Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre

Introduction: Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. Materials and Methods: We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. Results: A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Conclusion: Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

Prevalence of Opportunistic Pathogens and Diversity of Microbial Communities in the Water System of a Pulmonary Hospital / 生物医学与环境科学（英文）

Objective@#Our objective was to investigate the occurrence of opportunistic pathogens and characterize the bacterial community structures in the water system of a pulmonary hospital.@*Methods@#The water samples were collected from automatic and manual faucets in the consulting room, treatment room, dressing room, respiratory ward, and other non-medical rooms in three buildings of the hospital. Quantitative polymerase chain reaction was used to quantify the load of several waterborne opportunistic pathogens and related microorganisms, including spp., spp., and . Illumina sequencing targeting 16S rRNA genes was performed to profile bacterial communities.@*Results@#The occurrence rates of spp., spp., and were 100%, 100%, and 76%, respectively in all samples. Higher occurrence rates of were observed in the outpatient service building (building 1, 91.7%) and respiration department and wards (building 2, 80%) than in the office building (building 3), where no was found. were more abundant in automatic faucets (average 2.21 × 10 gene copies/L) than in manual faucets (average 1.03 × 10 gene copies/mL) ( < 0.01). , , , , , and were the dominant bacterial phyla. Disinfectant residuals, nitrate, and temperature were found to be the key environmental factors driving microbial community structure shifts in water systems.@*Conclusion@#This study revealed a high level of colonization of water faucets by opportunistic pathogens and provided insight into the characteristics of microbial communities in a hospital water system and approaches to reduce risks of microbial contamination.

El controvertido complejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento vegetal y patógenas de plantas, animales y humanos / The controversial Burkholderia cepacia complex, a group of plant growth promoting species and plant, animals and human pathogens

El complejo Burkholderia cepacia está formado por 22 especies conocidas como patógenos oportunistas en personas inmunocomprometidas, especialmente en aquellas con fibrosis quística. También se aíslan de infecciones nosocomiales y son difíciles de erradicar debido a su capacidad intrínseca para resistir una gran variedad de antibióticos. En general, estas especies presentan genomas de gran tamaño (hasta 9 Mpb) divididos en 2-5 replicones. Esta característica aporta una gran versatilidad metabólica, que se considera importante para habitar el suelo, el agua, las plantas, incluso los nódulos en leguminosas. Algunas especies del complejo B. cepacia exhiben actividades benéficas, como biorremediación, biocontrol y promoción del crecimiento vegetal. No obstante, debido a su papel en infecciones de humanos, su uso en la agricultura está restringido. El complejo B. cepacia es un tema constante de estudio debido a su impacto en el sector salud y su potencial en la agricultura. En este trabajo se examina la historia del complejo B. cepacia y se revisa la información reciente relacionada con este grupo de bacterias.

The Burkholderia cepacia complex is a group of 22 species, which are known as opportunistic pathogens in immunocompromised people, especially those suffering from cystic fibrosis. It is also found in nosocomial infections and is difficult to eradicate due to intrinsic resistance to several antibiotics. The species have large genomes (up to 9 Mbp), distributed into 2-5 replicons. These features significantly contribute to genome plasticity, which makes them thrive in different environments like soil, water, plants or even producing nodules in legume plants. Some B. cepacia complex species are beneficial in bioremediation, biocontrol and plant-growth promotion. However, because the B. cepacia complex is involved in human infection, its use in agriculture is restricted. B. cepacia complex is being constantly studied due to the health problems that it causes and because of its agricultural potential. In this review, the history of B. cepacia complex and the most recently published information related to this complex are revised.

Aerobiología y biodeterioro del género Aspergillus Link en depósitos de tres instituciones patrimoniales cubanas / Aerobiology and biodeterioration of the genus Aspergillus Link in repositories of three Cuban heritage intitutions

Las especies del género Aspergillus Link constituyen importantes agentes biodeteriorantes de objetos de valor constructivo, cultural y patrimonial. En ambientes laborales, sus propágulos y metabolitos pueden provocar afecciones a la salud humana. Los estudios aeromicológicos pueden contribuir a minimizar el impacto de Aspergillus spp. en el biodeterioro y la calidad de vida. Se han caracterizado de acuerdo a su potencial biodeterió- geno y patogénico representantes de Aspergillus spp. en el aire de depósitos de materiales en tres instituciones patrimoniales cubanas. Las muestras se tomaron empleando un biocolector SAS súper 100. Se evaluó cualitativamente la actividad celulolítica, amilolítica y proteolítica de los aislados; así como la excreción de pigmentos y ácidos orgánicos. Se evaluó el crecimiento a 37°C y la secreción de hemolisinas. Aspergillus spp. constituyó parte considerable de la micobiota aérea viable en los depósitos con 22 especies correspondientes a 12 secciones, las de mayor variabilidad fueron Flavi y Restricti, mientras la primera y la sección Aspergillus fueron las mejor representadas. El 74 por ciento de las cepas mostraron alta capacidad para degradar los compuestos orgánicos evaluados y secretar ácidos, mientras el 34 por ciento excretó pigmentos de amarillo a pardo oscuro, se evidenció un amplio potencial biodeteriorante en general. Más del 30 por ciento de los aislados mostraron ser patógenos oportunistas peligrosos para el hombre al crecer a 37°C, secretar hemolisinas, y presentar un tamaño conidial que posibilita la depositación en alvéolos pulmonares. Las cepas con mayor impacto biodeteriorante y patogénico fueron las correspondientes a las Secciones Flavi, Nigri y la especie Aspergillus fumigatus Fresen.

Species of the genus Aspergillus Link cause damage to objects constructive, cultural and heritage value. In work environments, their propagules and metabolites may cause disorders to human health. Aerobiological studies can help minimize the impact of Aspergillus spp. in the biodeterioration and quality of life. Aspergillus spp. strains present in the air of the repositories in three Cuban heritage institutions were characterized according to their biodeteriogenic and pathogenic potential. Each isolated was classified taxonomically, cellulolytic, amylolytic and proteolytic activity as well as excretion of pigments and organic acids was evaluated. The capacity to grow at 37°C and secrete hemolysins was qualitatively evaluated. Aspergillus spp. was significant portion of viable air micobiota in the three repositories with 22 species corresponding to 12 sections, most variability were Flavi and Restricti, while the first section and Aspergillus were the best represented. The 74 percent of the strains showed high ability to degrade organic compounds evaluated and secrete acids, while 34 percent excreted pigments from yellow to dark brown, evidenced a broad biodeteriogenic potential in general. More than 30 percent of the isolates were shown to be dangerous opportunistic pathogens for humans to grow at 37°C, secrete hemolysin, and present a conidial size which enables the deposition pulmonary alveoli. Strains higher biodeteriogenic and pathogenic impact were those corresponding to the Flavi, Nigri sections and the species Aspergillus fumigatus Fresen.

Doença granulomatosa mimetizando lesão gliomatosa / Granulomatous Diseases may Mimic Glial Tumor Lesion

Desde 1981 a aids tem estado presente em nossa sociedade. Como consequência, doenças infectocontagiosas e novos patógenos oportunistas têm desenvolvido novos comportamentos e adquirido novas virulências. Mesmo com a aquisição de novas tecnologias ­ como técnicas imunológicas, ressonância magnética (RM), tomografia computadorizada (TC), tomografia por emissão de pósitron (PET) e espectrometria ­, existem desafios para o diagnóstico que incluem falsos negativos e positivos. Reportamos nossa experiência com paciente imunocomprometido e suas múltiplas infecções oportunistas, e juntamos casos com diferentes patógenos que mimetizam tumores de estirpe glial com resultados falsos positivos e negativos nas provas imunológicas, seja por comprometimento imunológico do hospedeiro, seja por provas cruzadas de colagenoses.

Since 1981 AIDS has been present in our society. Following it, controlled infection diseases and new opportunistic pathogen have raised different behavior and virulence. Even with the important technical advance such as immunologic assay, magnetic resonance (MRI), computed tomography CT, positron emission tomography (PET) and spectrometry there still exists a real challenge for diagnosis, including high levels of false negatives. We report in this work our experience with imunocompromised patients and their multiple opportunistic diseases and attach it different pathogens that may mimic tumoral glial diseases with false positive and negatives results in immunological assay, developed by host imunocompromised reactivity or by cross reaction of collagenosis desease.

Penicillum marneffi infection presenting as lump abdomen.

Penicillum Marneffi is the third leading opportunistic pathogen in HIV endemic areas. We report a case, with a rare clinical presentation as lump abdomen with newly diagnosed HIV -1 antibody reactive status. A diagnosis was made by endoscopic biopsy of growth in second part of duodenum which on histopathology and culture detected Penicillum Marneffi. He was treated with intravenous amphotericin B for 2 weeks followed by oral itraconazole. This case is reported for its unusual presentation to sensitize clinicians to consider this as an etiology in patients in HIV endemic areas who present as lump abdomen.

Ochrobactrum anthropi : An unusual pathogen: Are we missing them.

With increasing incidence of immunocompromised patients, many unusual organisms are emerging as pathogens in these patients. Ochrobactrum anthropi is an emerging opportunistic pathogen in immunocompromised patients. Here, we report two cases of neonates who presented with septicemia due to O. anthropi. Both were preterm and low birth weight babies admitted in the Neonatal Intensive Care Unit of our Hospital. One baby manifested with respiratory distress and eventually died. The second baby responded well to treatment and was discharged. The clinical presentation of infections along with microbiological characteristics and clinical significance of the organism are described.

Isolation of Extended Spectrum ß-lactamase (ESBL) Producing Bacteria from Urban Surface Waters in Malaysia

Background: This was a preliminary study to test for the presence of multiple antibiotic-resistant extended spectrum β-lactamase (ESBL) producing bacteria in Malaysian urban surface waters. Although the literature review revealed several published papers on clinical ESBL isolates in Malaysia, none were found on ESBL isolates obtained from local surface waters. Methods: Isolated bacterial species were tested for resistance to cefotaxime, amoxicillin/clavulanate and aztreonam, and susceptibility to imipenem and meropenem using antibiotic susceptibility testing (AST) by disc diffusion. This served as a screening step to detect bacteria that could be potential ESBL species. 16S ribose ribonucleic acid (rRNA) polymerase chain reaction (PCR) testing with two clusters of bla (β-lactamase) gene primers was used to test for the bla genes CTX-M (Groups 1, 2, 9), OXA-1, SHV and TEM. Results: A total of 19 isolates were found, possessing at least one of the bla genes tested for. There was a relatively high occurrence of CTX-M genes (84.2%) among these, followed by TEM genes (47.4%). The isolates were identified as Enterobacteriaceae (89.5%), predominantly Escherichia coli and Klebsiella pneumoniae. Conclusion: There appears to be a high occurrence of ESBL-bacteria in local surface waters, among these being opportunistic pathogens. The persistence and spread of these species in the environment poses a threat to exposed human populations.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.