Rapid detection of drug-resistant Mycobacterium tuberculosis by Modified MODS assay suitable for resource-poor settings.

BACKGROUND: Cross contamination and biosafety are concerns with the microscopic observation drug susceptibility assay. To address these issues, we modified the MODS technique in the current study. METHODOLOGY/PRINCIPAL FINDINGS: Two hundred and seventy-five samples were processed on LJ media and drug susceptibility was performed by the Indirect agar proportion method. A modified MODS test was done in tissue culture bottles. GenoType MTBDRplus assay was performed to detect the resistance and mutational pattern associated with the resistances. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of tuberculosis by modified MODS were 97.44%, 80.00%, 97.44%, and 80.00% respectively. The perfect agreement was seen between modified MODS and the Indirect agar proportion method for drug susceptibility testing of isoniazid (kappa = 0.923) and rifampicin (kappa = 1). The contamination rate, cost and TAT for modified MODS were less as compared to the solid media. In the case of MDR-TB isolates S531L (66.66%) was the most prevalent mutation in the rpoB gene followed by S315T2 mutation (58.33%) and T8C (41.66%) in katG and inhA gene respectively. In hetero-resistant strains, C-15T mutation (37.50%) was the most common followed by A-16G (12.50%) in the inhA gene. In INH mono-resistant strains only two mutations were observed i.e., S-315T1(50%) and C-15T (50%) in the katG and inhA genes respectively. CONCLUSIONS/SIGNIFICANCE: Modified MODS proved to be cost-effective and user-friendly, with minimal risk to the handler and no cross-contamination between samples were observed. Hence, it can be used in low-income countries for early detection of tuberculosis and its resistance.

Synthesis, Characterization, and Antimicrobial Activity of Ultra-Short Cationic ß-Peptides.

The development of new antibiotics is urgently required because of the rapidly growing resistance against conventional antibiotics. The antimicrobial peptides show potential as small antibiotic molecules. The stability of peptides is a primary concern for the use of peptides as drugs. Introducing ß-amino acids into peptide sequences can be useful in preventing biological degradation by proteolytic enzymes. Herein, we describe the synthesis, characterization, and antimicrobial activity of ultra-short cationic ß-peptides, LA-ß3,3-Pip-ß2,2-Ac6c-PEA, P1; LA-ß3,3-Pip(G)-ß2,2-Ac6c-PEA, P2; LAU-ß3,3-Pip-ß2,2-Ac6c-PEA, P3, and LAU-ß3,3-Pip(G)-ß2,2-Ac6c-PEA, P4. Peptides P1-P4 were evaluated against Gram-negative, Gram-positive, MRSA, and multi-drug resistant E. coli (MDR-E. coli). P3 exhibited the most potent antimicrobial activity against E. coli, S. epidermidis, S. aureus, K. pneumoniae, S. mutans, and E. faecalis, with MIC values 0.5, 2, 0.5, 1, 2, and 1 µg/mL, respectively. P3 exhibited time- and concentration-dependent bactericidal activities against E. coli, S. aureus, and E. faecalis with a killing rate of 1.6 logs/h. The treatment of E. coli with peptide P3 showed membrane disruption. In addition, P3 exhibited the inhibition of biofilm produced by E. coli, synergism with antibiotics (ciprofloxacin, streptomycin, and ampicillin), 100% cell viability against AML12, RAW 264.7, and HEK-293 cell lines at 1, and 10 µg/mL concentrations.

Identification and pattern of antifungal susceptibility of Candida species isolated from cases of vaginitis in a tertiary care hospital in India.

Background and Objectives: Vulvovaginal candidiasis (VVC) is one of the most frequent reasons for gynecological consultations. Candida albicans is responsible in the majority of cases. Lately, VVC caused by non-albicans Candida spp. (NAC), which are resistant to routinely used antifungals, is on the rise. This study was designed to determine the prevalence of Candida in patients suffering from vaginitis and to assess the predisposing factors along with identification of Candida species and evaluation of their susceptibility profile. Materials and Methods: High vaginal swabs were collected from 225 women. Sample processing consisted of Gram stain and culture onto Sabouraud's dextrose agar and HiChrom Candida Differential agar. Isolates were identified and speciated using VITEK2 Compact System. Susceptibility testing was done using VITEK2 AST-Y S08 cards and disc diffusion. Results: Candida spp. were isolated from 94 (41.8%) of the cases. C. albicans was the predominant species (71.6%) followed by other NAC spp. (28.4%). Pregnancy and diabetes were the most frequently implicated risk factors (67.1% and 44.4%). High resistance was observed in NAC spp. as opposed to C. albicans to all antifungal agents tested. Conclusion: Empirical therapy with routinely used antifungals can be initiated for C. albicans. In the case of NAC spp., identification should be followed by susceptibility testing.

Glucose metabolic reprogramming and modulation in glycerol biosynthesis regulates drug resistance in clinical isolates of Candida.

AIMS: The study is aimed at understanding the novel molecular mechanisms governing drug resistance in the opportunistic fungi belonging to the genus Candida. METHODS AND RESULTS: This is a multipronged study wherein different assays like drug susceptibility and whole cell proteome analysis, stress tolerance assay, measurement of total internal glycerol content, western blot analysis, reactive oxygen species (ROS) measurement, glucose uptake, lactate production, ATP generation, and NADPH measurements were made.The study reveals an incidence of different species of Candida in the northern most part of India (Kashmir valley). Resistant isolates, mostly resistant to azoles were reported across all the species. The study revealed a difference in resistance mechanisms between Candida albicans and C. glabrata clinical isolates. Further, such resistance mechanism (in the case of C. albicans) was mostly mediated by Hexokinase 2 (Hxk2) and Glucose-6-phosphate dehydrogenase (G6pd). Increased expression of Hxk2 was associated with increased glucose uptake, more lactate production, and more ATP generation in drug-resistant C. albicans. At the same time, increased G6pd expression was responsible for the increased production of NADPH, which imparts a better ROS scavenging potential. While in C. glabrata the resistance was linked with glycerol metabolism, where the drug-resistant isolate tends to accumulate more glycerol as an osmolyte in response to external stresses. This glycerol accumulation was found to be triggered by the HOG1-MAPK pathway. CONCLUSION: The study concludes that, like various human malignant tumors, there is a strong correlation between drug resistance and aberrant cellular metabolism in the opportunistic fungi belonging to the genus Candida.

An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network.

OBJECTIVE: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network. SETTING: A 780-bed, tertiary-level, public teaching hospital in northern India. METHODS: After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash. RESULTS: Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified. CONCLUSIONS: Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

Comparative evaluation of serological tests used for the diagnosis of rickettsial diseases prevalent in the temperate region of North India.

PURPOSE: The clinical manifestations of rickettsial diseases mimic other endemic infections with similar presentations thus posing a serious challenge to clinicians for their diagnosis. For the diagnosis of rickettsial disease serological tests like Weil Felix, ELISA and IFA are used. There are limited studies that have evaluated different serological tests for the diagnosis of rickettsial diseases. Therefore, the present study was undertaken to evaluate the ELISA and Weil Felix test for the diagnosis of rickettsial diseases prevalent in this region. METHODS: Samples from 281 patients clinically suspected of rickettsial diseases were tested for spotted fever group (SFG), typhus group (TG) and scrub typhus group (STG) by Weil Felix, ELISA and IFA was taken as the gold standard. Baseline titers and cut-off ODs were calculated by taking samples from healthy blood donors. RESULTS: The sensitivity, specificity, positive and negative predictive value of Weil Felix test ranged from 30% to 44%, 83.46%-97.86%, 9%-77%, 92-96% respectively. The sensitivity and specificity, positive and negative predictive value of ELISA ranged from 80.77% to 96.15%, 96.33%-98.43%, 70.21%-88.64%, 92.89%-99.60% respectively. Maximum cross-reactions were observed between SFG and STG by the Weil Felix test and between STG and TG by ELISA. CONCLUSIONS: ELISA was found to be sensitive and specific for the diagnosis of rickettsial diseases. It is easy to perform, does not require a technical expert for result interpretation and a large number of samples can be processed at a time.

Evaluation of various phenotypic methods for differentiation of Candida dubliniensis from Candida albicans.

INTRODUCTION: Candida dubliniensis was first identified by Sullivan et al. (1995) in Dublin, Ireland. Its clinical significance is associated with development of fluconazole-resistance and invasive diseases in immunocompromised hosts. C. dubliniensis share many features with C. albicans so has been overlooked and misidentified for a long time. AIMS: Evaluation of various phenotypic tests with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) as a gold standard to find out the best method/methods for identifying C. dubliniensis. MATERIALS AND METHODS: First PCR-RFLP was performed on 186C. albicans and 14C. dubliniensis strains and then five phenotypic tests were performed simultaneously on all the strains. RESULTS: The results of salt tolerance test at 48 h, colony color on HiCrome candida differential agar (HCDA) at 72 h, heat tolerance test at 48 h, xylose assimilation using discs at 72 h and growth on xylose based agar medium (XAM) at 48 h are completely concordant with PCR-RFLP. Colony color on Tobacco agar could differentiate accurately 100% test strains while peripheral hyphal fringes and chlamydosporulation on this agar was seen in only 86% and 87% respectively. Our routine methods proved to be cost effective than PCR-RFLP but the turnaround time was same or more than PCR-RFLP. CONCLUSION: For routine identification of C. dubliniensis we recommend use of colony color on HCDA and growth on XAM as simple, reliable and inexpensive method.

Airway Microbiology in Children with Cystic Fibrosis: A Prospective Cohort Study from Northern India.

OBJECTIVE: The objective of this study is to find the organism profile and antimicrobial susceptibility patterns in children with cystic fibrosis (CF). DESIGN: Prospective cohort study. SETTING: Hospital-based study. INTERVENTION: Sputum cultures/throat swabs were collected from the study population. Relevant details like anthropometry, systemic examination findings and investigations were entered in a pre-designed format. Sputum culture was subjected to microbiological analysis at the hospital microbiology laboratory. MAIN OUTCOME MEASURE: Prevalence of positive sputum/cough swab culture in CF patients, their organism profile and antibiotic sensitivity. RESULTS: A total of 63 patients were enrolled in the study. A total of 136 organisms were grown in our study population. Thirteen different organisms were isolated, which included five gram-positive bacteria, six gram-negative bacteria, eight Candida spp. and one filamentous. Antibiotic sensitivity profile of the Pseudomonas aeruginosa showed excellent sensitivity to all the aminoglycosides, piperacillin-tazobacteum and polymixin, similarly methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus and Enterococcus spp. were uniformly sensitive to vancomycin, linezolid and teicoplanin. Fungal isolates showed 100% sensitivity to all the antifungals tested including azoles and amphotericin B. CONCLUSION: We observed 61% of culture positivity for different organisms in our study. Staphylococcus aureus and P. aeruginosa were the most frequently isolated organisms. Pseudomonas aeruginosa isolates were largely sensitive to aminoglycosides, carbapenems and polymixin. We found an unusually higher incidence of enterococcal infection in our study cohort with few vancomycin-resistant isolates.

Epidemiology of hepatitis B and C viral infections in Ladakh region.

BACKGROUND: Little is known about the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Ladakh, a mountainous region with low population density. We, therefore, determined these and tried to identify risk factors associated with these infections. METHODS: Randomly selected residents of Ladakh region were tested for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc) and antibodies to HCV (anti-HCV). A subset of HBsAg-positive persons were tested for hepatitis B e-antigen (HBeAg) and HBV DNA and those with anti-HCV for HCV RNA. Viral genotype was also determined. RESULTS: Of the 2674 subjects, 141 (5.3%) tested positive for HBsAg, i.e. had current HBV infection and 339 (12.7%) tested positive for either HBsAg and or anti-HBc, i.e. had either current or past infection with HBV. Anti-HCV antibody was detected in 22 (0.8%) subjects. The HBsAg positivity rate was higher in Kargil district (8.3%) than in Leh district (3.3%). No particular risk factor was identified for either infection. Of the 141 and 22 specimens that contained HBsAg and anti-HCV, respectively (one had both), 74 and none tested positive for HBV DNA and HCV RNA, respectively. Of the 29 specimens that had sufficient HBV DNA for genotyping, 21, 7, and 1 specimens had HBV genotypes D, C, and A, respectively. CONCLUSION: The overall prevalence of HBV infection seems to be higher in Ladakh region, especially the Kargil district. The prevalence of anti-HCV was similar to that in other parts of India. ᅟ ᅟ.

Antibiotic resistance in Helicobacter pylori: A mutational analysis from a tertiary care hospital in Kashmir, India.

Background: Helicobacter pylori infection is recognised as type 1 carcinogen by the International Agency of Research on Cancer. Previous studies in our hospital have revealed high prevalence of H. pylori in our population with a high recurrence rate after completion of treatment. This prompted us to undertake this study. Aim: This study aimed to determine common gene mutations leading to resistance to clarithromycin, metronidazole, tetracycline and quinolones in H. pylori in patients attending our hospital. Settings and Design: This is a cross-sectional hospital-based study. The study was approved by the Institutional Ethics Committee. Materials and Methods: This study was conducted on 196 adult dyspeptic patients with an indication for upper gastrointestinal endoscopy. Gastric biopsies collected from them were subjected to histopathological examination, rapid urease test (RUT) and culture. Of the 196 patients, 95 met the inclusion criteria. Drug susceptibility testing (DST) by various polymerase chain reaction-based methods was done for 47 RUT-positive biopsies and 13 H. pylori isolates. Results: Maximum resistance was seen to metronidazole (81.66%) followed by clarithromycin (45%) and quinolones (3.33%). No high-level resistance was seen to tetracycline. In clarithromycin-resistant cases, A2142G mutation was more prevalent than A2143G mutation. Multidrug resistance (resistance to metronidazole and clarithromycin) was seen in 41.66% of patients. Conclusions: Tetracycline and quinolones could be the antibiotics of choice in the eradication of H. pylori in this region, while recurrence of the infection with H. pylori could be expected among patients receiving either metronidazole or clarithromycin, for eradication therapy. DST should be done on a routine basis utilising both phenotypic and genotypic methods to prevent further emergence of resistance in this region.

Predominance of Central Asian and European families among Mycobacterium tuberculosis isolates in Kashmir Valley, India.

BACKGROUND: As there are no data available regarding the strains of Mycobacterium tuberculosis circulating in Kashmir Valley, India, the current study aimed at describing the genetic diversity of M. tuberculosis strains in this region, by spoligotyping and 12-locus-based MIRU-VNTR typing (Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat). METHODS: Sputa from 207 smear positive cases with newly diagnosed pulmonary tuberculosis were subjected to culture for M. tuberculosis. Eighty-five isolates confirmed as M. tuberculosis were subjected to drug susceptibility testing and molecular typing by spoligotyping and MIRU-VNTRs. RESULTS: Drug susceptibility results of 72 isolates revealed 76.3% as fully sensitive while 5.5% as multidrug resistant (MDR). Spoligotyping of 85 isolates detected 42 spoligotypes with 50 isolates (58.8%) clustered into seven spoligotypes. SIT26/CAS1_Del was the major spoligotype (23, 27%) followed by SIT127/H4 (12, 14.1%); CAS lineage (37.6%) was predominant, followed by Haarlem (25.8%) and ill-defined T clade (23.5%). MIRU-VNTR analysis displayed 82 MIRU patterns from 85 strains, including 3 small clusters and 79 unique. MIRU 26 was found to be the most discriminatory locus. CONCLUSIONS: Kashmir Valley has CAS as the predominant lineage of M. tuberculosis similar to the rest of the Indian sub-continent, while it is peculiar in having Euro American lineages such as Haarlem and ill-defined T clade.

Molecular identification of Candida species isolated from cases of neonatal candidemia using polymerase chain reaction-restriction fragment length polymorphism in a tertiary care hospital.

CONTEXT: Candida spp. is an emerging cause of bloodstream infections worldwide. Delay in speciation of Candida isolates by conventional methods and resistance to antifungal drugs in various Candida species are responsible for the increase in morbidity and mortality due to candidemia. Hence, the rapid identification of Candida isolates is very important for the proper management of patients with candidemia. AIMS: The aim was to re-evaluate the identification of various Candida spp. by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) and to evaluate the accuracy, speed, and cost of phenotypic methodology versus PCR-RFLP. SETTINGS AND DESIGN: Hospital-based cross-sectional study. MATERIALS AND METHODS: Ninety consecutive clinical isolates of seven Candida species, isolated from blood of neonates and identified by routine phenotypic methods, were re-evaluated using universal primers internal transcribed spacer 1 (ITS1) and ITS4 for PCR amplification and Msp I restriction enzyme for RFLP. STATISTICAL ANALYSIS USED: Kappa test for agreement. RESULTS: The results of PCR-RFLP were 100% in agreement with those obtained using conventional phenotypic methods. Identification could be achieved within 3 work days by both the methods. Our routine methods proved to be cost effective than PCR-RFLP. CONCLUSIONS: We can continue with our routine phenotypic methods and PCR-RFLP can be used for periodic quality control or when conventional methods fail to identify a species.

Hypertonic xylose agar medium: A novel medium for differentiation of Candida dubliniensis from Candida albicans.

BACKGROUND: Candida dubliniensis is a pathogenic Candida species which shares many phenotypic features with Candida albicans. These similarities have caused significant problems in the identification of C. dubliniensis in an average clinical mycology laboratory. Several phenotypic-based tests have been developed to distinguish C. albicans from C. dubliniensis but none has been demonstrated being sufficient alone for accurate differentiation of the two species. AIM: To facilitate the differentiation of these species, we evaluated the utility of a novel medium 'Hypertonic Xylose Agar Medium' (HXAM). MATERIALS AND METHODS: A total of 200 Candida spp. were tested in this study which included 186 stock strains of C. albicans and 14 strains of C. dubliniensis. Identification of all these strains was confirmed by polymerase chain reaction-restriction fragment length polymorphism using Bln I (Avr II) enzyme. All isolates were inoculated on HXAM, incubated at 28°C and examined for visible growth every day up to 7 days. RESULTS: On this medium at 28°C, all 186 C. albicans isolates showed visible growth at 48 h of incubation whereas none of the 14 C. dubliniensis isolates did so even on extending the incubation period up to 7 days. CONCLUSION: Hence, we propose HXAM as a sole phenotypic method for identifying C. dubliniensis from germ-tube-positive isolates or from stock collections of known C. albicans.

Rapid drug-susceptibility testing of Mycobacterium tuberculosis clinical isolates to first-line antitubercular drugs by nitrate reductase assay: A comparison with proportion method.

OBJECTIVE/BACKGROUND: Early initiation of therapy in patients with tuberculosis is imperative for its control. Conventional methods of susceptibility testing such as the proportion method (PM) require visual detection and counting of colonies that takes up to 6weeks. Rapid and simple phenotypic methods that have been endorsed by the World Health Organization can serve as alternatives. METHODS: In this study, we evaluated the colorimetric nitrate reductase assay, which utilizes the detection of nitrate reduction as an indicator of growth much earlier compared with PM (within 7-14days). The susceptibility of 75 clinical isolates of Mycobacterium tuberculosis to four first-line antitubercular drugs was tested by nitrate reductase assay and compared with the standard PM. In this assay, inoculation was done on both drug-free and drug-containing Löwenstein-Jensen medium containing sodium nitrate. After incubation for 7-14days, reduction to nitrite was taken as an indicator of growth, which was detected by color change on addition of Griess reagent. RESULTS: Agreement between nitrate reductase assay and PM was 100% for rifampicin, 97.30% for isoniazid, 93.30% for streptomycin, and 98.60% for ethambutol. Cost/isolate with this assay was found to be approximately two times lesser than that of PM. All results were obtained in 7-14days by nitrate reductase assay, which was significantly rapid compared with 42days taken for obtaining results by PM. CONCLUSION: Nitrate reductase assay can be used as a rapid and inexpensive method for drug-susceptibility testing of M. tuberculosis for first-line antitubercular drugs without compromising accuracy of standard methods.

Emphysematous pyelonephritis caused by Candida parapsilosis: an unknown etiological agent.

Emphysematous pyelonephritis (EPN) a rare complication commonly seen in diabetic patients is a necrotising gas producing infection of the renal parenchyma and perinephric tissue predominantly caused by uropathogenic bacteria. Fungi have been rarely reported as the etiological agents, isolated from blood and/ or urine culture. We report a case of EPN caused by a rare etiological agent. A 60 year old diabetic female with no previous history of hospitalization presented to us with a short history of febrile illness associated with abdominal pain. Investigations revealed unilateral EPN "Wan type 1". Patient was treated with systemic antifungal therapy as per culture sensitivity and it alone proved to be an effective treatment of this clinically difficult condition. Patient was discharged in a satisfactory clinical condition. A rare etiology should always be kept in mind while evaluating a case of EPN.

Clinical profile and surgical outcome for pulmonary aspergilloma: nine year retrospective observational study in a tertiary care hospital.

BACKGROUND: The indications and the outcome of surgery for pulmonary aspergilloma remain highly controversial. This retrospective observational study was conducted to study the clinical profile, indications, post-operative complications and long term outcome of patients having pulmonary aspergilloma. METHODS: From January 2000 to October 2008, 52 patients underwent surgery for pulmonary aspergilloma at our tertiary care institute. RESULTS: The group consisted of 32 males and 20 females with a mean age of 39.3 ± 11.2 years. The most common indication for surgery was hemoptysis (96.15%). The underlying lung diseases were tuberculosis (75%), bronchiectasis (5.76%), and lung abscess (5.76%). In one patient (2%), concomitant ruptured lung hydatid cyst and an aspergilloma was present. The procedures performed were lobectomy (n = 43), bilobectomy (n = 3). pneumonectomy (n = 3), segmental resection (n = 3). The post-operative mortality was 1.92% (one patient). Overall complications occurred in 12 (23.07%) patients. The complications included prolonged air leak (n = 6), bleeding (n = 3), empyema (n = 1), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). The mean follow-up period was 38 ± 18.6 months. There was no recurrence of disease or hemoptysis. CONCLUSION: Pulmonary aspergilloma is common in developing countries like India in which there is high prevalence of pulmonary tuberculosis. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of symptoms including hemoptysis. We recommend early surgical resection of symptomatic aspergilloma with reasonable complications. Pre-operative preparation of the patients, meticulous surgical technique and post-operative chest physiotherapy reduces the rate of complications. Complications may still occur and are largely related to the underlying lung pathology; however, the long term outcome is good.

Bipolaris hawaiiensis keratomycosis and endophthalmitis.

Following trauma with rice stalk to the left eye, corneal ulcer with abscess and hypopyon developed in an immunocompetent male. Direct examination of the corneal scrapings revealed septate, branched fungal hyphae. Bipolaris hawaiiensis was isolated after culture on blood agar and Sabouraud dextrose agar. Because of delay in diagnosis and appropriate treatment, the patient developed endophthalmitis needing evisceration.

Bacterial and fungal profile of corneal ulcers--a prospective study.

Corneal ulceration continues to be one of the most important causes of ocular morbidity and blindness worldwide. Between April 1999 and May 2001, 80 patients with corneal ulceration were examined to find the causative microorganisms, the sensitivity pattern of bacterial isolates to antibiotics, the predisposing factorsfor ulcerative keratitis and the comparison between culture and gram staining results. Corneal ulceration was seen more in males than females, predominantly in farmers (61.25%) and trauma was the commonest predisposing factor, the agents being mainly organic agricultural materials. Of the 80 corneal ulcers, 32(40%) yielded pure bacterial growth while fungal growth was seen in 10(12.5%). Streptococcus pneumoniae was the commonest bacterium while Aspergillus fumigatus and Fusarium species were the commonest fungi isolated. Most of the bacterial isolates were sensitive to chloramphenicol and tetracycline followed by the quinolones. The overall sensitivity and specificity of Gram staining as compared to culture was 57.14% and 94.7% respectively.

Pulmonary pseudallescheriasis in a patient with healed tuberculosis.

Pulmonary pseudallescheriasis in an immunocompetent patient without a pre-existing cavity or cyst is a rare phenomenon. We report a case of invasive pulmonary pseudallescheriasis in a lobectomised patient treated for tuberculosis. Filamentous fungi with pyriform conidia were seen in the bronchoalveolar lavage fluid . The fungus was identified as Pseudallescheria boydii on culture.