Outbreak of Ralstonia mannitolilytica in Hemodialysis Unit: A Case Series.

Ralstonia mannitolilytica is a Gram-negative soil bacteria. It is an emerging opportunistic pathogen in hospital-acquired infections. Maintenance hemodialysis patients at Manipal Hospital Outpatient Haemodialysis unit, Bengaluru, witnessed an outbreak of R. mannitolilytica infection between October 2016 and November 2016. Five patients were infected and one of them presented with infective endocarditis. All patients were successfully treated with antibiotic according to culture and sensitivity pattern. Immediately following the outbreak, environmental sampling was done. The culture from sterile water was positive for R. mannitolilytica growth. The Department of Infection Control ordered for discarding the whole batch of sterile water followed by water treatment with shock chlorination and room disinfection. Following implementation of the same, the outbreak of R. mannitolilytica infection was controlled. R. mannitolilytica infections are hospital acquired, affecting mainly immunocompromised patients. The disease onset and progression is rapid. Early identification of the organism and treatment with appropriate antibiotics is important.

Dense Deposit Disease Involving C3 and C4d Deposits.

Dense deposit disease (DDD), earlier called Type II membranoproliferative glomerulonephritis is distinct disease having frequent relapses reaching end-stage kidney disease by 10-year in up to 50%-60% of cases and high recurrence rate in the allograft. The term DDD is derived from its distinctive ribbon-like osmiophilic deposits in the lamina densa of glomerular basement membrane by electron microscopy. Pathogenetically, alternate pathway dysfunction leads to this disease, which is diagnosed by ultrastructure. Herein, we describe our observation of C4d positivity in an adolescent boy with DDD.

Primary hyperparathyroidism in a child.

Primary hyperparathyroidism is rare in children. We report a 12-year-old girl who presented with recurrent renal calculi, muscular weakness and inability to walk; was diagnosed to have parathyroid adenoma and underwent parathyroidectomy.

Sunitinib induced nephrotic syndrome and thrombotic microangiopathy.

Sunitinib is an oral, multitargeted receptor tyrosine kinase inhibitor of targets such as vascular endothelial growth factor and platelet derived growth factor receptor. It is used for the treatment of metastatic renal cell carcinoma (RCC). Use of sunitinib has been associated with renal dysfunction and nephrotic syndrome. However, simultaneous occurrence of nephrotic syndrome and renal dysfunction in a patient treated with sunitinib is rare. We report a case of metastatic RCC treated with sunitinib for 22 months who presented with nephrotic syndrome and renal dysfunction. Renal biopsy was diagnostic of thrombotic microangiopathy with diffuse effacement of podocytic foot process.

Postrenal transplant laryngeal and visceral leishmaniasis - A case report and review of the literature.

Visceral leishmaniasis (kala-azar) is a disease caused by protozoa of genus Leishmania. It is currently regarded as the second most dreaded parasitic disease, next to malaria. There have been very few case reports of visceral leishmaniasis among the renal transplant recipients. We present a renal allograft recipient with symptoms of fever, sore throat, hoarseness of voice, lymphadenopathy, splenomegaly, and pancytopenia after 7 years post-transplant period. On investigating, he was diagnosed to have extensive visceral leishmaniasis with laryngeal involvement. Despite extensive PubMed literature search, we could not find any case report of postrenal transplant visceral and laryngeal leishmaniasis and to the best of our knowledge this is the first case report of this kind.

Diffuse mesangial sclerosis - Report of two cases.

Diffuse mesangial sclerosis (DMS) is a rare cause of nephrotic syndrome in the infantile and childhood period. DMS is a phenotypic expression of syndromic entities such as WAGR syndrome (Wilms' tumor, aniridia, genitourinary anomalies and mental retardation), Denys Drash syndrome, Pierson syndrome, Frasier syndrome, or Galloway-Mowat syndrome. We report two cases of DMS, one presenting in first year of life and another in second decade of life. Both of them had fatal outcome. Recognition of the disease is very important in modifying the management of patient and active surveillance of family members.