A study of the association between virulence factors and antifungal susceptibility profile of Candida species recovered from cases of vulvovaginal candidiasis.

Background: The incidence of mycotic infections, especially of Candida, has gradually increased over the past few years. In clinical practice, azoles are the most frequently used antifungal agents and the growing incidence of systemic candidiasis and resistance to antifungals have become a matter of concern worldwide. Virulence factors in Candida spp. may be critical for predicting the response of antifungal drugs. Objectives: This study aimed to identify the relationship between virulence factors and the antifungal susceptibility of Candida. Methodology: This cross-sectional study was conducted on a sample of 55 Candida strains isolated from vulvovaginal samples of patients in the reproductive age group, presenting with signs and symptoms of vulvovaginitis in a large tertiary care hospital in central India. Results: A majority of the Candida were sensitive to three tested drugs (89% to amphotericin B, 76.4% to fluconazole, and 89.1% to voriconazole). Resistance to fluconazole was highest at 16.4%. No significant relationships were identified between antifungal sensitivity of the three azoles with biofilm formation, phospholipase, or proteinase synthesis. Conclusions: High level of antifungal resistance to the three antifungals, especially to voriconazole, is worrisome; however, none of the virulence markers have a significant association with antifungal sensitivity of Candida species. This finding rules out the effect of the virulence of the pathogen on drug response.

SXT constin among Vibrio cholerae isolates from a tertiary care hospital.

BACKGROUND & OBJECTIVES: The SXT element, also known as 'constin' (conjugable, self transmissible, integrating element) is an integrating conjugative element (ICE) in Vibrio cholerae discovered in the chromosome of epidemic V. cholerae O139 strain MO10 (SXT MO10 ) which arose in late 1992 in Chennai, India. SXT related ICEs have become widespread and currently, most if not all Asian V. cholerae clinical isolates contain SXT related ICEs. The present study attempts to determine the presence of SXT Int gene in V. cholerae recovered between 2005 to 2007 in a tertiary care hospital, demonstrate its conjugal nature and also detect co-presence and co-transfer of plasmids in representative isolates. METHODS: This prospective study was done on 116 V. cholerae isolates [114- O1 (107 ogawa and 7 inaba) and 2 - Non O1 Non O139 V. cholerae] from watery stools between 2005 to 2007 recovered from equal number of patients. PCR was carried out using SXT Int specific primers that produced a 592 bp internal fragment of SXT element, and rifampicin resistant strain of E.coli K-12 was used as recipient in conjugation experiments to study transfer of SXT, as also co-transfer of resistance to tetracycline, erythromycin, and nalidixic acid. Antibiotic susceptibility was performed against various antibiotics. RESULTS: Of the 116 isolates, 110 (94.8%) were positive for SXT element by PCR. It was demonstrated in 94.7 per cent of the O1, and 100 per cent of non O1 non O139 V. cholerae. All 2005 isolates, 25 per cent of 2006 isolates and 96.6 per cent of 2007 isolates were positive for SXT. Thirty two drug resistance patterns were observed and the 2007 isolates showed resistance to as many as eight antibiotics. The resistance of SXT positive isolates was higher than those of SXT negative and the typical drug resistance pattern corresponding to SXT ET and SXT MO10 was shown by only one V. cholerae O1 isolate. Successful conjugal transfer of SXT was seen in 31 (88.6%) of the 35 isolates studied without any co-transfer while, presence of plasmids was observed in two of the 31 donor V. cholerae studied. INTERPRETATION & CONCLUSIONS: The demonstration of SXT element and its successful horizontal transfer in V. cholerae isolates studied emphasizes the need for its detection to monitor antibiotic resistance and dissemination in V. cholerae.

Acrophialophora fusispora: an emerging agent of human mycoses. A report of 3 new clinical cases.

Acrophialophora fusispora is a soil-borne fungus, which is emerging as a human pathogen. Only four cases of human infection had been described previously. We describe three more cases, two from Europe and one from India. Since this fungus has been misidentified in several other cases, it is probably more frequent than first thought.

Typhoidal Salmonellae: Use of Multi-Locus Sequence Typing to Determine Population Structure.

Enteric fever is an invasive infection predominantly caused by Salmonella enterica serovars Typhi and Paratyphi A. The pathogens have evolved from other nontyphoidal salmonellaeto become invasive and host restricted. Emergence of antimicrobial resistance in typhoidal salmonellae in some countries is a major therapeutic concern as the travelers returning from endemic countries carry resistant strains to non endemic areas. In order to understand the epidemiology and to design disease control strategies molecular typing of the pathogen is very important. We performed Multilocus Sequence Typing (MLST) of 251 S. Typhi and 18 S. Paratyphi strains isolated from enteric fever patients from seven centers across India during 2010-2013to determine the population structure and prevalence of MLST sequence types in India. MLST analysis revealed the presence of five sequence types (STs) of typhoidal salmonellae in India namely ST1, ST2 and ST3 for S. Typhi and ST85 and ST129 for S. Paratyphi A.S. Typhi strains showed monophyletic lineage and clustered in to 3 Sequence Types-ST1, ST2 and ST3 and S. Paratyphi A isolates segregated in two sequence types ST85 and ST129 respectively. No association was found between antimicrobial susceptibility and sequence types. This study found ST1 as the most prevalent sequence type of S. Typhi in India followed by ST2, which is in concordance with previous studies and MLST database. In addition a rare sequence type ST3 has been found which is reported for the first time from the Indian subcontinent. Amongst S. Paratyphi A, the most common sequence type is ST129 as also reported from other parts of world. This distribution and prevalence suggest the common spread of the sequence types across the globe and these findings can help in understanding the disease distribution.