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  Most popular articles (Since August 03, 2013)

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A comparative analysis of isolation and antibiotic sensitivity pattern of Pseudomonas aeruginosa isolated from pus and urine with special reference to phenotypic and genotypic expression of extended spectrum beta lactamases (ESBLs)
PA Shiny, S Rajendran, Y Lakshmi Sarayu
January-June 2013, 15(1):3-6
Pseudomonas aeruginosa (Ps. aeruginosa) is a classic opportunistic pathogen with innate resistance to many antibiotics and disinfectants. The aim of this study was to find the prevalence and the resistance pattern, phenotypic, and genotypic characterization of Ps. aeruginosa from different source of infection. The present study was carried out with a total of 1000 clinical samples including 500 pus samples and 500 urine samples, which were received from patients admitted in the various departments of Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram. Of the 500 pus and 500 urine samples screened, the percentage positivity of Ps. aeruginosa was 12.8% (64) and 4% (20), respectively. Pseudomonas aeruginosa from different samples showed different sensitivity patterns to different antibiotics. In case of isolates from pus, all (100%) were sensitive to Imipenem, while resistance was maximum to Cefotaxime (93.75%). When Pseudomonas aeruginosa isolated from urine was tested for the same antibiotics, sensitivity was maximum (90%) to Tobramycin, while resistance was maximum (80%) to Cefotaxime and Aztreonam. ESBL positive Ps. aeruginosa isolated from pus and urine was 50% and 40%, respectively. The genotype characterization of 25 of these strains showed 6 with CTX-M and 12 with SHV genes.
  2,631 17 1
A case of Scedosporium apiospermum Otomycosis
Manjusree Shanmugham, M Renuka, Ramani Bai Joseph Theodore
July-December 2013, 15(2):79-80
Otitis externa caused by Scedosporium apiospermum is extremely rare. We report a case of otomycosis in a chronic alcoholic who presented at the Otorhinolaryngology Outpatient Department with complains of right ear discharge and hearing loss. Scedosporium apiospermum (Pseudallescheria boydii) was isolated repeatedly from ear discharge. The patient was treated with surgical debridment and topically with Clotrimazole.
  2,307 5 -
Nocardia causing chronic suppurative otitis media and cortical venous thrombosis
Kiran Chawla, Anusha Gopinathan, Chandrashekar Udyawara Kudru, Shivashankara Kaniyoor Nagiri
January-June 2014, 16(1):27-29
Nocardia is known to cause myriad of infections like pulmonary, cutaneous or disseminated in immunocompromised persons. We report a rare case of Nocardia asteroides complex causing chronic suppurative otitis media (CSOM) in a patient with idiopathic thrombocytopenic purpura (ITP), and then leading to cortical venous thrombosis. The patient was treated successfully and discharged till follow-up.
  2,255 6 -
Characterisation of Malassezia species and their clinical correlation in a tertiary healthcare centre in South India
Ambujavalli Balakrishnan Thayikkannu, Anupma Jyoti Kindo, Mahalakshmi Veeraragahavan
July-December 2013, 15(2):49-53
Genus Malassezia consists of 14 species of yeast like fungi that commonly causes superficial mycoses. It is a topic of intense interest but its fastidious nature restricts its research. Speciation gives us better treatment strategies especially with global concern over high Minimum Inhibitory Concentrations (MICs) to anti-fungal agents and emerging resistance. Aim of the study was to speciate Malassezia using phenotypic methods and to analyse the risk factors and its clinical correlation. The study was conducted at our university teaching hospital in south India over a one year period after approval by the Institutional Ethics Committee. A total of 105 patients, who had skin lesions resembling diseases caused by Malassezia, were included. The skin scrapings were subjected to 10% KOH wet mount. Culture was put up on Sabouraud's dextrose agar (SDA), with and without olive oil overlay (SDA-O) and modified Dixon's agar. Gram's stain, catalase test, aesculin hydrolysis, Tween assimilation, temperature tolerance and Tween 40-based precipitate production were done to characterise Malassezia species. The most common age was 20-40 years, with a slight female predominance (58.1%). Among the study group (n = 105), 87 had the prototype disease - pityriasis versicolour (PV). Out of 105 patients, 62.9% were fresh cases and 37.1% came with recurrences. The most common site to be affected by PV was the back, followed by chest. M. globosa was the most common species in both the hypopigmented and hyper pigmented groups. In three patients, two species were isolated from the same lesion. A sequential use of these simple tests helps greatly in a financially constrained set up for speciation of Malassezia in the laboratory.
  2,169 24 1
Non-fermenting Gram-negative bacilli (NFGNB) other than Pseudomonas
Indumathi Vrithamani Aprameya
July-December 2013, 15(2):59-61
  2,136 49 -
Aerobic bacteriological profile and their antibiotic susceptibility in Chronic Suppurative Otitis Media in patients from Mangalore, Karnataka State
Anup Kumar Shetty, Akshata Shetty
January-June 2014, 16(1):3-7
Chronic suppurative otitis media is an infection of the middle ear and mastoid cavity. It is one of the most common causes of deafness. Low social-economic status, overcrowding, malnutrition and poor hygiene are the common risk factors and it commonly affects infants and children. The common pathogens responsible are Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Aspergillus species, Candida species etc. Several studies similar to this have been done previously from various regions of our country and also from several parts of the world. There are no studies done recently from this region to determine the bacteriological profile of aerobic bacteria and their antibiotic susceptibility in this region. The study was done for six months and the sample size was 80. Ear swab culture was done on blood agar, MacConkey agar, and chocolate agar. The culture plates were processed and identification of the isolates and antibiotic susceptibility were done as per standard methods. Samples with bacterial growth were 66 (82.5%), fungal growth were 10 (12.5%) and 4 (5%) samples had no growth. There were 82 isolates of bacteria and fungi from 80 patients. The predominant bacteria were Pseudomonas aeruginosa with 31 (37.80%) isolates followed by Staphylococcus aureus 25 (30.49%). All 31(100%) P. aeruginosa isolates were sensitive to colistin and polymixin B, while 30 (96.8%) isolates showed sensitivity to piperacillin-tazobactam, cefoperazone-sulbactam and aztreonam. Only 21 (67.7%) isolates were sensitive to gentamicin, 23 (74.2%) isolates were sensitive to ciprofloxacin, whereas 24 (77.4%) isolates were sensitive to levofloxacin. All 25 (100%) S. aureus isolates showed sensitivity to vancomycin, teicoplanin and linezolid whereas 23 (92%) isolates showed sensitivity to amikacin, doxycycline and clindamycin. Only one isolate (4%) was sensitive to ampicillin whereas 8 (32%) were sensitive to amoxicillin-clavulanic acid in vitro. P. aeruginosa and S. aureus are the most common aerobic bacterial pathogens in chronic suppurative otitis media. P. aeruginosa showed 100% sensitivity to Colistin and Polymixin B followed by Piperacillin-tazobactam (96.8%), Cefoperazone-sulbactam (96.8%) and Aztreonam (96.8%). S. aureus showed 100% sensitivity to Vancomycin, Teicoplanin and Linezolid followed by Amikacin, Doxycycline and Clindamycin (92% each). Culture and sensitivity should be done in chronic suppurative otitis media before initiating antibiotic therapy.
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Chiranjay Mukhopadhyay, Vandana Kalwaje Eshwara, Vinod Bhat Hattangadi
January-June 2013, 15(1):11-18
Melioidosis is a disease of public health importance in South East Asia and northern Australia, caused by a Gram negative soil-dwelling bacterium, Burkholderia pseudomallei. Sporadic cases are reported from other parts of the world, including India, while detailed information is unavailable. The disease is mainly seen in the population who are in prolonged contact with soil and are diabetic. There is a close association of the disease with rainfall. The primary manifestation is pneumonia with or without septicaemia, but other organs like bone and joints, liver, spleen, lymph nodes may also be affected. Despite improvements in antibiotic therapy, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. The accurate and practical diagnostic set up is still unavailable in many parts of India, which leads to under- or mis-diagnosis, and fatality. The disease needs more attention from the microbiologists, clinicians and researchers from India, since studies related to the pathogenesis and virulence factors, preventive measures, vaccine prospects, and better management may reduce the burden of the disease.
  1,762 34 1
Cytomegalovirus infection associated hemophagocytic syndrome
Mohammed Hisham, S Remadevi, MB Shabina, MP Jayakrishnan
January-June 2013, 15(1):22-24
Virus-associated hemophagocytic syndrome (VAHS) is a rare complication in early cytomegalovirus (CMV) infection. It is a life-threatening condition characterized by prolonged fever, hepatosplenomegaly, and cytopenia. There is no standard therapy for VAHS and the clinical course is variable. Herein, we report a 3-month-old boy whose clinical and laboratory findings were consistent with CMV infection-associated hemophagocytic syndrome. In spite of prompt diagnosis and treatment, the infant expired due to progressive respiratory failure.
  1,670 9 1
Moraxella osloensis causing left subclavian artery thrombus infection
Kavita Raja, Molly Antony, KP Shashidhar, M Unnikrishnan
January-June 2013, 15(1):25-27
A case of left subclavian artery aneurysm with thrombus from which Moraxella group was recovered on culture is described. Patient had presented with life threatening hemoptysis, which on computed tomography (CT) scan evaluation of the chest, revealed a fistulous communication between aneurysm from the origin of left subclavian artery and segmental left upper lobe bronchus. Biochemically on the Vitek system and by growth characteristics organism present was identified as Moraxella osloensis. It was highly sensitive to all antibiotics tested. Cocci with exactly the same morphology could be seen in the Gram stain of a sputum sample from the patient. Postoperative antibiotics eradicated the bacteria and so no growth occurred on culture of the sputum. To our knowledge, this is the first ever time Moraxella species has been isolated from an arterial thrombus, particularly so from a person with normal heart valves.
  1,615 21 -
Geetha Raveendran, Ramani Bai Joseph Theodore, Ragi Rajeev Geetha Kumari
January-June 2013, 15(1):28-29
Gonorrhoea is one of the commonest sexually transmitted infections (STI) in human beings. Prompt and adequate antibiotic treatment can cure this condition, but the rapid identification of the organism is interfered by the fastidious nature of the bacteria, presence of mixed infections, and normal flora of the genital tract. Here, we report a case of gonorrhoea which was culture positive, treated promptly, and cured.
  1,529 13 -
A study on bacterial profile of burn wound infections
Sathya Bhama, Resmi Rajan, Ramani Bai Joseph Theodore
July-December 2013, 15(2):54-58
Aim: This study was conducted to find out the bacterial aetiological agents of burn wound infections with antimicrobial testing of the bacterial isolates. Materials and Methods: This is a descriptive study of 203 patients with burn wound infections at Government Medical College, Thiruvananthapuram during the period January 2010 to April 2011. The specimens were cultured using aerobic microbiological techniques. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. Results: Cultures from burn wound revealed Pseudomonas aeruginosa as the most common organism followed by Staphylococcus aureus, Escherichia coli, Acinetobacter baumannii and Klebsiella pneumoniae. There was a high rate of multidrug-resistant organisms. However, all the staphylococci were susceptible to Vancomycin and the gram negatives were susceptible to Carbapenems. Conclusion: Collection of appropriate specimens for culture before starting of antibiotics helps in better management, along with isolation precautions. However close follow-up and repeat specimens are necessary for appropriate change in antibiotics. For empiric treatment Vancomycin and Imipenem appear to be a good combination in this hospital.
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Phenotypic detection of β-lactamases in enterobacteriaceae using a 12-disk procedure
Chithra Valsan, Jily P Chinnan, KA Sathiavathy
January-June 2013, 15(1):7-10
Background: Laboratory detection of various β-lactamases like extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, carbapenemases, etc., is often complicating and challenging to the clinical laboratories. The prevalence of these resistance mechanisms varies from place to place and from hospital to hospital. Aim: This study was aimed at detecting the prevalence of these resistant phenotypes among Enterobacteriaceae isolates, along with assessing the use of a 12-disk procedure for the same. Results: We found that the prevalence of ESBLs was 60%, AmpC was 10%, and carbapenemases was 12.6% in these isolates. All the strains which were pure ESBL, AmpC, or carbapenemase producers, and were picked up by the Vitek, were also detected by the 12 disc method. But in some of the strains where ESBLs coexisted with AmpC, the presence of AmpC masked the effect of clavulanate enhancement which is used for the detection of ESBLs. Conclusion: Resistant bacteria are prevalent in this hospital and this 12 disc method helps in identifying a majority of them.
  1,478 32 -
Chorioamnionitis due to Arcanobacterium haemolyticum
Sahira Haneefa, Resmi Rajan, Ramani Bai Joseph Theodore, Arya Raveendran Vasantha
January-June 2013, 15(1):34-35
Chorioamnionitis can result either from the ascending of organisms from vagina after rupture of membrane or via the blood stream. This report describes a case of chorioamnionitis caused by Arcanobacterium haemolyticum, an unusual causative agent of chorioamnionitis. This is a case of a 22-year-old second gravida who was admitted for safe confinement at 34 weeks of gestation due to polyhydramnios. Passing of yellowish, foul smelling discharge intermittently was noticed. A. haemolyticum was isolated from amniotic fluid. Chorioamnionitis can result in significant maternal and fetal mortality and morbidity. Hence, it is important to ascertain the prompt diagnosis and treatment of suspected cases.
  1,462 6 -
Mycobacterium fortuitum infection following inguinal hernia repair with mesh: A case series
Kundoly Velayudhan Suseela, Oommen Ninan Ashok, Kizhakke Ambramoli Sathiavathy
July-December 2013, 15(2):69-71
Rapid growing mycobacteria (RGM) are notorious for chronic infections and non-healing surgical wounds. There are reports of infections of implants by RGM, particularly Mycobacterium fortuitum. These conditions necessitate wound exploration to find out the actual pathogen. Herein, we report three cases of M. fortuitum infection following inguinal hernia repair with mesh.
  1,368 4 -
Extrapulmonary tuberculosis at an unusual site
Samitha Nair, Jyothi Rajahamsan, Geetha Raveendran, Ramani Bai Joseph Theodore
January-June 2014, 16(1):24-26
Tuberculosis remains a major public health problem. One-third of the cases diagnosed with tuberculosis have extrapulmonary disease. Here, we report a rare presentation of extrapulmonary tuberculosis involving the spleen. This isolate was a sensitive one and hence the patient responded to the standard regime. Traditional methods of diagnosis are time-consuming but accurate and should be mandatorily followed by drug susceptibility testing to rule out multidrug and extensively drug-resistant tuberculosis.
  1,349 11 -
Invasive sinonasal Scopulariopsis mimicking mucormycosis
Mini P Narayanan, Ashokan Kuttiyil, Shabana Orvankundil, Rema Devi Surendran
July-December 2013, 15(2):75-78
We report a case of invasive sinonasal Scopulariopsis that mimicked mucormycosis in a 63-year-old diabetic patient. The isolated fungus from functional endoscopic sinus surgery (FESS) specimen was identified as Scopulariopsis brevicaulis. The patient was treated with Amphotericin B followed by Itraconazole. Aetiological identification of the fungus is very essential for preventing recurrence.
  1,316 6 -
Concurrent occurrence of Amp C and Cefotaxime (CTX)-M inclinical isolates of enterobacteriaceae
Diji Sara Varghese, Uma Sekar, Mariappan Shanthi, Kamalanathan Arunagiri, Arun Vishwanathan, VM Vidhya, Balaraman Sekar
January-June 2014, 16(1):11-16
Enterobacteriaceae producing both Amp C beta lactamases and extended-spectrum beta lactamases (ESBLs) have been increasingly reported worldwide. While the phenotypic tests for ESBL is standardised and used widely, it is not so for Amp C. When they coexist they may mask each other's detection phenotypically. We undertook this study to detect the concurrent occurrence of Cefotaxime (CTX)-M and plasmid Amp C in clinical isolates of Enterobacteriaceae by phenotypic and genotypic methods. One hundred clinically significant isolates of Escherichia coli (E. coli; 43), Klebsiella pneumoniae (K. pneumoniae; 43) and Proteus mirabilis (P. mirabilis; 14) were included in the study. Antibiotic susceptibility testing to various classes of antimicrobials was performed by disc diffusion using Clinical Laboratory Standards Institute (CLSI) guidelines. Isolates were screened for production of ESBL by CLSI method and Amp C beta lactamase by inhibitor based method using boronic acid and cloxacillin. Polymerase chain reaction (PCR) was performed for the detection of plasmid Amp C genes and blaCTX-M . Plasmid Amp C genes were detected in 27 isolates which included CIT (Origin Citrobacter freundii): 14; DHA (Dhahran Hospital in Saudi Arabia): 12; EBC (Origin Enterobacter cloacae): 1. BlaCTX-M was detected in 51 isolates. Both coexisted in one E. coli and two K. pneumoniae. In one of the K. pneumoniae isolate, all phenotypic tests employed were negative. A high degree of cross resistance to other classes of antimicrobials was observed. Carbapenem resistance was noted in 21 isolates. The concurrent occurrence of Amp C and CTX-M is not common in clinical isolates of Enterobacteriaceae. Phenotypic tests perform poorly when these enzymes are coproduced.
  1,296 7 -
Comparison of various methods for detection of AmpC β-lactamase enzyme
Vrushali Harsh Thakar, Meera Modak
July-December 2013, 15(2):45-48
Fifty multidrug-resistant bacterial isolates were tested for extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase enzyme production. Cefoxitin (30 μg) resistance was used as the screening test for AmpC enzyme detection. Phenotypic confirmation was done by conventional three-dimensional enzyme extract test (TDET), AmpC disc test and modified three-dimensional test (MDT). A total of 45 (90%) strains were AmpC positive by the screening test. Out of these 45 strains, 40 strains were positive by AmpC disc test, 39 strains by TDET and 38 strains by MDT. Cefoxitin resistance can be used as the screening test. AmpC disc test is simple to perform and gives rapid result. So, it can be used as a phenotypic method for detection of AmpC enzyme production in resource-limited settings where genotypic detection methods are not available.
  1,211 24 -
Acute brucellosis caused by Brucella melitensis: A case report
Shailaja T Sukumaran, Sushitha S Thayyil, Sathiavathy K Ambramoli
July-December 2013, 15(2):66-68
Members of the genus Brucella are aerobic, small, Gram-negative coccobacilli, which include seven species, of which four are human pathogens, namely Brucella melitensis, Br. abortus, Br. suis and Br. canis. Brucellosis, a zoonosis continues to be a major public health problem worldwide. We report a case of acute brucellosis caused by Br. melitensis in a 25-year-old male working in Middle-East, who presented with fever of 3 weeks duration. He was empirically treated as a case of enteric fever. Br. melitensis was isolated from his blood culture using automated blood culture system and the serology was positive for Brucella IgM antibody. The patient responded well to injection streptomycin 0.75gm IM and doxycycline 200mg daily for a period of three weeks.
  1,214 12 -
Microbial profile of suppurative keratitis a prospective study
Beena Paul, P. S. Girija Devi
January-June 2014, 16(1):8-10
This is a prospective study on the microbial profile of suppurative keratitis conducted at Regional Institute of Ophthalmology, Trivandrum for a period of 2 years from March 2006 to February 2008. The objective was to identify the specific causative organisms from patients with suppurative keratitis in a tertiary referral eye care center in South Kerala. All consecutive cases of clinically diagnosed corneal ulcers were evaluated. Corneal scrapings were performed and processed for direct microscopy and culture on appropriate media. A total of 1221 cases of corneal ulcers were evaluated. Causative organism was isolated in 343 cases (28.09%). Among them, 240 cases (69.9%) were fungi and 97 cases (28.27%) were bacteria. Acanthamoeba was isolated in six cases (1.74%). Among fungi Fusarium species and Aspergillus species were predominant (31.66%) followed by Penicillium species (24.58%). Among bacteria, Gram-positive cocci (26.80%) were predominant followed by Pseudomonas (24.74%).
  1,194 13 -
A case report of Candida pelliculosa sepsis in newborn nursery ICU
Anitha Madhavan, V Jayalakshmi, B Sobha
January-June 2013, 15(1):32-33
Nosocomial transmission of Candida is a very important cause of infection in the neonatal intensive care unit (ICU). We report a cluster of fungemia cases caused by Candida pelliculosa in 17 neonates in our inborn nursery. Of these, 16 were premature babies who showed signs of infection. Yeast colonies isolated from their blood cultures were identified by Vitek 2 System (bioMerieux) at the Regional Cancer Centre Thiruvananthapuram. All the babies were treated with Amphotericin B successfully, with no relapse. Extensive sampling was undertaken from the ICU and cultures performed. Although no definite source could be identified, nosocomial spread of Candida stopped after infection control measures were strictly reinforced in the inborn nursery. This highlights nonalbicans Candida as an emerging pathogen in neonatal ICUs.
  1,189 7 -
Lid abscess with periorbital cellulitis caused by Dirofilaria repens
AR Vinayakumar, Katherine Joseph, Andrews C Joseph, Annie Johny
July-December 2013, 15(2):81-83
Dirofilaria is a common parasite of domestic and wild animals. Man gets infected accidentally by inoculation of arthropods infected with the microfilariae during their blood meal. Human infection with Dirofilaria repens results in coin lesions in the lungs, subcutaneous mass anywhere in the body or ocular lesion that may be sub-conjunctival or periorbital. Human dirofilariasis is prevalent in several regions of the world and is on the rise in many parts of India, particularly in Kerala. We hereby report a case of ocular dirofilariasis that presented as lid abscess with periorbital cellulitis.
  1,127 8 -
Burkholderia pseudomallei: Three cases in 6 months in Central Travancore
Seema Oommen, Sreeja Nair, Kavitha Nair, P Viswanathan, PM Sivan Pillai
January-June 2013, 15(1):19-21
Melioidosis caused by Burkholderia pseudomallei has been reported from various parts of the country and from northern Kerala. This is the first series of documented cases from Central Travancore, Kerala. The most common predisposing factor in all these three cases was diabetes mellitus followed by chronic alcoholism. Early clinical suspicion and correct microbiologic diagnosis, which help in institution of appropriate therapy, remain the key factors in reducing the mortality associated with this disease.
  1,089 15 -
Rhodotorula species from CAPD fluid
Sathya Bhama, Beena Paul, Ramani Bai Joseph Theodore, Soumia Sugathan
January-June 2014, 16(1):38-39
Rhodotorula is a pigmented yeast, a part of phylum Basidiomycota, that is quite easily identifiable by distinctive orange/red colonies when grown on Sabourauds Dextrose Agar. While being considered as a common contaminant, Rhodotorula may infect individuals with predisposing risk factors like patients with acquired immunodeficiency syndrome (AIDS), endocarditis, central venous catheter infections, fungaemia and sepsis. We report a case in which the Rhodotorula species was isolated from the peritoneal dialysis fluid of a 7-year-old child with the prune belly syndrome. The child was given systemic anti-fungals, and peritoneal dialysis (PD) catheter was removed after which the child became asymptomatic.
  1,099 5 -
Case study of aspergillus flavus causing unilateral acute progressing corneal melt
S. K. Prabhakar, G. S. Vijaykumar, S. Rohit Rao
January-June 2014, 16(1):32-34
Twenty-eight-year-old female patient, reported with history of acute painful loss of vision, following contact with Parthenium plants 15 days ago. Slit lamp examination showed 4-5 mm circumscribed thick plaque of slough in the central cornea with satellite infiltration and tenacious hypopyon. Ten percent potassium hydroxide (KOH) preparation of the slough revealed plenty of septate fungal hyphae. Topical Natamycin was instilled with no improvement. Ulcer debridement was done and thick plaque was subjected to microbiological examination. Fungal culture yielded Aspergillus flavus. Topical Amphotericin B was added along with Natamycin. Despite good response the condition progressed to quick melting and perforation. Crystalline lens extruded through the perforation, after several bouts of sneezing. Perforation was managed by therapeutic corneal grafting. Drug resistance, drug toxicity, corneal thinning and the strain by the patient might explain the disease progression. Factors causing corneal melt and the measures adopted to prevent the intraocular spread are presented.
  1,087 12 -