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  ~ Table of Contents - Current issue
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October-December 2014
Volume 32 | Issue 4
Page Nos. 363-473

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GUEST EDITORIAL  

Ebola virus re-emergence: Is it really knocking at our door? Highly accessed article p. 363
L Dar, A Choudhary
DOI:10.4103/0255-0857.142229  PMID:25297017
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SPECIAL ARTICLE Top

The threat of Ebola: An update Highly accessed article p. 364
Baijayantimala Mishra
DOI:10.4103/0255-0857.142230  PMID:25297018
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REVIEW ARTICLE Top

Future of diagnostic microbiology Highly accessed article p. 371
N Khardori
DOI:10.4103/0255-0857.142233  PMID:25297019
Diagnostic Microbiology is the tool that makes it possible to identify the exact etiology of infectious diseases and the most optimal therapy at the level of individual patients as well as communities. Conventional methods require time to grow the microbes in vitro under specific conditions and not all microbes are easily cultivable. This is followed by biochemical methods for identification which also require hours and sometimes days. Transport of the specimens under less than ideal conditions, prior use of antibiotics and small number of organisms are among the factors that render culture-based methods less reliable. Newer methods depend on amplification of nucleic acids followed by use of probes for identification. This mitigates the need for higher microbial load, presence of metabolically active viable organisms and shortens the time to reporting. These methods can be used to detect antibiotic resistance genes directly from the specimen and help direct targeted therapy. Since these methods will not fulfill all the diagnostic needs, a second approach is being used to shorten the time to identification after the organism has already grown. Mass spectrometry and bioinformatics are the tools making this possible. This review gives a historical perspective on diagnostic microbiology, discusses the pitfalls of current methodology and provides an overview of newer and future methods.
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ORIGINAL ARTICLES Top

Refractory giardiasis: A molecular appraisal from a tertiary care centre in India p. 378
P Yadav, V Tak, BR Mirdha, GK Makharia
DOI:10.4103/0255-0857.142236  PMID:25297020
Purpose: The intestinal flagellate Giardia lamblia includes many genetically distinct assemblages, of which assemblage A and B, predominantly infect humans. Nitroimidazoles derivatives (metronidazole and tinidazole) and nitazoxanide are some of the therapeutic agents for treatment of giardiasis. Nevertheless, some individuals with giardiasis are non-responsive to standard therapy. The present study highlights cases of refractory giardiasis and attempts to elucidate if genetic heterogeneity in the parasite is associated with treatment failure. Materials and Methods: Three stool samples were obtained on three consecutive days from 4000 patients with diarrhoea and were microscopically examined for the detection of trophozoites, and/or cysts, using both normal saline and Lugol's iodine. A hemi-nested polymerase chain reaction (PCR) assay using triose phosphate isomerase (tpi) as the target gene was performed to determine the assemblages. Sequencing of the PCR products of the patients showing failure to treatment of giardiasis was also performed. Results: Two per cent (82/4000) of the total patients were microscopically positive for Giardia lamblia in the stool samples. All these patients were treated with metronidazole/tinidazole as per the standard regimens. However, eight patients showed treatment failure to giardiasis as stool examinations were repeatedly positive even after treatment with multiple courses of anti-giardial therapy. Genetic characterisation of all eight Giardia isolates showed that they belonged to Assemblage B and had homogeneous sequences. These patients were either treated with extended regimens or with combination therapy of anti-giardials. Conclusion: In our experience, combination of two or more drugs for a longer duration is the treatment modality to treat refractory giardiasis.
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Research on Toxocara Canis antibodies obtained from patients with eosinophilia p. 383
E Artinyan, H Kirkoyun Uysal, O Akgul, S Altiparmak, YA Oner
DOI:10.4103/0255-0857.142239  PMID:25297021
Background: Eosinophils may suggest the presence of a great variety of anomalies whereupon allergies, malignancies, certain tissue disorders, idiopathic hypereosynophilic syndrome and parasitic infections (with the exception of protozoons) can be cited as a few. Although the clinical manifestations may differ, the eosinophils level is quite an important data in cases related to the helminth infections. Similarly, in parasitic infections related to larva migrans (visceral, cutaneous, ocular), the eosinophils level is again a primary indicator and its evident cause is the roundworm Toxocara spp. Aim: The aim of this study was to evaluate the significance characteristics of Toxocara spp. in patients with eosonophilia. Materials and Methods: In our study, serums were collected from 93 patients of various age groups with eosonophilia (10% and above) while visiting Istanbul University Medical Faculty due to various complaints. Results: Serum samples were treated with Toxocara IgG ready ELISA kit and Toxocara western blot IgG ready kit. Based on the ELISA method; out of 93 patients, 30 patients (32.3%) were positive. Western blot technique; 45 (48.4%) were positive with anti-toxocara IgG antibodies. Conclusion: Results point out to western blot technique being more sensitive and superior on a scale of (P < 0.0001) when compared with the ELISA method.
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Possibility of scrub typhus in fever of unknown origin (FUO) cases: An experience from Rajasthan p. 387
R Bithu, V Kanodia, RK Maheshwari
DOI:10.4103/0255-0857.142241  PMID:25297022
Purpose: Fever of unknown origin (FUO) has multiple causes. Scrub typhus is less known cause of FUO in India. The present study reports a recent epidemic of scrub typhus amongst cases of FUO from different areas of Rajasthan, India. There was high mortality in undiagnosed cases of FUO which lead to the diagnosis of scrub typhus. Objective: To study the possibility of scrub typhus as a causative factor in FUO cases by qualitative detection of IgM antibodies with ELISA. Materials and Methods: From September 2012 to December 2012, 271 serum samples of FUO cases were analysed for IgM antibodies to Orientia tsutsugamushi along with dengue, malaria, typhoid, tuberculosis and brucellosis. Results: Scrub typhus IgM antibodies by ELISA were detected in 133 (49.1%) patients. Scrub typhus positivity was significantly higher among female in comparison to males (P < 0.05). Maximum positivity of scrub typhus was found in females of 46-60 years age group. The laboratory parameters were abnormal in most of the patients as evident by thrombocytopenia (63%), deranged liver functions (56%) and renal functions (25%). Conclusion: The present study emphasises the importance of scrub typhus among cases of FUO especially after rainy season and during early cooler months. The study also highlights the significance of ELISA method for rapid and early reporting and ruling out scrub typhus in FUO cases.
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Distribution of different yeasts isolates among trauma patients and comparison of accuracy in identification of yeasts by automated method versus conventional methods for better use in low resource countries p. 391
N Rajkumari, P Mathur, I Xess, MC Misra
DOI:10.4103/0255-0857.142243  PMID:25297023
Introduction: As most trauma patients require long-term hospital stay and long-term antibiotic therapy, the risk of fungal infections in such patients is steadily increasing. Early diagnosis and rapid treatment is life saving in such critically ill trauma patients. Aims: To see the distribution of various species of Candida among trauma patients and compare the accuracy, rapid identification and cost effectiveness between VITEK 2, CHROMagar and conventional methods. Settings and design: Retrospective laboratory-based surveillance study performed over a period of 52 months (January 2009 to April 2013) at a level I trauma centre in New Delhi, India. Materials and Methods: All microbiological samples positive for Candida were processed for microbial identification using standard methods. Identification of Candida was done using chromogenic medium and by automated VITEK 2 Compact system and later confirmed using the conventional method. Time to identification in both was noted and accuracy compared with conventional method. Statistical analysis: Performed using the SPSS software for Windows (SPSS Inc. Chicago, IL, version 15.0). P values calculated using χ2 test for categorical variables. A P < 0.05 was considered significant. Results: Out of 445 yeasts isolates, Candida tropicalis (217, 49%) was the species that was maximally isolated. VITEK 2 was able to correctly identify 354 (79.5%) isolates but could not identify 48 (10.7%) isolates and wrongly identified or showed low discrimination in 43 (9.6%) isolates but CHROM agar correctly identified 381 (85.6%) isolates with 64 (14.4%) misidentification. Highest rate of misidentification was seen in C. tropicalis and C. glabrata (13, 27.1% each) by VITEK 2 and among C. albicans (9, 14%) by CHROMagar. Conclusions: Though CHROMagar gives identification at a lower cost compared with VITEK 2 and are more accurate, which is useful in low resource countries, its main drawback is the long duration taken for complete identification.
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Rapid screening of rpoB and katG mutations in Mycobacterium tuberculosis isolates by high-resolution melting curve analysis p. 398
M Haeili, AI Fooladi, SZ Bostanabad, DD Sarokhalil, F Siavoshi, MM Feizabadi
DOI:10.4103/0255-0857.142245  PMID:25297024
Background: Early detection of multidrug-resistant tuberculosis (MDR-TB) is essential to prevent its transmission in the community and initiate effective anti-TB treatment regimen. Materials and Methods: High-resolution melting curve (HRM) analysis was evaluated for rapid detection of resistance conferring mutations in rpoB and katG genes. We screened 95 Mycobacterium tuberculosis clinical isolates including 20 rifampin resistant (RIF-R), 21 isoniazid resistant (INH-R) and 54 fully susceptible (S) isolates determined by proportion method of drug susceptibility testing. Nineteen M. tuberculosis isolates with known drug susceptibility genotypes were used as references for the assay validation. The nucleotide sequences of the target regions rpoB and katG genes were determined to investigate the frequency and type of mutations and to confirm HRM results. Results: HRM analysis of a 129-bp fragment of rpoB allowed correct identification of 19 of the 20 phenotypically RIF-R and all RIF-S isolates. All INH-S isolates generated wild-type HRM curves and 18 out of 21 INH-R isolates harboured any mutation in 109-bp fragment of katG exhibited mutant type HRM curves. However, 1 RIF-R and 3 INH-R isolates were falsely identified as susceptible which were confirmed for having no mutation in their target regions by sequencing. The main mutations involved in RIF and INH resistance were found at codons rpoB531 (60% of RIF-R isolates) and katG315 (85.7% of INH-R isolates), respectively. Conclusion: HRM was found to be a reliable, rapid and low cost method to characterise drug susceptibility of clinical TB isolates in resource-limited settings.
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Is universal sample processing methodology better than conventional techniques for detection of tuberculosis? p. 404
V Mittal, F Haider, S Singhal, S Jamal
DOI:10.4103/0255-0857.142249  PMID:25297025
Background: The identification of infectious cases is a crucial first step for tuberculosis control programmes worldwide. It relies exclusively on the detection of acid-fast bacilli in sputum by smear microscopy. Therefore, there is an urgent and definite need to improve the sensitivity of smear microscopy. Objective: The USP method was compared with the two most commonly used conventional methods of smear microscopy namely; direct smear microscopy and the microscopy by modified Petroff's method. Materials and Methods: Two samples from each patient were taken from 197 patients of presumptive tuberculosis. One smear was made for direct Ziehl-Neelsen staining and two smears were made after processing by two concentration methods i.e., modified Petroff's and USP solution. LJ media were inoculated for culture after processing by both concentration methods. Results: Among 197 cases 93 were culture positive by either method. Out of 93 culture-positive sample, 78.5% were direct smear positive, 89% were 4%NaOH smear positive and 96% were USP smear-positive samples but difference in diagnostic accuracy of USP (96%) and modified Petroff method (93%) is not statistically significant (P > 0.01). Conclusion: The present study evaluated the smear microscopy by USP method with two conventional methods, direct microscopy and microscopy by modified Petroff's method. The study concludes that although USP method is more sensitive than conventional methods, it is not feasible to include it in diagnosis of early tuberculosis within RNTCP.
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Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat p. 408
HB Pandya, Harihar Har Agravat, JS Patel, NRK Sodagar
DOI:10.4103/0255-0857.142256  PMID:25297026
Background: Antimicrobial resistance is a growing problem in H. pylori treatment. The study was intended to evaluate the prevalence of resistance amongst 80 H.pylori isolates cultured from biopsy taken during routine endoscopies in 2008-2011. Materials and Methods: 855 gastro duodenal biopsies were collected and cultured on H.pylori selective medium (containing Brucella agar and Columbia agar (Hi media), with Skirrow's supplement (antibiotic supplement) and 7% human blood cells). H.pylori was isolated from 80 specimens. The antimicrobial susceptibility of H.pylori isolates was carried out by the Kirby Bauer technique against metronidazole (5 µg), clarithromycin (15 µg), ciprofloxacin (5 µg), amoxicillin (10 µg), tetracycline (30 µg), erythromycin (15 µg), levofloxacin (5 µg), and furazolidone (50 µg) (Sigma- Aldrich, MO). Results: 83.8% isolates were resistant to metronidazole, 58.8% were resistant to Clarithromycin 72.5% were resistant to Amoxicillin, 50% to Ciprofloxacin and 53.8% to tetracycline. furazolidone, erythromycin and Levofloxacin showed only 13.8% resistance to H.pylori. Multi drug resistance with metronidazole+ clarithromycin+ tetracycline was 85%. For all the drugs Antimicrobial resistance rate was found higher in males compare to females. Metronidazole and amoxicillin resistance was found noteworthy in patients with duodenal ulcer (p = 0.018), gastritis (P = 0.00), and in reflux esophagitis (P = 0.00). clarithromycin and tetracycline resistance was suggestively linked with duodenitis (P = 0.018), while furazolidone, erythromycin and levofloxacin showed excellent sensitivity in patients with duodenitis (P value- 0.018), gastritis (P= 0.00) and reflux esophagitis (P = 0.00). Resistance with metronidazole (P = 0.481), clarithromycin (P= 0.261), amoxicillin (P = 0.276), tetracycline (P = 0.356), ciprofloxacin (P = 0.164) was not correlated well with Age-group and Gender of the patients. Conclusion: A very high percentage of patients were infected with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen.
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A possible alternative to the error prone modified Hodge test to correctly identify the carbapenemase producing Gram-negative bacteria p. 414
SS Jeremiah, V Balaji, S Anandan, RD Sahni
DOI:10.4103/0255-0857.142258  PMID:25297027
Context: The modified Hodge test (MHT) is widely used as a screening test for the detection of carbapenemases in Gram-negative bacteria. This test has several pitfalls in terms of validity and interpretation. Also the test has a very low sensitivity in detecting the New Delhi metallo-β-lactamase (NDM). Considering the degree of dissemination of the NDM and the growing pandemic of carbapenem resistance, a more accurate alternative test is needed at the earliest. Aims: The study intends to compare the performance of the MHT with the commercially available Neo-Sensitabs - Carbapenemases/Metallo-β-Lactamase (MBL) Confirmative Identification pack to find out whether the latter could be an efficient alternative to the former. Settings and Design: A total of 105 isolates of Klebsiella pneumoniae resistant to imipenem and meropenem, collected prospectively over a period of 2 years were included in the study. Subjects and Methods: The study isolates were tested with the MHT, the Neo-Sensitabs - Carbapenemases/MBL Confirmative Identification pack and polymerase chain reaction (PCR) for detecting the blaNDM-1 gene. Results: Among the 105 isolates, the MHT identified 100 isolates as carbapenemase producers. In the five isolates negative for the MHT, four were found to produce MBLs by the Neo-Sensitabs. The Neo-Sensitabs did not have any false negatives when compared against the PCR. Conclusions: The MHT can give false negative results, which lead to failure in detecting the carbapenemase producers. Also considering the other pitfalls of the MHT, the Neo-Sensitabs - Carbapenemases/MBL Confirmative Identification pack could be a more efficient alternative for detection of carbapenemase production in Gram-negative bacteria.
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Use of MALDI-TOF MS technique for rapid identification of bacteria from positive blood cultures p. 419
Sung Kuk Hong, Beung Ki Chang, Sang Hoon Song, Eui-Chong Kim
DOI:10.4103/0255-0857.142261  PMID:25297028
We evaluated the feasibility of same-day routine aerobic bacterial identification using the following procedures: Picking colonies from 4 and 6 h incubated subculture from positive blood culture bottle and analyzing them by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). The matched identification rate of this procedure at the species level was 80.6% (141/175) for the 4-h cultures compared with overnight cultures and 90.9% (159/175) for the 6-h cultures. Thus, our technique provides an easy and rapid method for identification of aerobic bacteria in routine clinical microbiology laboratories.
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COMMENTARY Top

MALDI-TOF MS for rapid identification of clinically relevant bacterial and fungal isolates p. 423
CR Setty
PMID:25297029
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BRIEF COMMUNICATIONS Top

Prevalence and antibiotic susceptibility of thermophilic Campylobacters from sources implicated in horizontal transmission of flock colonisation p. 425
S Parkar, D Sachdev, B Kapadnis
DOI:10.4103/0255-0857.142259  PMID:25297030
Thermophilic Campylobacter are commonly associated with poultry as commensals of the avian gut and are the causative agent responsible for human Campylobacteriosis. This study aimed to establish the prevalence of Campylobacter spp. from environmental sources that have previously been implicated as sources of horizontal transmission. The highest prevalence of thermophilic Campylobacter was found in water samples (87.5%) and lowest from flies (7.2%). Only C. jejuni was isolated from all sources. A secondary aim was to provide a baseline of resistance profiles of Campylobacter spp. isolates obtained. Alarmingly all the C. jejuni isolates from environmental sources as well as humans were multi-drug resistant.
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Declining trend of resistance to first-line anti-tubercular drugs in clinical isolates of Mycobacterium tuberculosis in a tertiary care north Indian hospital after implementation of revised national Tuberculosis control programme p. 430
A Jain, P Diwakar, U Singh
DOI:10.4103/0255-0857.142257  PMID:25297031
Trends showing drug-resistance pattern are needed to understand direction of tuberculosis (TB) control programme. The drug-resistance pattern in state of Uttar Pradesh, India, is not documented. Here we are reporting the prevalence of multi-drug-resistant (MDR) and drug-resistant TB in previously treated cases of pulmonary tuberculosis following launch of revised national TB control programme (RNTCP) in whole of Uttar Pradesh. Isolates of Mycobacterium tuberculosis, from patients of pulmonary tuberculosis, who were treated with antitubercular drugs for more than 4 weeks, were tested for resistance to first-line drugs; streptomycin (S), Ethambutol (E), Rifampicin (R) and isoniazid (H) over a period of 4 years, 2009-2012. Total 2496 isolates of M. tuberculosis were tested, of which 1139 isolates (45.6%) were pan-sensitive and 370 (14.8%) were pan-resistant. Total 695 isolates (27.8%) were MDR. Maximum resistance was with Isoniazid (n = 1069, 42.8%) followed by streptomycin (n = 840, 33.7%), rifampicin (n = 742, 29.7%), and ethambutol (n = 613, 24.6%). A decline in number of MDR strains and individual drug resistance was seen. Total MDR strains in the year 2009, 2010, 2011 and 2012 were 35.6%, 30.8%, 26.7% and 22.8% respectively. The drug resistance pattern reported from time to time may vary substantially. The decline in drug resistance visible over last four years, after implementation of DOTS, appears promising.
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Clonal Diversity and Drug Resistance in Mycobacterium tuberculosis Isolated from Extra-pulmonary Samples in Central India - a Pilot Study p. 434
P Desikan, DS Chauhan, P Sharma, N Panwalkar, P Yadav, BS Ohri
DOI:10.4103/0255-0857.142255  PMID:25297032
In India, extrapulmonary tuberculosis (EPTB) accounts for 10 - 15% of all types of tuberculosis. To identify and compare predominant spoligotypes and drug-resistance patterns in strains of Mycobacterium tuberculosis isolated from extrapulmonary and pulmonary specimens in central India, drug susceptibility testing and spoligotyping were carried out. Spoligotyping data was analyzed using SITVIT2 database. ST11/EAI3_Ind with 33% isolates among extrapulmonary specimens and ST26/CAS1_DEL with 28% isolates among pulmonary specimens were the most predominant lineages. Multidrug resistance was found in 5.5% of the strains isolated from extrapulmonary specimens in contrast to 17% isolated from pulmonary specimens.
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Disseminated Bacillus Calmette-Guerin infections after intravesical therapy p. 438
I Gerogianni, S Gravas, K Gourgoulianis, I Neonakis, E Petinaki
DOI:10.4103/0255-0857.142254  PMID:25297033
Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the treatment of choice for superficial bladder carcinoma. Disseminated BCG infection presenting as granulomatous hepatitis or pneumonitis is a very rare complication of this treatment. Here we report a case series of seven patients previously treated with BCG presenting with pneumonitis. In two of the cases, identification of Mycobacterium bovis was achieved with molecular methods.
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CASE REPORTS Top

Cerebral phaeohyphomycosis - could early diagnosis have saved the patient? p. 440
SP Khetan, VA Agrawal, MS Qazi
DOI:10.4103/0255-0857.142248  PMID:25297034
Cladophialophora bantiana brain abscess is a rare and frequently fatal infection, often seen in immunocompetent individuals. 34 year old immunocompetent woman who presented with convulsions is reported. She was initially treated with antituberculous drug. During 15 days of treatment, she deteriorated. Hence she underwent craniotomy, which revealed brain abscesses due to C. bantiana. Subsequently she was treated with fluconazole , but eventually succumbed to the infection on the 7th day of treatment. Mortality remains high with this rare mycosis, even in immunocompetent patients. The case illustrates the clinical and radiological similarities between tuberculoma and other etiologies of brain abscesses. This emphasizes the need to perform histological and microbiological studies prior to the initiation of any form of therapy.
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Diphtheria-like illness in a fully immunised child caused by Corynebacterium pseudodiphtheriticum p. 443
VA Indumathi, R Shikha, DR Suryaprakash
DOI:10.4103/0255-0857.142250  PMID:25297035
Corynebacterium pseudodiphtheriticum is a common commensal flora of the upper respiratory tract in humans. Though the pathogenicity of C. pseudodiphtheriticum is not rare, its role as an opportunistic pathogen is mainly limited to the lower respiratory tract, particularly in patients with underlying systemic conditions or immune-compromisation. We hereby present the first case of C. pseudodiphtheriticum causing diphtheria-like illness affecting the upper respiratory tract of a 6-year-old fully immunised otherwise healthy child. In countries with very low incidence of diphtheria, C. pseudodiphtheriticum should be included in differential diagnosis for a child presenting with diphtheria-like illness. Simple, rapid screening tests should be used to differentiate it from C. diphtheriae and hence, to prevent unnecessary concern in community.
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Subdural empyma due to Mycobacterium fortuitum in a non-HIV patient p. 446
SS Tankhiwale, VJ Katkar
DOI:10.4103/0255-0857.142251  PMID:25297036
A 14-year-old male child presented with high grade intermittent fever with altered sensorium since 5-6 days and generalised seizures. On examination neck stiffness noticed with normal haemogram and chest X-ray. CSF microscopy was normal and no growth seen in aerobic culture. CT scan showed loculated lesion. Drained pus showed acid fast organism and culture on Lowestein Jensen medium showed pale-coloured growth on 3 rd day. Organism identified as Mycobacterium fortuitum by biochemical test. Interesting aspect of this case was there is no history of trauma or injection and patient was negative for HIV antibody.
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A rare case of subcutaneous mucormycosis due to Syncephalastrum racemosum: Case report and review of literature p. 448
S Mangaraj, G Sethy, MK Patro, S Padhi
DOI:10.4103/0255-0857.142252  PMID:25297037
Zygomycosis represent a group of uncommon but potentially fatal fungal infections. The incidence of zygomycosis has increased manifold in recent years. Despite aggressive treatment, it can lead to a highly invasive disease state with fatal outcomes, especially among immuno-compromised. Syncephalastrum racemosum is a fungus belonging to Zygomycetes. Very few cases of human disease caused by this particular fungus have been documented. However, it has been clearly implicated in causing highly invasive disease in recent reported cases. Knowledge about the pathogenicity and clinical presentation of this rare fungal infection will alert the clinicians for instituting an early appropriate therapy leading to better outcomes.
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Sphingomonas paucimobilis bacteraemia and shock in a patient with rheumatic carditis p. 451
Y Yozgat, A Kilic, C Karadeniz, R Ozdemir, O Doksoz, G Gulfidan, T Mese
DOI:10.4103/0255-0857.142253  PMID:25297038
Acute rheumatic fever (ARF) carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+) T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis.
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CORRESPONDENCES Top

High prevalence of New Delhi metallo-β-lactamase in Acinetobacter calcoaceticus-A. baumannii complex at two tertiary care centres in north India p. 455
V Gautam, A Mewara, A Raj, V Gupta, N Singla, P Ray
DOI:10.4103/0255-0857.142231  PMID:25297039
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Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy p. 456
NH Ahmed, I Biswal, P Roy, RK Grover
DOI:10.4103/0255-0857.142232  PMID:25297040
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Role of cold agglutination test in the diagnosis Mycoplasma pneumoniae infection in HIV infected children p. 458
AK Bahadur, SD Nadagir, BV Peerapur
DOI:10.4103/0255-0857.142234  PMID:25297041
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Production of neuraminidase in relation with biofilm formation among clinical and healthy skin isolates of Acinetobacter species p. 459
Gopinath Prakasam, Anusha Rohit, E Padmasini, S Srivani Ramesh
DOI:10.4103/0255-0857.142235  PMID:25297042
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Small colony variants of Staphylococcus aureus: Enemies with hidden weapons p. 460
S Bhattacharyya, D Kumar
DOI:10.4103/0255-0857.142237  PMID:25297043
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Vancomycin resistance due to VanA in an Aerococcus viridans isolate p. 462
WQ Zhou, DM Niu, ZZ Zhang, MZ Ning, H Shen, K Zhang
DOI:10.4103/0255-0857.142238  PMID:25297044
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Azithromycin zone interpretation for Salmonella: Time to Adopt BSAC's zone diameters? p. 465
S Rai
DOI:10.4103/0255-0857.142240  PMID:25297045
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Impact of diet alteration on oral microflora by addition of probiotics p. 466
M Astekar, GK Sidhu, NS Kathuria
DOI:10.4103/0255-0857.142242  PMID:25297046
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Biofilm formation by Candida species on intrauretheral catheter and its antifungal susceptibility profile p. 467
S Chaudhary, C Gupta, S Das, R Saha, M Rani, VG Ramachandran
DOI:10.4103/0255-0857.142244  PMID:25297047
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Prevalence of multiple antibiotic resistant Escherichia coli serotypes in raw sewage of North-Western Punjab, India p. 468
H Kumar, N Kaur, R Palaha
DOI:10.4103/0255-0857.142246  PMID:25297048
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SNIPPETS Top

Research snippets p. 471
P Desikan
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2004 - Indian Journal of Medical Microbiology
Published by Medknow

Online since April 2001, new site since 1st August '04