materials washed in contaminated water or handled by unhygienic hands are also important vehicles of transmission of pathogenic bacteria. Reheating of refrigerated food kept at room temperature for a very long time also perpetuates spores and may lead to food poisoning. All these preventive measures when taken into account can help to reduce the burden of diarrheal episodes. However despite preventive measures if diarrhea occurs, restoration of fluid and electrolyte balance in the form of oral rehydration therapy is of paramount importance in the management of the illness.

Human listeriosis, a dreaded gastrointestinal disease of the West has surfaced in the last two decades in India, and there have been a series of reports on sporadic cases. The causative organism, Listeria monocytogenes is an intracellular Gram-positive bacillus ubiquitous in soil and vegetation. It is responsible for cases and outbreaks of febrile gastrointestinal disease in otherwise healthy people and invasive listeriosis, which usually affects pregnant women, newborns & the elderly. Immunocompromised individuals and pregnant women have been identified as major risk factors for listeriosis. It is about 20 times more common in pregnant women than in the general population. It causes mild illness in mothers, but can be devastating to the fetus, in some cases leading to severe disease or fetal death. It may cause abortion, premature labour, fetal death or neonatal morbidity in the form of septicemia and meningitis. This review is an attempt to sensitize clinicians especially obstetricians to include listeriosis as a differential diagnosis in patients with high suspicion and institute early antimicrobial therapy. Also there is need to press upon proper counseling of pregnant women for preventive measures against this deadly infection.

Human listeriosis, a dreaded gastrointestinal disease of the West has surfaced in the last two decades in India, and there have been a series of reports on sporadic cases. The causative organism, Listeria monocytogenes is an intracellular Gram-positive bacillus ubiquitous in soil and vegetation. It is responsible for cases and outbreaks of febrile gastrointestinal disease in otherwise healthy people and invasive listeriosis, which usually affects pregnant women, newborns & the elderly. Immunocompromised individuals and pregnant women have been identified as major risk factors for listeriosis. It is about 20 times more common in pregnant women than in the general population. It causes mild illness in mothers, but can be devastating to the fetus, in some cases leading to severe disease or fetal death. It may cause abortion, premature labour, fetal death or neonatal morbidity in the form of septicemia and meningitis. This review is an attempt to sensitize clinicians especially obstetricians to include listeriosis as a differential diagnosis in patients with high suspicion and institute early antimicrobial therapy. Also there is need to press upon proper counseling of pregnant women for preventive measures against this deadly infection.

Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to weeks after being infected by an enteric, urogenital or upper respiratory infection. The most common enteric bacterial pathogens that have been associated with ReA include Salmonella, Shigella, Campylobacter, enterotoxigenic Escherichia coli and Yersinia. It is quite necessary to determine the burden of ReA due to enteric infections using standard criteria. The clinician should investigate for the evidence of previous bacterial infections. In addition, it is very important to carry follow-up studies of patients with enteric infection so as to clarify the association of ReA with enteric pathogens. No curative treatment for reactive arthritis (ReA) exists. Instead, treatment aims at relieving symptoms and is based on symptom severity. Prevention of enteric and genitourinary bacterial infections is the best option.

Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to weeks after being infected by an enteric, urogenital or upper respiratory infection. The most common enteric bacterial pathogens that have been associated with ReA include Salmonella, Shigella, Campylobacter, enterotoxigenic Escherichia coli and Yersinia. It is quite necessary to determine the burden of ReA due to enteric infections using standard criteria. The clinician should investigate for the evidence of previous bacterial infections. In addition, it is very important to carry follow-up studies of patients with enteric infection so as to clarify the association of ReAwith enteric pathogens. No curative treatment for reactive arthritis (ReA) exists. Instead, treatment aims at relieving symptoms and is based on symptom severity. Prevention of enteric and genitourinary bacterial infections is the best option.

Background & Objectives: The familiarity on the part of the clinician with ascitic fluid interpretation and with ascitic fluid characteristics in various diseases will increase the chances of controlling ascites early. The definite diagnosis of spontaneous bacterial peritonitis (SBP) is based on clinical evidence, neutrophil count and positive ascitic fluid culture. The objective of this study was to identify the bacterial agents from ascitic fluid and to determine their antibiotic resistance profile. Material and Methods: Aretrospective analysis of 132 ascitic fluid specimens collected for direct Gram's staining and culture during March 2012 to April 2013 was performed. The antibiotic susceptibility testing was done as per Clinical laboratory Standard Institute guidelines. The extended-spectrum beta-lactamase (ESBL) production in Gram negative isolates were determined. Results: On Gram's staining, microorganisms with pus cells were seen in 20.4% and culture was positive in 37.8% of samples. Most of the isolates were Gram negative (70%). Among Gram negative isolates, E. coli was most common isolate (74%) followed by Acinetobacter spp. (11.6%), Enterobacter spp.(5.8%), Pseudomonas aeruginosa (5.8%) and Klebsiella oxytoca (2.9%). Among Gram positive isolates, Staphylococcus aureus, Enterococcus faecalis and coagulase negative staphylococci were 73.3%, 20% and 6.7% respectively. ESBLs were detected among 17.6% of E. coli and 30.5% of Klebsiella oxytoca isolates and all were multidrug resistant. All the strains were found to be sensitive to imipenem. Interpretation & Conclusion: The knowledge of presumptive causative organism and their antibiotic resistance profile will help the clinician in choosing empirical antibiotic therapy in suspected patients of SBP.

Background & Objectives: The familiarity on the part of the clinician with ascitic fluid interpretation and with ascitic fluid characteristics in various diseases will increase the chances of controlling ascites early. The definite diagnosis of spontaneous bacterial peritonitis (SBP) is based on clinical evidence, neutrophil count and positive ascitic fluid culture. The objective of this study was to identify the bacterial agents from ascitic fluid and to determine their antibiotic resistance profile. Material and Methods: Aretrospective analysis of 132 ascitic fluid specimens collected for direct Gram's staining and culture during March 2012 to April 2013 was performed. The antibiotic susceptibility testing was done as per Clinical laboratory Standard Institute guidelines. The extended-spectrum beta-lactamase (ESBL) production in Gram negative isolates were determined. Results: On Gram's staining, microorganisms with pus cells were seen in 20.4% and culture was positive in 37.8% of samples. Most of the isolates were Gram negative (70%). Among Gram negative isolates, E. coli was most common isolate (74%) followed by Acinetobacter spp. (11.6%), Enterobacter spp.(5.8%), Pseudomonas aeruginosa (5.8%) and Klebsiella oxytoca (2.9%). Among Gram positive isolates, Staphylococcus aureus, Enterococcus faecalis and coagulase negative staphylococci were 73.3%, 20% and 6.7% respectively. ESBLs were detected among 17.6% of E. coli and 30.5% of Klebsiella oxytoca isolates and all were multidrug resistant. All the strains were found to be sensitive to imipenem. Interpretation & Conclusion: The knowledge of presumptive causative organism and their antibiotic resistance profile will help the clinician in choosing empirical antibiotic therapy in suspected patients of SBP.

Background & Objectives: The usual approach to treat Salmonella infections has been the use of conventional antibiotics, but the emergence of MDR (multidrug-resistant) strains and their undesirable effects has diverted the scientific interest towards the use of natural antibacterial and anti-inflammatory compounds. In this context, Withania somnifera (ashwagandha) is one such alternative, which has been safely used for centuries in Indian Ayurvedic medicine for the treatment of various ailments. The present study was therefore, planned to evaluate the antibacterial, anti-inflammatory (edema) and immuno-modulatory potential of the purified whole root extract of Withania somnifera against Salmonella enterica serovar Typhimurium. Material and Methods: Female inbred BALB/c mice, 4-6 weeks old (16-22 gm in weight), were procured from the Central Animal House, Panjab University, Chandigarh (India). Results: Well-diffusion assay and CFU (colony forming units) enumeration confirmed the in-vitro inhibitory potential of Withania somnifera. The anti-inflammatory potential of ashwagandha was confirmed by mouse paw oedema test and flicking response. Further, a significant decrease in MDA (malondialdehyde) and increase in SOD (superoxide dismutase) levels revealed the modulatory effects of ashwagandha in terms of macrophage functions. Withania somnifera also demonstrated excellent in-vivo potency against serovar Typhimurium as evident by reduction in the number of Salmonellae in the liver, spleen and intestine along with histological studies. Interpretations & Conclusion : From the present study, it may be concluded that Withania somnifera possesses strong antibacterial as well as anti-inflammatory potential against Salmonella enterica serovar Typhimurium as evidenced by in-vitro, ex-vivo and in-vivo tests.

Background & Objectives: The usual approach to treat Salmonella infections has been the use of conventional antibiotics, but the emergence of MDR (multidrug-resistant) strains and their undesirable effects has diverted the scientific interest towards the use of natural antibacterial and anti-inflammatory compounds. In this context, Withania somnifera (ashwagandha) is one such alternative, which has been safely used for centuries in Indian Ayurvedic medicine for the treatment of various ailments. The present study was therefore, planned to evaluate the antibacterial, anti-inflammatory (edema) and immuno-modulatory potential of the purified whole root extract of Withania somnifera against Salmonella enterica serovar Typhimurium. Material and Methods: Female inbred BALB/c mice, 4-6 weeks old (16-22 gm in weight), were procured from the Central Animal House, Panjab University, Chandigarh (India). Results: Well-diffusion assay and CFU (colony forming units) enumeration confirmed the in-vitro inhibitory potential of Withania somnifera. The anti-inflammatory potential of ashwagandha was confirmed by mouse paw oedema test and flicking response. Further, a significant decrease in MDA (malondialdehyde) and increase in SOD (superoxide dismutase) levels revealed the modulatory effects of ashwagandha in terms of macrophage functions. Withania somnifera also demonstrated excellent in-vivo potency against serovar Typhimurium as evident by reduction in the number of Salmonellae in the liver, spleen and intestine along with histological studies. Interpretations & Conclusion: From the present study, it may be concluded that Withania somnifera possesses strong antibacterial as well as anti-inflammatory potential against Salmonella enterica serovar Typhimurium as evidenced by in-vitro, ex-vivo and in-vivo tests.

Background & Objective: Fluoroquinlones (FQ) have been highly effective drugs for treatment of shigellosis all over the world. Ciprofloxacin resistance in Shigella flexneri has emerged as a therapeutic challenge in our region. Here, we report clinical presentation of patients in whom S. flexneri was isolated from stool specimens as well as trends of ciprofloxacin susceptibility for the period 2000-2005. Material and Methods: Stool samples were cultured and shigella spp. were identified using standard methods Antibiotic susceptibility was performed in accordance with Clinical Laboratory Standards (CLSI). Minimum inhibitory concentration (MIC) studies were performed by using the agar dilution technique of CLSI and E test. Patients' clinical details and response to therapy were noted. Plasmid profile of ciprofloxacin resistant strains was performed by the rapid alkaline lysis method. Conjugation experiments were done to determine whether quinolone resistance was transferable to E .coli J 53 Rif R. Results : From 995 stool samples submitted from 1st Jan 2005 to 31st Dec 2005, 53 shigellae were isolated. S. flexneri (31 isolates, 60.7%) was the predominant isolate, followed by S. dysenteriae (7), S .sonnei and S. boydii (6 each) and 3 (nonagglutinable). Isolates from 23 out of 28 patients (82%) with S. flexneri shigellosis showed ciprofloxacin resistance (MIC>4). Seven patients infected with S. flexneri did not show any response to either ciprofloxacin/ ofloxacin, but 3 patients responded to ceftriaxone & 4 patients respond to combination of amikacin & ciprofloxacin. Three patients showed a partial response, 2 relapsed after an initial response. Over a period of five years, a trend towards increasing MIC was noticed. Though the increase in MIC values appears gradual for MIC <4, a sharp peak is noticed for MIC>4 in 2005. Though plasmids of 2, 4 and 1.8 Kb were transferred to E coli, the E coli conjugants were susceptible to ciprofloxacin, thereby confirming that ciprofloxacin resistance was not plasmid mediated Interpretation & Conclusion: There is a great immediate need for an effective oral agent that can be safely used for treatment of children with shigellosis along with continued surveillance required at regional and national level.

Background & Objective: Fluoroquinlones (FQ) have been highly effective drugs for treatment of shigellosis all over the world. Ciprofloxacin resistance in Shigella flexneri has emerged as a therapeutic challenge in our region. Here, we report clinical presentation of patients in whom S. flexneri was isolated from stool specimens as well as trends of ciprofloxacin susceptibility for the period 2000-2005. Material and Methods: Stool samples were cultured and shigella spp. were identified using standard methods Antibiotic susceptibility was performed in accordance with Clinical Laboratory Standards (CLSI). Minimum inhibitory concentration (MIC) studies were performed by using the agar dilution technique of CLSI and E test. Patients' clinical details and response to therapy were noted. Plasmid profile of ciprofloxacin resistant strains was performed by the rapid alkaline lysis method. Conjugation experiments were done to determine whether quinolone resistance was transferable to E. coli J 53 Rif R. Results: From 995 stool samples submitted from 1st Jan 2005 to 31st Dec 2005, 53 shigellae were isolated. S. flexneri (31 isolates, 60.7%) was the predominant isolate, followed by S. dysenteriae (7), S. sonnei and S. boydii (6 each) and 3 (nonagglutinable). Isolates from 23 out of 28 patients (82%) with S.flexneri shigellosis showed ciprofloxacin resistance (MIC>4). Seven patients infected with S.flexneri did not show any response to either ciprofloxacin/ ofloxacin, but 3 patients responded to ceftriaxone & 4 patients respond to combination of amikacin & ciprofloxacin. Three patients showed a partial response, 2 relapsed after an initial response. Over a period of five years, a trend towards increasing MIC was noticed. Though the increase in MIC values appears gradual for MIC <4, a sharp peak is noticed for MIC>4 in 2005. Though plasmids of 2, 4 and 1.8 Kb were transferred to E coli, the E coli conjugants were susceptible to ciprofloxacin, thereby confirming that ciprofloxacin resistance was not plasmid mediated Interpretation & Conclusion: There is a great immediate need for an effective oral agent that can be safely used for treatment of children with shigellosis along with continued surveillance required at regional and national level.

Background & Objectives: There is an increasing tendency among people for the consumption of ready to eat food, especially among urban people, which increases the risk of food-borne diseases. The prevalence of antimicrobial resistance among food-borne pathogens has increased during recent decades. The present study was conducted to isolate various enteric bacterial pathogens from ready to eat food samples sold in local market and to check their susceptibility to commonly used antimicrobials. Material & Methods: For the isolation of enteropathogens, 50 different ready to eat foods were collected from retail market of Chandigarh, India and its periphery. The samples were inoculated on MacConkey agar after serial dilutions and isolates obtained were identified morphologically and biochemically using standard procedures. Their susceptibility to commonly used antimicrobials was checked. Results: A total of 57 bacterial isolates were obtained which included E. coli (42%), Klebsiella spp. (25%), Salmonella spp. (9%), Enterobacter spp. (9%), Pseudomonas spp. (5%), Shigella spp. (4%) and Proteus spp. (4%). The isolates showed highest rate of resistance towards amoxicillin followed by norfloxacin and nalidixic acid. Interpretation & Conclusion: All of the isolated bacteria showed resistance to two or more antibiotics studied. The prevalence of antibiotic resistance among food-borne pathogens is a major threat which may pose difficulty in further treatment.

Background & Objectives: There is an increasing tendency among people for the consumption of ready to eat food, especially among urban people, which increases the risk of food-borne diseases. The prevalence of antimicrobial resistance among food-borne pathogens has increased during recent decades. The present study was conducted to isolate various enteric bacterial pathogens from ready to eat food samples sold in local market and to check their susceptibility to commonly used antimicrobials. Material & Methods: For the isolation of enteropathogens, 50 different ready to eat foods were collected from retail market of Chandigarh, India and its periphery. The samples were inoculated on MacConkey agar after serial dilutions and isolates obtained were identified morphologically and biochemically using standard procedures. Their susceptibility to commonly used antimicrobials was checked. Results: A total of 57 bacterial isolates were obtained which included E.coli (42%), Klebsiella spp. (25%), Salmonella spp. (9%), Enterobacter spp. (9%), Pseudomonas spp. (5%), Shigella spp. (4%) and Proteus spp. (4%). The isolates showed highest rate of resistance towards amoxicillin followed by norfloxacin and nalidixic acid. Interpretation & Conclusion: All of the isolated bacteria showed resistance to two or more antibiotics studied. The prevalence of antibiotic resistance among food-borne pathogens is a major threat which may pose difficulty in further treatment.

Background & Objectives : Hepatitis C virus (HCV) genotype has emerged as an independent factor for disease progression, and it also influences the duration and response to anti-viral therapy. HCV genotypic distribution varies geographically. This retrospective analysis was performed to study the genotypic distribution of chronic hepatitis C and its effect on disease presentation in northern Indian population. Material and Methods: All treatment eligible patients with HCV infection presenting to the gastroenterology outpatient department at our institute between January 2004 and December 2013 were enrolled. Results: A total of 1202 patients with hepatitis C virus infection were included. The mean age of patients was 41.5 ±11.8 years and 70% were males. The mean ALTlevel was 106.4 ± 85.4 IU/Land high viral load was present in 50.7%. Evidence of cirrhosis was present in 22.5%. The most common genotype was genotype 3 (80.1%), followed by genotype 1 (15.4%), genotype 4 (1.4%) and genotype 2 (0.5%). All the clinical and biochemical characteristics in genotype 1 and 3 patients were similar except that a significantly higher proportion of patients with genotype 1 had a high viral load. The percentage of cirrhotic patients among genotype 1 was 25.9% as compared to 22.2% among genotype 3. Interpretation & Conclusion: Genotype 3 is the most prevalent genotype in the HCV infected patients in northern India, followed by genotype 1. There was no significant difference in disease presentation among genotype 1 and 3 patients.

Background & Objectives: Hepatitis C virus (HCV) genotype has emerged as an independent factor for disease progression, and it also influences the duration and response to anti-viral therapy. HCV genotypic distribution varies geographically. This retrospective analysis was performed to study the genotypic distribution of chronic hepatitis C and its effect on disease presentation in northern Indian population. Material and Methods: All treatment eligible patients with HCV infection presenting to the gastroenterology outpatient department at our institute between January 2004 and December 2013 were enrolled. Results: A total of 1202 patients with hepatitis C virus infection were included. The mean age of patients was 41.5 ±11.8 years and 70% were males. The mean ALTlevel was 106.4 ± 85.4 IU/Land high viral load was present in 50.7%. Evidence of cirrhosis was present in 22.5%. The most common genotype was genotype 3 (80.1%), followed by genotype 1 (15.4%), genotype 4 (1.4%) and genotype 2 (0.5%). All the clinical and biochemical characteristics in genotype 1 and 3 patients were similar except that a significantly higher proportion of patients with genotype 1 had a high viral load. The percentage of cirrhotic patients among genotype 1 was 25.9% as compared to 22.2% among genotype 3. Interpretation & Conclusion: Genotype 3 is the most prevalent genotype in the HCV infected patients in northern India, followed by genotype 1. There was no significant difference in disease presentation among genotype 1 and 3 patients.

Background & Objectives: Acute viral hepatitis (AVH) is a systemic infection affecting the liver predominantly. It is a major public health problem in India and other developing nations having inadequate sanitary conditions. This study was undertaken to determine the trends of Hepatitis A & E & their coinfection in a tertiary care hospital so that appropriate management of cases as well as prevention can be planned. Material & Methods : Over a 2-year period, a total of 5894 serum samples were collected from clinically suspected cases of hepatitis. The serum samples were screened for IgM anti-HAV and IgM anti-HEV. Seasonal variation & age group wise seropositivity of hepatitis A&E was studied. Results: Out of the total 5894 samples screened, the percentage positivity of Hepatitis A was 6.7%, 6.2% and Hepatits E was 14.1%, 13.9% respectively in 2012 & 2013. Of both Hepatitis A & E positive cases, males outnumbered females. Majority of HAV positive cases were children whereas majority of hepatitis E positive cases were adults. Interpretation & Conclusion: The prevalence of HEVwas more than HAVin enterally transmitted viruses, making them a major public health problem in our area. Seasonal trends of infection were observed in addition, co-infection though infrequent, but still detected in many cases.

Background & Objectives: Acute viral hepatitis (AVH) is a systemic infection affecting the liver predominantly. It is a major public health problem in India and other developing nations having inadequate sanitary conditions. This study was undertaken to determine the trends of Hepatitis A & E & their coinfection in a tertiary care hospital so that appropriate management of cases as well as prevention can be planned. Material & Methods: Over a 2-year period, a total of 5894 serum samples were collected from clinically suspected cases of hepatitis. The serum samples were screened for IgM anti-HAV and IgM anti-HEV. Seasonal variation & age group wise seropositivity of hepatitis A & E was studied. Results: Out of the total 5894 samples screened, the percentage positivity of Hepatitis A was 6.7%, 6.2% and Hepatits E was 14.1%, 13.9% respectively in 2012 & 2013. Of both Hepatitis A & E positive cases, males outnumbered females. Majority of HAV positive cases were children whereas majority of hepatitis E positive cases were adults. Interpretation & Conclusion: The prevalence of HEVwas more than HAVin enterally transmitted viruses, making them a major public health problem in our area. Seasonal trends of infection were observed in addition, co-infection though infrequent, but still detected in many cases.

Background & Objectives: Ascitic fluid infections are frequent complications among patients of cirrhosis with ascities, of which spontaneous bacterial peritonitis (SBP) is the most common and potentially fatal. This study was planned to know the etiology and current antibiotic susceptibility profile of the isolates from the SBP patients. Material and Methods: A total of 50 cases of SBP from cirrhosis patients with ascites were enrolled in this study. Samples were processed in automated Bactec or Bac-T /Alert. Further identification & antimicrobial susceptibility testing was done by VITEK-2 system. Results: Most common organism isolated was Escherichia coli (40%) followed by Coagulase negative Staphylococci, Klebsiella pneumonia and Acinetobacter baumanii. Among all Gram negative isolates, 94.7% were sensitive to tigecycline, 92.1% sensitive to colistin. It also showed high susceptibility to amikacin and carbapenems while low susceptibility was seen to others. All the gram positive organisms were sensitive to vancomycin & linezolid and show moderate sensitivity to ciprofloxacin, tetracycline, cotrimoxazole, and gentamycin. Low sensitivity was seen to penicillin. Methicillin resistant coagulase negative Staphylococci (MRCoNS) were seen in 4 (57%) isolates. Interpretation & Conclusion: Escherichia coli is the most common cause of SBP. Antimicrobial resistance is increasing therefore early detection and determination of antimicrobial susceptibility pattern is important to reduce the mortality and morbidity associated with ascitic fluid infections.

Background & Objectives: Ascitic fluid infections are frequent complications among patients of cirrhosis with ascities, of which spontaneous bacterial peritonitis (SBP) is the most common and potentially fatal. This study was planned to know the etiology and current antibiotic susceptibility profile of the isolates from the SBPpatients. Material and Methods: A total of 50 cases of SBP from cirrhosis patients with ascites were enrolled in this study. Samples were processed in automated Bactec or Bac-T /Alert. Further identification & antimicrobial susceptibility testing was done by VITEK-2 system. Results: Most common organism isolated was Escherichia coli (40%) followed by Coagulase negative Staphylococci, Klebsiella pneumonia and Acinetobacter baumanii. Among all Gram negative isolates, 94.7% were sensitive to tigecycline, 92.1% sensitive to colistin. It also showed high susceptibility to amikacin and carbapenems while low susceptibility was seen to others. All the gram positive organisms were sensitive to vancomycin & linezolid and show moderate sensitivity to ciprofloxacin, tetracycline, cotrimoxazole, and gentamycin. Low sensitivity was seen to penicillin. Methicillin resistant coagulase negative Staphylococci (MRCoNS) were seen in 4 (57%) isolates. Interpretation & Conclusion: Escherichia coli is the most common cause of SBP. Antimicrobial resistance is increasing therefore early detection and determination of antimicrobial susceptibility pattern is important to reduce the mortality and morbidity associated with ascitic fluid infections.

Changing patterns of antibiotic sensitivity of V. cholerae is a major concern as Multiple-Antibiotic-Resistant (MAR) V. cholerae isolates are being reported from various parts of the world. The study was conducted to analyze the prevalence and antibiotic resistance pattern of V. cholerae O1. Samples were processed according to the standard guidelines. Sporadic outbreaks occurred in June 2004 and March 2010. Antibiotic resistance was seen in the strains isolated. Alarge number of cholera epidemics have been associated with MAR strains of V. cholerae. This makes it imperative that all isolates be constantly subjected to susceptibility testing and resistance patterns to each antibiotic be monitored.

Changing patterns of antibiotic sensitivity of V. cholerae is a major concern as Multiple-Antibiotic-Resistant (MAR) V. cholerae isolates are being reported from various parts of the world. The study was conducted to analyze the prevalence and antibiotic resistance pattern of V. cholerae Ol. Samples were processed according to the standard guidelines. Sporadic outbreaks occurred in June 2004 and March 2010. Antibiotic resistance was seen in the strains isolated. Alarge number of cholera epidemics have been associated with MAR strains of V. cholerae. This makes it imperative that all isolates be constantly subjected to susceptibility testing and resistance patterns to each antibiotic be monitored.

Abdominal tuberculosis is a most common type of extra-pulmonary tuberculosis. Abdominal tuberculosis can occur primarily or it can be secondary to a tubercular focus elsewhere in the body. Atotal of 153 samples (gastrointestinal biopsies and ascitic fluid) were processed and direct microscopy, culture and Amplified Mycobacterium Tuberculosis Direct Test (AMTDT) were performed. Comparative analysis of the results was done. The overall positivity by culture was 1.3% and by AMTDT was 5.2%.

Hookworm is one of the important soil-transmitted helminthes and is usually diagnosed by characteristic clinical findings such as anaemia and laboratory investigations like blood examination showing eosinophilia and stool microscopic examination showing characteristic egg morphology. A40-year-old man complained of epigastric pain and passage of black coloured stools for 2 months. There was no eosinophilia and stool was positive for occult blood but no helminthic egg was detected microscopically. Under the impression of peptic ulcer disease with chronic blood loss, upper gastrointestinal endoscopy was performed. Many worms were found in the duodenum incidentally by endoscopy & were identified as Necator americanus and successfully eradicated by mebendazole treatment. It is always crucial to do repeated stool examinations and to observe the duodenum carefully by endoscopy where parasite infestation is suspected clinically.

Hookworm is one of the important soil-transmitted helminthes and is usually diagnosed by characteristic clinical findings such as anaemia and laboratory investigations like blood examination showing eosinophilia and stool microscopic examination showing characteristic egg morphology. A40-year-old man complained of epigastric pain and passage of black coloured stools for 2 months. There was no eosinophilia and stool was positive for occult blood but no helminthic egg was detected microscopically. Under the impression of peptic ulcer disease with chronic blood loss, upper gastrointestinal endoscopy was performed. Many worms were found in the duodenum incidentally by endoscopy & were identified as Necator americanus and successfully eradicated by mebendazole treatment. It is always crucial to do repeated stool examinations and to observe the duodenum carefully by endoscopy where parasite infestation is suspected clinically.

Food material including seeds can be a very common presentation in the appendicectomy specimens. On histological examination they can sometimes be mistaken as worms or their ova. Here we discuss the differentials and differentiating features of common parasites, ova and plant material/seeds found in appendix specimens. A female presented in the emergency unit with abdominal pain, whose diagnostic laproscopy with appendicectomy was done and histology of the appendix showed food material with plant cell matrix along with moderate acute inflammation in the mucosa. Therefore these should be clearly identified in histology by looking at their morphology which can help us in diagnosing and managing the patient appropriately.

Food material including seeds can be a very common presentation in the appendicectomy specimens. On histological examination they can sometimes be mistaken as worms or their ova. Here we discuss the differentials and differentiating features of common parasites, ova and plant material/seeds found in appendix specimens. A female presented in the emergency unit with abdominal pain, whose diagnostic laproscopy with appendicectomy was done and histology of the appendix showed food material with plant cell matrix along with moderate acute inflammation in the mucosa. Therefore these should be clearly identified in histology by looking at their morphology which can help us in diagnosing and managing the patient appropriately.

Tubercular appendicitis is surprisingly rare, even in countries where this infection is endemic. We report a case of isolated tubercular appendicitis with atypical presentation. A39 year male patient presented with abdominal pain and mild fever. On the basis of Ultrasonography and CECT findings, the patient was diagnosed as a case of appendicitis with perforation. Percutaneous (PC) drainage of the fluid revealed acid fast bacilli however no detectable tubercular focus was found elsewhere in the body. The patient was managed conservatively. Preoperative diagnosis of primary tubercular appendicitis is rarely made. It needs high index of suspicion. It should always be confirmed by histopathology.

Tubercular appendicitis is surprisingly rare, even in countries where this infection is endemic. We report a case of isolated tubercular appendicitis with atypical presentation. A39 yearmale patient presented with abdominal pain and mild fever. On the basis of Ultrasonography and CECT findings, the patient was diagnosed as a case of appendicitis with perforation. Percutaneous (PC) drainage of the fluid revealed acid fast bacilli however no detectable tubercular focus was found elsewhere in the body. The patient was managed conservatively. Preoperative diagnosis of primary tubercular appendicitis is rarely made. It needs high index of suspicion. It should always be confirmed by histopathology.