Refractory giardiasis in a child with steroid-resistant nephrotic syndrome.

Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia intestinalis and one of the most common parasitic intestinal diseases in humans worldwide. It mainly manifests as a self-limited illness in the case of immunocompetent patients and usually does not require treatment. However, immunodeficiency is a risk factor for the onset of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazole therapy is presented. A 7-year-old male patient with steroid-resistant nephrotic syndrome came to our hospital because of chronic diarrhoea. The patient was on long-term immunosuppressive therapy. Microscopic examination of stool showed a significant number of trophozoites and cysts of G. intestinalis. Treatment with metronidazole for longer duration than recommended has failed to clear the parasite in the present case.

Cystic Echinococcosis of Liver and Spleen Communicating to the Lung: A Rare Case.

The annual cystic echinococcosis (CE) incidence in endemic countries is between 1 and 200 per 100,000 population. The clinical manifestations of CE are associated with damage or dysfunction of target organs and affect primarily the liver in around 70% of cases and lungs in around 20% of cases. The involvement of the spleen is rarely seen, representing 2 to 6% of all CE cases. We describe a 60-year-old female patient who presented with 15 days' history of intermittent fever and abdominal distension, having significant hepatosplenomegaly. CE was diagnosed involving the liver, spleen, and lungs and was confirmed radiologically and microbiologically. CE is caused by the larval or cystic stage of the zoonotic dog-tapeworm. Humans can be infected by ingestion of contaminated food or water. At present, there are nine species under the genus Echinococcus with E. granulosus sensu stricto having worldwide distribution, while the rest are focally distributed. CE involving multiple organs is rare. CE should be taken into consideration in patients with these symptoms in endemic areas.

Multidrug resistant superbugs in pyogenic infections: a study from Western Rajasthan, India.

INTRODUCTION: the crude mortality rate due to infectious diseases in India is approximately 417 per one lakh persons and pyogenic infections are one of the significant contributor. Poor antimicrobial stewardship in India has led to an increase in multidrug resistant superbugs in both community as well as hospital settings. The aim of this study was to identify the bacterial etiology of pyogenic infections and to evaluate their antimicrobial resistance profile. METHODS: this is a retrospective observational study from January, 2018 to December, 2018. A total 1851 samples, collected as a part of patient care were included in this study. Specimens were subjected to culture on Blood agar and MacConkey agar and incubated at 37°C for 48 hours. Species identification was done as per standard laboratory protocol. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion according to Clinical and Laboratory Standards Institute guidelines. RESULTS: of total 1851 samples, culture was positive in 61.54%. A total 70.59%, Gram negative organisms were isolated followed by Gram positive cocci in 45.48%, yeast in 1.05%, coryneform bacteria in 0.79% and in one case, non-tubercular mycobacteria was isolated. Staphylococcus aureus (30.9%) was the predominant organism isolated. Most common multi drug resistant isolates were Klebsiella spp. (74.79%) and Acinetobacter spp. (74.32%). CONCLUSION: this study gives an insight about the prevalence and common etiology of pyogenic infections along with their antimicrobial resistance profile in north western region of India. This study will contribute in formulating antibiotic stewardship program by selecting the antibiograms of pyogenic isolates.

Spectrum of leprosy among suspected cases attending a teaching hospital in Western Rajasthan, India.

BACKGROUND: Leprosy is a chronic granulomatous infectious disease, which mainly involves skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. According to National Leprosy Eradication Programme 2017-18 annual report, the annual new case detection rate from Rajasthan is 1.27 per 1 lakh population and prevalence rate is 0.14. AIMS AND OBJECTIVE: The main objective of this study was to determine the spectrum of Mycobacterium leprae infections among suspected cases attending a teaching hospital in western Rajasthan, India. MATERIALS AND METHODS: This is a retrospective study conducted in the Department of Microbiology, in a teaching hospital, western Rajasthan, between the period of January 2017 and April 2019. The records of modified Ziehl-Neelsen staining during the study period were analyzed. The demographic data like age and sex along with clinical diagnosis were also recorded from laboratory register and hospital information system. RESULTS: Out of total 91 suspected cases, 30.77% was microbiologically confirmed cases of leprosy. Out of total positive cases, 71.43% were male and 28.57% were female. A maximum number of positive (50%) were found in the age group of 31-50 years. CONCLUSION: Present study gives an insight about the spectrum of leprosy in the region. The large number of positive cases signifies that leprosy awareness and programs aimed at elimination need to be more vigorously implemented. To achieve complete eradication from this menace, newer strategies like effective vaccine development and drug-resistance testing should be implemented.

An injection abscess due to M. fortuitum: A rare case report.

An iatrogenic injection abscess is usually easy to treat if caused by aerobic bacteria but some rapidly growing mycobacteria (RGM), namely, Mycobacterium fortuitum, M. chelonae, and M. abscessus are associated with postinjection abscess and may cause delayed wound healing. RGM can cause mild localized cellulitis or abscess to osteomyelitis following penetration injuries or unsafe injection practices. A 7-year-old girl was presented to pediatric surgery OPD with abscess formation over the right buttock. Incision and drainage from abscess were performed in OPD and pus sample was sent for aerobic bacterial culture and sensitivity. On gram stain plenty of pus cells with no microorganism were seen and growth on blood agar after 48 h of aerobic incubation at 37°C showed small off-white pinpoint, smooth butyrous waxy colonies. Smear prepared from blood agar showed uniformly stained short, slender, faintly stained gram-positive bacilli, for which acid-fast staining (1% and 20% H2SO4) was performed that showed acid-fast bacilli. The isolate was further identified by the molecular method and was confirmed to be Mycobacterium fortuitum by genotype Mycobacterium CM VER 1.0 (HAIN LIFESCIENCE, BioMerieux India Pvt. Ltd.).

Dermatophytoses and spectrum of dermatophytes in patients attending a teaching hospital in Western Rajasthan, India.

INTRODUCTION: About 20-25% of the world's populations are infected with dermatophyte and the incidence of the disease is increasing steadily. In India, the cause of dermatophytoses is adversely influenced by economic factors such as poverty, poor hygiene and social conditions like overcrowding. The main objective of this study was to determine the prevalence, etiological agents, and distribution patterns of the disease among the patients attending a teaching hospital, Jodhpur. MATERIALS AND METHODS: This is a retrospective study conducted in the Department of Microbiology and Department of Dermatology of a teaching hospital, Jodhpur from January 2017 to May 2018. The microbiological records of potassium hydroxide (KOH) mount examination and the fungal culture report of skin, hair, and nail samples during the study period were analyzed. RESULTS: A total 363 skin, hair, and nail samples were received for fungal culture as investigations requested by dermatologist. Out of total 363 samples, KOH mount was positive in 58.4% and the culture was positive in 44.07% cases. Dermatophyte was isolated in 40.22% cases. Trichophyton mentagrophytes was the predominant dermatophyte (55%) isolated followed by T. tonsurans (22.5%) and T. rubrum (6.25%). CONCLUSION: The present study gives an insight about the prevalence and distribution pattern of dermatophytoses in Jodhpur, India. Tinea corporis was the most commonly diagnosed clinical condition followed by Tinea cruris. T. mentagrophytes was implicated as the predominating species.

Chronic Candida osteomyelitis of hard palate and nose: A diagnostic quandary.

Candida induced osteomyelitis is infrequent. There is scarcity of literature on this entity in maxillofacial region and thus there is possibility to mismanage such cases. We are presenting a case of chronic maxillofacial Candida tropicalis osteomyelitis causing palatal and septal perforation with saddle nose deformity in a young lady with commencement and progression of disease process over two pregnancies. Diagnosis was established by histopathology and repeated isolation on culture. Debridement followed by adequate antifungal therapy instituted.