Footprints of human melioidosis in the north western Indian states, expanding endemicity in India.

Melioidosis is endemic in India and well described from western and eastern coastal states. Sporadic cases of melioidosis have been diagnosed from Gujarat prior to current case series in patient with travel history to endemic areas. We noticed a rise in melioidosis cases from Gujarat and Rajasthan in the last two years. With this case series, we are reporting eleven melioidosis cases who have no travel history to endemic areas and acquired melioidosis locally. This case series alerts practicing clinicians in Gujarat and Rajasthan to look for and keep melioidosis as one of the differential diagnosis in appropriate clinical syndrome.

Melioidosis in Gujarat: a neglected tropical disease.

We report what we believe is the first case in Gujarat of melioidosis in a 67-year-old man. Awareness of this disease is limited, especially in areas supposed not to be endemic.

Corynebacterium minutissimum infecting pseudomeningocele: a rare case.

Invasive infections by Corynebacterium minutissimum are rarely documented. The significance of laboratory isolation of this bacterium from a sterile specimen such as cerebrospinal fluid is difficult to determine as it usually colonizes the skin. However, repeated isolation in a clinical setting should be treated appropriately. Here we report a first case of infected pseudomeningocele by C. minutissimum in an adult woman operated on for falcotentorial psammomatous meningioma. The patient was treated successfully with linezolid.

Neonatal meningitis and sepsis by Chryseobacterium indologenes: a rare and resistant bacterium.

Early neonatal meningitis with non-fermenting Gram negative bacilli (NFGNB) is rare, and whenever it occurrs, inanimate environment is usually implicated as the source. The authors report a case of neonatal meningitis and sepsis with Chryseobacterium indologenes, a rare non fermenting Gram negative bacterium with unusual antimicrobial susceptibility. Despite resistance to all the beta lactams, carbapenems and aminoglycosides, therapy with ciprofloxacin led to a favorable outcome.

Staphylococcus aureus bacteremia in an Indian tertiary care hospital: observational study on clinical epidemiology, resistance characteristics, and carriage of the Panton-Valentine leukocidin gene.

OBJECTIVES: To analyze the epidemiology and laboratory characteristics of Staphylococcus aureus bacteremia (SAB) in an Indian tertiary care hospital. METHODS: We collected clinical, epidemiological, and laboratory data of all cases of SAB during August 2010 through July 2011. All isolates were tested for the Panton-Valentine leukocidin (PVL) gene. RESULTS: Eighteen percent of all blood stream infections (BSIs) were attributable to S. aureus. Among a total of 70 cases of SAB, 54% were due to methicillin-resistant S. aureus (MRSA) and 46% to methicillin-susceptible S. aureus (MSSA). Seventy-four percent of the cases had community-acquired (CA) SAB, among whom 69% had been hospitalized previously. Skin and soft tissue infections (SSTI) (30%) and respiratory infections (24%) were the common sources of bacteremia. The overall case fatality rate was 27%, and a similar percentage (23%) of patients discontinued therapy due to a poor medical outcome. The PVL gene was detected in 16% of S. aureus isolates, predominantly in CA-S. aureus (82%). SSTIs and pneumonia were the common sources of bacteremia in 45% of patients infected with a PVL-positive strain. CONCLUSIONS: S. aureus is a significant cause of BSI with a case fatality rate comparable to those of other developing nations. The upsurge in MRSA rates is alarming in our setup. Antibiotic stewardship and strict control of antibiotic use must be implemented by health care professionals to curb the increasing trend in MRSA BSIs.

Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Causing Respiratory Tract Infections in a Tertiary Care Center.

BACKGROUND: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. MATERIALS AND METHODS: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. RESULTS: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. CONCLUSION: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage.

Successful treatment of right-sided native valve methicillin-resistant Staphylococcus aureus endocarditis and septicaemia with teicoplanin and rifampicin: a case report.

Vancomycin is the drug of choice in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection. However, the presence of certain clinical complications like renal failure alters vancomycin pharmacokinetics, leading to drug accumulation and toxicity. This highlights the need to identify an effective substitute for treating MRSA infections when vancomycin cannot be used. We report the case of a 57-y-old Indian male diagnosed with tricuspid valve endocarditis with septicaemia and a right upper lobe cavity caused by MRSA. The patient also presented with renal failure, which precluded the use of vancomycin for treatment. A 6-week regimen of teicoplanin and rifampicin was used instead, and the infection was successfully treated. This case report provides evidence of the effectiveness of teicoplanin and rifampicin in the treatment of MRSA bacteraemia in situations where the use of vancomycin is contraindicated.

A child with Erysipelothrix arthritis-beware of the little known.

Erysipelothrix rhusiopathiae is an established animal pathogen while the zoonotic infections in humans are rarely reported. Infections occur after exposure to animals or animal products that are mostly occupational in adults. Here we report in a child for the first time septic arthritis and osteomyelitis without an identifiable risk factor. A 5-year-old male child was admitted with pain in the left hip joint and inability to bear weight on the limb. Clinical examination followed by radiological and magnetic resonance imaging was suggestive of septic arthritis. Erysipelothrix rhusiopathiae grew from peroperative joint specimen. The infection was resolved following arthrotomy, joint lavage and antibiotic therapy.

Primary Amoebic Meningoencephalitis in an Infant due to Naegleria fowleri.

Primary amoebic meningoencephalitis (PAM) caused by free-living amebae Naegleria fowleri is a rare and fatal condition. A fatal case of primary amoebic meningoencephalitis was diagnosed in a 5-month-old infant who presented with the history of decrease breast feeding, fever, vomiting, and abnormal body movements. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and infant was put on amphotericin B and ceftazidime. Patient condition deteriorated, and he was discharged against medical advice and subsequently expired. We also reviewed previously reported 8 Indian cases of primary amoebic meningoencephalitis (PAM) and observed that for the last 5 years, none of the patients responded to amphotericin B. Has an era of amphotericin B-resistant Naegleria fowleri been emerged? Management strategy of PAM needs to be reviewed further.