Genotypically Confirmed Vancomycin-Resistant Staphylococcus aureus With vanB Gene Among Clinical Isolates in Kathmandu.

Purpose: Methicillin-resistant Staphylococcus aureus, a common bacterial pathogen causes various infections. The acquisition of various antimicrobial-resistant genes in S. aureus has led to the transformation of this bacterium into a superbug. Vancomycin resistance among MRSA isolates is an emerging threat in empirical therapy of various infections. The study was hence aimed to find out the susceptibility status of S. aureus isolates toward vancomycin and detect mecA, vanA, and vanB genes among the isolates. Methods: A total of 1245 clinical samples from the participants attending a tertiary care hospital in Kathmandu were processed. S. aureus isolated from the samples were subjected to antibiotic susceptibility patterns using the modified Kirby-Bauer disk diffusion method. Agar dilution method was used to determine the minimum inhibitory concentration of vancomycin. The antibiotic-resistant genes such as mecA, vanA, and vanB among S. aureus isolates were screened by a conventional polymerase chain reaction. Results: Of 1245 samples, 80 S. aureus were identified. Out of which, 47.5% (38/80) were phenotypically confirmed MRSA isolates. mecA gene was detected in 84.2% (32/38) of MRSA isolates. 10.5% (4/38) were confirmed as vancomycin-intermediate S. aureus (VISA) by MIC determination. None of the isolates was positive for the vanA gene; however, 2 isolates were found to possess the vanB gene. The 2 isolates have vancomycin MIC breakpoints of 4 to 8 µg/mL. Conclusion: There might be a spreading of vancomycin resistance among S. aureus, creating serious public health problems. Therefore, measures to limit vancomycin resistance should be considered in healthcare facilities as immediately as possible.

Kerion Celsi in a Nepalese Boy: An Underdiagnosed Cause of Scalp Swelling.

Tinea capitis (TC) is an infection of the scalp and hair caused by a dermatophyte fungus. Typically caused by the zoophilic and geophilic species of Microsporum and Trichophyton, it remains the commonest cutaneous fungal infection in children. A 9-year-old Nepalese boy was evaluated in outpatients for multiple boggy scalp lesions for two months. Suspecting a bacterial etiology, the lesions were excised and sent for cultures. While bacterial cultures failed to grow, endothrix spores were readily detected in potassium hydroxide preparation and histopathology. Trichophyton tonsurans was identified by the phenotype method and later confirmed by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF). Systemic antifungal therapy for 6 weeks along with local wound dressings resulted in complete recovery. At 2-year follow-up, focal alopecia was seen; however, no recurrence was noted.