Ravi Kumar Xcyton Innovative Diagnostic

1. For Critical Care Decisions Saving Lives – Preventing Disabilities THE XCYTON SYNDROME EVALUATION SYSTEM

11. Syndrome Signature Specific amplification The amplified product is introduced onto a Syndrome signature Evaluation Protocol Then it undergoes a process called Signature specific Hybridization, Then an enzymatic reaction occurs and a colored spot appears ..

17. Strategy for SES development

18. CNS INFECTIONS

19. PATHOGENS CAUSING AES Viruses Flaviviridae – JE, Dengue 1-4, West Nile Paramyxoviridae – Nipah, Measles, Mumps Enteroviridae – Polio, Coxsackie, Echo, Entero70-72 Rhabdoviridae – Rabies, Chandipura Togaviridae – Rubella Alphaviridae – Chikungunya Herpesviridae – HSV, CMV, VZV, HHV-6 Polyomaviridae - JC Bacteria M.tuberculosis S.pneumoniae H.Influenzae N.meningitidis Fungi C.neoformans Aspergillus Candida Mucor Rhizopus Parasites Toxoplasma gondii P.falciparum – not found in CSF

20. SENSITIVITY Virus Sensitivity (no. of viral particle /pfu/ml) JEV 100 Measles 0.1 Rubella 0.1 Mumps 0.5 Chikungunya 1 Rabies 1 Nipah 2.57fg Chandipura 1.47fgm Enteroviridae 1

21. LIMIT OF DETECTION OF PATHOGENS IN AES DNA CHIP Organism Sensitivity (organisms/ ml) Cross reactivity observed HSV 50 particles No M.tuberculosis 50 particle No H.influenzae 140 particles No N.meningitidis 115 particles No S.pneumoniae 400 particles No HHV-6 50 particle No T.gondii 50 particle No CMV 250 particles No VZV 4pfu No C.neoformans 50 particles No JC Not determined No

22. PRECISION STUDY Verification Criteria Reference Acceptance Criteria Precision Qualitative 20 data points; one pos for 20 days or duplicates for 10 days. Extraction to detection CLSI EP12-A MM6-A ≥ 95% precision Precision Quantitative 20 data points at 2-3 conc. Within run, between run, between day. Extraction to detection CLSI EP5-A & MM6-A ≥ 95% precision

27. ACURACY STUDY ON POSTMORTEM PROVEN CASES OF CNS DISEASES Sample Diagnosis Post mortem proven No Tested No Positive HSV Encephalitis 4 4 CMV Encephalitis 3 3 VZV Encephalitis 2 2 Toxoplasma Encephalitis 3 3 Tuberculous meningitis 3 3 Normal CSF’s obtained at spinal anesthesia 25 0

31. n = 60

32. AES EVALUATION – PANEL 1 Diagnosis at NIMHANS No Tested No. XCytoScreen +ve HSV 2 2 TB 3 2 +1 (CMV) Cryptococcus 4 2 + 1 (CMV) + 1(Toxo) Streptococcus pneumoniae 3 3 Neisseria meningitidis 2 2 Toxoplasma gondii 1 1 AES with no aetiological agent found 45 15 Spinal anaesthesia samples 50 0

33. CLINICAL SAMPLES - DISCORDANT Sample ID NIMHANS XDPL 31 Neg Tb+SP 35 Neg HSV 54 Neg HSV 62 Neg CMV 64 Neg HSV 68 Neg HSV,HHV-6 56 Neg SP 1005 Neg Sp 1006 Neg SP 1004 Neg SP 99 Neg VZV+TB+SP 100 Neg TB 96 Neg Tb+SP 311 Neg HSV 97 Neg CMV+ SP

34. EYE INFECTIONS

35. ACURACY STUDY OF EYE SAMPLES CONDUCTED AT SHANKAR NETRALAYA, CHENNAI Specimen Category No. Tested No. Positive HSV Culture Positive HSV FAT Positive 05 18 13 CMV FAT Positive 13 13 Adenovirus Culture Positive Adenovirus Culture negative in conjunctivitis 02 07 05 Varicella zoster virus 03 03 Aspergillus( KOH Positive) Aspergillus (KOH Negative) 04 16 12 Propionibacterium(PCR positive) 22 22 Bacterial Endopthalmitis ( culture/smear positive) 25 25 Mycobacterium tuberculosis (PCR Positive) 10 10 Toxoplasma ( PCR positive) 8 8 Mycobacterium chelonae (PCR Positive) 7 7 Mycobacterium fortuitum (PCR positive) 3 3 Aqueous Humour obtained at cataract surgeries (Non-infectious controls) 30 0

36. SEPTICAEMIA FEBRILE NEUTROPENIA TRANSPLANT INFECTIONS PNEUMONIA