Etiology and Antimicrobial Resistance Profile of Superficial Pyogenic Infections from a Tertiary Care Hospital, Western Rajasthan, India.

BACKGROUND: Superficial Pyogenic Infection (SPI) is the type of a pyogenic infection, which involves the infections of the skin, subcutaneous tissue, and soft tissue. These infections can cause significant morbidity. Antimicrobial Resistance (AMR) has emerged due to the rampant use of broadspectrum agents in superficial pyogenic infections. OBJECTIVE: The aim of the study was to identify the microbial profile of superficial pyogenic infections and study their antimicrobial resistance. METHODS: A cross-sectional observational study was carried out at the Department of Microbiology of a tertiary care hospital in the western region of Rajasthan. Samples included pus, aspirate from the abscess, necrotic tissue, and post-surgical drainage from infected skin at different sites of the patients attending OPD or admitted in IPD and ICU of the hospital. Identification of isolates was carried out by standard bacteriological techniques. The Antibiotic Susceptibility Testing (AST) of bacterial isolates was done by Kirby Bauer disk diffusion method on Mueller Hinton agar (HiMedia, India), and in a few cases, by automated Microscan system as recommended by the Clinical and Laboratory Standards Institute (CLSI), Wayne, USA. RESULTS: A total of 2283 various specimens were obtained from different areas of healthcare facilities. Pathogenic bacterial isolates were recovered from 303 specimens. Staphylococcus aureus and Escherichia coli were found to be the main offenders. The effective antibiotics for gram-positive isolates were clindamycin, cotrimoxazole, linezolid, tetracycline, and vancomycin, and for gram-negative bacteria, meropenem, imipenem and amikacin were seen to be effective. CONCLUSION: This study can help formulate a local antibiotic policy which will restrict the unsupervised antibiotic use and strengthen antibiotic stewardship practices in the hospitals.

Antifungal profile of vulvovaginal candidiasis in sexually active females from a tertiary care hospital of Western Rajasthan.

INTRODUCTION: Vulvovaginal candidiasis (VVC) is the commonest form of sexually transmitted infection especially in sexually active females. Various species of Candida i.e., Candida albicans and non-albicans Candida are associated with VVC. More than 75% of women experiences vulvovaginal candidiasis at least once in their lifetime and 10% of it can lead to recurrent VVC. So, this study was planned to evaluate the clinico-mycological profile and antifungal profile of VVC in sexually active female attending tertiary care hospital. MATERIALS AND METHODS: The present two months study was conducted in sexually active females attending Obstetrics -gynecology OPD with VVC in tertiary care hospital. Two high vaginal swabs were taken and fungal culture was done on SDA agar by standard methods. Identification and antifungal susceptibility testing of candidial isolates were done by standard mycological methods. RESULTS: Most of the patients belonged to younger age group between 18 and 29 years (55%). Lower abdominal pain was the most common symptom after vaginal discharge followed by burning sensation and pruritis. Candida glabrata (15) with 58% of all the isolates was the most common Candida species associated with VVC in this study, followed by Candida albicans (5, 19%). Highest antifungal resistance was observed to itraconazole (81%) followed by amphotericin B (35%) and fluconazole (31%). 81% resistance to itraconazole among Candida glabrata and Candida albicans. Voriconazole was maximum susceptible to all Candida species. CONCLUSION: This study highlights the incidence of VVC among sexually active females of reproductive age group as its recurrence may result into obstetric complications and even infertility and also enlightens the common Candida species and their antifungal profile, which would help the treating clinicians to formulate local antifungal treatment policy for VVC.

Case Series and Mini-Review on Elizabethkingia meningoseptica, A high Alert Organism Causing Meningitis in Premature Neonates from A Tertiary Care Hospital of Western Rajasthan.

BACKGROUND: Elizabethkingia meningoseptica is a ubiquitous organism rarely associated with human diseases, but its association especially among hospitalized premature neonates and immunocompromised individuals are not so common. CASE: We report two cases of neonatal bacteraemia and meningitis among low birth weight premature neonates admitted in neonatal intensive care units (NICU) by E. meningoseptica, a high alert organism associated with such conditions. CONCLUSIONS: E. meningoseptica, a high alert organism associated with meningitis among premature underweight neonates. High degree of resistant to most of the broad-spectrum antibiotics makes its management a challenging task. A good communication between the clinician and the microbiologist becomes very important for the proper management of the patients.

Diagnostic dilemma in a case of Salmonella Typhi sacroiliitis.

Sacroiliitis is a rare complication of enteric fever, seen in <1% of the cases and its concomitant presence with hepatitis has been reported only once. Incorrect or delayed diagnosis of enteric fever may lead to serious complications. Here, we present a complicated case of enteric fever in a 15 years old female who was misdiagnosed elsewhere to be a case of dengue fever owing to thrombocytopenia at presentation along with a weak positive dengue IgM immunochromatography test. The patient eventually developed a rare combination of complications (sacroiliitis, hepatitis, ascites and pleural effusion) and was transferred to our hospital where specific antimicrobial treatment was instituted after isolation of Salmonella Typhi from the clinical samples. This case demonstrates the importance of establishing the correct diagnosis by optimum utilization of the diagnostic services at the time of admission to prevent potentially life threatening complications in an otherwise treatable condition.

A Rare Fatal Cause of Acute Areflexic Quadriparesis in the Tropics.

BACKGROUND: Crimean-Congo hemorrhagic fever is a sporadic zoonotic viral illness recently becoming endemic in regions in the western parts of India. It usually presents as a viral hemorrhagic fever with severe liver and kidney failure. CASE REPORT: An 18-year-old male from the western part of Rajasthan presented with rapidly progressing areflexic weakness of limbs a week after brief fever. He deteriorated rapidly with drowsiness, fulminant liver failure, and acute kidney injury with high creatine kinase. He also developed thrombocytopenia and hemorrhage from various sites. Workup for viral hemorrhagic fever revealed IgM positivity for Crimean-Congo hemorrhagic fever. The patient kept worsening and died of multiorgan failure and diffuse alveolar bleeding after 14 days. CONCLUSIONS: This report highlights the need to expand the differential diagnoses in the commonly encountered presentation of acute quadriparesis to include the possibility of tick-borne diseases like Crimean-Congo hemorrhagic fever in the setting of bleeding diathesis and acute hepatorenal syndrome.

An injection abscess due to M. fortuitum: A rare case report.

An iatrogenic injection abscess is usually easy to treat if caused by aerobic bacteria but some rapidly growing mycobacteria (RGM), namely, Mycobacterium fortuitum, M. chelonae, and M. abscessus are associated with postinjection abscess and may cause delayed wound healing. RGM can cause mild localized cellulitis or abscess to osteomyelitis following penetration injuries or unsafe injection practices. A 7-year-old girl was presented to pediatric surgery OPD with abscess formation over the right buttock. Incision and drainage from abscess were performed in OPD and pus sample was sent for aerobic bacterial culture and sensitivity. On gram stain plenty of pus cells with no microorganism were seen and growth on blood agar after 48 h of aerobic incubation at 37°C showed small off-white pinpoint, smooth butyrous waxy colonies. Smear prepared from blood agar showed uniformly stained short, slender, faintly stained gram-positive bacilli, for which acid-fast staining (1% and 20% H2SO4) was performed that showed acid-fast bacilli. The isolate was further identified by the molecular method and was confirmed to be Mycobacterium fortuitum by genotype Mycobacterium CM VER 1.0 (HAIN LIFESCIENCE, BioMerieux India Pvt. Ltd.).

Case of Ludwig's angina due to Corynebacterium diphtheriae from western Rajasthan, India-A case report of an uncommon presentation.

Corynebacterium diphtheriae is a toxin producing, classically noninvasive bacteria that causes diphtheria a vaccine-preventable disease mainly in children. With increasing vaccine cover, new spectrum of infections is increasingly seen involving invasive infections and nontoxigenic strains of C. diphtheriae. Here, we present a case of Ludwig's angina caused by C. diphtheriae in a 45-year-old female. Only Corynebacterium spp. have been previously reported in Ludwig's angina patients.