Emergence of imported cutaneous leishmaniasis caused by Leishmania major: a case series from Kerala, India.

Cutaneous leishmaniasis (CL) is often considered a 'great imitator' and is the most common form of leishmaniasis. The Leishmania species responsible for CL varies among countries, as these species exhibit specific distribution patterns. The increased mobility of people across countries has resulted in the imported incidences of leishmaniasis caused by non-endemic species of Leishmania. During 2023, we confirmed three CL cases caused by L. major from Kerala, India, and upon detailed investigation, these were identified to be imported from the Middle East and Kazakhstan regions. This is the first report of CL caused by L. major from Kerala. The lesion morphology, detection of anti-rK 39 antibody and Leishmania parasite DNA from the blood samples were the unique observations of these cases. Kerala, being an emerging endemic zone of visceral leishmaniasis (VL) and CL, the imported incidences of leishmaniasis by non-endemic species can pose a significant threat, potentially initiating new transmission cycles of leishmaniasis caused by non-endemic species.

Prevalence of bla (CTX M) extended spectrum beta lactamase gene in enterobacteriaceae from critical care patients.

CONTEXT: Critical care units provide a favourable environment for the antimicrobial resistant organisms to disseminate. There is recent increase in number of extended spectrum beta lactamase (ESBL) producers because of the emergence of CTX M Beta lactamases produced by Enterobacteriaceae. They colonize the intestinal flora and spread with greater intensity in the community and hospital. Usage of Carbapenems becomes mandatory as the ESBL inhibitor combination antibiotics (Amoxicillin/Clavulanate) are not effective especially against CTX M ESBLs. AIM: The aim of this study is to detect ESBL producing bla CTX M gene in Enterobacteriaceae from infections in Critical care patients and to stress on the intensity of the problem and to make interventions to curb the emergence and dissemination of CTX M ESBLs. MATERIALS AND METHODS: A total of 118 Enterobacteriaceae isolates from Critical care unit patients were recovered from a variety of clinical specimens. Antimicrobial susceptibility test was done and isolates with resistance or with reduced susceptibility to any of the third generation Cephalosporins were selected for the study. Phenotypic confirmation of ESBL production was done by Double Disc Synergy Test and confirmed by minimum inhibitory concentration. Multiplex polymerase chain reaction was performed to screen the four groups of CTX-M ESBLs. RESULTS: Among the 118 isolates of Enterobacteriaceae 54 isolates were positive for CTX-M group I ESBL which constitutes 45.7 %. CONCLUSIONS: Early detection of CTX M producing Enterobacteriaceae by continuous surveillance and thereby reducing their spread and restricted use of third generation Cephalosporins (3GC) antibiotics could be the possible routes to prevent the emergence and spread of CTX M ESBL producing organisms.

Pyopericardium due to group D streptococcus.

Beta-hemolytic Enterococcus faecalis was isolated from the pericardial fluid obtained from a patient with pyopericardium. The patient was immunocompetent and had mild pleural effusion. He was treated with parenteral co-amoxiclav and amikacin, had underwent pericardiectomy with repeated pericardial aspiration, and recovered completely. To our knowledge, this is the first report of pyopericardium due to E. faecalis .

Severe Dupuytren's contracture of the proximal interphalangeal joint: treatment by two-stage technique.

Thirty-four patients with a Dupuytren's contracture in excess of 70 degrees of the proximal interphalangeal (PIP) joint were treated by preliminary palmar fasciotomy, release of the accessory collateral ligaments and PIP joint distraction using the S-Quattro for 6 weeks. A formal fasciectomy with full thickness skin graft was then performed 2 weeks after removal of the fixator. There was a mean residual flexion deformity of the PIP joint of 22 degrees (mean correction of 67 degrees) at an average follow-up of 30 months. There were no infections or amputations. We recommend this technique for the management of severe Dupuytren's contracture of the PIP joint.

Streptococcal pharyngitis: is penicillin still the drug of choice?

With the advent of cephalosporins, penicillin appears to have lost some ground for treatment of Acute Group A Beta Hemolytic Streptococcal Pharyngitis. It has been argued for some time now whether penicillin should remain the drug of choice for the management of this infection. Evidence has been presented both in favour and against using penicillin for Group A beta hemolytic streptococcal (GABHS) pharyngotonsillitis. In this commentary, we review the available data in the current literature and conclude that penicillin should still remain the drug of first consideration for GABHS pharyngitis. If penicillin treatments were less effective now, the clinical and bacteriologic failure rates should be on the rise compared to the previous years.

Effect of antiepileptic drugs valproic acid, carbamazepine and ethosuccimide on exploratory behaviour in mice.

Valproic acid in 100, 200 and 400 mg/kg doses produced a significant dose dependent decrease in exploratory behaviour, tested as number of head dips on the hole board. In the open field test, control mice entered less number of peripheral squares and more number of central squares on day 4 as compared to day 1 of the test. In the lower doses (100 and 200 mg/kg) valproic acid increased central square entries on day 1 with significant decrease by all doses on subsequent days indicating inhibition of exploratory behaviour. However, in peripheral square entry they followed the same pattern as control mice. Neither carbamazepine (10 and 20 mg/kg) nor ethosuccimide (100 and 200 mg/kg) affected exploratory behaviour in either the hole board or open field test.