Emergence of VIM-2 metallo-beta-lactamase producing Ralstonia pickettii clinical isolate in India.

A multidrug‑resistant clinical isolate of Ralstonia pickettii from a woman was analysed. Modified Hodge test was positive for carbapenemase production. Conjugation experiment revealed the presence of conjugative plasmid of >140 Kb size typed as IncN type. This is the first report of emergence blaVIM‑2 in R. pickettii in India.

Differences in vancomycin MIC among MRSA isolates by agar dilution and E test method.

In this study, the correlation between vancomycin minimum inhibitory concentration (MIC) obtained by the E test technique and the Clinical And Laboratory Standards Institute (CLSI) agar dilution method was evaluated. A total of 53 Methicillin Resistant Staphylococcus aureus (MRSA) strains were tested by both the methods in the present study. MICs of vancomycin obtained by the E test method were consistently higher (+0.5 to 2 log2 dilutions) than those obtained by the agar dilution method. Out of 53 MRSA isolates, 49 isolates showed higher MIC results by E test than by agar dilution method. Three isolates showed same MIC result by both methods. Since many studies have demonstrated increased clinical failure with MRSA isolates for which vancomycin MICs are increased (>1 μg/ml) but still within the susceptibility range (≤ 2 μg/ml), our findings suggest the requirement to re-look into the breakpoints for vancomycin for determining sensitivity of MRSA isolates. Guidelines should also specify the method to be used for determining the MIC.

Nodular regenerative hyperplasia of liver.

Nodular regenerative hyperplasia of the liver (NRHL) is a very rare cause of portal hypertension and liver failure. The condition is characterized by diffuse micronodular transformation of hepatic parenchyma without fibrous septa between the nodules. We present our experience with a 32-year-old woman who presented with recurrent episodes of upper gastrointestinal bleeding associated with massive splenomegaly who was subsequently found to have NRHL. This article considers the salient aspects of this rare condition, how it affects the patients and the options available in its management. A plea is made for the need for liver biopsy for all patients with portal hypertension especially those being considered for surgery.

Enhanced antibody response to a detergent-soluble antigen in human filariasis after treatment with diethylcarbamazine.

An antigen fraction has been isolated from the water insoluble component of cattle filarial parasite Setaria digitata by detergent NP-40 solubilization, precipitation with ammonium sulphate and fractionation on sephadex G-100. Immunoglobulin G response to the isolated antigenic fraction was selectively suppressed in asymptomatic microfilaraemic people in comparison to the amicrofilaraemic groups of endemic normals and chronic patients. However, treating microfilaraemic people with diethylcarbamazine enhanced the antibody levels by 10-fold. These results suggest that active infection suppresses the response induced by the isolated antigenic fraction which is elevated after clearance of microfilariae.