Early Microbiological Diagnosis Research Articles

A-282 Purpura fulminans caused by Haemophilus influenzae: case report of unusual etiology

Abstract Background Fulminant purpura is a clinical syndrome characterized by a purplish, ischemic-looking skin rash, commonly accompanied by systemic symptoms ranging from acute febrile syndrome to septic shock. Due to high lethality of possible infectious etiologies, immediate recognition and early initiation of empirical antimicrobial therapy are crucial to ensure better outcomes. Interdisciplinary collaboration among healthcare teams, infectious disease specialists and microbiologists is essential to ensure accurate and early microbiological diagnosis. Methods This work aims to report a case of Haemophilus influenzae-induced purpura fulminans that occurred in Fortaleza-CE, a coastal city in northeastern Brazil, highlighting clinical recognition and microbiological identification, based on review of medical records. Results Case report A 59-year-old man, originally from Germany, was on vacation in Brazil. He presented to emergency medical service with an acute onset of fever, abdominal pain and diarrhea, progressing to decreased level of consciousness and purplish ischemic skin lesions with hemorrhagic bullae on trunk and extremities (Figure 1), with no history of trauma. Upon admission, the blood exams showed bicytopenia - 1900 leukocytes/µL (86% segmented) and 51,000 platelets/µL - and very high C-reactive protein (41.58 mg/dL). Although empirical antimicrobial therapy with vancomycin and piperacillin-tazobactam was initiated, patient progressed to septic shock, hepatic dysfunction, requiring mechanical ventilation, vasopressor support, and renal replacement therapy. Blood cultures from hospital admission were positive after about 14 hours and allowed isolation of small and translucent colonies in Chocolate PVX plate Agar (BioMerieux™). Maldi tof analysis by Vitek MS identified H. influenzae (99.9 % accuracy). Despite prolonged hospitalization due to multiple organ dysfunctions, patient had a positive outcome. Conclusions This case illustrates the importance of immediate recognition of the syndrome coupled with assertive empirical treatment and early microbiological diagnosis for a positive clinical outcome, even in a severe presentation. Multiprofessional approach is essential for accurate and early diagnosis.

Clinical Presentations of Melioidosis and Antibiogram of Burkholderia pseudomallei: An 8-year Study in a Tertiary Care Center, South India

Abstract Background: Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in tropical countries. In nonendemic areas, the disease is rarely suspected because of varying clinical presentations and only a few attempts are made to isolate the pathogen. Many cases are left underdiagnosed or underreported in geographical areas where the disease is not endemic. This study aimed to analyze the clinical presentations, comorbidities, and antibiotic susceptibility patterns in patients with melioidosis in a tertiary care center. Materials and Methods: A retrospective study was done on culture-confirmed melioidosis patients admitted to a tertiary care center, from January 2015 to December 2022. Relevant information on clinical presentations, mortality rate, comorbidities, and antibiogram was collected from hospital medical records. Results: A total of 73 culture-confirmed cases of melioidosis were included in the study. Common clinical presentations were pneumonia (n = 35, 47.9%), septicemia (n = 13, 17.8%), and deep abscesses (n = 9, 12.3%). The mortality rate from melioidosis was 15.1% (n = 11). No significant difference was found in the mortality rate between pneumonia and septicemia groups (P = 0.716). Diabetes mellitus (DM) was the major comorbidity detected (n = 56, 76.7%). Isolates were susceptible to ceftazidime (n = 71, 97.3%), meropenem (n = 71, 97.3%), and co-trimoxazole (n = 60, 82.2%). Conclusions: Common clinical presentations of melioidosis in our setting were pneumonia and septicemia. DM was the major comorbidity. Nearly one in six patients died. Ceftazidime and meropenem were the effective antibiotics. These findings may help physicians to make an early microbiological diagnosis which is essential to reduce mortality.

Cryptococcal meningitis in people living with human immunodeficiency virus in Nepal: Perspectives from resource limited setting.

Early diagnosis of cryptococcal meningitis among people living with HIV (PLHIV) is crucial for its therapeutic success. The objective of this study was to diagnose cryptococcal meningitis in PLHIV cases using the available laboratory techniques for its confirmation in resource limited setting. This cross-sectional prospective study was conducted among 72 PLHIV with clinical suspicion of meningitis. Each cerebrospinal fluid (CSF) sample received at the National Public Health Laboratory, Kathmandu was processed for India ink staining, cryptococcal antigen lateral flow assay, and fungal culture following standard protocols. The laboratory-confirmed cryptococcal meningitis cases were between 24 and 69 years of age (median age 39 years) with 87.5% (12/14) of cases being male. Cryptococcus was detected in 22.22% (16/72) by any of the three tests, 19.44% (14/72) by cryptococcal antigen lateral flow assay, 16.66% (12/72) by India ink staining, and 8.33% (6/72) by culture. High percentage of cryptococcal meningitis among PLHIV warrants early microbiological diagnosis for better case management. Cryptococcal antigen detection immunoassay should be the priority test for laboratory diagnosis of cryptococcal meningitis in PLHIV. Alternatively, very simple and economic India ink staining of CSF specimens could be used in resource limited settings.

P08 The difficulty of Pseudomonas aeruginosa eradication in a post-spinal anaesthesia meningitis

BackgroundMeningitis and ventriculitis due to Pseudomonas aeruginosa are uncommon. They are commonly secondary hospital-onset and typically related to neurosurgical procedure. Previous studies have shown P. aeruginosa to be responsible for 1%–18% of nosocomial meningitis cases. Both treatment failure and relapses are known to occur, and the recorded mortality is high, approaching 80% in some studies.ObjectivesWe report a case of P. aeruginosa meningitis in a 26-year-old woman following spinal anaesthesia for caesarean section, its clinical characteristics, treatment challenges in the era of high generation antibiotics and the outcomes.ResultsA 26-year-old woman was hospitalized after 1 week of her third child delivery by caesarean section with spinal anaesthesia and 3 days after high fever and headache. Lumbar puncture was performed immediately, and leucocyte cell count was 723 cell/dL with 94% segmented neutrophils. CSF glucose was very low, and protein was 420 mg/dL. P. aeruginosa was isolated and it was susceptible to all antibiotics of standard panel. Cranial and lumbar region CT scans were normal. We modified empirical treatment and started ceftazidime and gentamicin. Three days after de-hospitalization in improved condition, she had high fever and strong headache and came back to hospital. We started treatment with imipenem and ciprofloxacin and 2 months after we performed several lumbar punctures, cranial MRIs and changed different antibiotic regimens with third generation cephalosporins, aminoglycosides, carbapenems and colistin; her clinical situation such as headache and fever and CSF did not show any sign of improvement. Susceptible P. aeruginosa was isolated each time we examined her CSF. She decided to leave the hospital and 2 weeks after her headache worsened and a convulsive attack happened. The cranial MRI showed hydrocephaly and a white precipitate (pus) in the left lateral ventricle. An extraventricular drain helped to resolve hydrocephaly and intraventricular colistin was injected until CSF was sterilized. After 1 month she was in a very good condition and a ventriculo-peritoneal shunt was placed.Conclusions P. aeruginosa meningitis was associated with some treatment difficulties. Even after an early nosological and microbiological diagnosis and an appropriate choice of antibiotics, based on bacterial meningitis treatment criteria and antibiogram, we couldn't eradicate the bacteria from CSF. To achieve success in this nosocomial infection from a not careful asepsis, sometimes a prolonged antibiotic and local treatment with intraventricular or intrathecal therapy is needed.

A case report of Sino-orbital Mucormycosis in a COVID-19 patient from eastern India: a “Red-alert” to physicians emphasizing the importance of early microbiological diagnosis

A 65 years old diabetic female, presented with swelling of left eye and multiple discharging sinuses near the inner canthus of the left eye. She had a history of recent COVID-19 infection and was treated with steroids. The pus from peri-orbital sinuses, in KOH stain showed presence of broad, non-septate, right-angle branching fungal filaments. An early microbiological diagnosis of Mucormycosis, based on the direct smear findings substantiated the clinical diagnosis and helped the patient to get timely treatment. We emphasize that a request for an early microbiological diagnosis may affect the outcome in this highly invasive fatal disease.

WEST NILE ENCEPHALITIS: MISGIVINGS ABOUT LUMBAR PUNCTURE IN A PATIENT WITH ICU DELIRIUM ON DUAL ANTIPLATELET THERAPY

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Delirium in the critically ill is common, reported in over 80% of ICU patients. When associated with fever, it warrants investigation. West Nile is an arbovirus that can cause neuroinvasive disease ranging from mild and self-limited to severe encephalitis with mortality rate of 10%. It is diagnosed with positive IgM antibody on cerebrospinal fluid (CSF), so lumbar puncture (LP) is important for this diagnosis. Traditionally, LP was thought to increase risk of serious bleeding complications such as spinal hematomas in patients on dual antiplatelet therapy (DAPT). We present a case of a patient with West Nile encephalitis whose symptoms were attributed to drug fever and ICU delirium after negative infectious workup and significant delay in LP due to DAPT. CASE PRESENTATION: A 59 year old male presented to the ER with chest pain. He was intubated on arrival and managed for acute myocardial infarction causing cardiogenic shock. He required percutaneous coronary intervention with drug-eluting stents and temporary mechanical circulatory support with Impella. Impella was removed 3 days later. He began to exhibit daily high-grade fevers. Antibiotics were started. He developed encephalopathy and could not be extubated, necessitating tracheostomy. Extensive infectious work-up including complete body imaging, blood, BAL, pleural fluid and urine cultures, respiratory viral panel, malaria, brucella, fungal tests were all negative. LP was considered but deferred as he was on DAPT after stent placement. Hyperthermic toxidromes were excluded. Drug fever in the setting of ICU delirium was considered and non-essential medications were eliminated. Fever persisted and LP was performed 3 weeks later. CSF studies were positive for West Nile Virus IgM antibody. Antibiotics were stopped. Supportive care was provided for West Nile encephalitis. The patient improved and was eventually discharged. DISCUSSION: Clinicians often lack crucial information needed to treat infections, with 30-60% of antibiotics prescribed in the ICU thought to be inappropriately broad or inappropriately narrow. Attributing an alarm symptom like fever to non-infectious causes in the setting of ICU delirium is a pitfall that can be avoided by completing infectious workup with LP. Recent studies do not show a significant increase in complications in patients who undergo LP while on antiplatelet therapy, with incidence of spinal hematomas ranging from 0-0.7%. CONCLUSIONS: While a risk benefit discussion is essential, our case underscores the importance of pursuing early microbiological diagnosis with LP in a patient with fever and encephalopathy, even when on DAPT. This allows de-escalation of antibiotics with their associated side effects, tailored therapy and data to inform prognosis. Reference #1: Lee, Paul W, and Michael Levy. "Risk of Hematoma From Aspirin or Clopidogrel Owing to Lumbar Puncture." Mayo Clinic Proceedings 94.8 (2019): 1552-555. DISCLOSURES: No relevant relationships by Abdul Khan, source=Web Response No relevant relationships by Sumit Patel, source=Web Response No relevant relationships by Nehan Sher, source=Web Response No relevant relationships by Tonya Whiting, source=Web Response

Role of automated GenexpertMTb/Rif system for rapid detection of Mycobacterium tuberculosis and Rifampicin resistance in extrapulmonary tuberculosis: A prospective study

Introduction: Extrapulmonary Tuberculosis is infection of mycobacterium tuberculosis involving organ other than lung. It account for 15-20% of all TB cases. Various combined approach used for diagnosis of Extrapulmonary TB. GeneXpert MTB/RIF System is cartridge based nucleic acid amplification test to detect tuberculosis and rifampicin resistance in two hours. Materials and Methods: This hospital based prospective study was carried out for period of 6 months with objective:-1) To evaluate the efficacy of GeneXpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis (EPTB) by comparing it with composite reference standard which include smear microscopy, clinical findings at time of presentation and three months follow up and radiological investigations.2) To look for Rifampicin Resistance by GeneXpert. Results: Out of total of 168 enrolled patients 135 patients met the criteria of composite reference standard (CRS). Among total 135 CRS+ve EPTB Cases, 23 were paediatric (below 12 years of age) and 112 were Adults. Smear Microscopy was positive in 18 patients while GeneXpert gave positive results in 38 patients (8 paediatric and 30 adult patients). Rifampicin resistance was detected in 4 patients. Pleural effusion is the most commonly obtained sample followed by CSF, lymphnode, ascitic, urine, other fluid. Conclusions: Sensitivity of GeneXpert is more as compared to smear microscopy. GeneXpert showed better sensitivity in CSF, tissue, lymphnode, pleural and urine. So early microbiological diagnosis and Rifampicin drug sensitivity in Extrapulmonary sample lead to early treatment initiation of Tuberculosis and decrease morbidity and mortality due to tuberculosis. RNTCP has also recommended use of GeneXpert in suspected TB in Extrapulmonary sites. Keywords: GeneXpert, Extrapulmonary Tuberculosis, Smear Microscopy, Sensitivity.

Bacterial Identification and Monitoring Around Two-Piece Dental Implants by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS).

Context Early microbiological diagnosis and treatment of periodontal pathogens is important for successful retention of dental implants. Aims This study aimed to identify and monitor oral bacterial colonization after successful two-piece dental implants. Settings and Design In this study, 50 two-piece dental implant subjects were included and assessed clinically, radiographically, and microbiologically. Methods and Material All the parameters were recorded at various stages after prosthesis placement. In each stage, nonadherent (peri-implant sulcular fluid) and adherent (curetted inner threads) samples were collected. Semiquantitative anaerobic culture of the samples were done in Anoxomat system. Bacterial colonies were first identified by routine microbiological methods and then by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method. Statistical Analysis All the results were analyzed by appropriate statistical methods (Chi-square, one factor analysis of variance, etc.). Results All the bacterial isolates were identified in the MALDI-TOF MS system with no failure. After implant placement for the nonadherent samples, the frequency (%) of Fusobacterium nucleatum, Prevotella melaninogenica, and Propionibacterium acnes decreased whereas frequency (%) of Escherichia coli, Staphylococcus epidermidis, and Streptococcus mitis increased. For adherent samples, the frequency (%) of E. coli, Enterococcus faecalis, Porphyromonas gingivalis, P. melaninogenica , and Veillonella parvula decreased, whereas frequency (%) of S. mitis and Streptococcus mutans increased. The postimplant mean nonadherent and adherent bacterial load increased with time but not significantly over the periods ( p = 0.302 and 0.123, respectively). Conclusion Combination of basic (semiquantitative culture method) and advanced microbiological method (MALDI-TOF MS) can be useful for accurate detection and monitoring of potential pathogens around two-piece dental implants.

Galactomannan and PCR in the Central Nervous System to Detect Invasive Mold Disease - A Retrospective Analysis in Immunocompromised Children

Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.

Prevalence of pathogens causing bacteraemia in tertiary care hospital

Prevalence of pathogens causing bacteraemia in tertiary care hospital - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/2394-5478.2019.0002, Indian Journal of Microbiology Research-Indian J Microbiol Res

Reliability of a multiplex PCR system for diagnosis of early and late prosthetic joint infections before and after broth enrichment

Early microbiological diagnosis of prosthetic joint infection (PJI) is essential for successful antimicrobial treatment; however, culture has limited sensitivity, particularly in patients who had received antibiotic therapy, and the utility of molecular methods for diagnosing PJIs remains debated. We investigated the reliability of a multiplex PCR system for the microbiological diagnosis of early and late PJIs.Samples of periprosthetic tissues, synovial fluid, and prosthetic implants from 47 patients with early (n=13) or late (n=34) PJI were analyzed by conventional culture and with the multiplex-PCR Unyvero ITI® (U-ITI) cartridge system. Samples treated with dithiothreitol (DTT) and synovial fluids were spread directly on agar plates and inoculated into enrichment broths. The synovial fluids, DTT eluates and enrichment broths were processed according to the U-ITI protocol.When compared against culture as the reference method, U-ITI analysis of DTT eluates had a sensitivity of 34.2%; sensitivity of U-ITI analysis increased up to 81.6% when enrichment broths were analyzed. In particular, sensitivity was 44.4% for synovial fluids, and 41.7%, and 23.5% for DTT eluates from early and late infections, respectively. Sensitivity of analysis of enrichment broths was 83.3% for early infections, 82.3% for late infections and 77.8% for synovial fluids.Our findings seem to suggest that, when coupled with the use of broth culture, U-ITI analysis may allow for more rapid microbial identification than biochemical methods, while no advantages in time to detect microbial growth were observed. Improvements, particularly in sensitivity, are needed to make it more suitable for diagnosis of early and late PJIs.

Successful Treatment of PD Peritonitis Due to Morganella morganii Resistant to Third-Generation Cephalosporins – A Case Report

Morganella morganii is a rare cause of peritonitis in patients on peritoneal dialysis (PD). Most of the reported cases have resorted to a switch to hemodialysis. We herein report a case of peritonitis due to M. morganii resistant to third-generation cephalosporins, which was treated successfully with intraperitoneal (IP) tobramycin followed by oral ciprofloxacin. Early microbiologic diagnosis is essential in the treatment of peritonitis from rare microorganisms such as Morganella morganii, and appropriate antibiotic therapy is the key to avoiding catheter loss and subsequent switch to hemodialysis.

Post-laser in situ keratomileusis interface fungal keratitis.

To report outcomes of post-laser in situ keratomileusis (LASIK) interface filamentous fungal keratitis. This retrospective interventional case series included 6 eyes of 5 patients with microbiologically proven post-LASIK interface fungal keratitis from August 2008 to August 2013. Patients presenting with concurrent bacterial/viral keratitis, systemic illness, prior ocular pathology, or those without a minimum follow-up of 3 months were excluded. Every case underwent microbiological scrapings from residual bed and undersurface of the flap after flap lift at presentation followed by voriconazole interface wash. Flap amputation was performed when required. The outcome measure was complete resolution of infection. The mean age was 24 ± 3.1 years. The male:female ratio was 4:1. The mean interval between LASIK and symptom onset was 4.16 ± 2 days; and the mean interval between symptom onset and patient referral was 3.16 ± 1.16 days. Interface scrapings showed filamentous fungal filaments in KOH wet mount. The culture grew Aspergillus in case 1 and case 5. Infiltrated LASIK flap needed to be amputated in 4 eyes of 3 patients. Voriconazole wash (100 μg/mL) of the stromal bed was performed in all cases. A positive response to therapy with resolution of infection was seen in all cases at a mean of 6.5 ± 4.6 days. No intraoperative or postoperative complications after interface scraping or voriconazole wash were observed. The final best-corrected visual acuity ranged from 20/20 to 20/80 at a mean follow-up of 9.1 ± 6.5 months. Post-LASIK interface fungal filamentous keratitis can present early and gives good outcomes with early microbiological diagnosis and appropriate management. Voriconazole is an efficient and probably safe adjunct in the armamentarium of corneal surgeons to treat such cases.

Case of Cutaneous Infection with Mycobacterium Fortuitum following Abdominal Liposuction and Abdominoplasty Complicated by Involvement of a Laparoscopic Gastric Band

Mycobacterium fortuitum is an ubiquitous, rapidly growing nontuberculous mycobacteria that has been known to contaminate water supplies and surgical equipment leading to postoperative skin and soft tissue infections. This report describes a case of cutaneous infection with M fortuitum following abdominal liposuction and abdominoplasty complicated by involvement of a laparoscopic adjustable gastric band. This case demonstrates how early microbiologic diagnosis, appropriate antimicrobial treatment, and prompt surgical intervention are very important in postcosmetic surgery wound and soft tissue infections. Furthermore, infections involving atypical mycobacterium can be particularly difficult to identify making the study of cases such as this all the more important.

Bacterial and antimicrobial resistance profile of bloodstream infections: A hospital-based study

Background: Bloodstream infections (BSIs) are one of the serious infections causing significant morbidity and mortality among hospitalized patients. Large numbers of cases of treatment failure are being reported due to emergence of drug resistance. Early microbiological diagnosis and determination of antimicrobial susceptibility pattern have been shown to improve treatment outcome. The present study was aimed to determine the bacterial and antimicrobial resistance profile of BSIs in a major tertiary care hospital. Materials and Methods: Blood samples in brain heart infusion (BHI) broth submitted to the microbiology laboratory for culture and sensitivity during a period of 1 year were included in the study. Samples were processed as per standard protocol of laboratory for isolation and identification. The antimicrobial susceptibility profile of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 4862 blood samples, 494 (10.16%) isolates were obtained. Of these isolates, 256 (51.82%) were Gram-negative and 230 (46.56%) were Gram-positive bacteria. The most commonly identified organism was coagulase-negative Staphylococcus (CoNS) (25.91%) followed by Acinetobacter spp. (20.24%) and Escherichia coli (14.98%). Gram-negative bacteria showed a higher rate of resistance as compared with Gram-positive bacteria. Conclusion: High prevalence of antimicrobial resistance was noted in this study, especially in Gram-negative bacteria. Hence, appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance profile as provided by microbiology laboratory. It would be advisable for the clinicians to mandate antimicrobial sensitivity testing for suspected cases of BSIs.

Inappropriate empirical antimicrobial therapy for multidrug-resistant organisms in critically ill patients with pneumonia is not an independent risk factor for mortality: Results of a prospective observational study of 758 patients.

The benefits of broad-spectrum initial empirical antibiotic therapy for all patients in intensive care units (ICUs) with high rates of multidrug-resistant organisms (MDROs) have not been critically evaluated. In this study, 758 ICU patients with pneumonia were prospectively evaluated. Of 349 positive respiratory cultures, 119 (34.1%) were with MDRO isolates. These were associated with increased mortality [adjusted hazard ratio (HR)=1.65, 95% confidence interval (CI) 1.01-2.68; P=0.04] as was increasing age and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Among the patients with MDRO-associated pneumonia, increasing age, APACHE II score and inappropriate definitive antimicrobial therapy (IDAT) were found to be significant risk factors for mortality (in-ICU mortality, adjusted HR=2.8, 95% CI 1.3-5.8; P=0.007), but inappropriate empirical antimicrobial therapy (IEAT) was not (in-ICU mortality, unadjusted HR=1.6, 95% CI 0.7-3.6; P=0.3). In conclusion, we found that among critically ill patients with MDRO-associated pneumonia, IEAT is not an independent risk factor for ICU mortality. Hence, we do not recommend the use of broad-spectrum initial empirical antimicrobial therapy for all patients, as its benefits may not outweigh the potential risks. Early microbiological diagnosis to facilitate implementation of early definitive antimicrobial therapy through use of novel technologies is likely to have a major impact.

Central nervous system tuberculosis: A disease from Papua New Guinea in North Queensland

To describe cases of confirmed central nervous system (CNS) tuberculosis seen at the major tertiary referral centre of North Queensland over a 10-year period. This is a retrospective case series-based study of all cases of proven Mycobacterium tuberculosis infection of the CNS presenting to a major tertiary referral centre of North Queensland between 2000 and 2010. Five cases of confirmed CNS tuberculosis were identified over the 10-year period with two deaths. All were from Papua New Guinea with a mean age of 7 years. Imaging and early microbiological diagnosis was critical in making the diagnosis. HIV infection was not a contributing factor. Multidrug resistance was inferred or confirmed in two cases. CNS tuberculosis is a disease being increasingly seen in North Queensland among children from Papua New Guinea. Anticipation of multidrug resistance is important in the immediate management of suspected cases.

Burkholderia pseudomallei: Three cases in 6 months in Central Travancore

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.

Human immunodefeciency virus associated cryptococcal meningitis at a tertiary care centre: diagnostic tools and antifungal susceptibility testing.

Cryptococcal meningitis has emerged as a leading cause of the infectious morbidity and mortality in HIV sero-reactive subjects and it is the second most common cause of the opportunistic neuroinfections in it. As this is a indistinguishable from other causes of meningitis, its early diagnosis is the key to the therapeutic success. This study was undertaken to know the incidence of Cryptococcal meningitis in HIV sero-reactive individuals and to assess the role of the microbiological parameters in its specific diagnosis, with a perspective of evaluating the anti-fungal resistance. A total of 66 CSF samples from suspected cases of meningoencephalitis were subjected to standard microbiological procedures. The Cryptococcal isolates were identified by microscopy, the cultural characteristics, melanin production on Niger Seed agar, urea hydrolysis, the Nitrate assimilation test and by capsular antigen detection by latex agglutination. The Cryptoccal isolates were further biotyped by using Canavanine-Glycine-Bromothymol blue agar. The Minimum Inhibitory Concentrations (MIC) of Amphotericin B and Fluconazole for the isolates were detected. The incidence of Cryptococcal meningitis in our study group was 18.2% (12/66). The Cryptococcal antigen was detected in all the 12 cases, whereas microscopy was positive only in 9 cases and Cryptococcus was isolated by culture in 10 cases. All the isolates were sensitive to Amphotericin B and 90% of the isolates were sensitive to Fluconazole. The CD4counts ranged between 22-138 cells /μl. A high incidence of Cryptococcal meningitis in HIV sero-reactive subjects necessitates the importance of a precise and an early microbiological diagnosis for better management of such subjects. Due to the growing concern of emerging drug resistance, the testing for the anti-fungal susceptibility has to be encouraged in all the cases.

Post-operative deep sternal wound infections: making an early microbiological diagnosis

Early microbiological diagnosis of deep sternal wound infections (DSWI) could improve outcomes by allowing targeted antibiotic treatment. This study aims to analyse the utility of superficial sternal wound swabs and blood cultures. From January 2005 to June 2011, 70 patients were prospectively identified with DSWI. Microbiological data were obtained retrospectively to study the correlation between superficial sternal swabs, blood cultures and the final culture results from deep sternal tissue. Colonization with multi-resistant organisms (MROs) was also analysed for its significance in the microbiological aetiology of DSWI. Patient characteristics were obtained to analyse predictors of infection caused by specific groups of organisms. Superficial swabs predicted the pathogen 75% of the time (n = 43). Specific to Staphylococcus aureus (n = 27), the positive predictive value of a superficial sternal swab was found to approach 100%. Colonization with MRO is 100% predictive of the pathogen in DSWI. The absence of gram-negative organisms from superficial swabs or blood cultures (n = 48) has a negative predictive value of 98%. The inclusion of blood cultures predicted the pathogen 82% of the time across all types of bacterial infections. Patient characteristics did not appear to predispose to infections caused by specific groups of organisms. Superficial swabs and blood cultures appear to be useful in establishing the microbiological aetiology of DSWI. Routing testing and reporting of these samples could enable early and targeted antimicrobial therapy in DSWI to improve outcomes.