Screening of methicillin-resistant Staphylococcus aureus in healthcare workers and students and its susceptibility to mupirocin in a tertiary care teaching hospital in South India.

BACKGROUND: Staphylococcus is the most common pathogen causing infection in hospitals. They also colonize the healthcare workers who serve as reservoir of infection. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a burning issue throughout the world contributing to significant morbidity and mortality. Use of mupirocin to eradicate the carrier state is the need of the hour. OBJECTIVES: To screen healthcare workers (HCWs) and medical students for MRSA and to know the susceptibility of mupirocin in this group. MATERIALS AND METHODS: A total of 432 students, nursing staff, doctors and house-keeping staff were screened for MRSA for 4 months. The MRSA and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) isolates were then tested for mupirocin resistance. RESULTS: Out of 432 samples, 24 (5.55%) were MRSA and 104 (24.07%) were MRCoNS. Only 4.16% (n = 1) showed high-level resistance to mupirocin among the MRSA isolates, while resistance among MRCoNS was higher at 6.7% (n = 7) for low-level resistance and 17.30% (n = 18) for high-level resistance. CONCLUSION: MRSA colonization of HCWs may serve as a source of infection and mupirocin resistance should be screened for all whether working in Intensive Care Units or not and if detected, alternative treatment should be used which will result in appropriate use of this antibiotic for decolonization.

Clinical and laboratory profile of dengue viral infections in and around Mangalore, India.

BACKGROUND: Dengue (DEN) is being recognised as the world's major emerging tropical disease. Clinically, DEN may resemble other infections such as malaria, leptospirosis, and typhoid, and thus, laboratory investigations are required for definitive diagnosis. Secondary DEN infection, caused most often by dengue virus (DENV) serotypes 2 and 3, is known to present with severe disease manifestations. This study was undertaken to examine the clinical and laboratory profile of DEN viral infections and to determine the circulating serotypes in and around Mangalore, India. MATERIALS AND METHODS: Serum samples from 285 clinically suspected cases of DEN in and around Mangalore between September 2013 and January 2014 were processed for detection of DEN IgM and IgG antibodies and nonstructural 1 (NS1) antigen using commercial ELISA kits. Detection of DEN viral RNA and serotyping was done by multiplex real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical and haematological profiles of the patients were analysed. RESULTS: Serum samples from 83 (29%) patients were positive for DEN NS1 antigen and/or IgM antibodies. 33 (45%) out of 73 serum samples processed by multiplex real-time RT-PCR were positive for DEN viral RNA. DEN-1, -2 and -3 were the serotypes identified in this study. Fever was the most common presenting symptom followed by myalgia/arthralgia. Majority of the patients had thrombocytopaenia. CONCLUSION: Early detection of DEN can be achieved effectively using NS1 ELISA and IgM capture ELISA. Circulating DENV serotypes should be closely monitored for prevention of fatal outcomes in secondary infections.

Isolation and Characterization of an Unknown Chrysosporium sp. Producing Subcutaneous Mycosis in an Immunocompromised Patient.

We report a case of subcutaneous fungal abscess over the great toe caused by a keratinophilic fungus, an unknown Chrysosporium sp., in a 60-year-old diabetic female who was treated successfully with oral fluconazole. The fungus was isolated from aspirated pus, and septate hyphae were seen in fine needle aspiration cytology. Ovoid- to club-shaped hyaline one-celled conidia (aleuriconidia) with broad truncated bases were seen, and sequencing of ITS1-5.8S-ITS2 rDNA revealed belonging to the order Onygenales and most closely related to Chrysosporium spp. isolated from a fowl. Of the 65 species within the genus Chrysosporium, very few have been reported as pathogenic.

Salmonella Paratyphi B septicemia in a Neonate.

Septicemia is a major cause of death in neonates especially in developing countries. We report a case of septicemia in a neonate due to Salmonella Paratyphi B. The baby responded well to therapy and recovered completely.

The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form Biofilms.

BACKGROUND: In spite of the decreasing incidence of orthopaedic device related infections to 1%, nowadays, device-related infections still remain a diagnostic, therapeutic and cost -related problem. AIMS AND OBJECTIVE: To record the common causative organisms and the contributing risk factors for orthopaedic device-related infections in a tertiary care teaching hospital. METHODS: In a prospective study, fifty patients who underwent orthopaedic device implantation from Jan 2009 - June 2010 were enrolled; among them, 42 patients were complicated with infections. The demography, microbiological data, treatment and the outcome of each patient were recorded. STATISTICAL ANALYSIS: The data was analyzed in terms of frequency and percentage. RESULTS: Of the 50 samples, 42(84%) were culture positive, while 8(16%) were cultures negative. The femur was the most commonly affected bone in both males (median age-37.1yrs) and females (median age-41.3 yrs). Staphylococcus aureus was the organism which was most commonly isolated and which caused biofilms, followed by non-fermenting, gram negative bacilli and Klebsiella spp. We reported the first case till date in the literature of Candida krusei PJI, to the best of our knowledge. No anaerobes were isolated. Tissue trauma, open fractures, post-operative surgical site infections and Diabetes mellitus were found to be the important risk factors. The biofilm forming organisms were commonly associated with polymicrobial infections and even an aggressive antibiotic therapy was often inadequate to eliminate the infections. A conservative surgical treatment was associated with treatment failures. Implant removal or replacement was required in most of the cases to eradicate the infection. CONCLUSION: The most common bacteria which were isolated included Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella. A majority of them are resistant to the commonly used antibiotics, leading to treatment failures which necessitated an implant removal.

Rhodococcus equi: a pathogen in immunocompetent patients.

Rhodococcus equi is an uncommon human pathogen known to cause lung infections in immunocompromised patients. We report two cases of Rhodococcus infections in immunocompetent individuals, who were treated successfully.

Fusarium Solani: a causative agent of skin and nail infections.

Fusarium spp are non-dermatophytic hyaline moulds found as saprophytes and plant pathogens. Human infections are probably a result of various precipitating predisposing factors of impaired immune status. Immunocompetent individuals of late are also vulnerable to various unassuming saprophytic and plant pathogens. To stress the need to identify correctly and institute appropriate antifungal therapy in newly emerging human fungal infectious agents. Repeated mycological sampling of the skin and nails of the suspected fungal infection were processed as per the standard format including direct microscopy and fungal culture on Sabouraud's dextrose agar. The fungus was isolated as Fusarium solani. Fusarium is an important plant pathogen and soil saprophyte. Infection is acquired by direct inoculation or inhalation of spores. It is associated with a variety of diseases like keratitis, onychomycosis, eumycetoma, skin lesions and disseminated diseases.

Case series: elizabethkingia meningosepticum.

Elizabethkingia meningosepticum is a saprophyte which exists in hospital water systems and it can be a potential source for nosocomial infections. Though the infection with these bacteria is rare, one should be aware that it is resistant to most of the antibiotics and that it has the ability to cause nosocomial infections. We are reporting here, a series of cases which were caused by E. meningosepticum.

Corynebacterium macginleyi` a rare bacteria causing infection in an immunocompromised patient.

Corynebacterium species are normal flora of skin and mucous membrane. In recent years, coryneforms have emerged as important opportunistic pathogens in immunocompromised patients. Majority of the Corynebacterium macginleyi isolates are from conjunctiva and cornea. The only reported non ocular isolates are from urinary tract infection, intra-venous catheter related infection, valvular endocarditis and septicaemia. We report herein a rare case of C. macginleyi isolated from tracheostomy site secretions in a patient with carcinoma larynx which was treated successfully with Cefoperazone-sulbactum for seven days and replacing tracheostomy tube. This is the first case of C. macginleyi reported from India.

Spectrum of melioidosis in the suburbs of Mangalore, S West Coast of India.

Melioidosis is an emerging infection in India. Seventeen cases of culture proven melioidosis are reported in this study. The isolation rate was high during the rainy season. Except one case, all the patients had diabetes mellitus as an underlying disease. Eleven patients improved with ceftazidime or combination therapy and maintenance therapy with doxycycline and Cotrimoxazole. The high prevalence of B. pseudomallei in this region is a matter for serious concern.

Melioidotic pericardial effusion.

Aim is to present a rare case of purulent pericardial effusion caused by Burkholderia pseudomallei. Pericardial sample was inoculated into Bactec Peds Plus/F broth of the Bactec automated system. After the system flagged positive, the broth was subjected to Gram stain, biochemical tests and drug susceptibility. The organism was identified as Burkholderia pseudomallei. Tuberculosis (TB) is the most common cause of pericarditis in countries where it remains a major public health problem, but in the western coastal districts of India, clinicians and microbiologists alike must be aware of Burkholderia pseudomallei a rare cause of pericarditis that can be misdiagnosed as TB pericarditis.

Salmonella Wien from gastroenteritis cases encountered in Mangalore, India: a report of 10 cases and review of the literature.

Ten cases of gastroenteritis due to S. Wien were reported from a tertiary care hospital in Mangalore, in the month of April 2008. Biochemically, it resembles S. Paratyphi B or S. Typhimurium. Serotyping was done at the Central Research Institute, Kasauli, to confirm the identity. The food source is more likely to be chicken or some poultry products. All the 10 cases recovered with symptomatic treatment including antimicrobials like fluoroquinolones. To the best of our knowledge, no documented report is available from India regarding the prevalence of this organism in humans.