Case Series: Microbacterium aurum Bacteremia in Immunosuppressed Patients-An Emerging Threat.

Blood stream infection with Microbacterium species in humans is rare and frequently linked to the presence of immunosuppressed conditions such as patients on chemotherapy or corticosteroids. Presence of indwelling catheters is also a potential risk factor for M. aurum infection. No case report has been documented in the literature regarding the pathogenic potential of M. aurum in causing bacteremia. This is the first case series reporting bacteremia by M. aurum describing the risk factors and sensitivity pattern of this pathogen. In this case series, we have described bacteremia caused by M. aurum. The risk factors and sensitivity pattern of this pathogen have also been evaluated. Here, we describe the clinical course and presentation of three patients whose blood culture showed growth of M. aurum. Indwelling venous catheter for hemodialysis or for chemotherapy for the treatment of acute lymphoblastic leukemia was found to be a risk factor in two patients. Rheumatoid arthritis was the underlying condition in the second patient and was started on immunosuppressants. Blood samples were collected during the febrile period. The blood culture samples of all these patients had pure isolates of M. aurum, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. All three patients were managed according to the sensitivity reports and were discharged in stable condition.

Epidemiology and Clinical Features of Burkholderia Bacteremia at a Hospital in India.

Burkholderia spp. are opportunistic pathogens that cause infection in patients with disrupted immunity. The study intended to demonstrate the epidemiology and clinical features associated with Burkholderia spp. bacteremia. This retrospective study was performed to assess the clinical and laboratory characteristics of patients whose blood cultures were growing Burkholderia spp. and, based on their underlying comorbidities, were subjected to survival analysis from January 2022 to December 2022 at a university hospital in northern India. Three hundred patients with Burkholderia spp. bacteremia were included in this study conducted over 1 year. The mean age of the patients was 33.86 years with a male predominance of 56.67% (170/300, 56.67%). Underlying malignancies (207/300, 69.0%) were the most common clinical diagnosis, and catheter in situ (300/300, 100.0%) was the most common risk factor. Burkholderia cenocepacia (244/300, 81.33%) was the most common Burkholderia spp. isolated. All isolates were highly susceptible to minocycline. Kidney disease (P = 0.029), hypertension (P = 0.005), type 2 diabetes mellitus (P = 0.039), and respiratory disease (P <0.001) in patients were significantly associated with death owing to Burkholderia spp. bacteremia, whereas patients with malignancies (P <0.001) and undergoing treatment were significantly associated with a better outcome when the microorganism was susceptible to empirical antibiotics. The presence of indwelling devices, mechanical ventilation (P <0.001), and a hemodialysis catheter (P = 0.026) were statistically significant risk factors associated with poor outcomes.

Characterization of Leuconostoc lactis Bacteremia during a 2-year Study at a Tertiary Care Center in North India-An Observational Analysis.

Leuconostoc species are regarded as important causes for many infections in immunocompromised patients. In this study, we assessed the characteristics of Leuconostoc spp. causing bacteremia in patients at our center. This observational analysis was conducted in the microbiology laboratory of a tertiary care center in northern India from July 2021 to July 2023. Patients in whom blood culture bottles were positive for Leuconostoc lactis were included in the study. Culture isolates were identified by MALDI-ToF MS as L. lactis and tested for antibiotic sensitivity results by Kirby-Bauer disk diffusion method. Demographic and clinical details were collected and analyzed. During the study period, 6,742 blood culture bottles flagged positive. Among these, L. lactis was isolated from 14 (0.21%) patients. The median patient age was 34 years. The male-to-female ratio was 2.5:1. All the patients with L. lactis bacteremia had an underlying condition leading to immunosuppression (e.g., carcinoma and chronic kidney disease). All the patients with L. lactis bacteremia had an intravascular device present at the time of bacteremia. All isolates in the study were sensitive to doxycycline, high level gentamicin, minocycline, ampicillin-sulbactam, and linezolid. Mortality was attributed to bacteremia by L. lactis in five patients. Appropriate and timely identification of the Leuconostoc species is important for the clinician to tailor regimens for the patients.

Case Report: Case Series of Kocuria palustris Bacteremia among Immunocompromised Patients.

Kocuria species are normal commensals of the skin that have been found in various environmental niches and are usually considered nonpathogenic. However, according to recent literature, Kocuria spp. have been associated with human infections. Kocuria palustris is an emerging opportunistic pathogen with great potential to cause disease in immunocompromised patients. The isolation and identification of this pathogen is necessary, as timely treatment with the appropriate antibiotics can help in reducing mortality among these patients. We present three cases of bacteremia in immunocompromised patients admitted to our hospital; one patient was receiving chemotherapy for gall bladder carcinoma, the second was on maintenance hemodialysis for chronic kidney disease, and the third was receiving chemotherapy for acute myeloid leukemia. All three patients presented with a fever in the setting of neutropenia during the course of treatment with chemotherapy (in Cases 1 and 3) or hemodialysis (in Case 2). The blood culture samples of all the patients had pure isolates of Kocuria species K. palustris, which was identified by matrix assisted laser desorption ionisation- time of flight mass spectrometry (MALDI-ToF MS). All three patients presented with febrile neutropenia during the course of treatment with chemotherapy (in Cases 1 and 3) or hemodialysis (in Case 2).

Comparison of Human Papillomavirus Genotype Detection in Paired Urine and Self-Collected Cervical Swabs: A Pilot Study.

OBJECTIVES: With the objective of establishing a simple, cost-effective, and effective screening tool for the screening of Human Papilloma Virus infection, the study was undertaken. MATERIAL METHODS: This pilot study was conducted on 20 urine samples of women whose cervical swabs were tested positive while screening for Human papilloma virus in asymptomatic women. RESULTS: HPV genotypes were detected in 94% (16/17) patients in urine samples by real-time PCR while a 100% detection rate (15/15) was observed in the cervical swab samples. The results of the urine and cervical swab samples, tested by the TRUPCR ®HPV high-risk genotyping kit, are shown in Table 2. HPV genotype 68 was found in 82.3% urinary samples and 100% of self-collected vaginal swab samples. Out of 16 positive urine samples, 2 were positive for HPV genotype 16 and 5 were positive for HPV genotype 18, and in cervical swab testing out of 15 positive samples, 3 were positive for HPV genotype 16, and 5 were positive for HPV genotype 18. Diagnostic accuracy of urine was found to be 98.8% (95% CI 79.43% - 100.00%). CONCLUSION: This pilot study aims to assess the accuracy of urine samples in the screening of HPV infection among asymptomatic women and establish the distribution of prevalent HPV genotypes. This may further contribute to standardizing the urine and cervical swab testing methods for cervical cancer screening strategies.

Cyclosporiasis in immunocompetent and immunocompromised patients - A Twelve years experience from a tertiary care centre in Northern India.

Context: Cyclosporiasis is an emerging enteric coccidian parasitic disease worldwide, caused by the parasite Cyclospora cayetanensis. There is scanty data from India, especially among immunocompetent patients. Aims: The aim is to evaluate the occurrence of Cyclosporiasis in immunocompetent and immunocompromised patients. Settings and Design: It is a prospective cohort study conducted from June 2006 to May 2018 at our tertiary care center. Materials and Methods: Stool samples were collected from the 900 patients with diarrhea (both immunocompetent and immunocompromised) and 170 healthy controls to look for Cyclospora by modified Kinyoun staining. Statistical Analysis: Mann-Whitney U test/Fisher exact test were used for statistical analysis. Results: Oocysts of C. cayetanensis were detected in 10/900 patients and none of the healthy controls. The median age of patients was 38.5 years (10-65 years) and males (6/10) outnumbered the females in harboring the parasite. Eight patients were immunocompromised (five postrenal transplant cases and one-one patient each with HIV, non-Hodgkin's lymphoma, and juvenile polyarthritis), and two patients were immunocompetent. Cyclospora infection was more common in immunocompromised patients (8/300, 2.67%) than the immunocompetent patients (2/600, 0.33%); P < 0.001. Eight patients responded well to trimethoprim-sulfamethoxazole, one died, and one was lost to follow-up. Coinfection with Cryptosporidium spp. was seen in one patient. Conclusion: Cyclospora causes diarrhea in both immunocompromised and immunocompetent persons. Its burden may be underestimated due to a lack of awareness and appropriate diagnostic methods. Special staining techniques are important for diagnosis as they may be missed by routine microscopy.

The utility of multiplex polymerase chain reaction for diagnosis of infectious diarrhoea in a tropical country.

PURPOSE: The etiology of infective diarrheaoften remains undiagnosed. We studied the role of multiplex polymerase chain reaction (PCR) for detection of etiological agents of diarrhoea. METHODS: Fast track diagnostics (FTD)gastroenteritis panel for bacterial and viral pathogens was used to test stool samples from patients with diarrhoea. RESULTS: Stool samples from 276 patients (138 immunocompetent and 138 immunocompromised) with diarrhoea and 138 healthy controls were tested. Bacterial culture was positive in 5 samples. Following agents were isolated: Shigella sonnei(2), Shigella dysentriae(1), SalmonellaParatyphi B(1) and Vibrio cholerae (1). Multiplex PCR panel did not include Vibrio cholerae in its panel. A total of 65 target pathogens were identified in 60/276 (21.7%) patients by multiplex PCR. 28/65(41.1%) and 37/65 (56.9%) were bacterial and viral agents respectively. Identified bacteria were Shigella(20), Salmonella(3), Campylobacter(4) and Clostridium difficile(1). Viral targets identified were Norovirus GII (28), Adenovirus(4), Astrovirus(3) and Sapovirus(2). All the controls were negative for enteropathogens by conventional methods and multiplex PCR. CONCLUSIONS: Our detection rates increased from 1.8% (5/276)by conventional methods to 21.7% (60/276)by multiplex PCR, which included both bacterial as well as viral targets.

Prevalence and Genetic Characterization of Cryptosporidium and Microsporidia Infecting Hematological Malignancy Patients.

PURPOSE: To evaluate the prevalence of Cryptosporidium and Microsporidia, associated risk factors and species identification in patients with haematological malignancies (HM). METHODS: A total of 148 consecutive patients with HM and 101 healthy subjects were evaluated for Cryptosporidium and Microsporidia using modified Kinyoun and modified Trichrome staining. Clinical, demographic and laboratory parameters were studied. The species of Cryptosporidium and Microsporidia were studied using PCR-RFLP. RESULTS: Of 148 HM patients initially screened, 47 were excluded from the final analysis due to inadequate clinical records. Patients with HM [n = 101, 63 (62.4%) male] more often had Cryptosporidium than healthy subjects [n = 101, 65 (74.4%) male] [3/101 (3%) vs. 0/101 (0%), p = 0.02]. Two of 101 (2%) HM patients and none of the healthy subjects had Microsporidia (p = 0.155). Diarrhea was more prevalent in HM patients with Cryptosporidium than those without [3, 100% vs. 39/96, 40.62%; p = 0.04). Both patients infected with Microsporidia presented with persistent diarrhea and fever. Cryptosporidium hominis was identified in all the three HM patients. Enterocytozoon bieneusi was identified in one HM patient infected with Microsporidia, which was classified as genotype Ind2. CONCLUSION: Cryptosporidium and Microsporidia may infect HM patients leading to overwhelming diarrhea. The commonest species of Cryptosporidium and Microsporidia found to infect HM patients are C. hominis and E. bieneusi.

Nanoparticles based therapeutic efficacy against Acanthamoeba: Updates and future prospect.

Acanthamoeba sp. is a free living amoeba that causes severe, painful and fatal infections, viz. Acanthamoeba keratitis and granulomatous amoebic encephalitis among humans. Antimicrobial chemotherapy used against Acanthamoeba is toxic to human cells and show side effects as well. Infections due to Acanthamoeba also pose challenges towards currently used antimicrobial treatment including resistance and transformation of trophozoites to resistant cyst forms that can lead to recurrence of infection. Therapeutic agents targeting central nervous system infections caused by Acanthamoeba should be able to cross blood-brain barrier. Nanoparticles based drug delivery put forth an effective therapeutic method to overcome the limitations of currently used antimicrobial chemotherapy. In recent years, various researchers investigated the effectiveness of nanoparticles conjugated drug and/or naturally occurring plant compounds against both trophozoites and cyst form of Acanthamoeba. In the current review, a reasonable effort has been made to provide a comprehensive overview of various nanoparticles tested for their efficacy against Acanthamoeba. This review summarizes the noteworthy details of research performed to elucidate the effect of nanoparticles conjugated drugs against Acanthamoeba.

Acanthamoeba and its pathogenic role in granulomatous amebic encephalitis.

Acanthamoeba is a free-living amoeba that is widely distributed in the environment. It is an opportunist protist, which is known to cause rare yet fatal infection of the central nervous system (CNS), granulomatous amebic encephalitis (GAE) in humans. GAE cases are increasingly been reported among immunocompromised patients, with few cases in immunocompetent hosts. Diagnosis of GAE primarily includes neuroimaging, microscopy, cerebrospinal fluid (CSF) culture, histopathology, serology and molecular techniques. Early diagnosis is vital for proper management of infected patients. Combination therapeutic approach has been tried in various GAE cases reported worldwide. We tried to present a comprehensive review, which summarizes on the epidemiology of GAE caused by Acanthamoeba along with the associated clinical symptoms, risk factors, diagnosis and treatment of GAE among infected patients.

A road less travelled: Clinical comparison of HIV seropositive and seronegative patients with cystoisosporiasis - An 11-year experience from a tertiary care centre in Northern India.

BACKGROUND: Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. METHODOLOGY: Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. RESULTS: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 ± 81.12cells/µL, mean absolute eosinophil count (AEC) was 229.16 ± 175.62 cells/µL and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 ± 414.88 cells/µL, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. CONCLUSION: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.