Molecular epidemiology of methicillin resistant staphylococcus aureus colonizing the anterior Nares of school children of Udupi Taluk.

CONTEXT: Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) cause serious skin and soft tissue infections including necrotizing fasciitis and necrotizing pneumonia. Production of Panton Valentine Leucocidine (PVL) toxin is implicated in its enhanced virulence. A variant of epidemic MRSA-15 (EMRSA-15) which produces PVL toxin has been isolated and characterized by pulsed-field gel electrophoresis (PFGE) method from the Indian population both in hospital and community settings. AIMS: Identify the epidemiological type of MRSA colonizing the anterior nares of school children in Udupi taluk. SETTINGS AND DESIGN: The study population included children of the age group of 5-16 years belonging to the Udupi taluk of Karnataka, India. A total of 1503 children were screened for MRSA colonization during July 2009 to December 2010. MATERIALS AND METHODS: PVL assay, Staphylococcal Cassette Chromosome (SCC) mec typing and PFGE typing were carried out with all the MRSA isolates. STATISTICAL ANALYSIS USED: Frequency distribution of different variables was assessed by SPSS. RESULTS: Among the 1.1% of MRSA, 58.8% (10/17) of isolates were positive for pvl and 41.7% (7/17) were identified as SCC mec type IV. PFGE patterns of all the strains were identical with Indian variant EMRSA-15; however they were different from classical EMRSA-15 in 3-4 bands. CONCLUSIONS: The Indian variant EMRSA-15 gains much epidemiological relevance owing to the acquisition of pvl gene. In spite of low prevalence of nasal colonization of MRSA, emergence of the virulent Indian variant EMRSA-15 in our community is a worrisome fact to be reckoned with.

Necrotizing fasciitis caused by a variant of epidemic methicillin resistant Staphylococcus aureus -15.

We report a case of necrotizing fasciitis (NF), caused by community-acquired epidemic methicillin resistant Staphylococcus aureus 15 (EMRSA 15). The patient had a prolonged recovery period following treatment with antibiotics and surgical debridement of the infected part. Molecular characterization revealed that the isolate carried Staphylococcal Cassette Chromosome mec (SCC mec) type IV harboring Panton-Valentine Leucocidin (pvl) gene and having accessory gene regulator (agr) type I. The isolate was positive for enterotoxin gene cluster (egc). Pulsed field gel electrophoresis patterns revealed that the isolate belonged sequence type 22, which is an Indian variant of EMRSA 15, reported earlier.

Melioidosis in southern India: epidemiological and clinical profile.

Melioidosis, which is mainly prevalent in Thailand and Australia, has shown an increasing trend in India in the last few years. We carried out a retrospective study of 25 culture-proven adult cases of melioidosis who were admitted to a tertiary care hospital in southern India during June 2001 to September 2007. There was a six-fold increase in the number of cases in 2006 and 2007 as compared to 2001. Diabetes mellitus was the predisposing factor in 68% of cases, followed by alcoholism (28%). The clinical presentations were fever (80%), pneumonia and/or pleural effusion (48%), hepatomegaly (56%), joint involvement, and/or osteomyelitis (48%), splenomegaly (40%), splenic abscess (24%) and septicemia (28%). The organism, Burkholderia pseudomallei, was sensitive to co-amoxiclav, cotrimoxazole, ceftazidime, and carbapenem. The study suggests that melioidosis is an emerging infectious disease in the southwestern coastal belt of India, and it is likely to happen at much higher incidence.

Ventilator-associated pneumonia with Col-S strains: a successful comeback of colistin!

Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broad-spectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.

Emerging extra-intestinal infections with Aeromonas hydrophila in coastal region of southern Karnataka.

BACKGROUND: Aeromonas species are gram-negative rods usually isolated from the gastrointestinal tract. They have been occasionally reported as a cause of extra-intestinal infections such as cellulitis, cholangitis, necrotizing fascitis, meningitis, bacteremia, or peritonitis in both immunocompetent and immunocompromised patients. AIM: To determine the role and possible pathogenesis of Aeromonas in extra-intestinal infections. SETTINGS AND DESIGN: Retrospective analysis carried out at Kasturba Hospital Manipal, Karnataka in the months of January and February 2007. MATERIALS AND METHODS: Clinical manifestations and management of eight cases of extra-intestinal infections caused by A. hydrophila , from the south Karnataka coastal region were reviewed. The isolates were identified with the help of biochemical tests using standard guidelines. RESULTS: All patients acquired Aeromonas infections in the community. Five (62.5%) had underlying illnesses, such as liver disease, diabetes mellitus or malignancy. Five (62.5%) had polymicrobial infections, and three (37.5%) were complicated with bacteremia. These included three patients with ulcers or abscess over the lower leg, two with cellulitis due to snake bite and one each with pelvic inflammatory disease, spontaneous bacterial peritonitis and pneumonia. A. hydrophila was found to be a causative agent of pelvic inflammatory disease or cellulitis following sea snake bite, and such a clinical scenario has not been previously described. Seven patients survived the illness. CONCLUSIONS: Isolation of A. hydrophila from extra-intestinal specimens demands utmost clinical and microbiological vigilance in diagnosis, since the organism can cause serious infections among immunocompromised as well as immunocompetent individuals.

Citrobacter freundii infection in glutaric aciduria type 1: adding insult to injury.

Glutaric aciduria type 1 (GA1) is an inborn error of organic acid metabolism, where the brain is the principal organ affected with exposure to toxic metabolic product, 3-hydroxyglutaric acid (3-OHGA). A 2-year-old boy with GA1 and delayed developmental milestones had an acute neurological crisis leading to massive brain abscess with Citrobacter freundi infection, a rare cause of neonatal meningitis and often associated with brain abscess. Both 3-OHGA and C. freundii can damage the blood-brain barrier and can cause significant trauma which demands immediate and appropriate management. Encephalopathic manifestations of GA1 may consequently increase the risk of meningeal infection and it has not been previously documented.

Ventilator-associated pneumonia with Col-S strains: a successful comeback of colistin!

Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broad-spectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.

Spectrum of opportunistic infections in AIDS cases.

Human Immunodeficiency viruses are the initial causative agents in AIDS, but most of the morbidity and mortality in AIDS cases result from opportunistic infections, Identification of such pathogen is very important for clinicians and health planners to tackle the AIDS epidemic in more effective manner. The present study describes the clinical and laboratory profile of 100 AIDS causes who presented to a referral hospital. Oral candidiasis (59.00%) was found to be the most common opportunistic infection, followed by tuberculosis (56.00%), Cryptosporidium infection (47.00%) and Pneumocystis carinii (7.00%). Presence of oral candidiasis and weight loss is highly predictive of low DC4 count and can be considered as a marker of HIV disease progression. The patients coinfected with HIV and tuberculosis are also on rise. Recognition of dual infection and taking adequate steps to deal with this epidemic is needed. As Cryptosporidium infection was detected in large number, provision of safe drinking water and maintaining good hygiene is important for prevention. Early diagnosis of opportunistic infection and prompt treatment, delays the progression towards AIDS. 91.00% of patients were infected with HIV1 and 4.00% had HIV2 infection and 5.00% were dully infected. 87.00% of patients were males and 13.00% were belonging to 21-40 years of age. Majority of them were belonging to lower socioeconomic status and heterosexual route of transmission was the commonest mode of spread.

Bacteraemia in high-risk patients.

In this study, we noticed a high incidence of bacteraemia in high-risk patients especially due to nonfermenter gram negative bacilli (NFGNB) and coagulase negative staphylococci (CoNS). Bacteraemia caused by some rare bacteria such as Moraxella spp., Aeromonas spp., Flavobacterium meningosepticum was also noted during the study. Antibiotic resistance pattern showed that many isolates were Multi Drug Resistant (MDR). This can be attributed to nosocomial-infection, which may occur due to more and more invasive procedures for diagnosis and therapy during long stay of patients in the hospital. Also, the MDR strains and the wide spread oxacillin resistant CoNS (OR-CoNS) and slowly emerging vancomycin resistant CoNS (VR-CoNS) associated with nosocomial infections pose a great threat to the clinicians. We recommend the usage of commonly used antibiotics along with cephalosporins for the patients admitted to these high-risk units, before the antibiotic susceptibility test findings.

Seroprevalence of HIV in Manipal.

A total of 32,406 persons were screened for HIV 1 and 2 antibodies between 1991 to 1999 by Enzyme Linked Immuno Sorbent Assay at Dept. of Microbiology, KMC, Manipal which is a rural teaching hospital. There was steady increase in seropositivity from 0.38% (1991) to 9.31% (1995) and thereafter there is decrease in the seropositivity rate to 4.15% (1999); but the number of cases screened increased from 1995 onwards. The HIV seropositivity is more in males 7.49% than in females (2.52%). The male to female positivity ratio is 2.72:1, inspite of the total number of samples screened of either sexes being equal. The prevalence of HIV among STD Clinic attendants was 8.22%. The foci of infection can be traced to cities such as Mumbai and the main mode of transmission is through unprotected heterosexual contact. The decrease in the seropositivity rate from 1996 onwards could be due to the AIDS awareness among public due to the control programmes. More awareness and public education is needed towards healthy sexual practices to avoid fresh HIV cases.

Pneumonia due to Trichosporon beigelii infection in HIV positive patient--a case report.

Pulmonary infection due to Trichosporon beigelii is uncommon. A case of Pneumonia in a 28 year old male patient with positive HIV status, secondary to Trichosporon beigelii is reported.

Salmonella senftenberg: ear infection. A case report.

A case of Otitis media, a rare complication of Salmonella senftenberg infection is reported.