Meena Dias

The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form Biofilms.

BACKGROUND In spite of the decreasing incidence of orthopaedic device related infections to 1%, nowadays, device-related infections still remain a diagnostic, therapeutic and cost -related problem. AIMS AND OBJECTIVE To record the common causative organisms and the contributing risk factors for orthopaedic device-related infections in a tertiary care teaching hospital. METHODS In a prospective study, fifty patients who underwent orthopaedic device implantation from Jan 2009 - June 2010 were enrolled; among them, 42 patients were complicated with infections. The demography, microbiological data, treatment and the outcome of each patient were recorded. STATISTICAL ANALYSIS The data was analyzed in terms of frequency and percentage. RESULTS Of the 50 samples, 42(84%) were culture positive, while 8(16%) were cultures negative. The femur was the most commonly affected bone in both males (median age-37.1yrs) and females (median age-41.3 yrs). Staphylococcus aureus was the organism which was most commonly isolated and which caused biofilms, followed by non-fermenting, gram negative bacilli and Klebsiella spp. We reported the first case till date in the literature of Candida krusei PJI, to the best of our knowledge. No anaerobes were isolated. Tissue trauma, open fractures, post-operative surgical site infections and Diabetes mellitus were found to be the important risk factors. The biofilm forming organisms were commonly associated with polymicrobial infections and even an aggressive antibiotic therapy was often inadequate to eliminate the infections. A conservative surgical treatment was associated with treatment failures. Implant removal or replacement was required in most of the cases to eradicate the infection. CONCLUSION The most common bacteria which were isolated included Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella. A majority of them are resistant to the commonly used antibiotics, leading to treatment failures which necessitated an implant removal.

food PoIsonIng duE to SALMONELLA ENTERICA sErotYPE WEltEvrEdEn In mangalorE

An outbreak of food poisoning due to Salmonella enterica serotype Weltevreden ( S.weltevreden ) involving 34 students has been reported from a tertiary care hospital in Mangalore. The symptoms developed 8-10 hours, after consuming a non- vegetarian dish, probably fish, from an outside caterer. The identity of the organism was confirmed at Central Research Institute, Kasauli. This report emphasizes the geographical distribution of this organism in the Coastal Karnataka region. S.Weltevreden may be overlooked due to the biochemical similarity to S. Paratyphi B & S. Typhimurium.

Fusarium Solani: a causative agent of skin and nail infections.

Fusarium spp are non-dermatophytic hyaline moulds found as saprophytes and plant pathogens. Human infections are probably a result of various precipitating predisposing factors of impaired immune status. Immunocompetent individuals of late are also vulnerable to various unassuming saprophytic and plant pathogens. To stress the need to identify correctly and institute appropriate antifungal therapy in newly emerging human fungal infectious agents. Repeated mycological sampling of the skin and nails of the suspected fungal infection were processed as per the standard format including direct microscopy and fungal culture on Sabourauds dextrose agar. The fungus was isolated as Fusarium solani. Fusarium is an important plant pathogen and soil saprophyte. Infection is acquired by direct inoculation or inhalation of spores. It is associated with a variety of diseases like keratitis, onychomycosis, eumycetoma, skin lesions and disseminated diseases.

Case series: elizabethkingia meningosepticum.

Elizabethkingia meningosepticum is a saprophyte which exists in hospital water systems and it can be a potential source for nosocomial infections. Though the infection with these bacteria is rare, one should be aware that it is resistant to most of the antibiotics and that it has the ability to cause nosocomial infections. We are reporting here, a series of cases which were caused by E. meningosepticum.

Corynebacterium macginleyi` a rare bacteria causing infection in an immunocompromised patient

Corynebacterium species are normal flora of skin and mucous membrane. In recent years, coryneforms have emerged as important opportunistic pathogens in immunocompromised patients. Majority of the Corynebacterium macginleyi isolates are from conjunctiva and cornea. The only reported non ocular isolates are from urinary tract infection, intra-venous catheter related infection, valvular endocarditis and septicaemia. We report herein a rare case of C. macginleyi isolated from tracheostomy site secretions in a patient with carcinoma larynx which was treated successfully with Cefoperazone-sulbactum for seven days and replacing tracheostomy tube. This is the first case of C. macginleyi reported from India.

A hospital based study of rickettsial diseases evidenced by Weil Felix test in a tertiary care hospital

Introduction: Rickettsial infections, one of the re-emerging diseases are increasingly underdiagnosed due to nonspecific symptoms, absence of reliable and affordable diagnostic test and contribute substantially to the acute febrile burden and preventive illness in many populations. A delay in diagnosis and therapy are associated with increased morbidity and mortality. Objectives: To determine and categorize rickettsial disease titers by Weil Felix test, and to know the frequency of rickettsial diseases in febrile patients presenting to a tertiary hospital. Materials and Methods: In a prospective study, a total of 100 samples were tested by Weil Felix test from patients with fever and results were analyzed. Results: Out of 100 samples 64 were positive. Male preponderance was seen. The most common clinical symptom were fever, rash followed by hepatomegaly and splenomegaly. One patient with a high titer of more than 1280 died of encephalitis. Conclusion: In the absence of availability of a good reliable serological or molecular evidence, Weil Felix test can be used in the laboratories mainly due to cost and technical aspects of other reliable tests for diagnosis.

Isolation and Characterization of an Unknown Chrysosporium sp. Producing Subcutaneous Mycosis in an Immunocompromised Patient

AbstractWe report a case of subcutaneous fungal abscess over the great toe caused by a keratinophilic fungus, an unknown Chrysosporium sp., in a 60-year-old diabetic female who was treated successfully with oral fluconazole. The fungus was isolated from aspirated pus, and septate hyphae were seen in fine needle aspiration cytology. Ovoid- to club-shaped hyaline one-celled conidia (aleuriconidia) with broad truncated bases were seen, and sequencing of ITS1-5.8S-ITS2 rDNA revealed belonging to the order Onygenales and most closely related to Chrysosporium spp. isolated from a fowl. Of the 65 species within the genus Chrysosporium, very few have been reported as pathogenic.

Rhodococcus equi: A pathogen in immunocompetent patients

Rhodococcus equi is an uncommon human pathogen known to cause lung infections in immunocompromised patients. We report two cases of Rhodococcus infections in immunocompetent individuals, who were treated successfully.

Recurring hand foot mouth disease in a child

Hand Foot Mouth Disease (HFMD) is a viral infection of children caused by Coxsackie virus A-16, a type of enterovirus. Individual cases and outbreaks of HFMD occur worldwide. There are reports of HFMD epidemics from India. Recurrence of HFMD is very rare. We report here, a sporadic case of recurrent HFMD.

Salmonella wien from gastroenteritis cases encountered in Mangalore, India : A report of 10 cases and review of the literature

Ten cases of gastroenteritis due to S. Wien were reported from a tertiary care hospital in Mangalore, in the month of April 2008. Biochemically, it resembles S. Paratyphi B or S. Typhimurium. Serotyping was done at the Central Research Institute, Kasauli, to confirm the identity. The food source is more likely to be chicken or some poultry products. All the 10 cases recovered with symptomatic treatment including antimicrobials like fluoroquinolones. To the best of our knowledge, no documented report is available from India regarding the prevalence of this organism in humans.