A case series of Covid-19-associated fungal infections: The gruesome twosome

Severe Acute Respiratory Syndrome Coronavirus-2(SARS-CoV-2) is the novel coronavirus responsible for causing Coronavirus disease (COVID-19). The pandemic has seen many ebbs and flows since its detection, particularly regarding various manifestations coupled with it. Secondary fungal infections, especially COVID-19-associated mucormycosis, have seen a summit, especially during the second wave of the pandemic. However, we reported a series of three cases of mucormycosis in association with another fungal mould from the sample received from patients infected with this virus that presented to our hospital during this pandemic. Our report is about the novelty of dual fungal infection caused by a Zygomycete group along with Aspergillus isolated from pulmonary as well as extra-pulmonary sites, all of which were confirmed on culture. Timely and multidisciplinary management of these patients helped patient survival

Bacteriological Profile of Wound Swab and Pus Samples Using Conventional Media and Chromogenic Medium.

Background: Wound infections continue to be a causeof concern as they can delay healing and cause woundbreakdown. Their effective treatment demands quickisolation and identification of causative organisms withappropriate antibiotic sensitivity pattern. Material andMethods: Wound swab and pus samples received frominpatient as well as outpatient department of all agegroups and both genders were processed usingconventional media as well as chromogenic medium(HiCrome UTI) and results of both were compared.Antibiotic sensitivity testing was done on Vitek 2Compact automated system. Results: Among 342samples, 77% showed growth. Fifty eight percentagewere Gram negative and 42% were Gram positiveorganisms. Polymicrobial growth was seen in 11% ofsamples. HiCrome UTI isolated all organisms inculture. Colony characteristics and colour of all isolateson HiCrome UTI were comparable to theiridentification on Vitek 2 Compact. Among the Grampositive organisms, commonest was MethicillinSensitive Staphylococcus aureus (MSSA 42%)followed by Methicillin Resistant Staphylococcusaureus (MRSA 33%), Enterococcus faecalis (10%),Staphylococcus epidermidis (8%), Staphylococcushaemolyticus (3%), Streptococcus pyogenes (2%) andStreptococcus agalactiae (2%). Most of the Grampositive organisms were sensitive to vancomycin,teicoplanin, linezolid and clindamycin The commonGram negative organisms were E. coli (36%),Klebsiella pneumoniae (20%), Pseudomonasaeruginosa (18%), Proteus mirabilis (7%),Enterobacter cloacae (6%) and Acinetobacterbaumannii (4%). Most of the Gram negative organismswere sensitive to cefepime, beta lactams-betalactamase inhibitors, aminoglycosides and fluoroquinolones. Conclusion: Gram-negative organismspredominated in our study. HiCrome UTI agar can beused as a cost-effective approach for rapid isolation ofall organisms. It gives definite identification ofcommon organisms and thus reduces turn-around-timefor the same. It provides presumptive identification ofinfrequent organisms which can be further confirmedby simple biochemical tests. Hence these properties ofHiCrome UTI agar help serve the purpose especiallyfrom mixed cultures and in resource constraint settings

Soft Tissue Infection Caused by Aeromonas hydrophila along with Staphylococcus aureus in a Patient with Diabetes Mellitus.

Aeromonas species are Gram-negative bacilli usuallyisolated from gastrointestinal tract but occasionallycause skin and soft tissue infections. We report a caseof soft tissue infection in a diabetic foot caused byAeromonas hydrophila along with MethicillinResistant Staphylococcus aureus. Aeromonas wasidentified to the species level by Vitek 2 Compact andother biochemical tests. The patient was initiallytreated empirically with parenteral amoxycillinclavulanic acid along with wound debridement.Linezolid was added after the culture and antibioticsusceptibility report. Wound healed with this treatmentregime along with regular saline dressing.

Inducible Clindamycin Resistance in Gram Positive Isolates Obtained from Clinical Samples in a Tertiary Care Hospital in Mumbai.

Background: Infections by Gram positive isolates are increasing due to which their antibiotic sensitivity pattern is changing. This has revived interest in Macrolide-Lincosamide Streptogramin Group B (MLSB) antibiotics. Misuse of MLSB antibiotics hasincreased resistance in Gram-positive organisms especially Staphylococcus species to these drugs. Clindamycin is an important drug for treatment of Gram-positive isolates. Hence detection of inducible clindamycin resistance in these clinical isolates is required to prevent therapeutic failure and avoid inadvertent use of this drug. Aim and Objectives: To detect inducible clindamycin resistance among Gram positive isolates obtained from clinical samples. Material and Methods: The study was carried out over a period of one year (Jan-Dec 2018). A total of 461 Gram positive isolates of Staphylococcus species, Streptococcus pneumoniae and Beta-haemolytic Streptococcus were identified from various clinical samples and antibiotic susceptibility done on Vitek2 Compact usi g GP ID, and 628 and ST01 cards respectively. According to CLSI 2017, D-zone test was performed for detection of inducible clindamycin resistance for strains resistant to erythromycin. Results: Staphylococcus aureus (SA) isolates were 59%, Staphylococcus epidermidis (SE) 21%, other Coagulase Negative Staphylococcus (CONS) 16%, Streptococcus pyogenes (Group A-beta haemolytic) 2%, Streptococcus agalactiae (Group B betahaemolytic) 1% and Streptococcus pneumoniae (alpha haemolytic) 1%. Isolates of Methicillin Sensitive Staphylococcus aureus (MSSA) were 58% and Methicillin Resistant Staphylococcus aureus (MRSA) were 42%. Frequencies of MS (clindamycin sensitive) phenotypes, inducible clindamycin resistance (MLSBi) phenotypes and phenotypes showing constitutive resistance (MLSBc) were 44%, 12% and 3% respectively among MSSA and 34%, 39% and 8% respectively among MRSA. Among SE, MS, MLSBc and MLSBi phenotypes were 39%, 24% and 12% respectively and 8%, 44% and 30% respectively among other CONS. One isolate of S. pyogenes was of MLSBi phenotype and none among S. agalactiae and S. pneumoniae. Conclusion: The study emphasizes the significance of conducting D-zone test along with routine antimicrobial susceptibility testing to guide in therapy and avoid treatment failures.

Invasive Actinomycosis of Maxilla-An Unusual Case Report

Cervicofacial actinomycosis is an unusual infectioncaused by Actinomyces species. It rarely involves themaxilla. We present a case of an elderly female with aleft sided maxillary swelling which was diagnosed asleft maxillary actinomycosis invading the adjacentstructures suspected to be secondary to a bone neoplasmon the basis of histopathology. The organism grew inculture in our laboratory and hence this case is adeviation from the common feature that cultures aremost of the times of little help in detecting thisorganism. The classical growth of this organism onculture in addition to the histopathology report highlyempowered the diagnosis of this case. Also, our findingsthat it can permeate the surrounding structures and canproduce a conundrum for the diagnosis are noteworthy

Efficacy of painless injection technique - Vibraject – Clinical trial in Chennai, India.

Background: Pain is the most common cause of needle Phobia. In order to overcome this many advanced injection techniques has been implemented. The most recent and advanced technique was using a small vibrating device to the conventional injection technique. Objectives: To evaluate the efficacy of vibraject versus conventional injection technique. Material and methods: Prospective, randomized, cross- over, single blinded design was carried out among adults above 18 years of age in private hospital in Chennai city, Tamil Nadu, India. Out of 52 subjects, 37 were willing to participate in the study. Split mouth technique was carried out. A calibrated single examiner used an appropriate amount of anaesthetic solution, 2% lidocaine with 1:100,00 dilution of epinephrine was injected slowly and then patient was asked to report their discomfort and pain was noted using verbal descriptor scale. Sign test was calculated to check the efficacy of vibraject to that of conventional injection technique. Results: The total sample size consists of 37 study subjects. Out of total study subject, 35 subjects reported increased pain score while using conventional injection technique than using vibraject with a significant difference (Z=-5.5, p=0.00). Out of total study subject, 14 subjects reported increased pain score while using conventional injection technique than using vibraject. The p value for 2-tailed sign test shows (p=0.04) there was significant difference between two techniques. Conclusion: Vibraject has significantly reduced pain both during insertion of needle and during deposition of solution when compared to the conventional injection technique.