Acute Unilateral Hypertensive Uveitis in Leptospirosis: A Case Report.

PURPOSE: We report the rare occurrence of unilateral acute hypertensive uveitis in the acute phase of systemic leptospirosis. METHODS: Observational case report and review of literature. RESULTS: A young male mason from coastal Karnataka in south India, presenting with acute febrile illness, was diagnosed to have systemic leptospirosis. He also had features of sudden raised intraocular pressure with anterior uveitis in one eye, which subsided with medical management. CONCLUSION: Leptospirosis should be considered as a differential in the diagnosis of acute hypertensive uveitis.

Understanding antimicrobial susceptibility profile of Finegoldia magna: an insight to an untrodden path.

BACKGROUND: Finegoldia magna (formerly known as Peptococcus magnus or Peptostreptococcus magnus) belonging to phylum Firmicutes, class Clostridia and genus Finegoldia, is the only species known to cause infections in human beings. Amongst Gram positive anaerobic cocci, F. magna is known to be the most virulent with a high pathogenic potential. Significant upsurge in antimicrobial resistance among anaerobes has been documented by various studies. F. magna is known to be susceptible to most of the anti-anaerobic antimicrobials, however, multidrug resistant strains are being reported in literature. The present study was undertaken to highlight the role of F. magna in clinical infections and to analyze their antimicrobial susceptibility patterns. METHODS: The present study was conducted in a tertiary care teaching hospital in Southern India. 42 clinical isolates of F. magna recovered from diverse clinical infections between January 2011 to December 2015 were studied. These isolates were subjected to antimicrobial susceptibility testing against metronidazole, clindamycin, cefoxitin, penicillin, chloramphenicol and linezolid. RESULTS: Among the 42 isolates studied, majority of them were revived from diabetic foot infections (31%) followed by necrotizing fasciitis (19%) and deep-seated abscesses (19%). All the F. magna isolates showed good in-vitro activity against metronidazole, cefoxitin, linezolid and chloramphenicol. Clindamycin and penicillin resistance were observed against 9.5% and 2.4% of the isolates respectively. However, ß-lactamase activity was not detected. CONCLUSION: The antimicrobial resistance among anaerobes varies from pathogen to pathogen and region to region. Hence, a deep understanding of resistance pattern is necessary for better management of clinical infections.

"Breast abscess in a male patient due to Finegoldia magna and Bifidobacterium scardovii: An unusual entity".

Breast abscess in men is a very uncommon condition. Unlike females, breast abscesses in men are commonly caused by aerobic organisms and very rarely by anaerobes. We are hereby reporting a case of retro-areolar abscess in a male patient caused by anaerobic organisms. The culture of the drained abscess yielded the growth of Finegoldia magna, a strict anaerobic Gram-positive cocci, and Bifidobacterium scardovii, a slow growing non spore-forming anaerobic Gram-positive bacilli. Timely surgical intervention and initiation of appropriate antimicrobial therapy showed an improvement of this condition.

Diagnosis of Chlamydia trachomatis genital infections in the era of genomic medicine.

PURPOSE: Chlamydial genital infections constitute significant sexually transmitted infections worldwide. The often asymptomatic status of C. trachomatis (CT) infections leads to an increased burden on human reproductive health, especially in middle- and low-income settings. Early detection and management of these infections could play a decisive role in controlling this public health burden. The objective of this review is to provide an insight into the evolution of diagnostic methods for CT infections through the development of new molecular technologies, emphasizing on -omics' technologies and their significance as diagnostic tools both for effective patient management and control of disease transmission. METHODS: Narrative review of the diagnostic methodologies of CT infections and the impact of the introduction of -omics' technologies on their diagnosis by review of the literature. RESULTS: Various methodologies are discussed with respect to working principles, required specifications, advantages, and disadvantages. Implementing the most accurate methods in diagnosis is highlighted as the cornerstone in managing CT infections. CONCLUSION: Diagnostics based on -omics' technologies are considered to be the most pertinent modalities in CT testing when compared to other available methods. There is a need to modify these effective and accurate diagnostic tools in order to render them more available and feasible in all settings, especially aiming on turning them to rapid point-of-care tests for effective patient management and disease control.

Diabetic Foot Infection with Bacteroides pyogenes.

>Diabetic foot infections are the most common serious diabetes-related complication posing significant socioeconomic burden on the health-care system. Diabetic foot microbiota consists of polymicrobial flora with predominance of Gram-negative aerobes and anaerobes. Here, we report a rare case of diabetic foot infection by Bacteroides pyogenes, an obligate Gram-negative anaerobic bacillus which is commonly encountered in polymicrobial animal bite wound infections.

Leptospiral uveitis in coastal Karnataka: A case report.

We report a case of a young male from Udupi, Karnataka, presenting with features of bilateral non-granulomatous anterior uveitis with mild vitritis. There was a history of fever and myalgia a month before ocular features, which was partially treated. He also gave a history of being actively involved in the flood relief work in the district, before the onset of fever. This prompted an evaluation of leptospirosis, which came positive. The possibility of leptospira uveitis needs to be considered, especially in cases of non-granulomatous uveitis after floods in areas endemic for leptospirosis, which may otherwise be wrongly labeled idiopathic.

Microbiological profile of chronic osteomyelitis with special reference to anaerobic osteomyelitis in a tertiary care hospital of coastal Karnataka.

Chronic osteomyelitis is a relapsing, persistent, low-grade inflammation of bone caused by various infectious agents. The present study, conducted over a two-year period, on specimens received from cases of chronic osteomyelitis was, to determine the frequency of isolation of aerobic and anaerobic bacteria and to analyse their antimicrobial susceptibility pattern. Specimens were processed for Gram stain, aerobic and anaerobic culture, and were identified according to standard techniques. Significant growth was observed in 102/204 specimens, in which aerobic growth was observed in 62 (60.8%) and anaerobic in 40 (39.2%). Resistance to metronidazole and clindamycin was observed in 6.7% and 30% of the anaerobic isolates, respectively. None of these were resistant to meropenem. A significant proportion of anaerobic isolates were found to be resistant to commonly used empirical drugs, such as clindamycin, thus necessitating a need for routine anaerobic susceptibility testing.

Antimicrobial Resistance Profile and Nim Gene Detection among Bacteroides fragilis Group Isolates in a University Hospital in South India.

INTRODUCTION: Members of Bacteroides fragilis group are the most frequently isolated anaerobic pathogens in the clinical laboratory from diverse infection sites. The objective of this study was to characterize B. fragilis isolates from various clinical specimens, to analyze their susceptibility profile toward most common anti-anaerobic antimicrobials, and to study the frequency of nim gene determining resistance to nitroimidazoles. METHODS: Specimens processed for anaerobic culture between January 2013 and December 2015 were analyzed. Isolates of B. fragilis group were identified and speciated by mass spectrometry. ß-lactamase production was detected using nitrocefin disks. Agar dilution and antimicrobial gradient diffusion methods were performed to study their susceptibility profile. The isolates were screened for nim gene by conventional gel-based polymerase chain reaction. RESULTS: A total of 57 isolates of B. fragilis group were studied. The commonly isolated species was B. fragilis (73.7%), followed by Bacteroides thetaiotaomicron (8.8%), Bacteroides vulgatus (8.8%), and others. Most of the isolates were recovered from deep-seated abscesses (47.4%). All isolates were found to be ß-lactamase producers. Metronidazole (Mtz) resistance was observed in 4 (7%) isolates. Higher rate of resistance was observed toward clindamycin (31.6%). None of the isolates tested were found resistant to chloramphenicol, piperacillin-tazobactam, and meropenem. nim genes were present in 4 (11.4%) B. fragilis isolates (n = 35). CONCLUSIONS: Resistance to the most commonly used empirical anti-anaerobic drugs including Mtz was noted in the isolates of B. fragilis group. Routine anaerobic cultures when indicated and continual surveillance of antimicrobial resistance among the anaerobic bacterial pathogens is essential.

Point-of-Care Ultrasound for Extrapulmonary Tuberculosis in India: A Prospective Cohort Study in HIV-Positive and HIV-Negative Presumptive Tuberculosis Patients.

Diagnosing extrapulmonary tuberculosis (EPTB) is challenging. Point-of-care ultrasound (POCUS) for human immunodeficiency virus (HIV)-associated EPTB is applied in sub-Saharan Africa. This study aimed at evaluating the applicability of POCUS for diagnosing EPTB in HIV-positive and HIV-negative presumptive tuberculosis (TB) patients in India, a country of moderate relative TB and HIV burden. Presumptive TB patients at Kasturba Hospital, Manipal, India, prospectively underwent POCUS evaluating for pericardial, pleural and ascitic effusion, abdominal lymphadenopathy, and hepatic and splenic microabscesses. Findings were correlated with TB category (confirmed TB, clinical TB, unlikely TB), HIV status, and discharge diagnoses. A total of 425 patients underwent POCUS; 81 (20%) were HIV-positive. POCUS findings were more common in HIV/TB coinfected patients than in HIV-positive patients with unlikely TB (24/40 (60%) versus 9/41 (22%), P < 0.001). Abdominal lymphadenopathy and splenic microabscesses were strongly associated with TB in HIV-positive patients (P = 0.002 and P = 0.001). POCUS findings did not correlate with TB in HIV-negative patients; a third of HIV-negative patients with unlikely TB and POCUS findings had cancer, another third other infectious diseases. Sonographic findings were common in HIV-positive and HIV-negative presumptive TB patients. POCUS was a useful bedside test for the detection of HIV-associated EPTB. In HIV-negative patients, POCUS detected features associated with EPTB but also of malignancy and other infectious diseases.

Anaerobic Bacteria in Clinical Specimens - Frequent, But a Neglected Lot: A Five Year Experience at a Tertiary Care Hospital.

INTRODUCTION: Anaerobic bacteria which constitute a significant proportion of the normal microbiota also cause variety of infections involving various anatomic sites. Considering the tedious culture techniques with longer turnaround time, anaerobic cultures are usually neglected by clinicians and microbiologists. AIM: To study the frequency of isolation of different anaerobic bacteria from various clinical specimens. MATERIALS AND METHODS: A retrospective study to analyse the frequency of isolation of different anaerobic bacteria, was conducted over a period of five years from 2011 to 2015 including various clinical specimens submitted to anaerobic division of Microbiology laboratory. Anaerobic bacteria were isolated and identified following standard bacteriological techniques. RESULTS: Pathogenic anaerobes (n=336) were isolated from 278 (12.48%) of overall 2227 specimens processed with an average yield of 1.2 isolates. Anaerobes were isolated as polymicrobial flora with or without aerobic bacterial pathogens in 159 (57.2%) patients. Anaerobic Gram-negative bacilli (140, 41.7%) were the predominant isolates. B. fragilis group (67, 19.9%) were the most commonly isolated anaerobic pathogens. Anaerobes were predominantly isolated from deep seated abscess (23.9%). CONCLUSION: Pathogenic anaerobes were isolated from various infection sites. Unless culture and susceptibility tests are performed as a routine, true magnitude of antimicrobial resistance among anaerobic pathogens will not be known. Knowledge of the distribution of these organisms may assist in the selection of appropriate empirical therapy for anaerobic infections.

Role of multiplex polymerase chain reaction in diagnosing tubercular meningitis.

Tuberculous meningitis (TBM) is one of the most serious manifestations of extrapulmonary tuberculosis. Timely and accurate diagnosis provides a favorable prognosis in patients with TBM. The study evaluated the use of multiplex polymerase chain reaction (PCR) in the diagnosis of TBM. A study was conducted on 74 patients clinically suspected with TBM. The cerebrospinal fluid (CSF) specimens were processed for smear microscopy, middle brook 7H9 culture, and multiplex PCR using primers directed against IS6110 gene and 38 kD protein for detection of Mycobacterium tuberculosis. The results were analyzed to assess the role of multiplex PCR in the diagnosis of TBM. A total of 26 (35.1%) patients were diagnosed with TBM. Microscopy was negative in all while culture was positive in two cases only. Comparing with clinical diagnosis and CSF adenosine deaminase levels of ≥10 U/L, multiplex PCR showed sensitivity, specificity, positive predictive value, and negative predictive value of 71.4%, 89.6%, 83.3%, and 81.2%, respectively, in the diagnosis of TBM.

Anaerobic infections in surgical wards: a two year study.

BACKGROUND AND OBJECTIVES: Anaerobic bacteria are recognized as important pathogens in surgical infections. However, they are the most overlooked microorganisms by the clinic and the laboratory because of the tedious culture techniques with longer turn-around times. The study was aimed to analyze the frequency of anaerobic bacterial surgical infections and their predisposing factors. MATERIALS AND METHODS: A retrospective study was conducted over a period of two years including patients with surgical infections. The specimens were processed by Gram staining, aerobic and anaerobic culture. The anaerobic bacteria were isolated using standard procedures. The predisposing factors and clinical presentation were studied in these patients. RESULTS: A total of 261 specimens were received from patients with diverse infections from surgical wards. Ninety-one anaerobes were isolated from 64 (24.5%) surgical patients with a predominance of Gram-negative bacilli (37.4%). Anaerobic bacteria as monomicrobial isolates were seen in 21.9% isolates. Anaerobic bacterial isolation along with aerobic bacteria was seen in 71.9% of patients and polymicrobial anaerobic growth was detected in 6.3% of patients. Diabetes mellitus (28, 43.8%) was found to be the most frequent predisposing factor. Bacteroides fragilis group (20.9%) were the most frequent anaerobic Gram-negative bacilli followed by Prevotella spp. (12.1%). Peptostreptococcus anaerobius was the predominant anaerobic cocci isolated (14.3%). Necrotizing fascitis (34.4%) was the most common clinical presentation with anaerobic etiology followed by deep seated abscesses (23.4%). CONCLUSION: Anaerobic bacteria were isolated from a significant proportion of surgical infections. To avoid therapeutic failures, anaerobic bacteria in surgical infections need to be recognized by surgeons and laboratorians.

Microbiological Characterization of Haemophilus influenzae Isolated from Patients with Lower Respiratory Tract Infections in a Tertiary Care Hospital, South India.

INTRODUCTION: Haemophilus influenzae is responsible for wide range of localized and invasive lower respiratory tract infections (LRTI) with the highest burden of disease in low and middle income countries. AIM: The aim of the present study was to characterize the H.influenzae isolates from suspected LRTI. MATERIALS AND METHODS: A prospective study was conducted over a period of one and half years (December 2012 to May 2014) including patients with LRTI. H.influenzae was isolated from lower respiratory specimens following standard procedures. Complete characterization of the isolates was performed by bio typing, capsular serotyping, molecular genotyping and antibiotic susceptibility testing. The predisposing factors and clinical presentation were studied in the infected patients. RESULTS: A total of 8995 samples were received during the study period, out of which growth was significantly observed in 2848 (31.7%) samples. Among the various respiratory pathogens, H.influenzae was isolated from 175 (6.14%) patients. Majority (78.9%) of the patients presented with acute exacerbations of chronic obstructive pulmonary disease. The isolates most frequently were of Biotype II (35.42%). Only four of the 50 isolates subjected to capsular serotyping were typeable and were of type b, e and f. All the 50 isolates tested were found to be non-typeable by PCR for capsular genotyping. Maximum resistance was found against ampicillin (9.71%). CONCLUSION: H.influenzae was found to be a significant cause of LRTI. Majority of the isolates were found to be non typeable strains. Non typeable H. influenzae isolates should not be neglected as they can colonize the respiratory tract in COPD patients and can lead to biofilm formation and treatment failure.

Comparing Assay Performance of ELISA and Chemiluminescence Immunoassay in Detecting Antibodies to Hepatitis B Surface Antigen.

INTRODUCTION: Antibodies to Hepatitis B surface Antigen (Anti-HBs) levels are measured as markers for immune response to vaccination and in decision making for post-exposure prophylaxis against Hepatitis-B. Several immunoassay formats are used to measure Anti-HBs, thus carrying the possibility of variation in measured levels between different assays. This study compares the performance of Chemiluminescence Immunoassay (CLIA) against Enzyme-linked Immunosorbent Assay (ELISA) in measuring Anti-HBs titer by looking into concordance between the two test reports. AIM: To compare the agreement between ELISA and CLIA in measurement of Anti-HBs antibody titers. MATERIALS AND METHODS: This prospective comparative study conducted at Kasturba Medical College, Manipal measured consecutive serum samples (69) sent for anti-HBs levels during May-June 2016 using both CLIA (Abbott Architect) and ELISA (Bio-Rad). Anti-HBs values of ≤10mIU/ml was considered as non-protective and >10mIU/ml as protective. The agreement between the tests in classifying the antibody titers as non-protective or protective was computed using Kappa coefficient, and the difference in individual titer values between the tests compared using Bland-Altman plot on SPSS (v.15). RESULTS: Out of the 69 samples analysed, 18 samples (26.1%) were of health-care personnel and remaining of patients. Agreement between ELISA and CLIA in identifying the antibody titers as protective and non-protective were 96.5% and 90.9% respectively, resulting in an agreement of 0.84. The coefficient-of-variation of ELISA and CLIA were 74.5% and 113.1%, respectively. Three value based discordant results were noted; two samples deemed protective by ELISA were reported as non-protective by CLIA. One non-protective titer by ELISA was reported as protective by CLIA. CONCLUSION: Analytical agreement is good between the two immunoassays. However there are some discrepancies in quantitative measurement. This may have been due the variation in the standard calibrators used in each assay. Though CLIA showed more variation in the values, it has the advantage of being automated test with low turn around time. Therefore, both the test methodologies can be reliably used in place of each other for detection of Anti- HBs titer.

Influence of pseudomonas aeruginosa on exacerbation in patients with bronchiectasis.

BACKGROUND: A majority of the studies done on the western population have shown that Pseudomonas aeruginosa causes many severe infections in patients with bronchiectasis as compared to other pathogens. There is scarcity of similar data from the Asian population. MATERIALS AND METHODS: A prospective study was undertaken to identify the various pathogens isolated from the respiratory samples of 117 patients with bronchiectasis from south India and to compare the clinicomicrobiological profile of infections caused by P. aeruginosa and other respiratory pathogens. RESULTS: The respiratory pathogens were isolated from 63 (53.8%) patients. P. aeruginosa was the most common isolate (46.0%) followed by Klebsiella pneumoniae (14.3%) and other pathogenic bacteria. Patients included in the P. aeruginosa group had a higher number of exacerbations (p: 0.008), greater number of hospital admissions (p: 0.007), a prolonged hospital stay (p: 0.03), and poor lung function, compared to the patients infected with the non-Pseudomonas group. CONCLUSION: It is necessary to investigate the etiology of respiratory tract infections among bronchiectasis patients followed by the prompt management of cases diagnosed with P. aeruginosa infections, so as to lower the morbidity and have a better prognosis.

Prevalence of Clinical Periodontitis and Putative Periodontal Pathogens among South Indian Pregnant Women.

In view of recent understanding of the association of periodontal infections and adverse pregnancy outcomes, the present investigation was undertaken to study the periodontal infections among 390 asymptomatic pregnant women and to find an association of bacterial etiologies with the disease. Prevalence of gingivitis was 38% and clinical periodontitis was 10% among the study population. Subgingival plaque specimens were subjected to multiplex PCR targeting ten putative periodontopathogenic bacteria. Among the periodontitis group, high detection rates of Porphyromonas gingivalis (56%), Prevotella nigrescens (44%), Treponema denticola (32%), and Prevotella intermedius (24%) were noted along with significant association with the disease (P < 0.05).

Stenotrophomonas maltophilia in Lower Respiratory Tract Infections.

BACKGROUND: Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia due to its characteristic inherent resistance to many broad- spectrum antibiotics. In this study we evaluated the demographic, clinical and microbiological profile of patients with lower respiratory tract infection due to Stenotrophomonas maltophilia. MATERIALS AND METHODS: A retrospective analysis of 33 patients diagnosed with Stenotrophomonas maltophilia lower respiratory tract infections during a period of two years from 2012 - 2013 was done. RESULTS: The predominant predisposing factor observed was mechanical ventilation in 17(51.5%) cases. Fluoroquinolones were the most effective antibiotic (26;78.8%) followed by trimethoprim-sulfamethoxazole (24;72.7%). Among the 19 patients treated with proper antibiotic, 13(68.4%) showed clinical improvement. Among the 14 patients who did not receive appropriate antibiotic for Stenotrophomonas maltophilia infection, 8(57.1%) showed improvement. Two (6%) had blood culture positive for Stenotrophomonas maltophilia. Mortality rate was 21.2%. CONCLUSION: Stenotrophomonas maltophilia is emerging as an important nosocomial pathogen with increased risk in patients on mechanical ventilation in ICU. Empiric therapy should include agents active against S.maltophilia such as newer flouroquinolones and trimethoprim-sulfamethoxazole.

Acute post-traumatic endophthalmitis secondary to Propionibacterium acnes.

Propionibacterium acnes has rarely been reported as the causative organism in acute endophthalmitis following penetrating ocular trauma. We report a 53-year-old man, who presented with best corrected vision of counting fingers at 2 m,

Multidrug resistant Gram-negative bacilli in lower respiratory tract infections.

BACKGROUND: Lower respiratory tract infections are among important causes of morbidity and mortality for all age groups. The emergence of multidrug resistant Gram-negative bacilli is an issue of increasing concern. MATERIALS AND METHODS: A retrospective study including respiratory specimens (sputum and BAL) was conducted in our tertiary care centre. Samples were processed for microscopy, culture and susceptibility testing following standard methods. Multidrug resistant Gram-negative bacilli causing lower respiratory tract infections were studied for their causation of disease. The effect of appropriate treatment on clinical outcome was observed. RESULTS: A total of 472 Gram-negative pathogens were isolated from sputum and broncho-alveolar lavage fluid specimens during the study period. Among these Gram-negative pathogens 175 (37%) were found to be multidrug resistant. Klebsiella pneumoniae 85 (48.6%) and Acinetobacter spp. 59 (33.7%) were the predominant multidrug resistant Gram-negative bacilli isolated. Based on clinico-microbiological correlation, 138 (78.9%) multidrug resistant isolates were found to be pathogenic and the rest 37 (21.1%) were considered as colonizers. After initiating appropriate antibiotic therapy, clinical improvement was seen in 110 (79.7%) patients. In the patients who showed improvement, amikacin (34.3%) and cefoperazone-sulbactum (21.8%) were found to be the most effective drugs. CONCLUSION: A large majority of the isolated multidrug resistant Gram-negative bacilli were found to be pathogenic. Regular surveillance which directs appropriate empirical therapy; and good clinic-microbiological workup of each case of lower respiratory tract infection can reduce the morbidity and mortality associated with multidrug resistant organisms.

Clostridium difficile infection at a tertiary care hospital in south India.

OBJECTIVE: The objective of this study was to detect C. difficile in patients presenting with Antibiotic Associated Diarrhoea. METHODS: Stool samples from twenty-five patients collected over a period of four months were processed for C. difficile by culture and the isolates were identified following standard methods. C. difficile toxins A and B and C. perfringens enterotoxin were detected by ELISA performed directly on stool specimens. RESULTS: Four patients (16%) were found positive for C. difficile infection. All patients with C. difficile infection received prior treatment with third-generation cephalosporins or beta-lactam/beta-lactamase inhibitor antibiotics. C. perfringens enterotoxin was found in two (8%) patients. Severe colitis was seen in one (25%) of the four patients who had co-infection with C. difficile and C. perfringens. CONCLUSION: This study demonstrated a significant occurrence of C. difficile infection in this hospital population. There is a need to further evaluate the role of C. perfringens in causing antibiotic associated diarrhoea. Good clinical and laboratory studies to generate local epidemiological data are essential to increase awareness among the treating clinicians about C. difficile infection. Also limited and rational use of broad spectrum antibiotics is recommended.