Background and Objectives: The increasing prevalence of metallo-β-lactamase (MBL)-producing enterobacteriaceae in many geographical regions and their potential for rapid dissemination has become a serious threat to public health. Thus, the present study was conducted to analyze the prevalence of MBL-producing enterobacteriaceae in a tertiary care hospital in Mumbai. Materials and Methods: The study was carried out in the Microbiology Department of a 330-bedded tertiary care hospital over a 5-month period, using clinical samples. Bacterial isolates were identified using the Vitek 2 compact system. All enterobacteriaceae isolates were checked for MBL production by the MBL E Test using MBL Ezy MIC™ Strips (HiMedia); and for carbapenem resistance using the Vitek 2 compact system. Results: The prevalence rate for MBL-producing enterobacteriaceae from the study was found to be 7.56%, of which the majority of isolates was detected in urine samples (76.92%). Although most of the MBL isolates were detected in samples from the wards (53.85%), a noteworthy number of isolates was also detected from the outpatient department (OPD;15.38%). Conclusion: Thus, the study shows a significant rate of MBL production among enterobacteriaceae isolated from hospitalized and OPD patients. This emphasizes the urgent need for antimicrobial stewardship at the hospital and community level.

Background: The problem of changes in pathogenic microbiological flora and the emergence of bacterial resistance have created major problems in the management of orthopaedic diseases and fractures. We, therefore, have conducted this study to find out the frequency of bacterial flora in relation to the different clinical syndromes and the antibiotic sensitivity pattern of various bacterial isolates and thus guide the empirical antimicrobial chemotherapy in orthopaedic wound infections. Materials and Methods: A retrospective study of the bacterial isolates of pus specimen collected from orthopaedic patients who had various clinical diagnoses was carried out at the Routine Laboratory of Department of Microbiology. The culture and antimicrobial susceptibility patterns were reviewed for the period 2007 through 2012. Results: During the six year study period from 1^st Jan 2007 to 31^st Dec 2012, our laboratory received a total of 1722 specimens of pus whose site of sample collection included open fractures, bed sores, surgical site infection (SSI), synovial fluid and pin tract site infections. Of these, 900 (52.26%) specimens showed culture positivity including 62 specimens yielding >1 organisms, 822 specimens (47.73%) did not show growth of any pathogenic organism after 48 hours of aerobic incubation. The isolation rate of gram positive and gram negative organisms from various clinical syndromes was roughly similar. Most of the gram positive organisms were sensitive to Cefazolin and most of the gram negative organisms to Amikacin. Conclusions: We recommend the combined use of Amikacin and Cefazolin as the first drugs of choice for empirical therapy in orthopaedic patients with wound infections.

Aim: To detect distribution of Yersinia enterocolitica in gastroenteritis cases, in environmental samples and food samples consumed by humans. Materials and Methods: Stool samples, environmental samples comprising water from water pools on the bank of river ‘Kabini,’ fruit juices from commercial fresh juice centers, pork intestinal contents, drinking water from public eateries, (‘paani puri’ outlets), public tap water samples and commercial prepacked juices. All samples were cultured by four different methods; direct plating on MacConkey agar, plating following cold enrichment, single alkali and double alkali treatment with KOH & PBS. Results: A total of 181 stool samples and 15 food and environmental samples were processed. Y. enterocolitica was isolated from one stool sample (0.55%) by cold enrichment method and from one water sample collected from river bank (6.6%). Conclusion: Y. enterocolitica is found in humans and in the environment in this region. Adopting a rapid isolation method may infuse interest among clinical microbiologists to undertake an epidemiological study on Y. enterocolitica and Yersiniosis. Unhygienic defaecation habits of the people and movement of swine herds along the river bank may be the source for river water contamination.

Aim: Nasal carriage of Staphylococcus aureus plays a pivotal role in the spread of nosocomial infections even in tertiary care centers. We decided to detect nasal carriage of S. aureus in our institution and eradicate it with local application of Mupirocin/Neomycin and to compare their efficiency. Materials and Methods: The study was conducted over a period of 12 months among 50 surgical theatre staff. In all, two nasal swabs were taken from each person at an interval of one week. Alternate nasal carriers identified were given Mupirocin/Neomycin for application in the anterior nares. A third swab was taken seven days after treatment. Observations and Result: Out of the fifty persons, 16 tested positive for S. aureus (32%). Out of the 16, two were Methicillin resistant Staphylococcus aureus (MRSA). All repeat swabs were negative after treatment with Mupirocin. However, 4% were not cured after treatment with Neomycin. Since the sample size is too small, an elaborate study should be conducted to include theatre staff of all speciality and this can confirm the promising role of Neomycin, as the percentage of resistance in this study appears negligible.

Histoplasmosis is commonly found in US and central America; recently cases were diagnosed from Kerala also. The causative organism Histoplasma capsulatum is found abundant in soil mixed with bird or bat guano. Infection occurs by the inhalation of small oval conidia which can enter the terminal bronchioles and then the alveolar spaces. They multiply inside the macrophages and the cellular immune system of the host decides the outcome. Usually it is a self limiting pulmonary infection, but it can vary from mild pneumonitis to severe acute respiratory distress syndrome. If primary manifestation progresses, disseminated histoplasmosis involving liver, spleen, bone marrow, adrenal gland and mucocutaneous membranes result. Skin test antigen is used in epidemiological studies to find the true extent of infection. Rapid diagnosis is possible with histoplasma antigen detection but serology is useful only in certain cases. Histopathology aids the diagnosis a lot. But the fungal culture remains the gold standard for the confirmation. Histoplasmosis is successfully treated with azoles if it is a mild infection and if severe liposomal Amphotericin B is used initially and then switched over to Itraconazole to be continued for several months.

Mucormycosis caused by Apophysomyces elegans is an emerging disease not only in immunocompromised hosts but also in the immunocompetent. Here, we report a case of invasive necrotizing fasciitis of left thigh due to Apophysomyces elegans in a diabetic. Below knee amputation of gangrenous right leg was done 20 days before this developed. Broad aseptate hyphae were observed in necrosed tissues. Surgical debridement was done and Amphotericin B was recommended. Isolate recovered in culture was identified as A. elegans based on induction of sporulation on water agar and other modified methods. Patient expired due to sepsis.

The most common presentation of Cryptococcus infection in immunocompromised patients is meningitis. Here, we report a patient with acquired immunodeficiency syndrome who developed pulmonary cryptococcosis due to infection with a poorly capsulated C. neoformans. Poorly capsulated strains of C. neoformans have been reported from HIV sero-positive patients. Patient had no history of any underlying chronic lung infection. Chest X-ray showed bilateral inhomogeneous haziness in middle and lower zones suggestive of acute bronchopneumonia. Diagnosis was based on culture findings and detection of cryptococcal capsular antigen by latex agglutination test. Unfortunately, patient died due to lack of clinical suspicion and delay in systemic antifungal treatment. This case highlights the importance of pulmonary cryptococcosis as a differential diagnosis while treating acute bronchopneumonia in immunocompromised hosts.

Shigella dysentery is common in developing countries, where poor hygienic conditions exist. Though most cases of shigellosis are self-limited, the cause for concern is the rising incidence of multidrug-resistant (MDR) shigella strains due to irrational use of antibiotics. We report a case of shigella dysentery caused by Ceftriaxone-resistant Shigella flexneri 2a, susceptible only to Azithromycin. The patient recovered after treatment with Azithromycin.

Dirofilariasis is an emerging zoonotic disease caused by Dirofilaria spp., a parasite carried by domestic dogs, cats and other wild animals. Human infection is accidental. Blood sucking arthropods transmit the infection to man. It usually presents as a nodular lesion in the lung, subcutaneous tissue, peritoneal cavity or eyes. We report a few cases of human dirofilariasis presented as subcutaneous swellings. In all the cases the larvae extracted were identified as Dirofilaria repens, based on the morphological features. The purpose of this article is to highlight the fact that human dirofilariasis is on the rise in Kerala, a geographical area that has a large mosquito density and high incidence of dirofilariasis in the canine population.

Chromobacterium violaceum is a saprophytic organism that rarely causes infection in human. Urinary tract infection by Chromobacterium violaceum is extremely rare. Here, we report the first case of urinary tract infection caused by Chromobacterium violaceum from India, in a 43-year-old diabetic female with intramural fibroid. The patient was successfully treated with Ciprofloxacin.

Exophiala jeanselmei is clinically redefined as a rare agent of subcutaneous lesions of traumatic origin eventually causing mycetoma. A case of eumycetoma of foot in a 42-year-old male was clinically diagnosed as dermoid cyst and was microbiologically confirmed as eumycetoma. This case is reported for its uncommon clinical presentation and etiological agent, Exophiala jeanselmei. The patient recovered completely after treatment with Ketoconazole.

Aspergillosis is one of the most common fungal infections in humans caused by Aspergillus species. However, not all Aspergillus species possess the same antifungal susceptibility patterns. Aspergillus terreus is an emerging pathogen which commonly occurs in infections of immunocompromised individuals and is associated with high mortality. It gains its importance in being mostly resistant to treatment with amphotericin B. The four cases of A. terreus reported here highlight the fact that fungal infections caused by this species are on the rise. Early diagnosis and prompt treatment are important to prevent an unfavorable outcome. The optimal therapy for infections caused by this emerging pathogen is still to be ascertained.

Aims: Tuberculosis diagnosis is still a challenge in resource-limited settings due to poor sensitivity of available tests, long time to reporting and costs. Lowenstein-Jensen (LJ) medium is the most commonly used semisolid medium for culture of Mycobacterium species. However, the growth is very slow which delays the reporting. Hence, there is a need of other better medium for obtaining rapid growth of Mycobacterium species, where advanced automated systems are not available. The aim of the present study was to assess the use of blood agar for primary isolation of Mycobacterium as well as to compare the time required for growth on blood agar and LJ medium. Materials and Methods: All clinical specimens were processed by N-acetyl-L-cysteine-sodium hydroxide decontamination method and inoculated on blood agar slants and LJ medium. These slants were observed daily for any growth. Ziehl-Neelsen stain and auramine phenol stain were used to identify acid-fast bacilli. Time taken for any visible growth on both media were recorded and compared. Results: Totally 94 samples were examined, 13.8% showed acid-fast bacilli in smears. The combined culture positivity with blood agar and LJ media was 12.7%. Mean time to detect macroscopic colonies of Mycobacterium species on blood agar was 20 ± 6 days when compared to 30 ± 5 days on LJ medium. Conclusion: Blood agar slants can be used as a good supportive media to LJ medium for rapid growth of Mycobacterium species, especially in small laboratories of developing countries where automated systems are not available.

A 20-year-old female patient presented with complaints of redness, irritation, foreign body sensation, pain and excessive watering in the right eye since one month. On examination, conjunctiva was congested with pseudo membrane over the inferior fornix. Staphylococcus aureus was isolated from the conjunctival swab. Case was diagnosed as pseudomembranous conjunctivitis (PMC) caused by Staphylococcus aureus.

After the introduction of Haemophilus influenzae conjugate vaccine, it is uncommon to see culture-positive cases of invasive H. influenzae disease with complication. It is one of the etiological agents in acute bacterial meningitis in childhood. This case of culture-positive H. influenzae type B meningitis with subdural hygroma as unusual neurological sequelae of Haemophilus type B invasive infection highlights the need of timely vaccination.