Fusarium Keratitis Treatment and Management: A Case Series of Emerging Organism

Infectious keratitis may be caused by viruses, bacteria, parasites, and fungi. Noninfectious can be caused by injury to the cornea, dryness of the cornea, allergies, and improper use of contact lenses. Fungi commonly responsible for corneal ulcers are Aspergillus (most common), Candida, and Fusarium. Both Aspergillus and Fusarium account for about one-third of all traumatic infectious keratitis. In the current case series, we submit 4 cases of Fusarium keratitis. A microbiological investigation like KOH mount is an important test that can confirm the presence of the fungal infection in samples. Topical and systemic anti-fungal treatment combinations give better outcomes in fungal keratitis patients. Culture is the gold standard, and fusarium species are rapid growers. All suspected patients should be screened for fungal culture in their primary visit to prevent further complications and disability

Candidemia: Speciation and Antifungal susceptibility testing from a Tertiary Care Hospital in Maharashtra, India

Introduction: Invasive fungal infections are an important nosocomial health problem, candidal infections being the most common. Candidal bloodstream infections (BSIs) account for one-fourth of the nosocomial BSIs. Candida albicans once the most common has now been replaced by nonalbicans Candida, accounting for majority of cases of candidal infections. The knowledge and understanding of specific risk factors, epidemiology, prophylactic measures, and outcomes with relation to speciation are changing rapidly. Emergence of antifungal resistance is a cause of concern. With this background, a prospective study was undertaken. Aims and Objectives: To isolate Candida spp. from blood cultures of patients with clinically diagnosed or suspected septicemia; to identify and speciate Candida isolates and carry out the antifungal susceptibility test; to determine incidence of candidemia; to find out the crude mortality rate in candidemia patients. Materials and Methods: Blood cultures received in the Department of Microbiology from various critical care units over a 1-year period were included in this study. Samples were cultured on Sabouraud dextrose agar and routine bacteriological cultures. Speciation of suspected Candida growth was done by conventional and automated system. Results: A total of 225 out of 839 blood cultures were culture positive. A total of 196 were bacterial pathogens. Candida spp. were isolated in 29 samples. These included 10 cases of Candida tropicalis, 8 Candida parapsilosis, and three cases each of C. albicans and Candida krusei. Fluconazole resistance was seen (minimum inhibitory concentration ≥64 μg/ml) in 4 isolates, 2 of C. krusei and 2 of Candida haemulonii. Incidence of candidemia was 3.46%. Crude mortality rate in the present study was 24%

The potential role of stethoscopes as a source of nosocomial infection

Background: Infectious diseases can be transmitted in various ways . Indirect transmission or vehicle-borne transmission of infection can occur through various agents like instruments, utensils, water, or food. In hospital settings, transmission of infection through contaminated medical devices is always a possibility. Stethoscope is the symbol of health professionals. However, the diaphragm and bells of the stethoscopes have been shown to harbor pathogenic and nonpathogenic microorganisms. Aims: 1) To determine the degree of contamination of stethoscopes used by clinicians and nurses. 2) To identify various microbes from such contaminated stethoscopes and to assess their role as potential pathogens. 3) To determine the effectiveness of 70% ethanol as a disinfecting agent. Materials and Methods: Stethoscopes of 50 healthcare workers from different departments were included in the study. Bacteriological cultures of the samples were done on blood agar and MacConkey agar plates. Organisms were identified by conventional phenotypic methods. Antibiotic sensitivity test (ABST) of the microorganisms was performed by Kirby-Bauer disk diffusion method. Results: Average number of colonies on each stethoscope was 30 . Pathogenic microorganisms including Staphylococcus aureus, Acinetobacter species, Citrobacter species, Pseudomonas stutzeri, Bacillus species, and Aspergillus fumigatus were identified. Among the potential pathogenic organisms, coagulase-negative staphylococci were isolated. Numbers of colonies were highest among the stethoscopes sampled from surgery ward and Medical Intensive Care Unit MICU. Conclusion: Stethoscopes harbor potential pathogens capable of surviving on their surfaces. Despite their best intentions, health professionals can act as a vector for transmission of disease. Disinfecting procedures may be necessary between consecutive patients. Attention to simple preventive strategies can reduce the disease transmission rate

Role of sepsis screen in the diagnosis of neonatal sepsis

Background: Neonatal sepsis is the single most important cause of neonatal deaths globally. The incidence of neonatal sepsis in India is 30/1000 live births. Though blood culture is the gold standard, but it is not always positive even if clinical features of sepsis are present in the neonate. Materials and Methods: Blood cultures and sepsis screen was carried out on 115 neonates. Out of 115 neonates with clinical features of sepsis, 75 were blood culture positive. Sepsis screen was carried out with total leucocytes count, absolute neutrophils count, ratio of immature neutrophils (band forms) to total neutrophil count, C-reactive protein. The identification of the causative organism was carried out by standard identification tests and antibiotic sensitivity testing as per Clinicaland Laboratory Standards Institute (CLSI) guidelines. Results: In this study, out of 115 cases of clinical neonatal sepsis 75 (65.2%) were culture positive. Among isolates, number of gram negative bacilli were 39 (52%) was more than gram positive cocci 36 (34.8%). However, Staphylococcus aureus 24 (32%) was most predominant. Forty (34.8%) were culture negative out of which 15(13%) neonates were positive for two or more sepsis screen tests. Conclusion: Blood culture and sepsis screen should be carried out in neonates suspected of sepsis; however, an immediate institution of empirical antibiotic therapy should be considered as culture positive and sepsis screen may not be positive in all the clinical sepsis cases to save lives

Significance of Various Diagnostic Modalities in Detection of Tuberculosis in Cervical Lymphadenopathy: A Study of 200 Cases

Background: Extrapulmonary tuberculosis (EPTB) makes for 25% of all instances of tuberculosis (TB) patients. The enigmatic clinical presentation of EPTB makes identification difficult since it simulates other chronic conditions such as neoplastic and inflammatory disorders and could culminate in treatment that is either insufficient or not required. For an affirmative and confirmed diagnosis, a substantial level of suspicion is imperative. The paucibacillary feature of EPTB makes diagnosis extremely difficult and necessitates the use of many diagnostic methods to arrive at a precise diagnosis. In December 2010, the World Health Organization recommended using GeneXpert/cartridge-based nucleic acid amplification test (CBNAAT) for the initial assessment of suspected cases of EPTB. Furthermore, fine-needle aspiration cytology (FNAC), Ziehl–Neelsen (ZN) stain, and the CBNAAT have to be utilized to exclude other possible origins of granulomatous inflammation. The goal of the current investigation is to comprehend how FNAC and ZN stains relate to CBNAAT and their diagnostic value. Methods: The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB. Results: There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive. Conclusion: CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB

Prevalence and antimicrobial susceptibility of high-level gentamicin resistant enterococci isolated from urine at a hospital in Pune, India

Introduction: Enterococci are one of the common organisms isolated from hospitalized patients with urinary tract infections. Guidelines recommend testing enterococcifor susceptibility to high-level gentamicin (HLG) and streptomycin. The present study was planned to determine the susceptibility of uropathogenic enterococci to high-level gentamicin in a tertiary care hospital. Materials and Methods: Prospective observational research was carried out at a tertiary care hospital for two years on all isolated enterococci from urine specimens. Identification and antibiotic susceptibility were performed as per standard methods. All the isolated enterococci were tested for high level gentamicin ((120µg) resistance and susceptibility to other recommended antimicrobial agents by standard methods. Results: A total of 320 uropathogenic enterococci were isolated and tested for antibiotic susceptibility. The majority of enterococci were isolated from elderly (34.06%) and admitted patients (69.06%). A total of 68.4% isolated enterococci were HLG resistant. HLG resistant enterococci were highly resistant to erythromycin (96.3%), ciprofloxacin (96.8%) and nalidixic acid (97.7%). Enterococci sensitive to HLG were significantly (p <0.05) less resistant to the other antimicrobial agents except nalidixic acid. Only 20.5% isolated Enterococci were resistant to vancomycin. All isolated enterococci were susceptible to linezolid. Conclusion: The study demonstrated high prevalence of HLG resistant enterococci causing UTI in our hospital setting. Compared to HLG sensitive enterococci, HLG resistant enterococci were more resistant to other antimicrobial agents tested. The findings highlight the need for mandatory testing of enterococci for HLG resistance to determine effective antimicrobials for treatment. IMC J Med Sci. 2023; 17(2):008. DOI: https://doi.org/10.55010/imcjms.17.018 *Correspondence: Dr. Sahjid Mukhida, Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India. E-mail: [email protected]

Occurrence of catheter-associated urinary tract infection in critical care units

Background: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection. The etiological agents of which may be varied. Advancing age, debilitation, diabetes mellitus, duration of catheterization are the risk factors. Complications include prostatitis, epididymitis, cystitis, pyelonephritis and septicemia in high-risk patients, adding to hospitalization and morbidity. With this background the present study was undertaken Objectives: (1) To identify microbial pathogens associated with urinary tract infection (UTI) in catheterized patients from Intensive Care Units (ICU) (2) to determine the susceptibility pattern of these isolates to antimicrobial agents (3) to determine the effect of days of catheterization and UTI. Materials and Methods: Consecutive urine samples of 345 catheterized patients admitted in ICUs were included in the study. They were processed by standard microbiological procedures. Isolated organisms were speciated, and antibiotic susceptibility performed as per standard guidelines. Results: From the 345 urine samples of catheterized patients, 205 showed no growth and were found to be sterile. Bacterial growth was seen in 69 patients and fungal growth in 50 patients. Among the bacterial isolates, Escherichia coli were isolated in 39, followed by Klebsiella spp. 14. The other isolates included Pseudomonas spp., Group D streptococci and methicillin-resistant Staphylococcus aureus. In the fungal isolates, Candida glabrata was the most common isolate. High resistance was seen among Klebsiella isolates (nalidixic acid-86% and cefotaxime-86%). Conclusion: Development of CAUTI is common in critically ill patients. Emphasis should be placed on good catheter management and reducing the duration of catheterization rather than prophylaxis in order to reduce the incidence of catheter-related UTI. Culture and susceptibility testing play a vital role in the management if UTI occurs

Seroprevalence of SARS-CoV-2 IgG in blood donors in a teaching institute from Western part of Maharashtra

Introduction: COVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 that has appeared as a global pandemic in recent times. Currently, the transmission rate has slowed down significantly, but the definite pathological reason behind this is still unknown. Therefore, the prevalence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody must be studied to establish the relation between the rate of transmission and antibody presence. Materials and Methods: A clinical assessment was performed to evaluate the seroprevalence of SARS-CoV-2 Immunoglobulin G (IgG) antibodies among 299 healthy volunteers in the period of February to May 2021. Serum samples were analyzed using chemiluminescent microparticle immunoassay (CMIA) technology to detect the presence of IgG antibodies. Result: It was observed that 21% of the participants were seropositive, and 78% of the population was seronegative across the different genders. This confirmed that the generation of antibodies is independent of gender. Simultaneously, a t-test was performed that further suggested no statistical correlation between gender and seroprevalence. Moreover, a comprehensive analysis was performed to establish the relation between age and blood group with the seroprevalence. However, there was no statistical relationship found among these parameters. Conclusion: This study assisted in examining the underlying causes of high or low seroprevalence among healthy volunteers