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Indian Journal of Medical Microbiology

existing clinical spectrum of diseases caused by this unusual pathogen around the world and adds to the growing body of literature documenting the virulence of these organisms in humans.

impact of members of the genus Kocuria. J Med Microbiol 2010;59:1395‑402.

*NH Ahmed, I Biswal, P Roy, RK Grover Department of Laboratory Medicine (NHA, IB, PR), Department of Clinical Oncology, Director and Chief Executive Officer (RKG), Delhi State Cancer Institute, Delhi, India

References 1. Martinaud C, Gaillard T, Brisou P, Gisserot O, de Jaureguiberry JP. Bacteraemia caused by Kocuria kristinae in a patient with acute leukaemia. Med Mal Infect 2008;38:165‑6. 2. Basaglia G, Carretto E, Barbarini D, Moras L, Scalone S, Marone P, et al. Catheter‑related bacteremia due to Kocuria kristinae in a patient with ovarian cancer. J Clin Microbiol 2002;40:311‑3. 3. Ma ES, Wong CL, Lai KT, Chan EC, Yam WC, Chan AC. Kocuria kristinae infection associated with acute cholecystitis. BMC Infect Dis 2005;5:60. 4. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty first Informational supplement. CLSI document M100‑S23 ; 2013;3. 5. Savini V, Catavitello C, Masciarelli G, Astolfi D, Balbinot A, Bianco A, et al. Drug sensitivity and clinical

vol. 32, No. 4

*Corresponding author ( email: [email protected]>) Received: 02‑09‑2013 Accepted: 06‑02‑2014 Access this article online Quick Response Code:

Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.142232

Role of cold agglutination test in the diagnosis Mycoplasma pneumoniae infection in HIV infected children Dear Editor, Studies have shown that CD4 depletion may enhance M. pneumoniae infection in human immunodeficiency virus (HIV)‑infected patient.[1] Diagnosis of M. pneumoniae infection is mostly based on serology as isolation of bacterium in sputum is insensitive, whereas polymerase chain reaction (PCR) lacks clinical relevance. Cold agglutination test is convenient and inexpensive serological test for this purpose. We have evaluated the reliability of Quantitative cold agglutination test and Rapid bed side cold agglutination test in diagnosis of M. pneumoniae infection in HIV‑infected children. Serum samples of 90 HIV proven children presenting with recent pulmonary complaints were subjected to Quantitative cold agglutination test, Rapid cold agglutination test using the standard procedure.[5] M. pneumoniae  IgM Enzyme Linked Immunosorbant Assay (IgM ELISA) was performed as the gold standard test and the results were compared. Of the total 90 cases tested, 29 (32.2%) were tested positive by Quantitative cold agglutination test of which 19 (65.5%) correlated with positive IgM ELISA test. Among positive cases, titres of ≥1:64 were observed in 21 (72.4%)

and 1:32 in 8 (27.5%). Rapid bed side cold agglutination test was found positive among 28 (31%) of which 15 (53.5%) correlated with positive IgM ELISA. A total of 29 (32.2%) cases tested were positive for IgM ELISA. Results concerning Reliability of cold agglutination test when compare to IgM- ElSA is given in Table 1. Shankar et al. reported sensitivity, specificity, positive and negative predictive values of 100%, 84%, 62% and 100%, respectively, for Quantitative cold agglutination test compared with IgM ELISA in HIV‑infected patients.[3] Ching YT et al. reported sensitivity and specificity of 78.3% and 41.3% and positive and negative predictive values of 43.4% and 76.7%, respectively, for Rapid cold agglutination test when compared with IgM ELISA in asthmatic children .[4] Kwan et al. reported sensitivity and specificity of 46% and 95% for Conventional Quantitative cold agglutination test .[5] According to the results obtained in our study, Cold agglutination test lacks sensitivity and specificity, hence IgM ELISA should be considered in diagnosis of M. pneumoniae infection in case of HIV‑infected children. Acknowledgement Mr. Kiran B and Mr. Rajesh M Technicians KIMS Hubli for their overwhelming technical support.

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Table 1: Reliability of cold agglutination tests in diagnosis of M. pneumoniae infection in HIV infected children (Compare to IgM ELISA as gold standard) Test Sensitivity Specificity Predictive value (%) (%) (%) Positive Negative Quantitative 65.5 83.6 65.5 83.6 cold agglutination Rapid 51.7 78.6 53.5 77.4 bedside cold agglutination

patients with pulmonary complaints in Chennai, South India. J Infect 2006;53:325‑30. 4. Ching YT, Yang YH, Chiang BL. The significance of rapid cold hemagglutination test for detecting M. pneumoniae infection in children with asthma exacerbation. J Microbiol Immunol Infect 2006;39:28‑32. 5. Kwan YS, Dong IW, Min HC. Flow Cytometric Measurement of Cold Agglutinins for Diagnosing Mycoplasma pneumoniae Pneumonia. Lab Med 2012;43:68‑73.

*AK Bahadur, SD Nadagir, BV Peerapur Department of Microbiology (AKB, BVP), Raichur Institute of Medical Sciences, Raichur, Department of Microbiology (SDN), Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.

HIV: Human immunodeficiency virus

References 1. Shankar EM, Kumarasamy N, Balakrishnan P, Soloman S, Devaleenol B, Rao A. Incidence of Mycoplasma pneumoniae in HIV infected patients with underlying upper and lower respiratory complaints and correlation with various immunological and hematological findings. Retrovirology 2005;2:S97. 2. Mandell GL, Bennet JE, Dolin R, Baum SG. Mycoplasma pneumoniae and atypical pneumonia. In: Principles and Practice of Infectious Disease. 16th ed. Amsterdam: Elsevier publication; 2008. p. 2271‑9. 3. Shanker EM, Kumarasamy N, Balakrishnan P, Soloman S, Lijith R, Vengatesan A, et al. Serosurveillance of acute Mycoplasma pneumoniae infection among HIV infected

*Corresponding author (email: ) Received: 30‑07‑2013 Accepted: 22-01-2014 Access this article online Quick Response Code:

Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.142234

Production of neuraminidase in relation with biofilm formation among clinical and healthy skin isolates of Acinetobacter species Dear Editor, Acinetobacter species has emerged as one of the most troublesome pathogen in healthcare facilities globally. They often colonise the skin and upper respiratory tract of hospitalised patients, which enables a wide spectrum of infections, including ventilator‑associated pneumonia, urinary tract infections, skin and soft tissue infections, etc.[1] Acinetobacter spp are the only Gram‑negative non‑fermenting bacteria which reside as a normal commensal in human.[2] Other than Acinetobacter baumannii, other species of this genera are gaining much importance as they are frequently encountered in different clinical conditions.[3] Certain bacteria are known to produce neuraminidase (sialidase) which discharges terminal sialic acids from glycoproteins, glycolipids and gangliosides found on the host cells.[4] The ability of neuraminidase produced by Pseudomonas aeruginosa was shown to act as an important marker for conferring virulent trait. Cacalano

et al., in 1992 stated that, neuraminidase plays an essential role in bacterial attachment followed by invasion into host cells.[5] After attachment the organism may form biofilm for subsequent colonisation. Data regarding neuraminidase production by Pseudomonas aeruginosa have already been well established. So far to the best of our knowledge there is only one report of neuraminidase‑producing Acinetobacter spp[6] and there is a paucity of information on virulence factors produced by Acinetobacter spp. Hence, we have investigated the neuraminidase production by Acinetobacter spp. We tested a total of 108 clinical isolates of A. baumannii from different clinical samples and 28 skin isolates (24 A. lwoffii and 4 A. junii) from healthy individuals. One hundred and eight A. baumannii clinical isolates includes, 38 endotracheal aspirates, 20 blood, 15 pus, 10 urine, 8 sputum, 5 bronchoalveolar lavage, 5 wound swabs, 3 oropharyngeal aspirates, 2 nasopharyngeal aspirates, one of each from diabetic foot ulcer and central vein tip. We have also included a known neuraminidase‑positive P.

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Role of cold agglutination test in the diagnosis Mycoplasma pneumoniae infection in HIV infected children.

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