Multidrug-resistant Bacteroides fragilis Isolated from a Case of Pyopneumothorax.

Aim: The aim of this case report is to present an unusual case of multidrug- resistant Bacteroides fragilis from a patient with pyopneumothorax who had a blunt injury to the thorax and got admitted in a tertiary care hospital, South India. Presentation of Case: The patient developed pyopneumothorax after a blunt injury and on admission was treated empirically with piperacillin-tazobactam and metronidazole. Following antibiotic sensitivity testing the B. fragilis strain isolated showed multidrug resistance including metronidazole. Imipenem was initiated replacing empiric therapy with a successful clinical outcome. Discussion: Bacteroides species are obligate anaerobic bacteria that are usually found in the gastrointestinal tract of the human body. Bacteroides species are the most commonly isolated anaerobic organisms from intra-abdominal lesions and rarely from intrathoracic disease conditions like pyopneumothorax. Pyopneumothorax caused by Bacteroides species is associated with high treatment failure and mortality rates in antibiotic-resistant cases. Though metronidazole is the mainstay of treating anaerobic infections, attention has to be given to the possibility of multidrug resistance when treating critical diseases. Conclusion: This case report summarizes the multidrug- resistance in Bacteroides fragilis strain isolated from a case of pyopneumothorax. The situation calls attention to the possibility of multidrug-resistance being underestimated when given as empirical therapy and institution of appropriate and timely antibiotic policy measures to prevent mortality.

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Unresolving pericarditis: Suspect filariasis in the tropics.

Filariasis, a mosquito-borne disease, is wide spread in India. While laboratory diagnosis has been conventionally done by demonstrating microfilaria in peripheral blood smears, occasionally they are reported in various body fluids including pericardial fluid. We report the case of 33-year-old man with severe dyspnoea and chest pain, referred from a private nursing home with a provisional diagnosis of unresolving pericarditis. Pericardial tap revealed massive pericardial effusion with actively motile microfilariae. No microfilariae (Mf) were seen in the peripheral blood. Haemorrhagic effusion resolved completely with DEC. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of pericardial effusion.

Molecular characterisation of Cryptosporidium: an emerging parasite.

PURPOSE: The aim of the present study was to determine the prevalence of Crytposporidium in local population and to understand its epidemiology by molecular methods. METHODS: Faecal samples from 681 children and 804 adults, admitted to tertiary care hospitals in twin cities of Hyderabad and Secunderabad with complaints of diarrhoea; and six calves with diarrhoea, were screened for Cryptosporidium oocysts by microscopy and enzyme linked immunosorbent assay (ELISA). Polymerase chain reaction restriction fragment length polymorphism (PCR RFLP) based identification of Cryptosporidium species in positive specimens was done to elucidate epidemiology of Cryptosporidium. RESULTS: Cryptosporidium was found in 52 (7.6%) children and 7(0.9%) adults and 1(16.6%) calf with diarrhoea. The prevalence of Cryptosporidium in children below five years of age was 8.2% and 14.3% in children in the age group of six months to one year. Of the 42 samples genotyped 29 (69%) were C. hominis and 8 (19%) were C. parvum and 5 (11.9%) were mixed infection with the two species. CONCLUSIONS: Children in the age group of six months to one year were found to be the most vulnerable. The occurrence of C. parvum, in nearly one third of cases in the present series indicates that the zoonotic transmission is of considerable significance in the epidemiology of Cryptosporidiosis in the study area.

Cryptosporidiosis in a tertiary care hospital in Andhra Pradesh.

Enteric protozoal parasitic infection has become an important cause of morbidity in children and adults. In the developing countries the association of Cryptosporidium with acute and persistent diarrhoea has been striking. Stool samples from 1002 patients (800 adults and 202 children) suffering from diarrhoea or other gastrointestinal symptoms were examined for the presence of Cryptosporidium parvum oocysts by modified Ziehl Neelsen stained smears. C. parvum was detected in 2.99% of children and 0.12% adults. Other parasites detected were E. histolytica (6.18%), G. lamblia (1.49%), A. lumbricoides (1.49%), hookworm (1.39%), Strongyloides stercoralis (0.39%), and Taenia (0.09%).