Sujeesh Sebastian

Chryseomonas luteola bacteremia in a patient with left pyocele testis with Fournier's scrotal gangrene.

phenotypic characters, including the presence of multi-trichous flagella and single polar flagellum in bio groups Ve-1 and Ve-2, respectively. The CDC groups Ve-1 and Ve-2 are named as Chryseomonas luteola and Flavimonas orrhyzihabitans, respectively. The CDC group Ve-1 is placed under the Pseudomonas stutzeri group in compliance with the colony characters as they form dry and wrinkled colonies. Based on the phylogenetic relationship studies, it was found that Chryseomonas luteola and Flavimonas orrhyzihabitans are junior subjective synonyms of Pseudomonas species. [2] Chryseomonas luteola is an aerobic, Gram-negative, motile rod found in the environment as saprophytes. It was previously named as Pseudomonas luteola and CDC group Ve-1 and was placed under the Pseudomonas stutzeri group based on 16S rRNA analysis. The infections caused by Chryseomonas luteola include bacteremia, pneumonia, biliary tract infections, surgical wound infections, abscesses, peritonitis, subdural empyema and infections associated with the presence of prosthetic devices. We report a case of bacteremia caused by Chryseomonas luteola in a patient with pyocoele testis with Fournier’s scrotal gangrene. CASE REPORT

Sonication of orthopaedic implants: A valuable technique for diagnosis of prosthetic joint infections

INTRODUCTION Accurate and prompt microbiological diagnosis of prosthetic joint infection (PJI) is crucial for successful antimicrobial treatment. Studies have shown the diagnostic utility of sonication of explanted implants in total joint arthroplasty but all did not use consensus statements for defining PJI. We evaluated the diagnostic utility of culture of samples obtained by sonication of explanted implants compared with periprosthetic tissue cultures (PTC) for the diagnosis of PJI using Musculoskeletal Infection Society (MSIS) consensus criteria. We also assessed the utility of culture of sonicate fluid for determining the microbial profile of PJI compared with standard culture methods. MATERIALS AND METHODS Forty consecutive revision arthroplasty cases were enrolled. Three to five periprosthetic tissue samples were obtained during each explant procedure. The 40 explanted implants were collected in sterile containers and sonicated under sterile conditions. MSIS criteria were used for the definition of PJI. RESULTS Twenty - seven patients had PJI and thirteen were aseptic failures. Of the PJI cases, there were nine cases of early PJIs, 10 of delayed PJIs and eight of late PJIs. Twenty-five (92.5%) of the twenty-seven patients with PJI, had positive cultures in the sonicate fluid of implants and in 18 (66.7%) of them cultures of the periprosthetic tissues were also positive. Both PTC and SFC cultures of implants were negative in all the 13 cases of aseptic failure. Sensitivity of sonicate fluid culture (SFC) of implants was greater than PTC (92.5% vs. 66.7%), P = .02. The specificity of both was 100%. The incidence of gram-positive and gram-negative bacteria was nearly equal by both methods. However, SFC showed an increased ability to detect Gram-positive pathogens which was evidenced by better recovery of coagulase-negative staphylococci. CONCLUSIONS Sonication of explanted implants is a simple and valuable microbiological technique and its routine use improves the diagnostic sensitivity of PJI.

Analysis of laboratory testing results for Chlamydia trachomatis infection in an STI clinic in India: Need for extragenital screening

BACKGROUND Extragenital sites are believed to serve as hidden reservoirs for ongoing transmission of infection. In addition, treatment for rectal Chlamydia infection is different from that of genital Chlamydia infection. Many cases may be missed if only genital testing is performed. METHODS Between September 2015 and August 2016, all male and female attendees at an STI clinic of a tertiary care hospital with genital and or extragenital discharge were screened for CT infection. Samples included endocervical swabs in women, urethral swabs and urine samples in men. Rectal and pharyngeal samples were collected wherever indicated. RESULTS Of total of 439 samples collected from 417 patients (245 women and 172 men), samples from women had a high positivity rate than men. (13.6% and 11%). High rates of rectal CT was detected nearly 30.43%. All rectal positive cases except one had no concomitant genital infection. CONCLUSIONS Prevalence of extragenital Chlamydia is increasing in men as well as women. What needs to be stressed on is the sexual behaviour of an individual and not the sexual identity. Further studies are needed to help formulate guidelines and recommendations for extragenital screening in a population.

Clonal dissemination of linezolid-resistant Staphylococcus haemolyticus harbouring a G2576T mutation and the cfr gene in an Indian hospital

Linezolid, an oxazolidinone drug available in both parenteral and oral formulations, has emerged as a novel alternative to vancomycin and other second-generation drugs for treatment of infections from Gram-positive cocci (Gu et al., 2013). Mutation at domain V of 23S rRNA can result in modification of the ribososmal peptidyl transferase centre region and resistance in isolates. A naturally occurring resistance gene cfr, encoding a cfr methyltransferase, has also been reported in clinical isolates. Moreover, resistance has also been associated with mutations in the genes for the ribosomal proteins L3 and L4, which interact closely with the linezolid binding site in the peptidyl transferase centre region (Long & Vester, 2012). Linezolid resistance in clinical staphylococcus isolates is increasingly being reported worldwide (Jones et al., 2009). Here, we describe four linezolidresistant clinical isolates of Staphylococcus haemolyticus with a dual mechanism of resistance.

Utility of 16S rRNA PCR in the Synovial Fluid for the Diagnosis of Prosthetic Joint Infection

Dear Editor, Conventional culture has been the mainstay for diagnosing prosthetic joint infections (PJIs), with synovial fluid and periprosthetic tissue samples being the preferred sample types [1]. However, culture-based methods often give false-negative results in patients with a high likelihood of PJI [2]. To overcome the limitations of culture methods, molecular techniques like universal 16S rRNA gene and pathogen-specific PCRs were developed for PJI diagnosis [2, 3]. Although PCR assays have shown satisfactory results in tests of periprosthetic tissue samples and sonication fluid, the diagnostic utility of PCR is less clear in tests of the synovial fluid [2-4]. Most studies that evaluated the utility of 16S rRNA PCR in the synovial fluid for diagnosing PJI have not used the Musculoskeletal Infection Society (MSIS) consensus criteria as the gold standard for PJI [2, 5]. Therefore, we evaluated the utility of 16S rRNA PCR in the synovial fluid for diagnosing PJI using MSIS criteria. A total of 85 patients (40 females) who underwent revision arthroplasty (87 procedures: 55 hip and 32 knee revisions) at All India Institute of Medical Sciences (AIIMS), New Delhi, India, between June 2013 to June 2017 were prospectively enrolled. Synovial fluid (N=87) and three to five periprosthetic tissue samples were collected intraoperatively from each patient (N =296) and were processed in accordance with standard protocols [3]. Briefly, tissue samples were aseptically disrupted using a sterile mortar and pestle with saline solution for one minute. Aliquots of synovial fluid and tissue samples were inoculated onto sheep blood agar (SBA), MacConkey agar (MA), and brain heart infusion agar (BHIA) plates, and in Robertson’s cooked meat broth (RCM). Both SBA and MA plates were incubated aerobically at 37°C for 2–4 days. BHIA plates were incubated anaerobically at 37°C for 7–14 days. RCM broth was subcultured if cloudy or systematically on the 7th and 14th day. Organisms were identified using the matrix-assisted laser desorption ionization-time-of-flight mass spectrometry system (Vitek MS; BioMérieux, Marcy-L’Etoile, France). PJI was confirmed according to MSIS guidelines [1]. This study was approved by the AIIMS institutional review board (Ref. No. IESC/T-419/01.11. 2013). Informed consent was obtained from all patients. A PCR assay targeting a partial region of the16S rRNA gene [6] was carried out for both synovial fluid and periprosthetic tissue samples. To eliminate any exogenous bacterial contamination, prior to amplification, the master mix (without the dNTP mix and primers) was incubated for 15 minutes with 0.1 IU of DNaseI enzyme (DNase I RNase-free, Thermo Fisher Scientific, Waltham, MA, USA). Bacterial species were identified by sequencing the PCR amplicons. A positive result from synovial fluid culture (SFC) or PCR was defined as a true positive when

A case of oropharyngeal Ureaplasma urealyticum infection in a human immunodeficiency virus positive bisexual male co-infected with human papilloma virus and Treponema pallidum

Introduction Management strategies for sexually transmitted infections (STIs) in their extragenital forms address Neisseria gonorrhoeae and Chlamydia trachomatis alone; whereas increased rates of isolation of other STI agents have been reported from various parts of the world. Their extragenital presence as a reservoir of infection emphasizes the need to screen and treat them at these sites. Case presentation A 35-year-old human immunodeficiency virus 1 infected bisexual male presented with urethral discharge and multiple ano-genital warts. He was reactive for the venereal disease research laboratory (VDRL) test. He tested positive for Ureaplasma spp. both by culture and PCR at urethral and oropharyngeal sites, but was negative at the rectal site. The patient was successfully treated with doxycycline and penicillin, and was followed up with a test of cure at 6 weeks. Conclusion In view of the disseminating infections that can be caused by Ureaplasma spp., it makes it important to screen for these infections even at non-genital sites, especially in the immunocompromised. STIs may be asymptomatic and can serve as a reservoir of infection in a population. This report should promote all efforts to formulate guidelines for extragenital screening of all STI pathogens.

Salmonella typhimurium infection in total knee arthroplasty: A case report with review of literature

Salmonella enterica serotype Typhimurium is a rare cause of prosthetic joint infection (PJI). The recognized predisposing risk factors for Salmonella septic arthritis include diabetes mellitus, renal failure, human immunodeficiency virus infection and chronic corticosteroid use. We describe a case of PJI of the knee in a 74-year-old lady who was on antitubercular treatment. The patient presented with discharging sinus and raised inflammatory markers. She was successfully treated by the removal of prosthesis and debridement followed by ciprofloxacin therapy for 6 weeks. This case report highlights the potential virulence of Salmonella in immunocompromised patient with a joint prosthesis. Continuous monitoring and close collaboration of microbiologists and orthopedicians helped obtain the resolution of infection in our patient.

Chlamydia trachomatis proctitis masquerading as carcinoma rectum: First case report from India

While proctitis is caused both by infectious and noninfectious causes, infectious causes are acquired typically sexually. Chlamydia trachomatis, which is the most frequent bacterial pathogen causing sexually transmitted infections worldwide, is one of the causative agents of proctitis. We report a case history of a bisexual male who presented to us with rectal bleeding. The colonoscopy showed a nodular ulcerated lesion in the rectum suggestive of rectal malignancy, but biopsies from rectal mass did not reveal malignancy. A rectal biopsy was positive for C. trachomatis by polymerase chain reaction assay, and a diagnosis of C. trachomatis proctitis was made. Considering the invasive anorectal disease and patients sexual history, he was treated with prolonged doxycycline therapy as per Centres for Disease Control and Preventions treatment recommendation for lymphogranuloma venereum. A high index of clinical suspicion along with appropriate microbiological testing can clinch the diagnosis of C. trachomatis infection.

A case of sterile pyuria caused by Chlamydia trachomatis and Mycoplasma hominis: A diagnostic challenge

Sterile pyuria is a highly prevalent condition with a wide aetiological spectrum, which often challenges the diagnostician. We describe the case of a middle-aged female admitted to the medical Intensive Care Unit for acute gastroenteritis, whose urinalysis revealed persistent sterile pyuria. Polymerase chain reaction assay in urine was positive for Chlamydia trachomatis and Mycoplasma hominis. She responded to antimicrobial therapy. We hereby reflect on the approach to a case of sterile pyuria and review the available literature on this entity.

Prosthetic joint infection due to Lysobacter thermophilus diagnosed by 16S rRNA gene sequencing.

We report the first case of prosthetic joint infection caused by Lysobacter thermophilus which was identified by 16S rRNA gene sequencing. Removal of prosthesis followed by antibiotic treatment resulted in good clinical outcome. This case illustrates the use of molecular diagnostics to detect uncommon organisms in suspected prosthetic infections.