Clinical and microbiological profile of Viridans group streptococcal bacteraemia; experience from South India.

Background: Viridans Group Streptococci (VGS) are a group of distinct species that can cause bacteraemia and other invasive infections. They are also among the common organisms causing infective endocarditis. Data on the epidemiology and clinical profile of VGS is limited, especially from India. Methods: We conducted an electronic medical record-based retrospective analysis of patients with VGS bacteraemia admitted to our hospital between January 2012 to December 2021. Blood cultures were incubated by BacT/ALERT system and bacterial identification and susceptibility testing were done by using the VITEK 2 microbial identification system. Susceptibility test reporting was as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The incidence, clinical profile, source of bacteraemia, co-morbidities and antimicrobial resistance among VGS bacteraemia were analyzed. Results: VGS were isolated in 219 patients, accounting for 3.2% of positive blood cultures during the period studied. The median age of the patients was 58 years and 69% were males. Diabetes mellitus was the most common co-morbidity (55%) followed by chronic kidney disease and chronic liver disease. Patients with haematological malignancy and neutropenia were few. Intra-abdominal infections were the most common source of infection and was noted in 26%. Infective endocarditis was diagnosed in only 10% of the cases. Streptococcus mitis was the most common species isolated followed by S. gallolyticus and S. sanguinis. 9.58% of the isolates could not be identified up to the species level. Overall penicillin susceptibility was 71% and ceftriaxone susceptibility was 92%, with individual species variation. In-hospital mortality was 19%. Conclusions: VGS are an important cause of bacteraemia and was associated with 19% mortality in our study. High rates of penicillin and ceftriaxone resistance are a reason of concern. Molecular diagnostics like matrix assisted laser desorption ionization-time of flight (MALDI-TOF) identification must be increasingly applied for species identification considering that a substantial number of isolates were not identified to species level.

Duodenal obstruction due to Strongyloides stercoralis in a patient with HTLV-1 infection.

Strongyloides stercoralis is a nematode helminth endemic to tropical and subtropical regions. Strongyloidiasis can manifest with varied clinical symptoms, predominantly gastrointestinal. Duodenal obstruction is an uncommon manifestation. We report such a patient with underlying Human T-lymphotropic virus type 1 (HTLV-1) infection.

Necrobiotic Xanthogranuloma as the Presenting Manifestation of Smouldering Myeloma.

Necrobiotic xanthogranuloma is a rare dermatological manifestation of underlying hematological malignancies, in particular, when associated with paraproteinemia. These patients who are clinically symptomatic with chronic papules, nodules or plaques which demonstrate a histopathological pattern suggestive of extensive and frequently confluent areas of necrobiosis with granulomatous infiltration, warrant evaluation for an underlying monoclonal gammopathy.