Wihiwot Valarie Lyngdoh

Association of biofilm production with multidrug resistance among clinical isolates of Acinetobacter baumannii and Pseudomonas aeruginosa from intensive care unit

Background and Aims: Given choice, bacteria prefer a community-based, surface-bound colony to an individual existence. The inclination for bacteria to become surface bound is so ubiquitous in diverse ecosystems that it suggests a strong survival strategy and selective advantage for surface dwellers over their free-ranging counterparts. Virtually any surface, biotic or abiotic (animal, mineral, or vegetable) is suitable for bacterial colonization and biofilm formation. Thus, a biofilm is “a functional consortium of microorganisms organized within an extensive exopolymeric matrix.” Materials and Methods: The present study was undertaken to detect biofilm production from the repertoire stocks of Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) obtained from clinical specimens. The tube method was performed to qualitatively detect biofilm production. Results: A total of 109 isolates of both organisms were included in the study, out of which 42% (46/109) isolates showed biofilm detection. Among the biofilm producers, 57% of P. aeruginosa and 73% of A. baumannii showed multidrug resistance (MDR) pattern which was statistically significant in comparison to nonbiofilm producers (P < 0.001). Conclusion: To the best of our knowledge, this is the only study to have tested the biofilm production in both P. aeruginosa and A. baumannii in a single study. Biofilm production and MDR pattern were found to be significantly higher in A. baumannii than P. aeruginosa. Antibiotic resistance was significantly higher among biofilm producing P. aeruginosa than non producers. Similarly, antibiotic resistance was significantly higher among biofilm producing A. baumannii than non producers.

Sub-cutaneous abscess caused by Nocardia asteroides in renal transplant recipient

Nocardia is a significant opportunistic pathogen in patients with compromised immunity. Nocardia asteroides was isolated from subcutaneous abscesses on the left thigh and shoulder of a renal transplant recipient. Direct examination of the aspirated pus showed branching filaments that were gram-positive and acid fast. The abscesses were drained and the patient responded to high dose co-trimoxazole therapy.

Clinico-aetiologic profile of Onychomycoses in a tertiary care centre in northeast India:

Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant.

Pulmonary Strongyloidiasis - A case report

Strongyloides stercoralis is an intestinal nematode with both free-living and parasitic stages and is common in the tropics. Chronic infection may lead to cutaneous, gastrointestinal, or pulmonary symptoms. We present the case of a 40-year-old male farmer, with on and off loose motions, productive cough, and loss of weight and was admitted with the provisional diagnosis of pulmonary tuberculosis. Rhabditiform larva of S. stercoralis was discovered in the sputum which was sent for screening of acid-fast bacilli. Stool examination was not done. There was no history suggestive of immunocompromised status and the screening test for HIV antibody was negative. Sputum culture showed growth of Escherichia coli. Other laboratory parameters were within normal limits. His chest X-ray revealed bilateral diffuse infiltrates. He was thereby diagnosed to be a case of pulmonary strongyloidiasis, but his condition deteriorated, and he expired before institution of any treatment. Although a potentially lethal opportunistic infection, strongyloidiasis is amenable to treatment with anthelmintics if detected in time. Hence, clinical suspicion with timely diagnosis and aggressive treatment becomes mandatory.

Prevalence of non-albicans candidemia in a tertiary care hospital in Northeast India

Background: Candidemia is gaining significance worldwide and is the fourth most common cause of bloodstream infections (BSI) with mortality ranging from 5% to 71%. Objectives: To determine the prevalence of candidemia and characterize the non-albicans candida (NAC) causing BSI. Materials and Methods: The study was conducted in the department of microbiology for a period of 2 years (January 2014-December 2015). Blood samples received were cultured in brainheart infusion broth. Subcultures were done in Sabouraud Dextrose Agar and Sabouraud Chloramphenicol Cycloheximide Agar. For identification of isolates, Gram stain, germ tube test, urea hydrolysis, cornmeal agar morphology, and sugar assimilation test were performed. Antifungal susceptibility testing was determined by Vitek 2 compact system using AST YS 06 Cards. Results: During the study period, a total of 4123 blood samples were received, of which 786 samples were positive. Among the 786 positive samples, 739 (94%) samples showed bacterial growth and 47 (6%) samples showed growth of Candida spp. The prevalence of NAC was 32 (70%) and rest 15 (30%) was Candida albicans. Most of the NAC species showed resistance to fluconazole, voriconazole, caspofungin, micafungin, and amphotericin B as compared to C. albicans. Conclusion: The study highlights the change in epidemiology in the species distribution of Candida. There is a rise in infections by NAC species as compared to those by C. albicans. Early and regular species identification and antifungal testing is necessary to decrease the mortality associated with it.

Characterization of Candida species from Intensive Care Unit Isolates in a Tertiary Care Centre in North-East India: A retrospective study

Background: Fungi have emerged as major causes of human diseases. Intensive Care Units (ICU), harbor almost all the risk factors for opportunistic fungal infections. Among these, Candida infections are very common with recent trends being rise in the non- Candida albicans (NCA) species along with an increase in resistance of these species to antifungal drugs. Aims: To characterize the Candida species from the clinical specimens of patients admitted in the ICU of Tertiary Care Centre in North-East India and to perform their antifungal susceptibility. Settings and Design: This retrospective study was conducted in the Department of Microbiology from January 2011 to December 2011. Materials and Methods: The following techniques were employed to characterize the isolates in the study - KOH mount, Grams stain, India ink preparation, culture on Sabourauds Dextrose Agar, Germ Tube test, Urea hydrolysis, morphology in Cornmeal Agar and chromogenic agar media, sugar fermentation and sugar assimilation tests and automated identification system, and the results were interpreted using standard protocols. Statistical Analysis Used: SPSS version 17.0 was used for all statistical computations and P Results: Out of 85 Candida isolates, Candida tropicalis (38%) was the most common, in all age groups. Infections were more common in patients above 40 years and males were affected more than females. NCA species were more resistant to fluconazole than C. albicans . Conclusions: The study highlights the change in epidemiology in the species distribution of Candida and a rise in infections by NCA species as compared to those by C. albicans . Knowledge of the local species distribution of Candida along with their antifungal susceptibility is essential to initiate and optimize therapy and outcome, especially in an ICU setup, which harbors patients susceptible to fungal infections.