Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting.

Dengue is endemic in Sri Lanka and the physician should be aware of different and unusual presentation of the illness. Rhabdomyolysis is a well-known complication following many viral and bacterial infections; however, only a few cases have been reported with dengue viral infections. Further occurrence of coinfection by dengue and bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) has been underestimated, and few reports have been published so far. This case describes a 17-year-old boy who presented with prolonged severe myalgia, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis, dark red urine, and a febrile illness that was diagnosed as having dengue viral myositis complicated with rhabdomyolysis and superinfection of MRSA. Despite intensive care management, he died due to multiorgan failure. Autopsy and serological studies confirmed the diagnosis. This case stresses that red-coloured urine in dengue patients is not always due to haematuria, and if a patient's vital signs do not respond to appropriate fluid management in DHF, sepsis from a secondary pathogen including MRSA should be suspected.

Introduction: Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy of urinary tract infection (UTI).The aim of this study is to describe antimicrobial susceptibility patterns and empirical prescribing practices in adult in-patients with UTI. Methods: The study was carried out at a tertiary care hospital in Sri Lanka. Data was collected from consecutive adult in-patients with positive urine culture and clinical features compatible with UTI. Antibiotic sensitivity testing was done using Joan Stokes method. The etiological uropathogens, antibiotic susceptibility rates (ASR), association between ASR and background variables and empirical prescribing practices were analyzed. Results: Seven hundred and forty five subjects were studied. Mean (SD) age was 48.2 (19) years and 441(59.2%) were females. Coliforms were the commonest isolates (85.6%). Overall, 76.8% of the isolates were susceptible to nitrofurantoin (coliforms 74.9%, Streptococcus spp. 100%, Staphylococcus spp. 95.6%). Overall susceptibility was < 50%, to many antimicrobials. Among coliforms and pseudomonas isolates, susceptibility to ciprofloxacin was 37.7% and 29.4% respectively. The susceptibility rates of coliforms varied according to age, gender, origin of UTI and presence of co-morbidities. Three hundred and eighty one (51.1%) subjects received empirical antimicrobials. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Despite high susceptibility, nitrofurantoin was empirically prescribed in only 9.2% patients. Conclusions: Susceptibility was low to many first and second line antimicrobials used to treat UTI in adults. There was obvious discrepancy between empirical prescribing practices and the susceptibility pattern of isolates. Incorporation of local surveillance data in clinical practice will be useful to optimize the use of empirical antimicrobial therapy.

Three cases of atypical mycobacterial infection were encountered following laparoscopic surgery at the Colombo North Teaching Hospital over a period of eighteen months from September 2014 to April 2016. The patients presented with port site infections and sinus tract formation three to four weeks after laparoscopic surgery performed in the same operating theatre. These cases were clinically suspected as atypical mycobacterial infection. The Ziehl Neelsen stain showed acid fast bacilli with atypical morphology and cultures grew mycobacteria other than tuberculosis (MOTT). Histology of tissues showed chronic granulomatous inflammation. The infections resolved with surgical intervention and long term antibiotic therapy. Erroneous practice of disinfection of laparoscopic instruments with formaldehyde was thought to be the cause of these infections. No cases were reported after implementing protocols for proper cleaning and disinfection of laparoscopes.