Enterococcal cerebellopontine angle abscess in a 12-year-old female

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally. Various aerobic and anaerobic bacteria have been reported as causative agents of brain abscess but only a few cases of enterococcal brain abscesses have been reported. Here we report a case of brain abscess in a 12-year-old female patient, who presented with a history of fever, chills, headache, convulsions since seven days and history of altered sensorium and aphasia since the last two days<b> . </b> The patient had chronic suppurative otitis media of both ears following trauma and presented with ear discharge. The diagnosis of brain abscess was done by computerized tomography scan and the pus was aspirated by left suboccipital burr hole operation. <i>Enterococcus species </i>was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotic treatment

Fatal Postoperative Candida glabrata Septicemia in a Child with Congenital Heart Disease

The incidence of candidemia has been reported to be high in some cardiovascular surgery units. Congenital heart disease has been considered a risk factor for acquisition of candidemia. This present case is a postoperative Candida glabrata in a child with congenital heart disease. A 3-year-old child, a previously diagnosed case of situs-solitus D loop situs with double outlet right ventricle, ventricular septal defect, pulmonary stenosis and large ostium secundum atrial septal defect, was admitted with history of effort intolerance. A left modified Blalock-Taussig shunt was performed and then the child underwent closure of the ventricular septal defect and the atrial septal defect. On the third day the patient developed fever. Klebsiella pneumoniae was isolated from blood which responded to piperacillin + tazobactam but on the twelfth day, the patient again developed fever spikes. The blood cultures performed at this time showed repeated isolation of Candida glabrata. Amphotericin B was started but still the patient deteriorated and died on the 22nd day after operation. The antifungal susceptibility of the isolate performed showed that the isolate was resistant to Amphotericin B

Antifungal susceptibility of Candida by disc diffusion method of isolates from clinical cases of vulvovaginitis of a tertiary care hospital in Mumbai

Background: Vulvovaginal Candidiasis (VVC) is a grave public health problem affecting young and middle-aged females especially during their reproductive life. Though Candida albicans is the commonest species involved, recurrent episodes of VVC are caused by non-albicans Candida (NAC) spp. The NAC spp also show resistance to commonly used antifungal drugs leading to recurrent infections, complications and treatment failure. In addition, widespread use and over the counter availability of antifungals leads to resistance. Therefore, antifungal susceptibility testing of Candida isolates is mandatory for selection of an appropriate and accurate antifungal therapeutic agent Objectives: To perform in vitro antifungal susceptibility testing by disc diffusion method. Materials and Methods: A total of 150 vaginal Candida isolates were used to perform Antifungal susceptibility test by disc diffusion method. Mueller Hinton Agar with 2% Glucose and 0.5 μg/mL Methylene Blue Dye medium and six antifungal drugs Amphotericin B, Fluconazole, Itraconazole, Ketoconazole, Clotrimazole and Nystatin were used. Results were calculated using CLSI M 44-A2 (S3) for fluconazole and standard reference articles for other drugs. Results and Conclusion: Susceptibility of Candida albicans was 100% to Amphotericin B, Nystatin and 97.2% to Ketoconazole. NAC spp were less susceptible to Fluconazole and Clotrimazole as compared to Candida albicans. Resistance was found even to Amphotericin B and Nystatin among NAC spp. Accurate and reliable antifungal susceptibility testing is necessary to help the clinicians in better patient management and preventing the emerging antifungal resistance

Enterococcal Cerebellopontine Angle Abscess in a 12-year-old Female

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally. Various aerobic and anaerobic bacteria have been reported as causative agents of brain abscess but only a few cases of enterococcal brain abscesses have been reported. Here we report a case of brain abscess in a 12-year-old female patient, who presented with a history of fever, chills, headache, convulsions since seven days and history of altered sensorium and aphasia since the last two days. The patient had chronic suppurative otitis media of both ears following trauma and presented with ear discharge. The diagnosis of brain abscess was done by computerized tomography scan and the pus was aspirated by left suboccipital burr hole operation. Enterococcus species was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotic treatment

Subcutaneous Phaeohyphomycosis in a Renal Transplant Patient by a Rare Fungus Medicopsis romeroi

Medicopsis romeroi is a dematiaceous fungus that rarely causes subcutaneous phaeohyphomycosis. Here, we report a subcutaneous phaeohyphomycosis caused by a rare dematiaceous fungus, M. romeroi, in a 56-year-old male renal transplant patient. The patient was admitted for graft dysfunction and was found to have painless swelling over the anterior aspect of the right knee, which was aspirated twice within 40 days. Broad septate hyphae (determined by microscopy) and growth of phaeoid in a culture were observed in both the specimens. No sporulation was observed in the slide culture. Swelling recurred even after treatment with voriconazole, so the lesion was surgically excised. Genotypically, the isolate was identified as M. romeroi in both specimens. He was discharged on voriconazole. During a 6-month follow-up, no relapse was noticed. Phaeohyphomycosis caused by M. romeroi is rare, with only a few cases reported in India. Laboratory diagnosis of Medicopsis by conventional methods is challenging. Medicopsis species should be considered one of the etiological agents for subcutaneous phaeohyphomycosis. Molecular methods should be used for the identification of unusual pathogens

WATERHOUSE-FRIDERICHSEN SYNDROME IN AN ADULT PATIENT WITH MENINGOCOCCAL MENINGITIS

Waterhouse-Friderichsen syndrome is one of the fatal complications of meningococcal infection. Here we report a fatal case of this syndrome due to Neisseria meningitidis in a 29-year-old male patient who was admitted with high-grade fever and chills and vomiting since 7 days, a skin rash over the abdomen and trunk, and altered sensorium since 2 days. On examination, the signs of meningitis were present along with the hemorrhagic rash. The diagnosis of adrenal hemorrhage was confirmed by computerized tomographic scan findings. The patient was started on intravenous ceftriaxone, and the cerebrospinal fluid was processed for bacterial culture, which yielded growth of N meningitidis. The patient's condition deteriorated; he developed purpura along with a fall in platelet count, and died due to shock. This case is being reported as such a complication is comparatively rare in this antibiotic era, especially in adults, and starting steroids like dexamethasone prior to antibacterial therapy may be useful to diminish the inflammation brought about by bacterial cell death and thus help in reducing the otherwise high mortality in these cases