BackgroundAcinetobacter has gained importance as a multi-drug resistant and hence a difficult to treat pathogen. This study was done to characterize our isolates with respect to drug resistance and presence of beta-lactamases which is a major mechanism of resistance and to type using RAPD and MLST so that comparison of our clones can be made with the existing international clones.Methods100 isolates recovered from clinical samples from two hospitals in Delhi were tested for their susceptibility against major groups of antimicrobials. The resistant isolates were screened and confirmed phenotypically for presence of ESBL, MBL and AmpC and MBLs also by PCR. The isolates were typed by RAPD and MLST.ResultsOut of the 100 isolates, 91, 78 and 2 % were MDR, XDR and PDR respectively. 97, 100 and 85 were screen positive for ESBL, AmpC and MBL respectively. Of these, 38.1 % were confirmed phenotypically to produce ESBL, 99 % produced AmpC and 29.4 % produced MBL comprising of GIM, VIM, SIM and IMP. MLST showed known STs 110, 188, 146, 69, 103, 108 and 194. Eight new STs were encountered. The RAPD showed a high degree of genetic variability among the isolates.ConclusionMajority of our isolates were MDR, producing one or more types of beta-lactamases. We encountered drug resistant international clones by MLST which are found in other continents there by confirming their spread to Indian sub continent. No data on ST types of other Indian isolates is available in the MLST database and hence comparison is not possible.

Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

No abstract

This item has no abstract. Follow the links below to access the full text.

Scedosporium apiospermum is a rare cause of infection but is increasingly being reported among immunocompromised individuals around the world. We report two cases of S. apiospermum, one of keratitis and the other of nasal polyp both from immunocompetent patients. The two cases were successfully treated with voriconazole. It is important to diagnose such infections as their antifungal susceptibility to amphotericin B is variable.

We report a case of onychomycosis from a 71-year old man which was caused by Monascus ruber. The diagnosis was based on culture morphological characteristics on Sabouraud's Dextrose agar and Malt Extract agar. The patient was successfully treated with oral terbinafine.

No abstract

Chronic canaliculitis is an inflammation of the lacrimal canaliculus. Inflammation of lacrimal canaliculus can occur secondary to dacryocystitis, but the most common cause is infection. 1 Bacteria, fungi and viruses can cause infection. The most common presenting symptom of canaliculitis is chronic conjunctivitis. Actinomyces species is classically cited as the most common organism causing canaliculitis. 2-4 Concretions in the lower palpebral conjunctiva/fornix with conjuctivitis can also be the presenting symptom of Actinomyces infection. 5 We hereby report two cases of chronic conjunctivitis, one with canaliculitis and the other with palpebral concretions, both were positive for Actinomyces and responded to topical 5% cefazoline eyedrops. Case Report-1 A 50 year old male presented to us with complaints of chronic irritation,watering and occasional redness of the right eye since past 8 months. He was prescribed various topical antibiotic drops but he did not respond to any of them. On examination, his vision was 6/6 in both eyes. Examination of the right eye revealed a tender swelling in the medial one third of the right lower lid with congestion of adjacent lower palpebral conjunctiva and pouting lower punctum (Figure 1