Fungal Keratitis Due to Fusarium lichenicola: A Case Report and Global Review of Fusarium lichenicola Keratitis.

Fusarium species are among the most commonly isolated causes of fungal keratitis. Most species of the genus Fusarium belong to Fusarium solani species complex (FSSC). Fusarium lichenicola, a member of the FSSC complex, is a well-established plant and human pathogen. However, reports of fungal keratitis due to Fusarium lichenicola have not been frequently reported. To the best of our knowledge, only twelve cases of Fusarium lichenicola keratitis have been reported in the past fifty years. Clinical cases of Fusarium lichenicola may have most likely been misidentified because of the lack of clinical and microbiological suspicion, as well as inadequate diagnostic facilities in many tropical countries where the burden of the disease may be the highest. We report a case of fungal keratitis caused by Fusarium lichenicola and present a global review of the literature of all cases of fungal keratitis caused by this potentially blinding fungus.

Melioidosis in Bihar, India: unearthing the first of many?

Melioidosis, a disease with protean clinical manifestations, is prevalent in many parts of India, with established endemic hotspots on the southern coast of the country. However, it is still underdiagnosed in many resource-poor regions of the country. We report what is, to the best of our knowledge, the first case of melioidosis diagnosed and treated in Bihar, an economically underdeveloped state in East India. The patient, a 52-year-old diabetic male, presented to the outpatient department with a fever of insidious onset along with pain and restriction of movement in the right shoulder joint and right knee joint, and swelling and tenderness of bilateral ankle joints. Radiological features were suggestive of multiple joint and organ abscesses. A diagnosis of disseminated septicaemic melioidosis was confirmed microbiologically. The patient improved clinically following aggressive treatment with meropenem and cotrimoxazole. The case highlights the need for increased clinical suspicion of melioidosis and adequate diagnostic facilities, as well as the need for early institution of appropriate empirical antibiotics in suspected cases of melioidosis in this region of the world.

Prevalence and Antibiogram of Urinary Tract Infections in Renal Transplant Recipients at a Tertiary Care Hospital in North India.

INTRODUCTION: Although, urinary tract infections (UTI) remain the most common cause of mortality and morbidity in renal allograft recipients, there is scarce data from India on the etiology and antibiogram of UTI post kidney transplantation. Therefore, the current study was undertaken to evaluate the prevalence, etiology and the antibiogram of pathogens causing UTI in this cohort. METHODS: Renal allograft recipients enrolled during the study period were screened for UTI by standard microscopy and routine culture on the day of admission and subsequently every 3rd day post-surgery till discharge. If UTI was present, the etiological agent and its antibiogram were recorded along with the demographic details of the patients. RESULTS: The prevalence of UTI post-transplantation at our centre was 30%. E.coli and Klebsiella pneumoniae were the most common organisms isolated in 42% and 39% cases, respectively. Majority of patients developed UTI on Day 6 (36.6%) and Day 9 (36.6%) post-transplant. Our study revealed a high percentage of resistance to commonly used 1st and 2nd line antibiotics like third generation cephalosporins (96.6%), fluoroquinolones (96.6%), and aminoglycosides (56.7%) and carbapenems (55.2%). CONCLUSION: Considering the high prevalence of UTI and antibiotic resistance rates in kidney transplant patients in our study, there is an urgent need for developing hospital based local antibiogram for appropriate management of UTI. Fosfomycin as an empirical therapy might be a useful choice for adequate coverage of potential pathogens at our centre. Further multi-centric studies on a larger sample size are recommended from India for formulating antibiotic policy.

Melioidosis: Reinfection going incognito as relapse.

Melioidosis has recently gained importance as an emerging disease in India. Recurrent melioidosis has been reported from different parts of the world and can be due to relapse or reinfection. Distinction between relapse and reinfection is important for epidemiology, investigation and management. Here, we present the data regarding rate of recurrence and utility of multilocus sequence typing (MLST) in differentiating relapse form reinfection amongst melioidosis patients from a tertiary care hospital in South India. Amongst the 31 patients who survived and underwent follow-up, 4 (13%) presented with recurrence. Three cases (75%) were identified as reinfection and one (25%) as relapse based on MLST. Re-exposure to environmental Burkholderia pseudomallei amongst patients with melioidosis in endemic areas is likely. In such a scenario, more often than not, recurrence of melioidosis can be attributed to reinfection.