Nasal carriage of Methicillin‑resistant Staphylococcus aureus among healthy population of Kashmir, India.

Background: Nasal colonisation with community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is being increasingly reported, especially in places where people are in close contact and where hygiene is compromised. The aim of this study was to find out prevalence of methicillin resistant S.aureus (MRSA) colonising anterior nares of healthy subjects. Materials and Methods: Nasal swabs of healthy subjects were collected aseptically and cultured using standard microbiological protocols. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method according to CLSI guidelines. Methicillin resistance was detected by cefoxitin disc diffusion method and confirmed by minimum inhibitory concentration (MIC) and amplification of mecA gene by PCR. Strain typing of MRSA strains was done by PFGE. Results: Out of 820 samples, S.aureus was isolated from 229 (27.92%) subjects. Of the 229 isolates, 15 were methicillin resistant. All S. aureus isolates were susceptible to vancomycin. Nasal carriage of MRSA was found to be 1.83% among healthy population. The isolates were found to be polyclonal by PFGE analysis. Conclusion: High prevalence of MRSA is a cause of concern and strategies to interrupt transmission should be implemented.

Recurrent meningitis due to Salmonella enteritidis: A case report from Kashmir India.

Recurrent bacterial meningitis in children is potentially life-threatening and induces psychological trauma to the patients through repeated hospitalization. Here we report a case of recurrent meningitis in a one month old baby. The CSF and blood culture grew Salmonella enteritidis. Injection ciprofloxacin and ceftriaxone were given for 3 weeks. Baby became symptomatically better and was afebrile at discharge. Twenty eight days after discharge baby got readmitted with complaints of fever and refusal of feeds. Blood and CSF culture again showed growth of Salmonella enteritidis. Physicians should be educated about the possibility of recurrence which may occur days or even weeks after apparent successful antibiotic treatment.

Sepsis due to linezolid resistant Staphylococcus cohnii and Staphylococcus kloosii: First reports of linezolid resistance in coagulase negative staphylococci from India.

Linezolid, a viable alternative to vancomycin against methicillin resistant staphylococcal isolates, has been in use for a decade around the globe. However, resistance against staphylococci remains extremely rare and unreported from most of the Asian countries. Herein, we report two cases of linezolid resistant, coagulase negative staphylococcal sepsis for the first time from India. The first case was an 18-year-old burn patient, who, after a major graft surgery, landed in sepsis, and linezolid resistant Staphylococcus cohnii with an minimum inhibitory concentration (MIC) of >256 μg/ml by both broth microdilution and Etest, was isolated from multiple blood cultures. The second patient was a 60-year-old male with an intracranial bleed and sepsis, from whose blood cultures, linezolid resistant Staphylococcus kloosii was repeatedly isolated. Linezolid MIC was >32 μg/ml by broth microdilution and >16 μg/ml by Etest.

Listeria monocytogenes meningoencephalitis in an immunocompetent, previously healthy 20-month old female child.

Invasive listeriosis predominantly affects pregnant women, neonates, elderly and people with a compromised immune function. For more than 80 years since the discovery of Listeria in 1924, only a few reports of invasive listeriosis in humans have emerged from India, with all of them in patients having an underlying predisposition. We, however, report Listeria monocytogenes meningoencephalitis in an immunocompetent, previously healthy, 20-month-old female child with no underlying predisposition. The patient showed poor response to empirical treatment with vancomycin and ceftriaxone but improved dramatically after substitution with ampicillin and amikacin. She had a complete recovery other than left lateral rectus palsy that persisted.

Ocular toxocariasis in a child: a case report from Kashmir, north India.

Toxocariasis is an important zoonotic disease caused by the second stage larva of Toxocara canis or Toxocara cati . The typical clinical syndromes of toxocariasis in humans are visceral and ocular toxocariasis. Ocular toxocariasis may presents as peripheral inflammatory mass, posterior pole granuloma and endophthalmitis. We report a serologically confirmed case of ocular toxocariasis in 12-year-old female. The diagnosis was confirmed by detection of anti- Toxocara antibodies in aqueous and vitreous sample by enzyme-linked immunosorbent assay. We suggest that ophthalmologist in this region should include ocular toxocariasis in differential diagnosis particularly in children and young adults.

Helminthic infestation in children of Kupwara district: a prospective study.

The present study deals with the investigation of the frequency of intestinal helminth parasites in children of Kupwara, Kashmir, India. Three hundred and twelve children in the age group of 4-15 years were examined for different intestinal helminths in three schools located in rural areas. Two hundred and twenty two of 312 (71.15%) tested positive for various intestinal helminths. The various helminth parasites included Ascaris lumbricoides , Trichuris trichiura , Enterobius vermicularis and Taenia saginata . By far, the highest frequency of 69.23% (216/312) was noted for Ascaris lumbricoides followed by Trichuris trichiura 30.76% (96/312), Enterobius vermicularis 7.69% (24/312) and Taenia saginata 7.69% (24/312). Single infection was found in 33.65% (105/312) and mixed infection was seen in 37.5% (117/312) children. This study emphasizes the need for improved environmental conditions, i.e., clean water supplies, enhanced sanitation and chemotherapy of school-age children in rural areas.

Fungemia caused by Verticillium species in an immunocompromised child.

The incidence of fungal infections is increasing due to immunocompromised states. We report a case of fungaemia due to a rare fungus - Verticillium, in a 6 year old child diagnosed as a case of acute lymphoblastic leukaemia- L1 with high grade fever. The patient was treated with amphotericin B with a good clinical response.