Endocarditis due to brucellosis is considered a rare occurrence involving native, congenital and prosthetic valves. The diagnosis needs high degree of suspicion in culture negative endocarditis especially in those with history of exposure to farm animals. A positive culture in a susceptible patient confirms the diagnosis with 91% sensitivity. An early diagnosis and prompt treatment with appropriate antibiotics can restore the valve structural integrity with minimal damage. Here we present a series of five cases of culture proven Brucella endocarditis (four native valves, one prosthetic valve) and this report discusses the diagnostic and management issues involved.

Introduction: The present study is a retrospective analysis of a total of 36 cases of bacteriologically proven extra-intestinal salmonellosis, managed at Nizam's Institute of Medical Sciences, between 1987 and 2012 (25 years). The extra-intestinal sites involved were the skin, cerebrum, spleen, ovary, synovium, and the skeletal muscle. Methodology: The extra-intestinal specimens were first processed using standard methods. Colonies suspected as Salmonella were identified by standard laboratory methods, initially by manual biochemical reactions and later by the API system (bioMerieux, Marcy l'Etoile-France) and the Vitek-2 system (bioMerieux). All the Salmonella isolates were sent to Central Research Institute, Kasauli, for serotyping. Results: The predominant serotype isolated was Salmonella Typhi (S. Typhi) in 27 (75%) patients, followed by Salmonella Senftenberg (S. Senftenberg) in 5 (14%), Salmonella Paratyphi A (S. Paratyphi A) in 3 (8%), and Salmonella Typhimurium (S. Typhimurium) in 1 (3%). There was an increasing resistance to ampicillin, chloramphenicol, cephalosporins (third generation), and quinolones over the 25 years.Conclusions: The diagnosis of extra-intestinal salmonellosis requires a high degree of clinical suspicion and should be included in the differential diagnosis in patients with deep-seated abscesses.

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Carbapenem-resistant pathogens cause infections associated with significant morbidity and mortality. This study evaluates the use of the loop-mediated isothermal amplification (LAMP) assay for rapid and cost-effective detection of bla NDM-1 and bla KPC genes among carbapenem-resistant Gram-negative bacteria in comparison with conventional PCR and existing phenotypic methods. A total of 60 carbapenem-resistant clinical isolates [Escherichia coli (15), Klebsiella pneumoniae (22), Acinetobacter baumannii (23)] were screened for the presence of carbapenemases (bla KPC and bla NDM-1 ) using phenotypic methods such as the modified Hodge test (MHT) and combined disc test (CDT) and molecular methods such as conventional PCR and LAMP assay. In all, 47/60 isolates (78.3 %) were MHT positive while 48 isolates were positive by CDT [46.6 % positive with EDTA, 30 % with 39 aminophenylboronic acid (APB) plus EDTA and 1.6 % with APB alone].Isolates showing CDT positivity with EDTA or APB contained bla NDM-1 and bla KPC genes, respectively. bla NDM-1 was present as a lone gene in 28 isolates (46.7 %) and present together with the bla KPC gene in 19 isolates (31.7 %). Only one E. coli isolate had a lone bla KPC gene. The LAMP assay detected either or both bla NDM-1 and bla KPC genes in four isolates that were missed by conventional PCR. Neither gene could be detected in 12 (20 %) isolates. The LAMP assay has greater sensitivity, specificity and rapidity compared to the phenotypic methods and PCR for the detection of bla NDM-1 and bla KPC . With a turnaround time of only 2-3 h, the LAMP assay can be considered a point-of-care assay.

Background: Aerobic nonfermenting gram-negative bacilli (NFGNB) are now emerging as important uropathogens.Methods: This study was done to know the significance of NFGNB other than P. aeruginosa and Acinetobacter spp. in Urinary Tract Infections (UTI) along with their antibiotic sensitivity pattern. Total 10,198 urine specimens received in eight months period from October 2013 to May 2014 were subjected to quantitative culture as per the standard procedures in the routine microbiology laboratory and the results were noted. Detailed clinical history and laboratory parameters (Total count, Urine microscopy: Pus cell and RBC) were gathered to know the significance of the organism.Results: Total 40.9% of the NFGNB isolates were clinical significant. Common risk factors associated with these NFGNB are ICU stay, previous hospitalization, catheterization and Diabetes Mellitus. Conclusion:Clinical correlation of NFGNB from urine is required before considering them clinically significant or contaminants.

PCD obviates surgery or acts as a temporizing measure in a significant number of patients with necrotizing pancreatitis. APACHE II scores and extent of intrapancreatic necrosis are principle factors determining success of PCD.

A bacteriologically proven case of brain abscess, due to Streptococcus oralis is being reported in a 12-year-old girl who is a known case of congenital heart disease. The patient presented with fever, headache and vomiting. Pus cultures yielded S. oralis.

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