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Mucormycosis, an angioinvasive infection is caused by the ubiquitous filamentous fungi of the order Mucorales and class Mucormycetes. Reports of this disease are on the rise over the past few decades. Rhino-oculo-Cerebral presentation associated with uncontrolled diabetes is the predominant characteristic of this entity. We report here a case of rhinooculocerebral mucormycosis (ROCM) due to Apophysomyces elegans (A. elegans) in a 45-year-old diabetic lady with background illness of hypothyroidism and polyradiculoneuropathy. Though this condition is usually managed with surgical debridement of the affected tissue and medical therapy with Amphotericin B, the isolate recovered in our case was found to be resistant to Amphotericin B.

This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics.

With rising reports of antifungal drug resistance among the isolates of Candida species, an increasing prevalence of this organism could have an impact on the treatment of Candidal oesophagitis and it should be approached with caution by the clinician.

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Tests based on the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine have emerged as potential point-of-care tests for tuberculosis (TB). We aimed to assimilate the current evidence regarding the diagnostic performance of LAM assays and to ascertain their clinical indication in settings with high and low prevalence of HIV-TB co-infection. Owing to suboptimal sensitivity, the urinary LAM assays are unsuitable as general screening tests for TB. However, unlike traditional diagnostic methods, they demonstrate improved sensitivity in HIV-TB co-infection which further increases with low CD4 counts. Accordingly, these assays are indicated as rule-in tests for TB in patients with advanced HIV-induced immunosuppression, and facilitate the early initiation of antituberculous treatment in them. They also offer incremental sensitivity and specificity when used as adjunct tests to smear microscopy and chest radiography in HIV-TB co-infection. They obviate the biohazards associated with sputum samples and provide an alternative diagnostic tool in sputum-scarce patients. Notwithstanding these advantages, the specificity of these assays is variable, which is mostly attributable to misclassification bias and cross-reactivity with non-tuberculous mycobacteria or other commensal flora. Furthermore, the inability to detect low titres of antigen in HIV-uninfected patients makes these assays unsuitable for use in settings with a low HIV prevalence. Future research targeted towards inclusion of specific monoclonal antibodies and more sensitive immunoassay platforms might help to improve the diagnostic performance of these assays and extend their applicability to the general population of patients with TB.

Background: Antimicrobials are a major class of drugs prescribed in Intensive Care Unit (ICU). Widespread use of empirical antibiotic therapy has facilitated the emergence of drug resistance, since empirical therapy is very often initiated at the outset, even before culture and sensitivity reports are available. The problem of drug resistance is on a rise, therefore, this study was planned to assess the drug resistance and sensitivity patterns of the blood isolates recovered from ICU.Methods: An observational- prospective study was conducted in the Tertiary care teaching hospital over a period of twelve months to assess antibiotic resistance and sensitivity pattern. A total of 104 consecutive patients receiving antibiotics in the ICU and having blood cultures with significant growth were included in the study. Blood sample was collected and after obtaining a culture growth, the identification and antimicrobial sensitivity testing was done.Results: Blood stream infection by Gram-negative bacteria (50.96%) was more common than Gram-positive bacteria (49.04%). Coagulase negative Staphylococci (CoNS) was the predominant single blood culture isolate (35.58%). Klebsiella pneumoniae (13.46%), Escherichia coli (12.50%), Acinetobacter baumannii complex (7.69%) were commonly isolated gram negative organisms. Gram positive isolates were resistant to beta lactams in maximum patients whereas Tigecycline, Linezolid, Daptomycin, Vancomycin, Nitrofurantoin and Teicoplanin were sensitive against them. Common gram negative isolates were sensitive to Colistin and Tigecycline but resistant to most of the antibiotics.Conclusions: A preponderance of gram negative bacteria over gram positive bacteria was noted with a higher degree of resistance to most of the first line antimicrobial agents.

A 54-year-old male patient attended the Ophthalmology OPD of Himalayan Institute of Medical Sciences Dehradun in January 2012. An electrician by profession he complained of pain, mild watering, photophobia and gradual loss of vision in right eye. He was on topical Norfloxacin eye drops but without much relief since 1 month. Uncorrected visual acuity of the right eye was 6/60. On examination, mild oedema was observed in the upper and lower lids of the right eye. Slit lamp examination revealed a 4x5 mm sized, para-central corneal ulcer 5 mm from the limbus on the inferior nasal aspect [Table/ Fig-1]. The ulcer was dry-looking with irregular margins and stromal infiltrates but there was no evidence of feathery margins. Satellite lesions were not seen and there was no evidence of immune ring. Infiltration involved all the layers of the cornea. There was an immobile hypopyon of 2 mm height from the limbus, present inferiorly. No pigmentation was noticed and lens and posterior segment were normal. Left eye was normal. A provisional diagnosis of fungal corneal ulcer was made. He did not reveal any history of trauma to the eye in the past.A direct KOH (Potassium hydroxide) mount from the corneal scraping revealed the presence of few septate hyaline hyphae. Growth on SDA (Sabouraud's dextrose agar) was obtained within a week and greyish black mycelia with numerous black sclerotia and a brown colour on the obverse and reverse covering the whole of the culture tube was seen . A LCB (Lactophenol cotton blue) tease mount from the growth on CMA (Corn meal agar) revealed acervular conidiomata with abundant setae, fusiform conidia and abundant appressoria with irregular margins . The slide cultures on PDA (Potato Dextrose Agar) after five days of growth at 25°C revealed hyaline, septate hyphae. Conidiomata were acervular, with 2 to 5 brown setae which had tapering ends [Table/ Fig-4]. Long conidia which were hyaline, aseptate and fusiform with straight and parallel walls and abruptly tapered ends were seen. Also few light brown appressoria were found. Antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines(M38-A2). The antifungal agents used included Amphotericin B (10 U), Fluconazole (25 μg), Ketoconazole (10 μg) and Voriconazole (10 μg).The isolate was found to be sensitive to Amphotericin B and Voriconazole and the patient was treated successfully with ocular administration of Amphotericin B for 2 month. The patient was followed up regularly with no evidence of any reoccurrence. DisCussionWe report for the first time the isolation of C. coccodes from India in a patient who had none of the known predisposing factors for this infection. He was successfully treated with ocular administration of Amphotericin B, contrary to the standard practice of surgical management for this condition.Six of the 66 species of Colletotrichum have been implicated in human infections till date [1][2][3][4]. Though all of them have been isolated from eye infections world over, to the b...