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Comparative study of syndromic and etiological diagnosis of sexually transmitted infection except human immunodeficiency virus in sexually transmitted infection and reproductive tract infection clinic attendees in central India Context: Most of the sexually transmitted infections (STIs), both ulcerative and non-ulcerative are prevalent in India. However, due to lack of adequate laboratory infrastructure in the country, information regarding STIs lies essentially on syndromic basis. Hence, there is very limited data of laboratory proven STIs. Aims: The aim of this study is to determine the prevalent STI and reproductive tract infection (RTI) in the region and comparison of etiological diagnosis with syndromic approach. Settings and Design: Cross-sectional study. Materials and Methods: A total of 1120 patients attending STI/RTI clinic were included in the study with one or more complaints as enunciated by World Health Organization in its syndromic approach. Depending on syndromic presentation, different samples such as ulcer swabs, genital swabs and blood samples were collected. These samples were processed by the standard guidelines of National AIDS Control Organization. Warts, Molluscum contagiosum and genital scabies were diagnosed clinically. Results: Age of acquiring STI in females (20-24 years) was lower than males (25-44 and more). Vaginal discharge syndrome (90.3%) was most common followed by cervical discharge syndrome (20%). The highest incidence of herpes (14.3%) seen in genital ulcerative diseases but clinically human papilloma virus (16.5%) was common. Overall, Candida was the most common isolates. Bacterial STIs like chancroid (0%) and gonorrhea (0.54%) are showing a declining trend. Laboratory confi rmation of syndromic diagnosis was seen in only 409/1120 (36.5%). Conclusions: Viral STIs/RTIs are getting the upper hand over bacterial. Syndromic algorithms have some shortcomings and they need to be periodically reviewed and adapted to the epidemiological patterns of STIs in a given setting.

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Introduction: Antimicrobial resistance in bacterial pathogens is associated with high morbidity and mortality. We aimed to evaluate antibiotic resistance and β-lactamase production in clinical isolates of a tertiary care hospital in Central India. Materials and Methods: Clinical isolates (n=6472 isolates) from patients with infection were identified using standard microbiological techniques. Antibiotic susceptibility testing was performed according to the CLSI guidelines using the Kirby-Bauer disc diffusion technique. AmpC production in Enterobacteriaceae isolates was tested in screening test. Cloxacillin combined disc diffusion test was performed using cefoxitin disc with and without cloxacillin. Metallo-β-lactamase production in Enterobacteriaceae isolates was tested in screening test. Non-fermenting Gram-negative isolates were tested by combined disc test using imipenem and imipenem-EDTA discs. Results: Most bacteremia cases were caused by Staphylococcus aureus (43.13%), non-fermenting spp. (27.44%) and coagulase-negative staphylococci (11.76%). Escherichia coli (55.85%) was the main cause of urinary tract infection followed by Acinetobacter spp. (11.71%) and Klebsiella pneumoniae (10.36%). No resistance to linezolid was seen in Gram-positive isolates. Frequency of vancomycin-resistance was about 9% in Enterococcus spp. Methicillin resistance was seen in 19% of S. aureus isolates. Enterobacteriaceae and Citrobacter freundii isolates were completely resistant to aminopenicillin, first-and second-generation cephalosporins and cefamycin. Moreover, Klebsiella isolates were resistant to aminopenicillin. Enterobacteriaceae isolates showed resistance to aminopenicillin (89.87%), cephalosporins (54-90%) and cephamycin (37-45%). E. coli isolates were sensitive to piperacillintazobactam (87-96%) and imipenem (99.68-100%). Extended spectrum β-lactamase production was seen in 166 Enterobacteriaceae isolates (30.24%). AmpC production was seen in 15 (2.73%) Enterobacteriaceae isolates. Total β-lactamase production was found in 19.23% of the isolates. The frequency of β-lactamase production was highest in K. pneumoniae (51.67%). Conclusions: It is necessary to monitor drug resistance and β-lactamase production. Moreover, it is recommended to perform routine β-lactamase testing in microbiology laboratories for determining prevalence of antibiotic resistance and controlling their spread.

Background: Epidemics of cholera have been reported from various parts of India. We investigated the epidemic of cholera that occurred in and around Yavatmal district in Maharashtra, India 2018, reported during March to July.Methods: 711 stool samples collected from diarrhea patients were bacteriologically analyzed for their identification and antibiogram of Vibrio cholera.Results: The cholera outbreak was caused by V. cholerae O1 Ogawa biotype El Tor. All the V. cholerae isolates from the stool samples were sensitive to tetracycline, doxycycline, ofloxacin, ciprofloxacin gentamycin, cotrimoxazole and resistant to ampicillin and ceftazidime.Conclusions: The present outbreak was due to V. cholerae O1 Ogawa El Tor which seems to have completely replaced O139 serogroup of the previous outbreaks during the last decade.

A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram's, and H and E-stained smears. All the three inoculated slants of Sabouraud's media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.

Context: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. Aims: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. Settings and Design: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. Subjects and Methods: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. Statistical Analysis: Statistical analysis was done using proportion, mean, and percentages. Results: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium . Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole–trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. Conclusion: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India.

BACKGROUND: In India neonatal septicemia is a leading cause of mortality. Regionwise variation regarding the predominant pathogens and their antibiotic sensitivity pattern were observed. The study was undertaken to know the pattern in this region. METHOD: The study comprised of 210 clinically suspected cases of neonatal septicemia admitted in the neonatal intensive care unit. Two to three ml blood was collected aseptically in Trypticase Soya broth and isolates were identified. RESULT: Growth was obtained in 106(50.47%) samples. Gram negative organisms were predominant. Multidrug resistant was observed in most of the organisms. CONCLUSION: As there was species-wise variation in antibiotic resistant pattern of organisms, we recommend antibiotic sensitivity should be done before starting antibiotics. As for as possible, first and second line antibiotics should be included in primary sensitivity testing to avoid delay in treatment and inappropriate use of antibiotics.