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)
190
Indian Journal of Medical Microbiology
*N Jindal, R Bansal, P Grover, R Malhotra
also prevalent. This is important since this could influence configuration of diagnostic assays as well as vaccine designs for our population. References 1.
2.
3. 4.
Chakravarti A, Ashraf A, Malik S. A study of changing trends of prevalence and genotypic distribution of hepatitis C virus among high risk groups in North India. Indian J Med Microbial 2013;31:354-9. Ghulam M, Shah J, Saba K, Nasir M, Tahir JF, Nakhshab C, et al. Current status of transmission risk factors and genotypes of hepatitis C virus in Punjabi population of Pakistan. IJAVMS 2011;5:271-82. Singh S, Malhotra V, Sarin SK. Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in India. Indian J Med Res 2004;119:145-8. Rehan HS, Manak S, Yadav M, Deepinder, Chopra D, Wardhan N. Diversity of genotype and mode of spread of hepatitis C virus in Northern India. Saudi J Gastroenterol 2011;17:241-4.
vol. 33, No. 1
Department of Microbiology (NJ, RB, PG, RM), Guru Gobind Singh Medical College, Faridkot, Punjab, India *Corresponding author (email: ) Received: 19-12-2013 Accepted: 24-03-2014
Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148440
Carriage of quinolone resistance in faecal coliforms among healthy individuals: A study from northeast India Dear Editor, Quinolones are potent broad-spectrum bactericidal agents along with their enhanced systemic activity against many gram-negative aerobes are extensively used in clinical medicine.[1] Faecal sample is considered as one of the most important reservoir of microorganisms and majority of microflora are coliforms that include the genus Escherichia, Enterobacter, Klebsiella spp. and Citrobacter spp. These faecal flora also act as reservoir for carriage of drug resistant determinants and their spread in environment. Hence, this study was designed to determine the quinolone resistance microbial load in the faecal sample of healthy individuals and to determine the genes responsible for this resistance. Antibiotic susceptibility of the isolates was determined by Kirby-Bauer disc diffusion method and the diameter of zone inhibition was compared with Clinical Laboratory Standard Institute (CLSI) guidelines.[2] Polymerase chain reaction (PCR) experiment was done for detecting the genes responsible for quinolone resistance such as qnrA, qnrB, qnrS, and qepA. Out of 82 isolates a total number of 44 (53.6%) organisms were found to be resistant to quinolone antibiotics. Among the 44 resistant isolates, the most predominant organism was found to be Escherichia coli followed by Klebsiella pneumoniae and Enterobacter spp. The PCR analysis showed that among the 44 resistant isolates, 7 isolates
harbouring qnrS, 5 isolates harbouring qnrA whereas only 1 isolate was found to be harbouring qnrB gene. [Table 1]. According to a previous report[3] the healthy members of a community represent the largest reservoir for bacteria resistant to antimicrobial agents. In this study, we found that a considerable number of isolates were resistant to quinolones. This resistance could be due to self-medication and sub-optimal dosage administration, which led to adaptation in the normal coliform. We also found that qnrS gene is more prevalent than qnrA gene in clinical Enterobacteriaceae, which was similar to the previous study.[4,5] Therefore, it can be concluded that the irrational use of antimicrobial agents at inadequately high doses, for inappropriate duration of therapy aggravate the development of resistance. This current study advocates the need for widespread and well-designed programme to monitor the emergence of bacterial resistance not just to quinolones but also to all the antimicrobial agents. Table 1: Total number of quinolone-resistance isolates (n=44) Number of quinolone-resistance isolates qnrS qnrA qnrB 4 3 1 Escherichia coli (n=33) 2 1 0 Klebsiella pneumoniae (n=8) 1 1 0 Enterobacter spp. (n=3)
www.ijmm.org
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.
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)
190
Indian Journal of Medical Microbiology
*N Jindal, R Bansal, P Grover, R Malhotra
also prevalent. This is important since this could influence configuration of diagnostic assays as well as vaccine designs for our population. References 1.
2.
3. 4.
Chakravarti A, Ashraf A, Malik S. A study of changing trends of prevalence and genotypic distribution of hepatitis C virus among high risk groups in North India. Indian J Med Microbial 2013;31:354-9. Ghulam M, Shah J, Saba K, Nasir M, Tahir JF, Nakhshab C, et al. Current status of transmission risk factors and genotypes of hepatitis C virus in Punjabi population of Pakistan. IJAVMS 2011;5:271-82. Singh S, Malhotra V, Sarin SK. Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in India. Indian J Med Res 2004;119:145-8. Rehan HS, Manak S, Yadav M, Deepinder, Chopra D, Wardhan N. Diversity of genotype and mode of spread of hepatitis C virus in Northern India. Saudi J Gastroenterol 2011;17:241-4.
vol. 33, No. 1
Department of Microbiology (NJ, RB, PG, RM), Guru Gobind Singh Medical College, Faridkot, Punjab, India *Corresponding author (email: ) Received: 19-12-2013 Accepted: 24-03-2014
Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.148440
Carriage of quinolone resistance in faecal coliforms among healthy individuals: A study from northeast India Dear Editor, Quinolones are potent broad-spectrum bactericidal agents along with their enhanced systemic activity against many gram-negative aerobes are extensively used in clinical medicine.[1] Faecal sample is considered as one of the most important reservoir of microorganisms and majority of microflora are coliforms that include the genus Escherichia, Enterobacter, Klebsiella spp. and Citrobacter spp. These faecal flora also act as reservoir for carriage of drug resistant determinants and their spread in environment. Hence, this study was designed to determine the quinolone resistance microbial load in the faecal sample of healthy individuals and to determine the genes responsible for this resistance. Antibiotic susceptibility of the isolates was determined by Kirby-Bauer disc diffusion method and the diameter of zone inhibition was compared with Clinical Laboratory Standard Institute (CLSI) guidelines.[2] Polymerase chain reaction (PCR) experiment was done for detecting the genes responsible for quinolone resistance such as qnrA, qnrB, qnrS, and qepA. Out of 82 isolates a total number of 44 (53.6%) organisms were found to be resistant to quinolone antibiotics. Among the 44 resistant isolates, the most predominant organism was found to be Escherichia coli followed by Klebsiella pneumoniae and Enterobacter spp. The PCR analysis showed that among the 44 resistant isolates, 7 isolates
harbouring qnrS, 5 isolates harbouring qnrA whereas only 1 isolate was found to be harbouring qnrB gene. [Table 1]. According to a previous report[3] the healthy members of a community represent the largest reservoir for bacteria resistant to antimicrobial agents. In this study, we found that a considerable number of isolates were resistant to quinolones. This resistance could be due to self-medication and sub-optimal dosage administration, which led to adaptation in the normal coliform. We also found that qnrS gene is more prevalent than qnrA gene in clinical Enterobacteriaceae, which was similar to the previous study.[4,5] Therefore, it can be concluded that the irrational use of antimicrobial agents at inadequately high doses, for inappropriate duration of therapy aggravate the development of resistance. This current study advocates the need for widespread and well-designed programme to monitor the emergence of bacterial resistance not just to quinolones but also to all the antimicrobial agents. Table 1: Total number of quinolone-resistance isolates (n=44) Number of quinolone-resistance isolates qnrS qnrA qnrB 4 3 1 Escherichia coli (n=33) 2 1 0 Klebsiella pneumoniae (n=8) 1 1 0 Enterobacter spp. (n=3)
www.ijmm.org
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.
