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.

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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.

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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.

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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.

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A case of Cryptococcus neoformans causing localized cutaneous lesion over the left upper lip in an acquired immunodeficiency syndrome (AIDS) patient with cryptocococcal meningitis and pulmonary tuberculosis.

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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.

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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.

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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.

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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.

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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.

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