Introduction: Systemic autoimmune diseases include conditions where the immune system fails to recognize self antigens leading to production of "auto antibodies" and subsequent damage to several organs and tissue systems, e.g., Systemic lupus erythematosus, Scleroderma or Systemic sclerosis, Dermatomyosits, Polyarteritis nodosa and Mixed connective tissue disease. Detection of antinuclear antibodies (ANA) has been found to be the single most important criteria for the diagnosis of connective tissue disorders. Materials and Methods: The commonly used methods to detect ANA like ELISA and indirect immunofluorescence (IFA) were evaluated in this study. Results: ELISA showed a sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate of 93%, 54%, 60%, 92%, 45% and 7% respectively when compared to IFA. Conclusions: ELISA is non-specific and less useful as a diagnostic test whereas ANA IFA is a more accurate test and the gold standard.

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Rothia mucilaginosa (previously Stomatococcus mucilaginosus) is a Gram-positive coccus residing in the oral cavity and respiratory tract as a part of normal flora. In the recent years, it has been associated with opportunistic infections in immunocompromised patients. In this case report, we present a case of pneumonia due to R. mucilaginosa. The isolate was confirmed using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry system.

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Introduction : Non-Typhoidal Salmonella (NTS) species are important food borne pathogens with acute gastroenteritis being the most common clinical manifestation. Certain serovars of Salmonella show a much higher predilection for causing bacteraemia. Though NTS infections are associated with significant morbidity and mortality worldwide; data on NTS in India are limited. Objectives : The aim of this study was to describe the prevalence and epidemiology of Non-Typhoidal Salmonella (NTS) in central Kerala, and to compare their sensitivity patterns with typhoidal Salmonella. Methods : A retrospective study was done on the blood and stool culture samples received by the microbiology laboratory of a tertiary care centre from January 2012 to August 2014. NTS were isolated and identified using standard bacteriological methods, including serotyping with specific antisera. The geographical distribution, co-morbid conditions and antibiotic sensitivity patterns were analyzed. Results : A total of 15 cases of NTS were isolated of which three isolates were associated with bactaeremia. Most common isolates were S. Typhimurium and S. Enteritidis. We also isolated S. Weltreveden from two patients. Conclusion : Knowledge of the prevalent of serotypes and their sensitivities would be useful for epidemiological and treatment purposes.

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Background and Objectives: Increasing reports of Vancomycin creep have been observed in both Methicillin sensitive and Methicillin resistant staphylococcal isolates. The objective of this study was to determine the sensitivity pattern among clinical isolates of Methicillin sensitive and Methicillin resistant Staphylococcus aureus (MRSA), S. epidermidis, S. haemolyticus, to Vancomycin, Teicoplanin and Linezolid. Materials and Methods: A total of 82 S. aureus, 34 S. epidermidis and 26 S. haemolyticus isolated during Jan 2011 to Dec 2011 were included in the study. None of the S. aureus isolates were resistant to Vancomycin and Linezolid. Only one MRSA isolate was resistant to Teicoplanin. Vancomycin resistant strains among Methicillin resistant S. epidermidis was one (4.3%) and among S. haemolyticus was two (8.3%) respectively. Teicoplanin resistant strains among Methicillin resistant S. epidermidis was six (26.1%) and among S. haemolyticus was two (8.3%). Linezolid resistant strains among Methicillin resistant S. epidermidis was two (8.7%) and among S. haemolyticus was one (4.2%). Conclusion: Emergence of Vancomycin, Teicoplanin and Linezolid resistance among Methicillin resistant coagulase negative staphylococci (CoNS) is alarming limiting the therapeutic options.

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Background and Objectives: Diarrhoea is one of the leading causes of morbidity and mortality among children under 5 years. Study was aimed to evaluate the role of different categories of diarrhoeagenic Escherichia coli (DEC) in children <5 years of age hospitalised for acute/persistent diarrhoea, by multiplex polymerase chain reaction assay for simultaneous detection of five categories of DEC using eight virulent genes and antibiotic susceptibility pattern of DEC. Materials and Methods: Faecal samples from 355 children with and 150 children without diarrhoea were collected from 2011 to 2013 from King George Medical University and Balrampur Hospital of Lucknow district, Uttar Pradesh, India and were tested for enteric pathogens using conventional diagnostic methods and molecular methods. Results: DEC was detected in 152 (42.81%) children with and 14 (9.33%) in children without diarrhoea respectively. The most common pathotype was enteroaggregative E. coli (EAEC) in cases and controls (16.05% and 5.33%), followed by enteropathogenic E. coli (12.67% and 2.66%), enterotoxigenic E. coli (8.73% and 1.33%), enteroinvasive E. coli (5.35%/and nil) in cases and controls respectively, enterohaemorrhagic E. coli was not detected in any of the diarrhoeal samples. DEC isolates showed a low rate of sensitivity to Ampicillin (07.89%), Amoxycillin-Clavulanic acid (06.57%), Trimethoprim/Sulphamethaxazole (20.39%), Nalidixic acid (24.34%,), Ciprofloxacin (34.34%), Ceftriaxone (23.68%)), Chloramphenicol (33.55%) and Cefoxitin (30.26%) while they were more sensitive to Amikacin (65.78% sensitive), Piperacillin/Tazobactam (61.84% sensitive) and Gentamicin (61.84% sensitive). Interpretation and Conclusions: DEC strains are a significant cause of diarrhoea in children. EAEC was the most frequent pathotype in the study. The high level of antimicrobial resistance in our study raises a broader discussion about the indiscriminate use or misuse of antibiotics and the risks of empirical antibiotic therapy in children of a very young age.

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In contrary to the belief that less invasive modalities offer reasonable success rates with minimal infection complications, discitis after lumbar endoscopic discectomies occurs in 2-3% of patients. We present a rare case of post-operative discitis, due to non-pigment producing Serratia marcescens in a female patient who had undergone single level lumbar endoscopic discectomy 6 weeks back. The patient was able to completely resume her activities 12 weeks after surgical irrigation and debridement, appropriate antibiotics and strict bed rest. Our case sheds light on a serious complication after a minimally invasive surgery by a relatively rare pathogen and highlights its clinical significance.

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Erysipeloid is a cutaneous infection produced by Erysipelothrix rhusiopathiae following trauma. Here, we present a case of erysipeloid with lesions along the lymphatics on the right lower leg in a man who was working in a prawn farm. The lesion resembled sporotrichosis clinically.

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Enteric fever remains a major source of morbidity and mortality worldwide. Despite advances in therapy, the emergence of drug-resistant strains and their persistence confound this. The clinical profile of Salmonella infections and its drug susceptibility varies between geographical regions and countries, attributable to inadequate hygiene, and sanitation as a common factor. In this article, we describe a series of seven cases of enteric fever due to Salmonella Typhi and Salmonella Paratyphi A, which were diagnosed at a tertiary care hospital in Kerala with the purpose of identifying their antibiotic sensitivity pattern. Ceftriaxone is presently considered as the drug of choice due to increasing fluoroquinolone resistance. Oral Azithromycin remains a good substitute. Decreasing multidrug-resistant strains and increase in susceptibility to Ampicillin, Chloramphenicol, and Cotrimoxazole were noted. These changing trends highlight the need for better preventive measures, including proper sanitation and judicious use of antibiotics, adhering to correct dosage and duration, rather than searching for novel treatment options. Vaccination should be ideally promoted in endemic areas.

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Otitis media is a persistent, insidious, and dangerous disease because of multiple aetiology and serious complications. Hence, a study was conducted to find out the bacterial and fungal aetiology of suppurative otitis media. Aim: The aim was to find the prevalence of bacterial and fungal pathogens in acute and chronic otitis media. Materials and Methods: A total of 260 patients having otitis media belonging to all age groups and both sexes who attended the ENT outpatient department were selected for study for a period of 1-year. Ear discharge was collected under aseptic precautions using sterile cotton swabs. Both bacterial and fungal culture were done. The antimicrobial susceptibility of bacterial isolates was done including detection of extended-spectrum β-lactamase and detection of metallo β-lactamase for resistant strains. Results: In acute suppurative otitis media, Gram-positive organisms 48 (55.18%) were predominant compared to Gram-negative organisms 37 (42.52%). No fungal isolates were obtained in the present study. In the case of chronic suppurative otitis media (CSOM), bacteria were isolated in 129 (74.57%) cases and fungus in 41 (23.7%) cases. Polymicrobial infection was found only in 14 (10.85%) cases. Among the bacterial isolates in CSOM, Gram-negative organisms (65.35%) were more compared to Gram-positive organisms (35.65%).

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Background: There has been a gross under diagnosis of scrub typhus cases in India due to its non-specific and diverse clinical presentations, limited awareness, lack of high index of suspicion, and limited number of clinical studies. An early diagnosis and prompt institution of treatment can avert significant morbidity and mortality. Materials and Methods: This was an observational study of prospective design conducted in the Department of General Medicine, Government Medical College, Kozhikode over a period of 1½ years from 1 ^st January 2012 to 31 ^st June 2013. Patients with clinical features suggestive of scrub typhus with positive Weil-Felix OXK ≥160 or 4 fold increase in titre and/or positive IgM ELISA for scrub typhus were included in the study. Results: Out of 70 patients with clinical features suggestive of scrub typhus, 39 (56%) were males, and 31 (44%) were females. Most cases occurred during the cooler months of the year (October to February). Fever was the most prominent symptom (100%) followed by headache in 68 (98.6%) patients. The most common physical sign was lymphadenopathy in 44 (62.8%) cases, eschar was present in 32 (45.7%) cases with groin being the most common site (31.3%). Leucocytosis was observed in 28 (40%) and was associated with statistically significant mortality rate and increased complications like meningoencephalitis. Mortality rate was also higher in the patients with erythrocyte sedimentation rate >100 (46.2%) (P = 0.002) and in patients with serum albumin <2 g% (66.7%) (P = 0.001). An association between low serum albumin (<2 g%) and myocarditis was also observed. The complications observed in our study were myocarditis in 17.1%, meningoencephalitis in 14.3%, acute kidney injury in 44.3%, and adult respiratory distress syndrome in 8.5%. Totally, 62 (88.6%) patients responded to Doxycycline whereas 8 (11.4%) showed no response and were treated with Azithromycin or Chloramphenicol. There is an emerging resistance to Doxycycline in the community. The case fatality rate was 14.3%.

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Although acute gastroenteritis is the most common manifestation of Salmonella infections, the illness can present with focal lesions in almost any organs with or without septicaemia. We describe here a case of chronic osteomyelitis right trochanter with septic arthritis hip caused by Salmonella typhimurium which was treated with surgical debridement and Ciprofloxacin.

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Nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients and also sometimes in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system (CNS). Nocardial brain abscesses are rare CNS infections with high mortality rate reaching 34% which is considered the highest amongst brain abscesses caused by microorganisms. We report two cases of nocardial brain abscesses in patients with pre-existing lung disease. The first case presented with seizures and the second with hemiparesis, hemianopia and pleural effusion. Magnetic resonance imaging (MRI) brain showed space occupying lesions, thought to be tuberculoma or malignant brain tumor. Per operatively they were found to be abscesses. The Gram stain of pus from both cases and cultures of pus and pleural fluid yielded Nocardia farcinica. Histopathology of brain tissue was also corroborative. Both patients were started on long term therapy of Sulphamethoxazole-Trimethoprim (Co-trimoxazole) and in the second case of disseminated nocardiosis, Ceftriaxone and Linezolid was added. These cases highlight the importance of including nocardial abscesses as differential diagnosis in immunosuppressed patients presenting with neurological deficits and abnormal MRI. Multisystem nocardiosis may not be as rare as assumed. Thus an increased vigilance towards diagnosis and appropriate treatment including surgical intervention is required for reducing morbidity and mortality.

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Background: Mycotic keratitis is an important cause of corneal blindness in developing countries including India. It is more common in the tropics and subtropical regions. A retrospective study was done in all patients with clinically suspected fungal keratitis at Peoples Education Society Medical College and Research Institute Hospital, Kuppam, Andhra Pradesh from January 2011 to December 2013 to determine the causative agents and to identify the predisposing factors of mycotic keratitis. Out of 63 cases with corneal ulcer, 39 cases were diagnosed with mycotic keratitis by culture (36 cases) or by potassium hydroxide preparation (three cases). Males were more commonly affected and were mostly in the age group above 50 years Fusarium species (55%) was the most common fungus isolated followed by Aspergillus flavus (22%). Direct microscopic detection of fungal structures in corneal scrapings permits a rapid presumptive diagnosis and early institution of antifungal therapy which is necessary to prevent blindness.

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