Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background: The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods: Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results: 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions: The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Diphtheria-like illness in a fully immunised child caused by Corynebacterium pseudodiphtheriticum.

Corynebacterium pseudodiphtheriticum is a common commensal flora of the upper respiratory tract in humans. Though the pathogenicity of C. pseudodiphtheriticum is not rare, its role as an opportunistic pathogen is mainly limited to the lower respiratory tract, particularly in patients with underlying systemic conditions or immune‑compromisation. We hereby present the first case of C. pseudodiphtheriticum causing diphtheria‑like illness affecting the upper respiratory tract of a 6‑year‑old fully immunised otherwise healthy child. In countries with very low incidence of diphtheria, C. pseudodiphtheriticum should be included in differential diagnosis for a child presenting with diphtheria‑like illness. Simple, rapid screening tests should be used to differentiate it from C. diphtheriae and hence, to prevent unnecessary concern in community.

Disseminated nocardiosis in an elderly patient presenting with prolonged pyrexia: Diagnosis by thyroid abscess culture.

We report a case of nocardiosis in an immunosuppressed elderly patient who presented with prolonged pyrexia. Nocardia asteroides was isolated from the thyroid, with CT scan evidence of dissemination to the brain, abdomen and lungs. The patient succumbed to illness despite aggressive therapy. Autopsy could not be performed. To the best of our knowledge, this is the first reported case from India, on Nocardia asteroides affecting the thyroid tissue.

Isolation of Mycobacterium chelonae from wound infection following laparoscopy: A Case Report.

M. chelonae is a rare cause of human infection and is difficult to diagnose unless suspected for the same. A 55 year old healthy gynaecologist, diagnosed to have right inguinal hernia, underwent laparoscopic hernioplasty, after which he showed signs of post-operative wound infection which was confirmed to be due to M. chelonae. Definitive identification of this species of mycobacterium was possible by growth characteristics and biochemical tests. The organism was sensitive to Kanamycin, Clarithromycin, Ciprofloxacin and Amikacin. However, complete recovery from infection was possible after prolonged treatment with antibiotics to which the organism was sensitive.

Injection site abscess due to Mycobacterium fortuitum: a case report.

Injection abscess is an iatrogenic infection occurring as an isolated case or as cluster outbreak. These infections occur due to contaminated injectables or lapse in sterilisation protocol. While pathogens such as Pseudomonas, Klebsiella, E. coli, and S. aureus are the usual causative agents, unusual organisms such as mycobacteria, particularly the rapidly growing non-tuberculous mycobacteria (NTM) may cause the abscess. The chances of overlooking these organisms is high unless an acid fast bacilli (AFB) smear and culture is done on all aspirated pus specimens. We report a case of a three year old child who presented with a gluteal abscess following an intramuscular infection with an unknown preparation.

A case of injection abscess due to salmonella typhi.

To the best of our knowledge, injection abscess due to Salmonella typhi has not been reported earlier. A patient with fever of unknown origin was diagnosed as suffering from typhoid fever, administered a course of ceftrioxone but patient developed an injection abscess due to S.typhi, abscess was drained and patient was started on ciprofloxacin to which he responded favourably.

Evaluation of ParaHITf strip test for diagnosis of malarial infection.

This study sought to determine whether dip stick strip test containing antibody for Plasmodium falciparum histidine rich protein-II (PfHRP-II) antigen could be used for identification of P. falciparum and P. vivax malaria in man. The results obtained were also compared with the results of standard microscopic examination. A total of 150 cases were included for the study. Fifty cases were non-febrile cases with no history of malaria acting as control group and the rest 100 cases were having fever and formed the test group. All the cases in the control group was found to be negative for both microscopic examination and strip test. In the test group, all samples that showed positive for P. falciparum by microscopy was also found to be positive for strip test. Whereas, all those samples that were positive for P. vivax in microscopic examination was found to be negative for strip test indicating species specificity of the strip test. In addition, two other cases that were negative for microscopic examination were found to be positive for the strip test. Statistical analysis was done to compare the validity of the results of strip test with that of the results of microscopic examination.