Sushma Krishna - Academia.edu (original) (raw)

Papers by Sushma Krishna

SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS

Introduction: Skeletal tuberculosis accounts for 10-35% of Extra-Pulmonary Tuberculosis (EPTB) an... more Introduction: Skeletal tuberculosis accounts for 10-35% of Extra-Pulmonary Tuberculosis (EPTB) and 3% of all cases of tuberculosis. Spine is involved in about 50% cases of skeletal tuberculosis. The diagnosis of Spine TB in the developing world until recently has been carried out by clinical presentation and neuro imaging modalities like X-ray/CT/MRI. Until the molecular era, the diagnostic tests at laboratories had mostly remained less contributory with low reliability and accuracy. The objective of the study was to review the spinal cases of TB and present an overview of the different methods of microbiological diagnosis in patients with Spine TB at our center. Methodology: Retrospective study (April 2016 – April 2019) of all consecutive patients suspected with pyogenic or Spine TB was undertaken with relevant clinical details. With the radiological screen the probable TB patients were sampled (tissue, pus, abscess fluids and exudates) and were processed for ZN stain, Culture (con...

The Indian Journal of Chest Diseases and Allied Sciences

A B S T R A C T Lymphatic filariasis in India contributes to nearly 40% of the global endemic bur... more A B S T R A C T Lymphatic filariasis in India contributes to nearly 40% of the global endemic burden. There is paucity of data regarding the association of chronic lymphatic filariasis with diabetes, coronary heart disease and other comorbidities. Case records over a period of ten years from 2001-2010 were reviewed and 113 diagnosed chronic filariasis cases from 13 districts of the state were identified.Prevalence of each of the morbidity with age and sex association was calculated. A total of 82(72.6%) of them were in the age group of 60-85 years. Hypertension was noted in 48, type II diabetes in 46 and coronary artery disease in 43. Filariasis had a significant association with type II diabetes mellitus and coronary artery disease (p value< 0.05). Secondary infection. of leg ranging from cellulitis to gangrene was seen in 33(29.2%). Lymphatic Filariasis may be linked as an inclining factor for the development of type II diabetes mellitus and coronary heart disease over 60 years...

Indian Journal of Medical Ethics, 2020

J Krishnamurti, a renowned philosopher, describes fear as the transition from the convictions of ... more J Krishnamurti, a renowned philosopher, describes fear as the transition from the convictions of the Known to the flux of the unknown 1. The weakening of the interspecies transmission barrier between the animal and human interface has strengthened this fear. Consequently, our impulsive selves have taken precedence over our reflective voices.

International Journal of Case Reports, 2019

Case Report IJCR (2019) 4:84 From Colonoscope to Microscope: the Diagnosis of Trichuris Trichiura... more Case Report IJCR (2019) 4:84 From Colonoscope to Microscope: the Diagnosis of Trichuris Trichiura Soil Transmitted Helmenthiasis (STH) is a major public health problem in the developing countries. Trichuriasis is one of the common prevalent parasitic infestations in the tropical and subtropical countries across the globe incuding India. However, there has been a steady decline of STH in the last five years where there has been success of albendazole with Mass Drug Administration (MDA) in National Filariasis Control Program and Kerala state has been one of them. We report a case of whipworm infection that was incidentally diagnosed by colonoscopy where repeated stool microscopy was uncontributory. The worm can be overlooked, particularly if colon preparation is not good.

The Internet Journal of Pulmonary Medicine, 2009

Melioidosis is a known emerging infectious disease in India. Pulmonary melioidosis presents as ac... more Melioidosis is a known emerging infectious disease in India. Pulmonary melioidosis presents as acute fulminant septecemia, subacute illness, chronic infection, or subclinical disease. Aspiration of water containing bacteria is an unique mode of transmission, which can give rise to pulmonary melioidosis with or without septicaemia. The two unique presentations of pulmonary melioidosis in non-diabetic patients were documented following fresh water drowning and aspiration of water. They had different clinical and radiological presentation, course of illness, and outcome, although the source of infection was similar. One of the patient succumbed to septecemic shock while the other survived with the adequate treatment. Melioidosis was never the differential diagnosis in both the cases. It shows the urgency of the disease to be highlighted in this part of the world, especially among the clinicians and microbiologists, so every similar episode of drowning might be complimented by the work up of melioidosis and managed as critical.

Corynebacterium urealyticum though rare, is known to cause alkaline-encrusted urinary tract infec... more Corynebacterium urealyticum though rare, is known to cause alkaline-encrusted urinary tract infections and struvite calculi. Identification of the bacilli and administration of the right antibiotic therapy is important in preventing persisting infections and complications. This report describes one of the rare cases which was encountered on routine urine culture of a long term catheterized patient following a road traffic accident. This case highlights the importance of the proper identification of gram positive bacilli and suggests that they may not be disregarded as urinary contaminants.

SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, 2013

Melioidosis is known endemic in many Southeast Asian countries, especially Thailand, and in North... more Melioidosis is known endemic in many Southeast Asian countries, especially Thailand, and in Northern Australia. The disease was long considered under-recognized in India but has now gained the status of emerging infectious disease here. Increasing isolation of the causitive agent B. pseudomallei is encountered in the recent years from this part of western coastal India. We report one such case of pulmonary melioidosis in an elderly patient misdiagnosed as tuberculosis ending fatally. Prompt microbiological diagnosis prevents the unnecessary Anti-TB treatment or prophylaxis. This was also our first of isolation of B. pseudomallei from endotracheal aspirate. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2012; IX(2) 15-18 DOI: http://dx.doi.org/10.3126/saarctb.v9i2.7973

International Journal of Case Reports and Images, 2014

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, mont... more International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

Tropical doctor, 2010

We present the first two fulminant cases of pulmonary melioidosis in febrile neutropenic patients... more We present the first two fulminant cases of pulmonary melioidosis in febrile neutropenic patients with acute and varied presentations seen in our institution and their fatal outcome. A high index of suspicion coupled with microbiological confirmation can facilitate the administration of the appropriate therapy in cases of melioidosis that differ from other bacterial infections in terms of presentation and the response to antimicrobials.

Brazilian Journal of Infectious Diseases, 2008

Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in... more Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multidrug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broadspectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.

Microbiology Discovery, 2013

Infections by Cryptococcus neoformans usually involves the central nervous system and the respira... more Infections by Cryptococcus neoformans usually involves the central nervous system and the respiratory tract. We report a case of disseminated cryptococcosis with cryptococcal empyema and liver abscess. The initial diagnosis was only ascites with hepatitis and or cholangitis of unknown cause. Routine chest X-ray film showed pleural effusion, and his retropositive status was detected for the first time. Dissemination was considered when the computerized abdomen scans carried out revealed multiple cystic lesion of the liver with an abscess with diffuse peritoneal thickening. Culture of pleural fluid and liver abscess aspirate grew C. neoformans. Patient improved symptomatically with antifungal therapy. This case illustrates that disseminated cryptococcosis has to be included in the differential diagnosis in a systemic infection with thoraco-abdominal involvement, more so in an immunocompromised patient. Early diagnosis with relevant investigations like computerized tomography scans plays a key role in the administration of anti-fungal therapy which can be life saving.

Annals of Tropical Medicine and Public Health, 2011

Introduction: Typhoid fever still continues to be a major public health problem, particularly in ... more Introduction: Typhoid fever still continues to be a major public health problem, particularly in developing countries. A simple, reliable, affordable, and rapid diagnostic test has been a long-felt need of the clinicians. We, therefore, prospectively evaluated the sensitivity and specificity of Typhidot (IgM), a serological test to identify IgM antibodies against Salmonella typhi. Materials and Methods: The study was carried out in the Department of Microbiology, Apollo Hospital, Bangalore between January 2009 and March 2009 on a total of 186 samples from clinically suspected febrile patients. Blood culture as well as Typhidot test was performed for each of the cases. Results: Out of 61 clinically diagnosed typhoid fever, 50 were blood culture positive for S. typhi all 50 were Typhidot (IgM) positive and 11 were missed out on both. The sensitivity, specificity, positive and negative predictive values of the test using blood culture as gold standard were 100%, 95.5%, 89.2%, and 100%, respectively for typhoid fever. Conclusion: Typhidot (IgM) test is rapid, easy to perform, and reliable for diagnosing typhoid fever, and useful for small, less equipped laboratories as well as for the laboratories with better facilities in typhoid endemic countries.

International Journal of Diabetes in Developing Countries, 2014

Tropical Doctor, 2011

Salmonellosis is a common infection in systemic lupus erythematosus patients. The present study r... more Salmonellosis is a common infection in systemic lupus erythematosus patients. The present study reports on two such cases of Salmonella typhimurium septic arthritis among the 102 patients seen during a four-year period.

Transactions of the Royal Society of Tropical Medicine and Hygiene, 2008

Melioidosis has recently gained the status of an emerging disease in India. Multidrugresistant (M... more Melioidosis has recently gained the status of an emerging disease in India. Multidrugresistant (MDR) Gram-negative bacteria, however, are already responsible for treatment failure and mortality. In addition, pandrug-resistant (PDR) Gram-negative bacteria have emerged as a new threat to modern medicine. The treatment, clinical follow up, and outcome of 25 patients with melioidosis and 46 patients with MDR non-fermenters (Pseudomonas aeruginosa and Acinetobacter spp.) infection were documented during the period 2005 2007. Pandrug resistance status of the MDR strains was evaluated with the minimum inhibitory concentration breakpoint of colistin. Skin and soft-tissue involvement (16%), liver abscess (16%) and bone and joint involvement (16%) were the most common presentations of melioidosis in diabetic patients. The presence of septicaemia (44%) and major organ failure (48%) resulted in death. Relapse was seen in patients with inappropriate treatment. Clinical cure was observed in five cases infected with PDR strains; colistin was used in only one case. Comorbid conditions may have contributed to the high fatality (82.7%). More awareness among clinicians and laboratory staff, and environmental investigations of soil are required for accurate diagnosis and prompt treatment of melioidosis. For MDR strains, colistin is the 'last resort' and should be used with caution; resistance should be monitored both globally and locally.

Journal of Medical Case Reports, 2012

Introduction: Melioidosis, endemic in Thailand and in the Northern Territory of Australia is an e... more Introduction: Melioidosis, endemic in Thailand and in the Northern Territory of Australia is an emerging infectious disease in India which can present with varied forms. A case of melioidosis, presenting as a rare anterior mediastinal mass which can masquerade as malignancy or tuberculosis, is described here. With treatment, our patient initially showed an increase in the size of mediastinal node and development of new submandibular node.. To the best of our knowledge, this phenomenon has not been documented in the literature and the same is highlighted in this case report. Case Presentation: A 43-year-old Asian man with diabetes presented with fever, loss of appetite, weight loss for one month and painful swelling below his left mandible for five days. An examination revealed an enlarged left submandibular lymph node and bilateral axillary lymph nodes. A chest X-ray showed mediastinal widening. Computed tomography of his thorax showed a lobulated heterogeneously enhancing anterior mediastinal mass encasing the superior vena cava suggestive of malignancy. An excision biopsy of the lymph node showed granulomas suggestive of tuberculosis but bone marrow culture and lymph node aspirate culture grew Burkholderia pseudomallei. He was treated with parenteral ceftazidime and amoxicillin-clavulanic acid. During the course of treatment, he developed an enlargement of the submandibular lymph node on the opposite side. It gradually subsided with the continuation of therapy orally with a combination of cotrimoxazole and doxycycline for six months. A repeat computed tomography chest scan showed resolution of the mediastinal mass. Conclusion: Melioidosis can present as a mediastinal mass that mimics tuberculosis or malignancy. During the initial phase of treatment of melioidosis, the appearance of new lymph nodes or an increase in the size of the existing lymph nodes does not mean treatment failure. Inexperienced clinicians may consider this as treatment failure and may switch treatment. To the best of our knowledge, this is the first report documenting this phenomenon in melioidosis cases.

Journal of Hospital Infection, 2010

International Journal of Infectious Diseases, 2010

Conclusion: The overall prevalence of transmitted resistance-associated mutations was found to be... more Conclusion: The overall prevalence of transmitted resistance-associated mutations was found to be 1.4%, lower than the alert cut off of 5% defined by WHO. HIV-1 subtype C exhibited enormous polymorphism in RT and protease regions of pol gene as compared to subtype B.