Histoplasmosis in India: truly uncommon or uncommonly recognised?

OBJECTIVES: To study the clinical profile of patients with proven histoplasmosis who had presented to a tertiary care referral centre. METHODS: We retrospectively analysed the medical records of 24 patients diagnosed to have histoplasmosis between January 2002 and April 2011. Histoplasmosis was diagnosed when compatible intracellular organisms were seen on biopsy and/or when Histoplasma capsulatum was grown in culture. RESULTS: Twenty four patients were diagnosed to have histoplasmosis of whom 23 were male. Diabetes and HIV infection was the most common co-morbid conditions. Subacute progressive disseminated histoplasmosis (PDH) (22 patients) was the most common clinical presentation. Ten patients had received 2-3 months of empiric anti-tuberculous therapy (ATT) with no response prior to the diagnosis of histoplasmosis. Fever, weight loss, hepato-splenomegaly, oral ulcers and lymphadenopathy were the most common clinical features. Bilateral adrenal enlargement was detected by imaging in 15 patients and adrenal insufficiency was noted in 4 patients. Itraconazole alone was used for treatment in 20 patients while 3 patients were treated with amphotericin B initially, followed by itraconazole. Response to therapy was excellent in 20 patients. CONCLUSIONS: Histoplasmosis is an under-recognized disease in India and should be considered in the differential diagnosis of male patients with prolonged fever, adrenal enlargement, hepato-splenomegaly, oral ulcers and granulomatous disease on histopathology without response to ATT. When tissue biopsy specimens show granulomas, fungal stains should be routinely performed. Treatment with itraconazole leads to an excellent outcome in most patients.

Susceptibility profile of Gram-negative bacteremic isolates to beta lactam-beta lactamase inhibitor agents in comparison to other antibiotics.

BACKGROUND: Comprehensive understanding about the local antibiogram is an essential requirement for preparation of hospital or unit based antibiotic policy. Bacteremic isolates are the most useful ones for this purpose, representing invasive disease. OBJECTIVE: To analyze susceptibility pattern of bacteremic Gram-negative isolates in our center, to various antibiotics, including beta lactam-beta lactamase inhibitor (BL-BLI) agents and carbapenem. MATERIALS AND METHODS: This is a retrospective study done in Apollo Specialty Hospital, a tertiary care oncology center in South India. The susceptibility of Escherichia coli, Klebsiella, Acinetobacter and Pseudomonas blood culture isolates, identified between January 2013 and June 2014 to various antibiotics were analyzed. RESULTS: A total of 231-Gram-negative bacteremic isolates were analyzed. ESBL rate among E. coli isolates was 82.7% (67 out of 81) and 74.3% (58 out of 78) in Klebsiella. Carbapenem (imipenem) susceptibility rate in E. coli was 76.5%, Klebsiella 58.9%, Acinetobacter 32% and Pseudomonas 77.2%. Colistin susceptibility in E. coli was 96.2%, Klebsiella 93.5%, Acinetobacter 92.8% and Pseudomonas 97.7%. Difference in the susceptibility of Enterobacteriaceae to BL-BLI agents (especially cefepime-tazobactam) and carbapenem were minimal. In nonfermenters, BL-BLI susceptibility was better than that of carbapenem. CONCLUSION: Findings of the study make a strong argument for using BL-BLI agents and sparing carbapenem to curtail the spiraling scenario of carbapenem resistance.