Emphysematous osteomyelitis caused by Salmonella typhi in beta thalassemia major.

There have been various cases of salmonella osteomyelitis reported in sickle cell anemia. We present a case of emphysematous osteomyelitis caused by Salmonella typhi in a 29-year-old beta thalassemia major patient. Diagnosis of emphysematous osteomyelitis was confirmed by computed tomography and magnetic resonance imaging, and culture of pus drained during surgical debridement confirmed the causative microorganism, Salmonella typhi. Antimicrobials were given according to microbiological sensitivity for a period of 8 weeks. Our patient also received hyperbaric oxygen therapy. At the end of therapy, he was afebrile and laboratory parameters normalized with a residual joint deformity which developed within 3 months.

A Relook of Cefuroxime in Community Infections: An Option Still Beneficial.

In community and family practice, infections are a common OPD presentation. In the management of common bacterial infections seen in community especially RTI, UTI, SSTI; cefuroxime a second generation cephalosporin with a broad spectrum of activity can be used for empirical treatment. To know current place of cefuroxime in the management of infections, physicians, surgeons, microbiologist, chest physician, gynecologist and pediatrician came together to discuss and debate their experience with cefuroxime and its place in today's world. Cefuroxime is a drug which balances efficacy with safety. Several international bodies and guidelines including the US FDA and The British Thoracic Society, the World Society of Emergency Surgery (WSES) have recommended cefuroxime for the management of community acquired pneumonia and skin and soft tissue infection respectively. Cefuroxime has been recommended in the 2015 list of the US FDA list of drugs which can be used safely during pregnancy. Cefuroxime can become a useful empiric choice antibiotic for the Indian physicians treating urinary tract infections, respiratory tract infections and skin and soft tissue infections in their outpatient departments.

Differentiation of Candida dubliniensis on chrom agar and Pal's agar.

Difference in expression of putative virulence factors and in antifungal susceptibility among different Candida species has raised the need for species-level identification. The close relationship of Candida dubliniensis with C. albicans has led to misidentification of C. dubliniensis isolates as C. albicans. Phenotypic tests include ability to produce chlamydospore on casein agar, colony colour development on differential media CHROM agar Candida medium and ability to form hyphal fringe on Pal's agar, have been used to differentiate these two Candida species. Fifty isolates of Candida species were recovered from various specimens (blood, urine, tissue and respiratory secretions) from diabetic and cancer patients between April and July 2007. The isolates were tested for chlamydospore production on casein agar. These were also streaked simultaneously on CHROM agar, Pal's agar and a combination of CHROM agar supplemented with Pal's agar for identification and differentiation of C. dubliniensis from C. albicans. On CHROM agar, 19 isolates were identified as C. dubliniensis, nine as C. albicans, 10 as C. krusei, nine as C. tropicalis and two as C. glabrata. One was indeterminate and later identified as C. dubliniensis. Out of the 20 C. dubliniensis isolates, 19 isolates exhibited hyphal fringe on Pal's agar. On CHROM agar supplemented with Pal's agar, 16 out of the 19 fringe-positive isolates exhibited fringe surrounding the bluish green-coloured colonies of C. dubliniensis. Additional identification tests like growth at 45 degrees C and ability to reduce 2,3,5-triphenyltetrazolium chloride were time efficient, inexpensive and easy-to-use methods for differentiation of C. dubliniensis and C. albicans isolates. CHROM agar when supplemented with Pal's agar gave definitive identification between C. dubliniensis and C. albicans.

Incidence of carbapenem-resistant Pseudomonas aeruginosa in diabetes and cancer patients.

Two hundred and thirty isolates of Pseudomonas aeruginosa were obtained from samples of patients having diabetes (75%), cancer (20%), and both diabetes and cancer (5%) who were admitted to a tertiary care hospital in Western India from January to December 2006. These isolates were tested for susceptibility to antipseudomonal drugs and considered to be resistant to carbapenem when the zone of inhibition around imipenem and meropenem discs was < or =13 mm. Of these 230 isolates, 26% were found to be carbapenem resistant. The rapid dissemination of carbapenem resistance is worrisome and calls for the implementation of surveillance studies as well as judicious use of antibiotics.

An observational study to detect leptospirosis in Mumbai, India, 2000.

BACKGROUND: Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai. AIMS: To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness. METHODS: From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (>39 degrees C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed. RESULTS: Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis. CONCLUSION: Leptospirosis should be suspected in febrile children with contact with flood water.

Vibrionaceae from cases of acute diarrhoea and their antimicrobial sensitivity pattern - a five year prospective study.

Over a five year period, stool samples were screened for Vibrionaceae from cases of acute diarrhoea, to study their isolation rate and their antimicrobial sensitivity pattern. All the isolates were identified by standard laboratory techniques. A total of 323 species belonging to Vibrionaceae were isolated from 4492 stool samples tested over five year period (1996-2000), giving a positivity rate of 7.2%. Maximum isolation was during the months of May to August (62.5%). Out of 323 isolates, Vibrio spp. comprised 252 and 93.3% of them were Vibrio cholerae O1 biotype El Tor. Aeromonas spp. were isolated from 71 samples and 64.8% of them were A. hydrophila. V. cholerae showed 86.8% sensitivity to amikacin followed by 73.8% to cefotaxime. Tetracycline sensitivity was only 39.6%. Aeromonas spp. also showed maximum sensitivity to amikacin (70.4%). Isolation of Vibrio spp. have increased over the years, whereas Aeromonas spp. have decreased. Amikacin sensitivity has remained within 70-80% over the years, cefotaxime sensitivity has increased and tetracycline sensitivity has decreased.

Bacteriological studies of gas gangrene and related infections.

Gas gangrene, a life threatening condition is predominantly caused by Clostridium spp. Over a five year period (1996-2000), 580 wound swabs were processed from patients who had vehicular accidents with crush injury. The specimens were processed for anaerobic and aerobic organisms by standard laboratory techniques. Of the 580 swabs, 55(9.48%) were primary smear positive for spore bearing bacteria, of which 48 grew Clostridium spp. They were the sole anaerobic isolates in 30 patients (62.5%) whereas Clostridium spp. along with nonsporing anaerobes were isolated in 18 patients. Clostridium perfringens was the predominant isolate in 39 out of 48 cases (81.3%). However, 16 wound swabs which were primarily smear negative for spore bearers, grew Bacteriodes fragilis (11) and Fusobacterium species (5). All these 16 patients had foul smelling discharge with crepitation in the tissues. Our study highlights that apart from Clostridium spp., non-clostridial crepitant infections may present as myonecrosis simulating gas gangrene.

Rhinocerebral mucormycosis in a pregnant woman with diabetic ketoacidosis.

Rhinocerebral mucormycosis (RCM) is a rare but often fatal condition characterized by aggressive necrotizing infection originating from nose and spreading to paranasal sinuses, orbit and central nervous system. Although Fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate fulminant infections in patients with underlying debilitating conditions. A case of RCM in a pregnant woman with diabetic keto-acidosis successfully treated by supportive care, amphotericin B and surgery is reported.

Aeromonas species isolated from cases of acute gastroenteritis.

A total of 67 Aeromonas strains were isolated as the sole bacterial pathogen from 1485 patients with acute gastroenteritis. A. hydrophila (64.2%) was the predominant isolate followed by A. sobria (28.4%) and A.caviae (7.4%). Majority of the isolates were sensitive to gentamicin, nalidixic acid but were resistant to ampicillin. Minimum inhibitory concentration (MIC) of resistant strains of Aeromonas to ampicillin ranged from 80-1280 microg/mL.

Anaerobes in pleuropulmonary infections.

A total of 76 anaerobes and 122 aerobes were isolated from 100 patients with pleuropulmonary infections, e.g. empyema (64), pleural effusion (19) and lung abscess (13). In 14% of the patients, only anaerobes were recovered, while a mixture of aerobes and anaerobes was encountered in 58%. From all cases of lung abscess, anaerobic bacteria were isolated, alone (04) or along with aerobic bacteria (13). From empyema and pleural effusion cases, 65.6% and 68.4% anaerobes were recovered respectively. Amongst anaerobes, gram negative anaerobic bacilli predominated (Prevotella melaninogenicus 16, Fusobacterium spp. 10, Bacteroides spp. 9), followed by gram positive anaerobic cocci (Peptostreptococcus spp. 31). Coliform bacteria (45) and Pseudomonas aeruginosa (42) were the predominant aerobic isolates.

An outbreak of leptospirosis in Mumbai.

Following prolonged water logging due to heavy rainfall in Mumbai during July 2000, a total of 102 patients clinically suspected of leptospirosis were admitted in our hospital. Blood samples were examined for the presence of leptospires by dark ground microscopy (DGM) and IgM antibodies were detected by ELISA. Out of 102 blood samples, 37 were positive by ELISA giving a positivity rate of 36.27%. Of these, only 24 were positive by DGM. Out of the positive cases, 37.83% had respiratory symptoms, 32.43% each had jaundice and conjunctival suffusion and 16.21% had renal involvement. Mortality amongst the positive cases was 10.81%. Apart from hepatic and renal involvement, respiratory symptoms due to leptospirosis are on the rise.

Helicobacter pylori in duodenal ulcer disease and its eradication.

Antral biopsy specimens were processed for Helicobacter pylori by Gram staining, rapid urease test (RUT) and culture from 25 patients with symptoms of duodenal ulcer, amongst whom the positivity rate was 84%. Follow up of 16 patients after appropriate therapy showed complete regression of the disease in 87.5% of cases whereas in 12.5% of cases a decrease in the extent of duodenal ulceration was noted.

Salmonella enteritidis meningitis - a case report.

A male infant admitted with pyogenic meningitis with protein energy malnutrition developed fatal infection due to Salmonella enteritidis. The same organism was isolated from CSF and blood cultures.

Corneal ulcer caused by Nocardia asteroides in a patient with leprosy.

Nocardia asteroides is a rare cause of keratitis usually associated with trauma. We report a case of corneal ulceration caused by N. asteroides in a patient with leprosy. This is the first case report of nocardial keratitis from Southeast Asia. The diminished corneal sensation in a patient with leprosy could be a predisposing factor for development or exacerbation of corneal ulceration.

Drug resistance to the first line of antitubercular regimen (a preliminary report).

Sputum samples from 100 patients of pulmonary tuberculosis were processed. These patients were admitted in group of Tuberculosis Hospital at Sewri, Mumbai, which is a referral tuberculosis hospital. Isolates were identified as M. Tuberculosis by biochemical tests. Antitubercular sensitivity testing for Isoniazid, Rifampicin, Ethambutol and Streptomycin was performed by resistance ratio method. Total resistance was 36% in our study. Resistance to Isoniazid was 61%: to Rifampicin was 50%, to Ethambutol was 8% and to Streptomycin was 41%. Primary drug resistance to Isoniazid was 45% to Rifampicin was 27%, to Ethambutol was 9%, and to Streptomycin was 54%. Secondary drug resistance to Isoniazid was 68% to Rifampicin was 60%, to Ethambutol was 8% and to Streptomycin was 36%. Secondary drug resistance to Isoniazid and Rifampicin is rising as compared to primary drug resistance to Isoniazid and Rifampicin. This is statistically significant (p < 0.001). 11 out of 36 cases (30%) showed multi drug resistance to Isoniazid and Rifampicin.