Procalcitonin in sepsis and bacterial infections

The differentiation of sepsis and systemic bacterial infections from other causes of systemic inflammatory response is crucial from the therapeutic point of view. The clinical signs and symptoms are non-specific and traditional biomarkers like white cell count, erythrocyte sedimentation rate and C-reactive protein are not sufficiently sensitive or specific to guide therapeutic decisions. Procalcitonin (PCT) is considered a reliable marker for the diagnosis and prognosis of moderate to severe bacterial infections, and it has also been evaluated to guide the clinicians in the rational usage of antibiotics. This review describes the diagnostic and prognostic role of PCT as a biomarker in various clinical settings along with the laboratory aspects and its usefulness in risk stratification and antibiotic stewardship

<i>Trichosporon</i> peritonitis following duodenal perforation

Fungal peritonitis, which was once a rare entity, is becoming increasingly common due to various immunocompromised conditions. <i>Candida</i> species are considered the common cause of fungal peritonitis in most cases. However, at present, other yeasts and filamentous fungi are replacing the dominance of <i>Candida albicans</i> as well as other <i>Candida</i> species. <i>Trichosporon</i> species are widely distributed in nature and are normal flora in the gastrointestinal tract of humans. Ever since the report of disseminated trichosporonosis in 1970, several cases of infections by various <i>Trichosporon</i> species in different clinical patients have been published. Here, we present a patient with <i>Trichosporon</i> peritonitis after duodenal perforation. To the best of our knowledge, this is the first case report of its kind from India

Study of bronchoalveolar lavage in clinically and radiologically suspected cases of pulmonary tuberculosis

Context: About 30 to 50 &#x0025; of pulmonary tuberculosis patients have sputum report negative for acid fast bacilli or present with no expectoration. A lot of research is going on to find methods to establish early and accurate diagnosis of pulmonary tuberculosis (PTB) as institutions of early treatment can have significant effects on morbidity and mortality of patients and also the development of MDR-TB. Samples other than sputum play an important role in the diagnosis of disease in such patients. Aims: To assess the significance of bronchoalveolar lavage samples and fiberoptic bronchoscopy (FOB) in the early diagnosis of occult sputum smear negative pulmonary tuberculosis. Settings and Design: Study was conducted in a tertiary care hospital. FOB was performed in patients with three consecutive sputum smear negative acid fast bacilli to obtain bronchoalveolar lavage (BAL) samples. Written informed consent was obtained from these patients. Materials and Methods: BAL samples were subjected to Z-N staining and culture on L-J slopes for acid fast bacilli. Sputum samples from the same patients were also cultured. Results: BAL samples were positive in 82.2&#x0025; of sputum smear negative samples. Culture positivity of BAL samples was 90.9&#x0025; as compared to sputum culture positivity which was 26.4&#x0025;. Overall diagnosis could be established in 86.6&#x0025; of patients with the help of fiber optic bronchoscopy. Conclusions: BAL samples are very useful in early sputum smear negative pulmonary tuberculosis and FOB can play an important role in diagnosis of lower respiratory tract infections with minimal complications in hands of an expert

Aspergillus niger peritonitis in a patient on continuous ambulatory peritoneal dialysis

Fungal peritonitis is an uncommon condition which is associated with high morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). It is associated with several complications and many of the patients who develop this condition are unable to resume CAPD treatment and have to shift to haemodialysis. Here we report the rare occurrence of fungal peritonitis due to Aspergillus niger in a patient on CAPD