Introduction: Tuberculosis (TB) causes significant morbidity and mortality worldwide as one of the leading infectious diseases. In India, more than 1.8 million new cases occur every year. Rapid and accurate diagnosis of TB would improve patient care and limit its transmission. This study aimed to evaluate a dual target polymerase chain reaction (PCR) diagnostic assay to detect Mycobacterium tuberculosis from pulmonary and extra-pulmonary samples at a tertiary care centre in South India. Methodology: Samples were collected from patients with a low index of suspicion of TB. Acid-fast smears were performed by Auramine O fluorescent microscopy and PCR was performed by using two site-specific primer pairs targeting IS6110 by nested PCR and TRC 4 by conventional PCR. Amplified products for IS6110 and/or TRC 4 were indicative of M. tuberculosis. Results: Among 114 (19 pulmonary and 95 extra-pulmonary) samples tested by PCR assay, 12 (11%) were positive for both IS6110 and TRC 4 , of which 11 (10%) were non-respiratory and one was (1%) respiratory in origin. PCR for TRC 4 alone was positive for eight (7%) nonrespiratory and two (2%) respiratory samples, while IS6110 alone tested positive for six (5%) non-respiratory samples and one (1%) respiratory sample. Of a total of 29 PCR positive samples, 17 (15 %) were acid-fast smear positive. Conclusion: Although the target site of IS6110 is specific for M. tuberculosis, some strains from South India may lack this region. Therefore, the use of an additional target site (TRC 4 ) is required for improved detection of M. tuberculosis.
Introduction Introduction: Melioidosis is an infection caused by, Burkholderia pseudomallei (B.pseudomallei), a facultative intracellular gram-negative, saprophytic bacilli, commonly found in soil or contaminated water.The organism is aptly called the “great mimicker” as it produces a wide variety of clinical manifestations. Case report: A 24-year-old primigravida was referred to the medicine outpatient department with complaints of fever and myalgia of 45 days duration. Laboratory investigations revealed anaemia, elevated serum ferritin and hepatosplenomegaly. Bone marrow study showed the presence of hemophagocytes and a diagnosis of hemophagocytic lymphohistiocytosis(HLH) was made. Blood and bone marrow culture sent to the microbiology laboratory grew non fermenting gram negative bacilli which was misidentified as Burkholderia cepacia by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (VITEK 2 system bioMérieux ). It was further identified as B.pseudomallei by 16S ribosomal RNA sequencing. Patient was treated with steroids and ceftazidime. She had to undergo medical termination of pregnancy as there was severe intrauterine growth restriction(IUGR) of the foetus. She responded well to the treatment and was discharged with maintenance therapy of sulfamethoxazole and trimethoprim. Conclusion: It is important to find out if the suspected pathogen is listed in the database of the automated identification system. Prognosis of melioidosis is excellent if early diagnosis and appropriate antibiotic treatment is provided.
Vibrio cholerae is gram-negative bacilli belonging to the Vibrionaceae family generally found in brackish and marine water. Based on the O antigen on the cell wall of the bacteria, they are divided into three major subgroups – V. cholerae O1, V. cholerae O139, and V. cholerae non-O1/non-O139. The serogroups O1 and O139 harboring cholera toxin gene cause diarrhea, while the non-O1/non-O139 can cause a milder diarrhea and extraintestinal infections. We report a case of acute exacerbation of chronic suppurative otitis media by V. cholerae O39, which is classified in the non-O1/non-O139 group. The patient presented with slowly progressive painful ear discharge which evolved over a period of 3 months. V. cholerae O39 was isolated from the ear discharge by culture and confirmed by serologic and molecular testing. The patient improved symptomatically with 1 week of treatment with intravenous ciprofloxacin and tobramycin ear drops.
The incidence of extraintestinal infection caused by Salmonella spp has been increased during the past decade. Here we report a case of a parotid abscess caused by Salmonella enterica subspecies enterica serotype Typhi (S. Typhi) in an individual without any significant abnormality of the parotid gland. A 68-year-old man presented to the surgical department with high-grade intermittent fever associated with painful swelling over the right side of the face, extending into the neck. An ultrasound of the neck revealed an abscess of the right parotid gland. S. Typhi was isolated from the pus drained from the parotid gland. The patient was treated with intravenous followed by oral cephalosporin for a period of 7 days. This case gives an insight into one of the rarer aetiological agents causing parotid abscess.
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