Traumatic implantation keratitis caused by Schizophyllum commune in Central India.

We present two cases with a history of trauma to the cornea and after a few days patients developed symptoms of corneal ulcers with one showing hypopyon as well. Due to strong suspicion of fungal keratitis both cases were treated with topical and intravenously voriconazole. Fungal culture showed white fluffy growth which was identified as Schizophyllum commune by conventional and molecular methods. In both cases surgical intervention was essential. Therapeutic keratoplasty was done in both cases but failed. Unfortunately, both patients lost vision in the affected eyes.

Unilateral complicated pleural empyema in a patient with bronchial asthma due to clindamycin-resistant Prevotella buccae.

Prevotella buccae (P. buccae) is a gram-negative obligate anaerobe mainly associated with infections of odontogenic origin. Non-oral monomicrobial infection by these obligate anaerobic bacteria is rare. Only a few cases of monomicrobial non-oral infections by P. buccae have been reported in the literature. We are reporting a case of unilateral complicated pleural empyema in a patient with bronchial asthma infected by P. buccae. Pleural fluid aerobic culture and blood culture reports were sterile. No acid-fast bacilli were detected by Acid Fast Bacilli (AFB) staining, and cartridge-based nucleic acid assay test (CBNAAT) reports were negative for Mycobacterium tuberculosis. The isolate, P. buccae was found susceptible to Metronidazole (MIC = 3 µg/ml) and resistant to Clindamycin (MIC = 256 µg/ml). In view of rising trends of antimicrobial resistance among anaerobes, it is recommended to perform anaerobic culture and sensitivity testing in clinically suspected cases of pleuropulmonary infection for appropriate diagnosis and optimal patient management. Clindamycin should be used with caution for empiric treatment.

A Psittacine bite and subcutaneous basidiobolomycosis: A case with a therapeutic challenge.

Basidiobolus ranarum is a saprophyte that can be found in soil, rotting vegetables, and frogs' digestive tracts. Clinically, basidiobolomycosis presents as a persistent infection of subcutaneous tissue affecting the trunk and extremities in an immunocompetent host. We describe a case of subcutaneous basidiobolomycosis in a 56-year-old immunocompetent woman farmer by occupation residing at remote part of central India. This study highlights the traumatic implantation and zoonotic potential of fungal species. Clinical suspicion of fungal etiology and timely mycology laboratory diagnostic support is key to address such cases. This case is documented to emphasize the problems of compliance to treatment specially in remote and poor patients challenging the treatment with complete cure. 2012 Elsevier Ltd. All rights reserved.

Rhino sinusitis caused by Lasiodiplodia theobromae in a diabetic patient.

We report an uncommon instance of rhinosinusitis by Lasiodiplodia theobromae in a known diabetic patient. A melanized fungus called Lasiodiplodia theobromae causes a typical plant disease that rots fruits and plants. Infections in humans are currently limited. Mostly from tropical and subtropical regions, there have been few reported occurrences. The fungus has been associated with clinical manifestations such as onychomycosis, corneal ulcers, and phaeohyphomycosis. Identification by phenotype was inconclusive. DNA sequencing was used for final identification. Amphotericin B and surgical debridement were effective treatments for the patient.

Utility of light-emitting diode microscopy for the diagnosis of pulmonary tuberculosis in HIV infected patients.

OBJECTIVE: To determine the utility of light-emitting diode fluorescent microscopy (LED-FM) for the diagnosis of pulmonary tuberculosis (PTB) in HIV-infected patients. MATERIAL AND METHODS: A cross-sectional study was performed on 400 HIV-infected, clinically or radiologically suspected PTB patients. Two sputum specimens were collected from each patient. Two direct smears were prepared from each sputum specimen. One was stained by ZN method and another by auramine-O method and reported as per the Revised National Tuberculosis Control Programme (RNTCP) guidelines. LED-FM stained smears were reported by two readers. All specimens were cultured on LJ medium after digestion and decontamination. Address and contact details of all the patients were recorded in case record form. They were contacted for follow-up if required. RESULTS: Of the 800 sputum specimens processed, 130 were positive by LED-FM method and 33 were positive by ZN method; 77 specimens showed growth of MTB on LJ medium. When compared with solid culture as a reference standard, LED-FM has a sensitivity of 67.53%, specificity of 88.71%, PPV of 40% and NPV of 96.08%. Seventy-eight LED-FM positive and culture negative specimens had scanty grading. Of these, 15 were confirmed as having PTB as they responded to anti-TB treatment. The concordance between two readers was 98.75%. CONCLUSION: LED-FM can be a good screening test for the diagnosis of PTB in HIV-infected patients. However, all scanty grade positive smears need to be confirmed by WHO approved gold standard.