ABSTRACT
We report a patient who developed a meticillin-resistant Staphylococcus aureus (MRSA) central venous catheter infection complicated by infective endocarditis. The patient was initially treated with glycopeptides, which led to the development of heterogeneous glycopeptide resistance, the detection of which required the use of a macro Etest screening test. Subsequently, the causative strain, confirmed by PFGE as a UK epidemic MRSA-15, was treated with daptomycin, and again resistance developed in vivo. The development in vivo of resistance to both these agents suggests that the resistance mechanisms may be associated. We suggest that the clinician managing MRSA infection should anticipate daptomycin resistance when reduced glycopeptide susceptibility is detected.
Subject(s)
Anti-Bacterial Agents/pharmacology , Daptomycin/pharmacology , Endocarditis, Bacterial/microbiology , Glycopeptides/pharmacology , Methicillin-Resistant Staphylococcus aureus/drug effects , Staphylococcal Infections/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/microbiology , Daptomycin/therapeutic use , Drug Resistance, Multiple, Bacterial , Endocarditis, Bacterial/drug therapy , Glycopeptides/therapeutic use , Heart Valve Prosthesis Implantation , Humans , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Mitral Valve/surgery , Renal Dialysis/adverse effects , Renal Dialysis/instrumentation , Renal Insufficiency/complications , Renal Insufficiency/therapy , Staphylococcal Infections/drug therapyABSTRACT
Antistreptolysin O (ASO) levels vary with age group of the study population and geographical locations. The present study was undertaken to determine the upper limit of normal of ASO in 200 normal children of 5-15 years of age with no history of recent sore throat infection. The standard tube dilution method (WHO) was used for estimating ASO titers. It was found that 239 IU was the upper limit of normal in the study population, which can be considered as the baseline ASO titer. This can provide useful guidelines for physicians in the interpretation of elevated ASO titers in cases of suspected acute rheumatic fever.
Subject(s)
Antistreptolysin/immunology , Rheumatic Fever/diagnosis , Streptococcus pyogenes/immunology , Adolescent , Age Factors , Antistreptolysin/blood , Child , Child, Preschool , Cohort Studies , Female , Humans , India , Male , Reference Values , Risk Assessment , Sampling Studies , Sensitivity and SpecificityABSTRACT
Sputum smear microscopy is the most efficient and rapid technique for detection of acid-fast bacilli (AFB). Fluorochrome method of staining is preferred for Mycobacteria in the overburdened laboratories as the fluorescing bacilli are more readily detected than the fuchsin stained bacilli in shorter period of time. A total of 300 sputum samples obtained from suspected cases of Tuberculosis were collected and were subjected to staining by rhodamine auramine at 37 degrees C and also at room temperature (conventional method). The smears were then blindly evaluated. Fifty-eight samples were positive by both methods and 5 were positive at 37 degrees C only. Staining at 37 degrees C increased the smear positivity by 8.6% over conventional staining at room temperature. No smears were positive only with staining at room temperature alone. Out of 58 smears positive by both methods, 25 had equal number of AFB in both smears, 22 had more AFB in smear stained at 37 degrees C and 11 had greater number of AFB in smears stained at room temperature. Our study, therefore, indicates that rhodamine auramine staining at 37 degrees C is superior to conventional auramine method at room temperature for detecting AFB in sputum smears.