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At 19 weeks 6 days ultrasonography of a 31-year-old G2P1L1 revealed a small echogenic area seen in the subvalvular apparatus of the mitral valve (anterior mitral leaflet) suggestive of cardiac rhabdomyoma (CR). At 28 weeks of gestation there was mild increase in the size of the CR (13 × 6 mm). There was no evidence of hemodynamic compromise. The interval growth of the fetus was satisfactory. The family tree of three generations was examined and revealed no evidence of Tuberous Sclerosis. She delivered a live 34 weeks 2.2 kg male baby with 8 and 9 Apgar scores at 5 and 10 minutes respectively. Baby suddenly developed cyanosis and died 24 hours after birth. The fetal autopsy confirmed the diagnosis of CR. Genetic analysis of neonatal blood revealed no evidence of TSC mutation suggestive of tuberous sclerosis.

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Purpose: S. pneumoniae ranks as the fourth-most lethal pathogen globally in terms of fatalities associated with or attributable to resistance. In this study, the Antimicrobial Testing Leadership and Surveillance (ATLAS) analysis from India aims to study the overall antimicrobial susceptibility (AMS) among pneumococcal isolates collected between 2018 and 2021. Methods: Non-duplicate clinically significant S. pneumoniae isolates were collected between 2018 and 2021. In vitro activity of antibiotics was assessed against S. pneumoniae. Susceptibility was confirmed at an International Health Management Associates (IHMA) laboratory using supplied broth microdilution panels (Omron Microscan Systems, Inc., Omron Corp., Kyoto, Japan), according to the Clinical and Laboratory Standards Institute (CLSI) guidelines for all antibiotics. Results: Of the total 86 non−duplicate isolates of Streptococcus pneumoniae collected from the tertiary care centers, the proportion of isolates increased from 8.14% (n=7) in 2018 to 43.02% (n=37) in 2020. Most isolates (n = 18; 48.65%) were collected from the age group of 31-60 years in the year 2020. Erythromycin revealed a decrease in susceptibility from the year 2018 (71.43%) to 2020 (16.22%). A decreased susceptibility of 90% was recorded for levofloxacin in the year 2021. Meropenem revealed a decrease in susceptibility from the year 2018 (85.71%) to 2020 (35.14%). Penicillin susceptibility decreased from 37.5% in 2019 to 27.03% in the year 2020. Clindamycin indicated a 100% susceptibility in the year 2018 which then decreased to 71.88% in 2019 and 56.76% in 2020. Linezolid and vancomycin were found to have uniform susceptibility of 100% throughout the years from 2018 to 2021. Conclusion: An increase in resistance to penicillin and macrolides among S. pneumoniae isolates was observed in the Indian population. Addressing the elevating rates of S. pneumoniae resistance may require pneumococcal conjugate vaccines (PCVs) with expanded serotype coverage and targeted antimicrobial stewardship efforts.

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