January - March 2015
187
Correspondences
Detection of various types of resistance patterns and their correlation with minimum inhibitory concentrations against clindamycin among methicillin resistant S. aureus isolates Dear Editor,
References
We read an article “Detection of various types of resistance patterns and their correlation with minimum inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates” published in Indian Journal of Medical Microbiology 2012;30:165-9.[1] The authors have targeted a very critical issue of identification of inducible MLSB resistance among MRSA isolates as therapeutic failure is common with inducible type of clindamycin resistance. However, a basic clarification is needed.
1.
For detecting MRSA isolates, the authors have used Kirby Bauer’s Disc Diffusion method with 1-μg oxacillin disc which requires supplementation of Mueller Hinton Agar with 2% NaCl and incubation at 35°C.[1] In Clinical and Laboratory Standards Institute (CLSI) guidelines 2006 (quoted by the authors), cefoxitin disc (30 μg) has been recommended for detection of MRSA.[2] Other studies including the one conducted by us also indicated that cefoxitin disc is far superior to other phenotypic methods and its results are in concordance with the PCR for mecA gene for MRSA detection.[3,4] CLSI guidelines (2011) state that cefoxitin is the surrogate marker for detection of MRSA.[5] Although use of oxacillin disc might not have varied the overall results of the study but as far as detection of MRSA is considered, cefoxitin disc would have been the better alternative as it is the potent inducer of mecA regulatory system, easy to put up and interpret.
2.
3.
4.
5.
Sireesha P, Setty CR. Detection of various types of resistance patterns and their correlation with minimal inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates. Indian J Med Microbiol 2012;30:165-9. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; sixteenth informational supplement M100-S16. Wayne: Clinical and Laboratory Standards Institute; 2006. Anand KB, Agrawal P, Kumar S, Kapila K. Comparison of cefoxitin disc diffusion test, oxacillin screen agar, and PCR for mecA gene for detection of MRSA. Indian J Med Microbiol 2009;27:27-9. Arora S, Devi P, Arora U, Devi B. Prevalence of Methicillin-resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Hospital in Northern India. J Lab Physicians 2010;2:78-81. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; twenty first informational supplement M100-S21. Wayne: Clinical and Laboratory Standards Institute; 2011.
S Arora, *N Jindal, V Sharma Department of Microbiology (SA, NJ), Guru Gobind Singh Medical College and Hospital, Faridkot, Department of Microbiology (VS), Chintpurni Medical College and Hospital, Pathankot, Punjab, India *Corresponding author (email: ) Received: 04-09-2013 Accepted: 13-03-2014 Access this article online Quick Response Code:
In clinical microbiology laboratory, accurate and early detection of multidrug-resistant (MDR) strains is the key for the better prognosis of infections and prevention of spread of antibiotic resistance. Small modifications in routine laboratory practices guided by standard references such as CLSI might help a lot to achieve this goal.
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148437
Four year data from an ICTC of a tertiary care hospital in Jaipur, Rajasthan Dear Editor, Human immunodeficiency virus (HIV) infections were reported to be about 33 million worldwide, of which an estimated 2.5 million people were in India at the end of 2006.[1] The epidemic is still going upswing
and it is important to control it. The most effective approach available for the prevention and control of any infection/disease is awareness generation and lifestyle changes. The general consensus among those fighting AIDS worldwide is that HIV testing should be carried out voluntarily, with the consent of the individual concerned.
www.ijmm.org
188
Indian Journal of Medical Microbiology
This view has been completely endorsed in principle and action by the Indian government and NACO, who have thus established hundreds of voluntary counselling and testing centres (VCTCs), now the Integrated Counselling and Testing Centre (ICTC) in India. The ICTC is a part of HIV prevention programme and is a place, where a person gets counselling and testing done, on his own will, or as advised by a medical provider. This is the entry point for comprehensive HIV care and treatment, as well as prevention. Hence awareness and acceptance of ICTC services is vital, if the HIV/AIDS epidemic is to be controlled.[2] The present study was conducted at the ICTC of the microbiology department of Mahatma Gandhi Medical College, which is a tertiary care hospital catering to the needs of Jaipur and adjoining districts, to find the prevalence of HIV among ICTC attendees. The study included all attendees of the ICTC referred from various departments and surrounding hospitals or direct walk-in attendees from July 2009 to June 2013. After obtaining informed consent and pre-test counselling, a blood sample was withdrawn and subjected to three rapid HIV tests (Immunocomb J Mitra and Co. Pvt Ltd, Delhi, India, SD BIOLINE HIV-1/2 3.0, Standard Diagnostics, Inc. Korea and PAREEKSHAK HIV 1/2 Triline Card Test, Bhat Bio-Tech India Pvt Ltd.) following the manufacturer’s instructions. Samples showing positive test results in all the three tests were declared HIV positive. The laboratory participates in stringent quality control measures, both internal and external. It receives samples for external quality assurance from the zonal reference laboratory on a quarterly basis. Data was summarised using percentage and analysed. A total of 8190 clients accessed ICTC services during the study period, out of which 135 were HIV-seropositive, giving a prevalence of 1.64%. There was only a single positive case for HIV 2. About 95% (7780) of the attendees were referred by the practitioners while only 5% were direct walk-ins. Out of total clients tested, 5487 (67%) were males, whereas females constituted 2703 (33%). A majority (88.3%) of those who were HIV-seropositive were between the ages of 15 and 49 years. Heterosexual behaviour was the most common mode of transmission (92%) of the HIV infection among our subjects. The least common risk behaviour patterns were infected blood and blood products (0.8%), homosexual behaviour (0.5%), and nil through infected needles and syringes. HIV counselling and testing services are a key entry point for prevention of HIV infection and treatment and care of people who are infected with HIV. The HIV prevalence in our study (1.64%) is quite similar to that reported by another study in Western India.[3] However,
vol. 33, No. 1
it is lower than the estimates provided by studies conducted in Karnataka (9.6%), West Bengal (17.1%), and Gujarat (4.8%).[4-6] There was only a single positive case for HIV-2, giving a seroprevalence of 0.01% and none was reactive for antibodies of both HIV-1 and HIV-2. All the seropositive clients were referred to the antiretroviral treatment (ART) centre for care and management after the post-test counselling. Since the first evidence of HIV-2 infection in India in 1991, studies from different parts have shown a varied seroprevalence. Studies conducted in Delhi and Pune have revealed almost similar HIV-2 sero positivity of 0.03% each.[7,8] Data from South India showed a prevalence of 0.13-1.8%.[9] While the figures in our study could mean genuine lower seroprevalence, it could also mean a gross under utilisation of the ICTC services by the high-risk populations. Another disturbing finding in the current study was a very low percentage of direct walk-ins, which could be due to strong social taboo present in the community regarding HIV. Self-stigma and fear of discrimination are often central to individuals not seeking HIV tests or treatment. Both these observations bring us to the same conclusion that it is extremely important to raise awareness by aggressive health education programmes and also to make it more acceptable by integration of ICTC into various community organisations. References 1.
2.
3.
4.
5.
6.
7.
8.
9.
www.ijmm.org
NACO News, behind the numbers. Newsletter of National AIDS Control Organization. Ministry of Health and Family Welfare (GOI) 2007;3:4. National AIDS Control Programme CMIS Bulletin. Govt. of India. Ministry of Health and Family Welfare ICTC 2007:13-7. Vyas N, Hooja S, Sinha P, Mathur A, Singhal A, Vyas L. Prevalence of HIV/AIDS and prediction of future trends in north-west region of India: A six-year ICTC-based study. Indian J Community Med 2009;34:212-7. Gupta M. Profile of clients tested HIV positive at a voluntary counselling and testing centre of a district hospital in Udupi. Indian J Community Med 2009;34:223-6. Joardar GK, Sarkar A, Chatterjee C. Profile of the attendees in the voluntary and testing centre of North Bengal medical college in the Darjeeling district of West Bengal. Indian J Community Med 2006;31:237-40. Sharma R. Profile of attendee for voluntary counselling and testing in the ICTC, Ahmadabad. Indian J Sex Transm Dis 2009;30:31-6. Kashyap B, Gautam H, Bhalla P. Epidemiology and seroprevalence of human immunodeficiency virus type 2. Intervirology 2011;54:151-5. Tadokar VS, Kavathekar MS. Seroprevalence of human immunodeficiency virus type 2 infection from a tertiary care hospital in Pune, Maharashtra: A 2 year study. Indian J Med Microbiol 2013;31:314-5. Murugan S, Anburajan R. Prevalence of HIV-2 infection in South Tamil Nadu. Indian J Sex Transm Dis 2007;28:113.
January - March 2015
189
Correspondences
*ER Sabharwal
Access this article online Quick Response Code:
Department of Microbiology (ERS), Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
Website: www.ijmm.org PMID: ***
*Corresponding author (email: ) Received: 08-11-2013 Accepted: 28-03-2014
DOI: 10.4103/0255-0857.148439
Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India Dear Editor, Apropos the article entitled “A study of changing trends of prevalence and genotypic distribution of Hepatitis C virus (HCV) among high risk groups in North India’’,[1] we wish to share the data from our region of North India (Faridkot- Malwa region of Punjab). To the best of our knowledge, adequate information from this region is lacking. A total of 12490 unselected patients attending inpatient and outpatient departments of our tertiary care hospital from January 2011 to December 2012 were tested for anti-HCV antibodies by third generation enzyme-linked immunosorbent assay (ELISA) (Microlisa, J Mitra and Co; India) and 839 (6.71%) were found to be positive for anti-HCV antibodies. Of these, 75 were tested for HCV-ribonucleic acid (RNA) using HCV real-time polymerase chain reaction (PCR) kit (Sacace biotechnologies) on smart cycler II, and 63 (84%) gave positive results for HCV-RNA. Their genotyping was done by Linear array HCV-genotyping kit (Roche Diagnostics, Mannheim, Germany) from an accredited laboratory. The risk factors and genotypes of the HCV-infected patients are shown in Table 1. In the present study, the most common risk factor observed was unsafe medical procedures (47.6%), which included history of therapeutic injections and major/ minor surgeries [Table 1]. A similar study from the Punjabi population of Lahore (Pakistan) has also reported therapeutic injections (unsafe) as the most common risk factor.[2] This could be because most of our population believes that injections relieve symptoms quickly. They
Risk factors Unsafe medical procedures Blood transfuse ion Dental procedures Total
also lack risk perception due to unsafe injections. A study by Chakravarti et al.,[1] reported blood transfusion to be the major risk factor (54.8%), which was observed in 30.2% of our study. Although, mandatory screening of blood for HCV was introduced in 2002, it seems that transmission of HCV through unscreened blood still continues. History of dental procedures, which was observed in 22.2% of our study, corroborates the findings of Chakravarti et al.[1] This could be because many dental procedures are performed by untrained individuals using unsterilised equipment. Similar to other studies from North India,[3,4] genotype 3 was the most common (55.6%) among all the risk groups of our study too. This was followed by genotype 1 (42.8%). Genotype 4 which was not observed by Chakravarti et al.,[1] was present in 1 (1.6%) of our patients. It has also been reported in Punjabi population of Lahore, Pakistan,[2] which is approximately 50 km from our region. In conclusion, our data highlights that the rampant use of injections (unsafe), unscreened blood transfusion, and dental procedures are playing a significant role in increasing the reservoir of HCV infection in Malwa region of Punjab. This underscores the need of strict implementation of infection control practices in healthcare settings and creating awareness among public by mass media, public health education and proper counselling of persons with high-risk practices. Our study also shows that although genotype 3 is the most commongenotypes in our region, other genotypes 1 (42.8%) and 4 (1.6) are
Table 1: Risk factors and genotypes of HCV infected patients Genotype 1 Genotype 2 Genotype 3 10 (33.3) 7 (36.8) 11 (57.9) 6 (42.9) 8 (57.1) 23 (36.5) 39 (61.9)
HCV: Hepatitis C virus www.ijmm.org
Genotype 4 30 (47.6) 19 (30.2) 14 (22.2) 1 (1.6)
Total 30 (47.6) 19 (30.2) 14 (22.2) 63 (100)
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
187
Correspondences
Detection of various types of resistance patterns and their correlation with minimum inhibitory concentrations against clindamycin among methicillin resistant S. aureus isolates Dear Editor,
References
We read an article “Detection of various types of resistance patterns and their correlation with minimum inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates” published in Indian Journal of Medical Microbiology 2012;30:165-9.[1] The authors have targeted a very critical issue of identification of inducible MLSB resistance among MRSA isolates as therapeutic failure is common with inducible type of clindamycin resistance. However, a basic clarification is needed.
1.
For detecting MRSA isolates, the authors have used Kirby Bauer’s Disc Diffusion method with 1-μg oxacillin disc which requires supplementation of Mueller Hinton Agar with 2% NaCl and incubation at 35°C.[1] In Clinical and Laboratory Standards Institute (CLSI) guidelines 2006 (quoted by the authors), cefoxitin disc (30 μg) has been recommended for detection of MRSA.[2] Other studies including the one conducted by us also indicated that cefoxitin disc is far superior to other phenotypic methods and its results are in concordance with the PCR for mecA gene for MRSA detection.[3,4] CLSI guidelines (2011) state that cefoxitin is the surrogate marker for detection of MRSA.[5] Although use of oxacillin disc might not have varied the overall results of the study but as far as detection of MRSA is considered, cefoxitin disc would have been the better alternative as it is the potent inducer of mecA regulatory system, easy to put up and interpret.
2.
3.
4.
5.
Sireesha P, Setty CR. Detection of various types of resistance patterns and their correlation with minimal inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates. Indian J Med Microbiol 2012;30:165-9. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; sixteenth informational supplement M100-S16. Wayne: Clinical and Laboratory Standards Institute; 2006. Anand KB, Agrawal P, Kumar S, Kapila K. Comparison of cefoxitin disc diffusion test, oxacillin screen agar, and PCR for mecA gene for detection of MRSA. Indian J Med Microbiol 2009;27:27-9. Arora S, Devi P, Arora U, Devi B. Prevalence of Methicillin-resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Hospital in Northern India. J Lab Physicians 2010;2:78-81. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; twenty first informational supplement M100-S21. Wayne: Clinical and Laboratory Standards Institute; 2011.
S Arora, *N Jindal, V Sharma Department of Microbiology (SA, NJ), Guru Gobind Singh Medical College and Hospital, Faridkot, Department of Microbiology (VS), Chintpurni Medical College and Hospital, Pathankot, Punjab, India *Corresponding author (email: ) Received: 04-09-2013 Accepted: 13-03-2014 Access this article online Quick Response Code:
In clinical microbiology laboratory, accurate and early detection of multidrug-resistant (MDR) strains is the key for the better prognosis of infections and prevention of spread of antibiotic resistance. Small modifications in routine laboratory practices guided by standard references such as CLSI might help a lot to achieve this goal.
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148437
Four year data from an ICTC of a tertiary care hospital in Jaipur, Rajasthan Dear Editor, Human immunodeficiency virus (HIV) infections were reported to be about 33 million worldwide, of which an estimated 2.5 million people were in India at the end of 2006.[1] The epidemic is still going upswing
and it is important to control it. The most effective approach available for the prevention and control of any infection/disease is awareness generation and lifestyle changes. The general consensus among those fighting AIDS worldwide is that HIV testing should be carried out voluntarily, with the consent of the individual concerned.
www.ijmm.org
188
Indian Journal of Medical Microbiology
This view has been completely endorsed in principle and action by the Indian government and NACO, who have thus established hundreds of voluntary counselling and testing centres (VCTCs), now the Integrated Counselling and Testing Centre (ICTC) in India. The ICTC is a part of HIV prevention programme and is a place, where a person gets counselling and testing done, on his own will, or as advised by a medical provider. This is the entry point for comprehensive HIV care and treatment, as well as prevention. Hence awareness and acceptance of ICTC services is vital, if the HIV/AIDS epidemic is to be controlled.[2] The present study was conducted at the ICTC of the microbiology department of Mahatma Gandhi Medical College, which is a tertiary care hospital catering to the needs of Jaipur and adjoining districts, to find the prevalence of HIV among ICTC attendees. The study included all attendees of the ICTC referred from various departments and surrounding hospitals or direct walk-in attendees from July 2009 to June 2013. After obtaining informed consent and pre-test counselling, a blood sample was withdrawn and subjected to three rapid HIV tests (Immunocomb J Mitra and Co. Pvt Ltd, Delhi, India, SD BIOLINE HIV-1/2 3.0, Standard Diagnostics, Inc. Korea and PAREEKSHAK HIV 1/2 Triline Card Test, Bhat Bio-Tech India Pvt Ltd.) following the manufacturer’s instructions. Samples showing positive test results in all the three tests were declared HIV positive. The laboratory participates in stringent quality control measures, both internal and external. It receives samples for external quality assurance from the zonal reference laboratory on a quarterly basis. Data was summarised using percentage and analysed. A total of 8190 clients accessed ICTC services during the study period, out of which 135 were HIV-seropositive, giving a prevalence of 1.64%. There was only a single positive case for HIV 2. About 95% (7780) of the attendees were referred by the practitioners while only 5% were direct walk-ins. Out of total clients tested, 5487 (67%) were males, whereas females constituted 2703 (33%). A majority (88.3%) of those who were HIV-seropositive were between the ages of 15 and 49 years. Heterosexual behaviour was the most common mode of transmission (92%) of the HIV infection among our subjects. The least common risk behaviour patterns were infected blood and blood products (0.8%), homosexual behaviour (0.5%), and nil through infected needles and syringes. HIV counselling and testing services are a key entry point for prevention of HIV infection and treatment and care of people who are infected with HIV. The HIV prevalence in our study (1.64%) is quite similar to that reported by another study in Western India.[3] However,
vol. 33, No. 1
it is lower than the estimates provided by studies conducted in Karnataka (9.6%), West Bengal (17.1%), and Gujarat (4.8%).[4-6] There was only a single positive case for HIV-2, giving a seroprevalence of 0.01% and none was reactive for antibodies of both HIV-1 and HIV-2. All the seropositive clients were referred to the antiretroviral treatment (ART) centre for care and management after the post-test counselling. Since the first evidence of HIV-2 infection in India in 1991, studies from different parts have shown a varied seroprevalence. Studies conducted in Delhi and Pune have revealed almost similar HIV-2 sero positivity of 0.03% each.[7,8] Data from South India showed a prevalence of 0.13-1.8%.[9] While the figures in our study could mean genuine lower seroprevalence, it could also mean a gross under utilisation of the ICTC services by the high-risk populations. Another disturbing finding in the current study was a very low percentage of direct walk-ins, which could be due to strong social taboo present in the community regarding HIV. Self-stigma and fear of discrimination are often central to individuals not seeking HIV tests or treatment. Both these observations bring us to the same conclusion that it is extremely important to raise awareness by aggressive health education programmes and also to make it more acceptable by integration of ICTC into various community organisations. References 1.
2.
3.
4.
5.
6.
7.
8.
9.
www.ijmm.org
NACO News, behind the numbers. Newsletter of National AIDS Control Organization. Ministry of Health and Family Welfare (GOI) 2007;3:4. National AIDS Control Programme CMIS Bulletin. Govt. of India. Ministry of Health and Family Welfare ICTC 2007:13-7. Vyas N, Hooja S, Sinha P, Mathur A, Singhal A, Vyas L. Prevalence of HIV/AIDS and prediction of future trends in north-west region of India: A six-year ICTC-based study. Indian J Community Med 2009;34:212-7. Gupta M. Profile of clients tested HIV positive at a voluntary counselling and testing centre of a district hospital in Udupi. Indian J Community Med 2009;34:223-6. Joardar GK, Sarkar A, Chatterjee C. Profile of the attendees in the voluntary and testing centre of North Bengal medical college in the Darjeeling district of West Bengal. Indian J Community Med 2006;31:237-40. Sharma R. Profile of attendee for voluntary counselling and testing in the ICTC, Ahmadabad. Indian J Sex Transm Dis 2009;30:31-6. Kashyap B, Gautam H, Bhalla P. Epidemiology and seroprevalence of human immunodeficiency virus type 2. Intervirology 2011;54:151-5. Tadokar VS, Kavathekar MS. Seroprevalence of human immunodeficiency virus type 2 infection from a tertiary care hospital in Pune, Maharashtra: A 2 year study. Indian J Med Microbiol 2013;31:314-5. Murugan S, Anburajan R. Prevalence of HIV-2 infection in South Tamil Nadu. Indian J Sex Transm Dis 2007;28:113.
January - March 2015
189
Correspondences
*ER Sabharwal
Access this article online Quick Response Code:
Department of Microbiology (ERS), Mahatma Gandhi Medical College, Jaipur, Rajasthan, India
Website: www.ijmm.org PMID: ***
*Corresponding author (email: ) Received: 08-11-2013 Accepted: 28-03-2014
DOI: 10.4103/0255-0857.148439
Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India Dear Editor, Apropos the article entitled “A study of changing trends of prevalence and genotypic distribution of Hepatitis C virus (HCV) among high risk groups in North India’’,[1] we wish to share the data from our region of North India (Faridkot- Malwa region of Punjab). To the best of our knowledge, adequate information from this region is lacking. A total of 12490 unselected patients attending inpatient and outpatient departments of our tertiary care hospital from January 2011 to December 2012 were tested for anti-HCV antibodies by third generation enzyme-linked immunosorbent assay (ELISA) (Microlisa, J Mitra and Co; India) and 839 (6.71%) were found to be positive for anti-HCV antibodies. Of these, 75 were tested for HCV-ribonucleic acid (RNA) using HCV real-time polymerase chain reaction (PCR) kit (Sacace biotechnologies) on smart cycler II, and 63 (84%) gave positive results for HCV-RNA. Their genotyping was done by Linear array HCV-genotyping kit (Roche Diagnostics, Mannheim, Germany) from an accredited laboratory. The risk factors and genotypes of the HCV-infected patients are shown in Table 1. In the present study, the most common risk factor observed was unsafe medical procedures (47.6%), which included history of therapeutic injections and major/ minor surgeries [Table 1]. A similar study from the Punjabi population of Lahore (Pakistan) has also reported therapeutic injections (unsafe) as the most common risk factor.[2] This could be because most of our population believes that injections relieve symptoms quickly. They
Risk factors Unsafe medical procedures Blood transfuse ion Dental procedures Total
also lack risk perception due to unsafe injections. A study by Chakravarti et al.,[1] reported blood transfusion to be the major risk factor (54.8%), which was observed in 30.2% of our study. Although, mandatory screening of blood for HCV was introduced in 2002, it seems that transmission of HCV through unscreened blood still continues. History of dental procedures, which was observed in 22.2% of our study, corroborates the findings of Chakravarti et al.[1] This could be because many dental procedures are performed by untrained individuals using unsterilised equipment. Similar to other studies from North India,[3,4] genotype 3 was the most common (55.6%) among all the risk groups of our study too. This was followed by genotype 1 (42.8%). Genotype 4 which was not observed by Chakravarti et al.,[1] was present in 1 (1.6%) of our patients. It has also been reported in Punjabi population of Lahore, Pakistan,[2] which is approximately 50 km from our region. In conclusion, our data highlights that the rampant use of injections (unsafe), unscreened blood transfusion, and dental procedures are playing a significant role in increasing the reservoir of HCV infection in Malwa region of Punjab. This underscores the need of strict implementation of infection control practices in healthcare settings and creating awareness among public by mass media, public health education and proper counselling of persons with high-risk practices. Our study also shows that although genotype 3 is the most commongenotypes in our region, other genotypes 1 (42.8%) and 4 (1.6) are
Table 1: Risk factors and genotypes of HCV infected patients Genotype 1 Genotype 2 Genotype 3 10 (33.3) 7 (36.8) 11 (57.9) 6 (42.9) 8 (57.1) 23 (36.5) 39 (61.9)
HCV: Hepatitis C virus www.ijmm.org
Genotype 4 30 (47.6) 19 (30.2) 14 (22.2) 1 (1.6)
Total 30 (47.6) 19 (30.2) 14 (22.2) 63 (100)
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
