PARVIMONAS MICRA AND FUSOBACTERIUM NUCLEATUM SEPTIC ARTHRITIS: A RARE ANAEROBIC DOUBLE TROUBLE

Septic arthritis is a condition initiated by pathogenic inoculation of joints either by direct or hematogenous route, necessitating immediate medical attention. Among aerobic bacteria, Staphylococcus aureus and Streptococcus spp. are commonly found in association with septic joints. Anaerobes are very rarely involved in the causation of septic arthritis with an estimated rate of <1%. We are presenting a case of septic arthritis of knee joint by Parvimonas micra and Fusobacterium nucleatum, both being constituents of microbial flora in the oral cavity and gastrointestinal tract. Gram stain and anaerobic culture incorporated along with the aerobic culture of synovial fluid have played an important role in the preliminary diagnosis of anaerobic septic arthritis in this case

Cervical Footprint Anthropometry in Indian Population: Implications on Design of Artificial Disc Replacement Devices

Study DesignCross-sectional study.PurposeTo accurately measure the dimensions of cervical endplates based on computed tomography (CT) scans in Indian population and assess accuracy of match with currently available cervical disc prostheses.Overview of LiteratureThe dimensions of currently available cervical disc replacement implants are based on early published geometrical measurements of vertebrae endplates for Caucasian population. To author's knowledge, similar study has not been published for patients from Indian subcontinent.MethodsCT scans of cervical spine of patients from Indian subcontinent were collected and reviewed. Seventy patients (54 men and 16 women; aged 18–56 years with average of 37 years) who underwent CT scans of cervical spine were included in study. 3D CT scans of sub axial cervical spine (C3 to C7) were analyzed. The anterior-posterior (AP) and central mediolateral (CML) dimensions of superior and inferior endplates from C3 to C7 were measured using digital measuring system.ResultsA total of 560 endplates of 70 patients were included in the study. The AP diameter of cervical endplates ranged from 0.87 to 2.47 cm. The CML diameters ranged from 0.84 to 2.98 cm. For levels C3/C4 and C4/C5 for AP dimension Prestige-LP (90.5%) and Prodisc-C (89%) discs showed higher percentage of matching than Discover discs (58.5%). For CML diameter, Prestige-LP (69.5%), Prodisc-C (70%) and Discover (39.5%) discs showed almost similar matching with measured endplates. For levels C5/C6 and C6/C7 for AP dimension, Prestige-LP (67.25%), Prodisc-C (49.35%) and Discover (51.5%) discs showed similar matching. For CML diameter Prestige-LP (32%), Prodisc-C (27.5%) and Discover (42.2%) discs showed poor matching with measured endplates.ConclusionsThis study indicates need for redesign of cervical disc prostheses to match Indian patients. The collected anthropometric dimensions from this study may be used to design and develop indigenous artificial total disc replacement prosthesis and even cervical cages in India. With the present study being a small pilot study, the authors recommend anthropometric CT measurements in larger number of Indian patients in order to validate footprint dimensions for designing better-matched prosthesis

STAPHYLOCOCCUS AUREUS INFECTIONS AND THEIR ANTIBIOTIC SUSCEPTIBILITY PROFILE AT A TERTIARY CARE HOSPITAL

  Objective: Staphylococcus aureus remains an important bacterial pathogen causing diverse infections which are both nosocomial and community acquired. Increasing resistance among S. aureus to various antibiotics is a cause of concern.Methods: A prospective observational study of 4 months duration was conducted to analyze the spectrum of infections caused by S. aureus and to study its antimicrobial resistance to commonly used antibiotics. Specimens from various clinical sites received in the laboratory for culture and sensitivity were processed as per standard techniques. Identification and susceptibility testing of S. aureus isolates were done using automated systems.Results: A total of 234 S. aureus isolates were obtained during the study period. Males accounted for 70.1% (n=164) of patients with S. aureus infections. These patients were uniformly distributed across all age groups. S. aureus was most commonly isolated from pus and exudates (64.5%) followed by respiratory specimens (20.5%) and mainly cultured from the skin and soft tissue infections (56%). Methicillin-resistant S. aureus (MRSA) accounted for 47% (n=110) of isolates. Higher rates of susceptibility were noted for tetracycline (95.3%), gentamicin (85.4%), and trimethoprim/ sulfamethoxazole (88%). Low susceptibility rate was seen for ciprofloxacin (11.2%). Inducible clindamycin resistance was seen in 22.4% (n=50) isolates. Methicillin-sensitive S. aureus isolates were found to be more susceptible to non-beta lactam antibiotics than the methicillin-resistant isolates.Conclusion: A high frequency of MRSA was found in our study. Regular surveillance of antimicrobial resistance profile of this most frequent pathogen is necessary to aid in providing appropriate empirical antibiotic therapy

Nonfermenting gram-negative bacilli other than pseudomonas aeruginosa and acinetobacter spp. causing respiratory tract infections in a tertiary care center

Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. Results: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. Conclusion: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage

Prevalence of Clinical Periodontitis and Putative Periodontal Pathogens among South Indian Pregnant Women

In view of recent understanding of the association of periodontal infections and adverse pregnancy outcomes, the present investigation was undertaken to study the periodontal infections among 390 asymptomatic pregnant women and to find an association of bacterial etiologies with the disease. Prevalence of gingivitis was 38% and clinical periodontitis was 10% among the study population. Subgingival plaque specimens were subjected to multiplex PCR targeting ten putative periodontopathogenic bacteria. Among the periodontitis group, high detection rates of Porphyromonas gingivalis (56%), Prevotella nigrescens (44%), Treponema denticola (32%), and Prevotella intermedius (24%) were noted along with significant association with the disease (P<0.05)

Influence of Pseudomonas aeruginosa on exacerbation in patients with bronchiectasis

Background: A majority of the studies done on the western population have shown that Pseudomonas aeruginosa causes many severe infections in patients with bronchiectasis as compared to other pathogens. There is scarcity of similar data from the Asian population. Materials and Methods: A prospective study was undertaken to identify the various pathogens isolated from the respiratory samples of 117 patients with bronchiectasis from south India and to compare the clinicomicrobiological profile of infections caused by P. aeruginosa and other respiratory pathogens. Results: The respiratory pathogens were isolated from 63 (53.8%) patients. P. aeruginosa was the most common isolate (46.0%) followed by Klebsiella pneumoniae (14.3%) and other pathogenic bacteria. Patients included in the P. aeruginosa group had a higher number of exacerbations (p: 0.008), greater number of hospital admissions (p: 0.007), a prolonged hospital stay (p: 0.03), and poor lung function, compared to the patients infected with the non-Pseudomonas group. Conclusion: It is necessary to investigate the etiology of respiratory tract infections among bronchiectasis patients followed by the prompt management of cases diagnosed with P. aeruginosa infections, so as to lower the morbidity and have a better prognosis

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90% of infections are asymptomatic, and the remaining 10% produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3% of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections

OCULAR FINDINGS OF HIV/AIDS PATIENTS AND THEIR CORRELATION WITH CD4 COUNT

BACKGROUND Ocular involvement in HIV/AIDS includes various clinical presentations including both anterior and posterior segment, most of the manifestations are those of the posterior segment. The severity of these posterior segment changes increases with decreased CD4 count. Aim of the study is to look for severity of ocular manifestations in correlation with CD4 count. MATERIALS AND METHODS A cross sectional study of ocular changes in 360 cases of HIV/AIDS patients between October 2016-May 2018. All patients underwent thorough ophthalmic evaluation including BCVA, Anterior segment examination with slit lamp biomicroscopy and posterior segment examination with Indirect ophthalmoscopy, CD4 count was noted and patients were categorised based on CD4 count and correlation of severity of ocular manifestations with CD4 count done with statistical software SPSS. RESULTS Out of 360 patients, 267 were on HAART. 54.4 % were males and 45.6% females. Maximum number of patients were in the age group of 31-40 years. Ocular manifestations were present in 252(70%) patients. Most common manifestation was HIV retinopathy (18.8%) followed by dry eye (6.9%), cataract (5.5%), CMV retinitis (5.2%), choroiditis (3.6%). CMV retinitis, choroiditis and orbital cellulitis were common in patients with CD4+count<50. Severity of ocular manifestations involving posterior segment and orbital cellulitis increased with decrease in CD4 count. There was statistically significant association between severity of ocular manifestations with CD4 count (P<0.001), and vision with CD4 count (P<0.001). CONCLUSION Patients with low CD4 count are at increased risk of acquiring severe manifestations such as posterior segment changes and orbital cellulitis. Complete ocular evaluation is must in all patients with HIV/AIDS for early diagnosis and treatment of sight threatening complications