Santwana Verma

Emerging Salmonella Paratyphi A enteric fever and changing trends in antimicrobial resistance pattern of salmonella in Shimla

This retrospective study incorporates a six years, six months (January 2000-June 2006) laboratory data comprising 258 isolates of Salmonella. Cultures were identified by standard methods. Salmonella enterica serotype Typhi (S.Typhi) was the more frequent serotype isolated i.e., 61.62% with the remaining 38.37% being Salmonella enterica serotype Paratyphi A (S. Paratyphi A). There was emergence of S. Paratyphi A as the predominant serotype in 2003-2004 with resurgence of serotype Typhi thereon. A total of 66.27% isolates were resistant to one or more antibiotics. MDR S. Typhi was 10.69% and while 13.13% were MDR S. Paratyphi A. There was decrease in resistance to ampicillin, cotrimoxazole in 2004 and nalidixic acid beyond 2005 and increase in resistance to cefuroxime. We also documented a decrease in resistance to ciprofloxacin after 2005.

Sporotrichosis in Sub-Himalayan India

Sporotrichosis is endemic in the Sub-Himalayan belt, which ranges from the northern to the north-eastern Indian subcontinent. Similar to many parts of the developing world, sporotrichosis is commonly recognized clinically in this region however consolidated epidemiological data is lacking. We report epidemiological, clinical and microbiological data from a hundred culture positive cases of sporotrichosis. Out of 305 clinically suspicious cases of sporotrichosis, a total of 100 isolates were identified as Sporothrix schenckii species complex (S. schenckii) on culture. Out of the culture proven cases 71% of the cases presented with lymphocutaneous type of lesions while 28% had fixed localized type and 1% had disseminated sporotrichosis. Presentation with lesions on hands was most frequently seen in 32% with arm (23%) and face (21%) in that sequence. The male to female ratio was 1∶1.27. Age ranged from 1 ½ years to 88 years. Mean age was 43.25 years. Disease was predominantly seen in the fourth to sixth decade of life with 58% cases between 31 and 60 years of age. Since the first report from the region there has been a steady rise in the number of cases of sporotrichosis. Seasonal trends reveal that most of the patients visited for consultation in the beginning of the year between March and April. This is the first study, from the most endemic region of the Sub-Himalayan belt, to delve into epidemiological and clinical details of such a large number of culture proven cases over a period of more than eighteen years which would help in the understanding of the local disease pattern of sporotrichosis.

A case of extensive chromoblastomycosis from North India

A case of extensive chromoblastomycosis of the right leg and thigh with verruciform to nodular lesions evolving rapidly over five years duration is reported. The diagnosis was confirmed by visualizing pathognomonic pigmented muriform bodies with unique septate hyphae and mycological culture yielding Fonsecaea pedrosoi.

Current spectrum of oculomycosis in North India: A 5-year retrospective evaluation of clinical and microbiological profile

Oculomycosis is a major cause of visual impairment. Eye pain, redness, discharge, diminution and photophobia are presenting features. We collected corneal scraping, vitreous, aqueous fluids and conjunctival swabs after the slit-lamp examination. Ophthalmological findings were hypopyon, stromal congestion, conjunctival congestion and epithelial defect. Direct microscopy of 10% potassium hydroxide (KOH) wet mounts, gram staining, fungal and bacterial cultures were performed. Fungal isolates were obtained in 24% patients with equal number of both sexes and average age 49 years. KOH revealed fungi in 73% samples and 43.33% were positive on Gram staining. Fusarium spp. (36.66%), Aspergillus spp. (23.33%) and melanised fungi (20%) were common etiological agents. Fusarium spp. was more often associated with complications. Trauma was a predisposing factor in 65% cases and occurred mainly with vegetable matter. The majority responded to the conservative management with 5% natamycin and four patients required surgery.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: a case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

Influenza A(H1N1)pdm09 cases in sub-Himalayan region, 2014-2015 India.

Current influenza A(H1N1)pdm09 strain severely involved many parts of the country. The study was conducted to analyze the clinicoepidemiological trend of influenza A(H1N1)pdm09 cases from October 2014 to March 2015. Samples processing was done as per the Center for Disease Control guidelines. A total of 333 specimens were processed out of which influenza A(H1N1)pdm09 constituted 24% (81) of total, 5% (18) cases were seasonal influenza A virus strains. Mean age group involved was 49 years with case fatality rate of 20%. Patients died were 63% males and 44% had comorbidities, and among them, 38% patients died within 24 h of hospitalization. The mean age of comorbid patients who died was 59 years; whereas the mean age of patients died having no co-morbidities was 41 years (P < 0.005). Mortality was seen among 81% (13) of patients who were on ventilator support. Added mortality in specific human group demands continuous surveillance monitoring followed by the detection of mutation, even in susceptible animal population.

Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus from Sub Himalayan Region of India

INTRODUCTION Clindamycin is an alternative antibiotic in the treatment of Staphylococcus aureus (S.aureus) infections, both in infections by methicillin susceptible and resistant (MSSA and MRSA) strains. The major problem of use of clindamycin for staphylococcal infections is the presence of inducible clindamycin resistance that can lead to treatment failure in such infections. AIM To determine inducible and constitutive clindamycin resistance among clinical isolates of S. aureus in a tertiary care centre of sub Himalayan region of India. MATERIALS AND METHODS A total of 350 isolates of S. aureus from various clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer disc diffusion method. Methicillin resistance was detected by cefoxitin (30μg) disc. All isolates were subjected to inducible clindamycin resistance was by Clinical Laboratory Standards Institute (CLSI) recommended D test. RESULTS Among 350 S.aureus isolates, 82 (23.42%) were MRSA and 268 (76.57%) were MSSA. Erythromycin resistance was detected in 137 (39.14%) isolates. Erythromycin resistance in MRSA and MSSA was 71.6% and 29.36% respectively. Overall clindamycin resistance was seen in 108 (30.85%) isolates. Constitutive MSLB phenotype predominated (29.62% MRSA; 13.38% MSSA) followed by iMLSB (28.39% MRSA; 9.29% MSSA) and MS phenotypes (13.58% MRSA; 6.69%MSSA). Both inducible and constitutive clindamycin resistance was significantly higher (p=0.00001, 0.0008 respectively) in methicillin resistant strains than in methicillin susceptible strains. CONCLUSION The present study gives a magnitude of clindamycin resistance among clinical isolates of S. aureus from this region of the country. Our study recommends routine testing of inducible clindamycin resistance at individual settings to guide optimum therapy and to avoid treatment failure.

Keratitis by Paecilomyces lilacinus: A case report from Sub-Himalayan region

Paecilomyces lilacinus is a filamentous fungus found in soil and air, which is a rare cause of ocular infection. The majority of case reports involving P. lilacinus among healthy hosts are of endophthalmitis and keratitis. We report a rare case of keratomycosis by P. lilacinus, in an immunocompetent, which responded well to treatment with ketoconazole. Some species belonging to the genus Paecilomyces such as P. lilacinus generally shows a poor response to conventional antifungal drugs. Therefore, correct identification of clinical isolates to the species level is mandatory for the appropriate treatment of the disease.

Antimicrobial resistance pattern and in vivo activity of azithromycin in Salmonella isolates

We evaluated antimicrobial susceptibility pattern of 42 Salmonella isolates from February 2012 through January 2013. We also determined the minimum inhibitory concentrations (MICs) of azithromycin against Salmonella isolates and compared them with corresponding disc diffusion sizes. Entire 42 isolates were sensitive to chloramphenicol, 41 (97.6%) were sensitive to cotrimoxazole and amoxicillin each. MICs for azithromycin ranged from 2 μg/ml to 24 μg/ml, corresponding zone diameters ranged from 15 mm to 33 mm and the two were significantly correlated (P = 0.001). Our results indicate that whereas, azithromycin is a potential therapeutic option, the sensitivity to the first line drugs and absence of multidrug resistance reinforce the concept of antimicrobial recycling.

Are We Neglecting Nontuberculous Mycobacteria Just as Laboratory Contaminants? Time to Reevaluate Things

Objectives Nontuberculous mycobacteria (NTM) incidences are on the rise worldwide, including the tuberculosis endemic areas. They should be identified rapidly to the species level and should be carefully differentiated as contamination, colonization, or disease. This study was aimed at determining the prevalence and clinicoepidemiological profile of mycobacteriosis cases. Materials and Methods Cultures were made on liquid and solid media. NTM were identified by polymerase chain reaction (PCR) restriction analysis (PRA) and gene sequencing. Data was analyzed using Epi-info 7. Results Out of the 1042 processed specimens, 16% were positive for M. tuberculosis complex and 1.2% for clinically significant NTM. M. intracellulare was the commonest species isolated. NTM were treated mainly on outdoor basis (92%), involving more extrapulmonary system (62%) and higher age-group of 41-60 years (69%). No significant factor was seen to be associated clinically, radiologically, and biochemically with the NTM infections. Conclusions Our study highlights the importance of early diagnosis and differentiation among Mycobacterium tuberculosis and NTM so that these NTM are not underestimated in routine diagnostic procedures merely as environmental or laboratory contaminants.