Chryseobacterium indologenes is a known colonizer of inanimate objects in the hospital environmen... more Chryseobacterium indologenes is a known colonizer of inanimate objects in the hospital environment. C. indologenes is not a part of human microflora, but it has been increasingly isolated from patients with bacteremia, pneumonia, and artificial shunt infections, especially in those who are admitted with long-term indwelling devices and prolonged exposure to broad-spectrum antibiotics. Opportunistic infections due to this organism, often arising from colonization of indwelling mechanical devices, are on the rise. It has increasingly been reported from Southeast Asia, mainly from Taiwan. However, there is a paucity of data regarding its occurrence and associated risk factors in the Indian healthcare set ups. The present study was aimed to quantify the burden of C. indologenes infections among the patients admitted in different disciplines. Consecutive specimens of blood, respiratory secretions, and urine received between February 15 and August 15, 2016, in the bacteriology laboratory of our hospital, were evaluated for the presence of Chryseobacterium spp. on routine culture. Blood specimens were cultured in BACTEC plus aerobic and anaerobic bottles (BD Diagnostics, Sparks, MD) followed by subculture on blood agar and MacConkey agar plates. Respiratory specimens (endotracheal aspirate, sputum, bronchial washing, and bronchoalveolar lavage fluid) were cultured onto blood, MacConkey, and hemin agar plates, incubated overnight at 37°C. Urine specimens were cultured on blood agar and CHROMagar (HiChrome, HiMedia, Mumbai, India) plates using semiquantitative calibrated loop technique. Background: Chryseobacterium indologenes is a hospital environment contaminant and can cause healthcare-associated infections. Methods: Patients with C. indologenes infections in a tertiary care center in North India for 6 months were evaluated for susceptibility patterns, comorbidities, mechanical devices, risk factors, and treatment outcomes. The organism was provisionally identified phenotypically, and identification was confirmed by the BD Phoenix automated microbiology system. Minimum inhibitory concentration values of antibiotic susceptibility were determined. Results: A total of 12 isolates of C. indologenes were recovered from 11 patients. Five patients had C. indologenes bloodstream infection (BSI), one had ventilator-associated pneumonia (VAP), and one had both BSI and VAP. In four others, the organism was isolated from the catheterized urinary tract. All VAP and BSI patients were admitted to the Intensive Care Units and mechanically ventilated; all had central lines and history of colistin therapy during the past 15 days. The common underlying risk factors were diabetes, hypertension, and coronary artery disease. Conclusions: C. indologenes infections are increasing because of higher use of carbapenems and colistin, to which it is intrinsically resistant.
M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differ... more M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Skin and soft tissue infections due to this organism can be acquired by direct contact with contaminated material through traumatic injury, surgical wound and environmental exposure or by secondary involvement of skin/soft tissue during disseminated disease. We report a case of Mycobacterium abscessus infection recovered from a post-operative mid-line abdominal wound to illustrate the diagnostic and management difficulties encountered in such patients.
BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the ... more BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the antibiotics of choice for urinary tract infections (UTIs). The choice of carbapenem prescription is strongly influenced by antimicrobial susceptibility testing (AST) report. With the publication of recent AST guidelines by the European Committee on AST (EUCAST), we were curious to evaluate the difference in results between Clinical and Laboratory Standards Institute (CLSI) and the EUCAST guidelines for the interpretation of carbapenems. During a period of 1 year, midstream urine specimens received in the laboratory were cultured by conventional techniques and 2932 of them grew significant colony counts of Escherichia coli. Out of them, 501 E. coli isolates which were resistant to at least six first-line antibiotics were further subjected to second-line antimicrobials imipenem and meropenem, reported by E-tests (bioMerieux, France). The E-test results were interpreted by both CLSI 2016 and EUCAST 6.0 (2016) guidelines. Weighted kappa was used to determine absolute agreement, and McNemar's Chi-square test was used to test the difference in proportions of susceptibility between two methods, respectively. Taking CLSI guidelines as a gold standard, there was 100% sensitivity in a susceptible category by the EUCAST guidelines for both the carbapenems. Weighted kappa showed good and moderate agreement between them for imipenem and meropenem, respectively. However, McNemar Chi-square test in the nonsusceptible category between the two tests was 9.38% and 33.03% for imipenem and meropenem, respectively, and they were highly significant (P < 0.001). A laboratory can follow EUCAST guidelines as well and the guidelines are more useful in urinary concentrated antibiotics such as carbapenems. Further other antibiotics need to be evaluated by both these guidelines.
Reviewing "zoonotic diseases" classically brings to mind human infections contracted in close ass... more Reviewing "zoonotic diseases" classically brings to mind human infections contracted in close association with animals, where outdoor occupations and afforested lands usually play a key role in the epidemiological triad. However, there is a very common, yet overlooked route of infection where humans may not come in direct contact with animals or implicated environments. Milk-borne diseases are a unique set of infections affecting all age groups and occupational categories of humans, causing 4% of all the foodborne diseases in the world. The infection reservoir may lie with milch animals and associated enzootic cycles, and the infectious agent is freely secreted into the animal's milk. Commercial pooling and processing of milk create unique environmental challenges, where lapses in quality control could introduce infective agents during downstream processing and distribution. The infectious agent is finally brought to the doorstep of both rural and urban households through such animal products. The domestic hygiene of the household finally determines human infections. One health approach can target preventive measures like immunization in animals, pasteurization and stringent quality control during the commercial processing of milk, and finally, hygienic practices at the level of the consumer, to reduce the burden of milkborne diseases. This review hopes to draw the attention of policymakers to this unique route of infection, because it can be easily regulated with cost-effective interventions, to ensure the safety of this precious food product, permeating the life and livelihood of humans from all walks of life.
BackgroundExtrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 1... more BackgroundExtrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 13.1%. Diagnosis of EPTB is often challenging as it resembles other granulomatous conditions pathologically. TB culture remains the gold standard for definitive diagnosis, but it takes longer time and WHO has recommended the use of GeneXpert Ultra for rapid diagnosis. This study aims the utility of GeneXpert Ultra for diagnosis of tubercular adenitis.MethodsThis prospective study included the suspected tubercular adenitis patients with lymphnode size of ≥ 20mm. Patients diagnosed with other aetiology of adenitis were excluded. Excision biopsy was performed in all patients. Tissue samples were sent for Ziehl Neelson (ZN) stain, GeneXpert Ultra, histopathology and mycobacterial culture (BACTEC). The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results.ResultsA total of 85 patients Lymph node were included, of which 60% (n=51) had cervical LN, 15%(n=13) abdominal LN, 12%(n=11) mediastinal LN, and 15%(n=11) others. Most of the patients (97%) HPE findings of granulomatous inflammation of which only 20%(n=17) were ZN stain Positive. TB culture showed positivity of 56.47%(n=48) . Mycobacterial tuberculosis was detected in 69%(n=59) of patients by GeneXpert Ultra & none of them showed Rifampicin resistance. The Sensitivity, specificity, PPV & NPV for GeneXpert Ultra were found 85.4%, 51.3%, 25.06% and 94.8%, respectively.ConclusionGeneXpert Ultra showed excellent sensitivity and negative predictive value for the diagnosis of TB Lymphadenitis. Further this method detects Rifampin sensitivity which is crucial for initiation of appropriate antitubercular drugs.Disclosures All Authors: No reported disclosures.
Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing... more Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing the impact of TB in high burden countries. The molecular method like GeneXpert has significantly improved the diagnosis of TB. GeneXpert Ultra is more sensitive to the diagnosis and helps in paucibacillary samples like cerebrospinal fluid (CSF). This study aims to provide its utility in diagnosis of central nervous system tuberculosis (CNS TB) in high TB burden geography. Methods This prospective observational study included the suspected cases of CNS TB with age ≥12 years. Patients who presented with ≥ 5 days history of CNS symptoms suggestive of tuberculosis with a lancet score of ≥ 6 on combination of clinical, CSF and imaging criteria were included in the study. Patients diagnosed with aetiology other than tuberculosis for CNS disease were excluded. CSF was analysed for GeneXpert Ultra and mycobacterial culture. The sensitivity, specificity, positive predictive value (PPV), and Nega...
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Introduction Mucormycosis and Aspergillosis are opportunistic fungal infections causing significa... more Introduction Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted. Case report Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence. Discussion The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.
Cerebral toxoplasmosis remains the most common cerebral focal lesion with to high morbidity and m... more Cerebral toxoplasmosis remains the most common cerebral focal lesion with to high morbidity and mortality in HIV-AIDS. A 55 year old G 2 P 1 female being treated for abnormal uterine bleeding presented with fever, paresthesia, altered sensorium, headache and progressive loss of vision in both eyes. She was referred for neurocysticercosis on account of multiple intracranial space occupying lesions and was subsequently diagnosed to have cerebral toxoplasmosis through stereotactic brain biopsy and imaging, finally leading to the diagnosis of HIV infection. Such patients with unknown immunocompromised status in low HIV-prevalence developing countries may present late on account of seeking delayed medical attention. Cerebral toxoplasmosis is an asymptomatic latent infection known to lead to the diagnosis of HIV infection.
Association of mucormycosis with COVID-19 disease is emerging as a matter of concern, with multip... more Association of mucormycosis with COVID-19 disease is emerging as a matter of concern, with multiple reports of rhino-cerebral-orbital and pulmonary involvement. The association of isolated renal mucormycosis in a patient with a history of COVID-19 infection is unknown. The immune dysregulation associated with COVID, along with the use of steroids, mechanical ventilation, and interleukin-6-directed therapies, predisposes to the development of mucormycosis. We report a rare case of primary renal mucormycosis in a young male following recovery from COVID-19. The unusual mode of presentation, rapidly progressive disease course, and the ensuing dilemmas in diagnosis and treatment merit critical analysis.
Fungal endocarditis is a rare and fatal condition , most frequently caused by the Candida an... more Fungal endocarditis is a rare and fatal condition , most frequently caused by the Candida and Aspergillus species. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, especially that of prosthetic valve endocarditis is extremely difficult. The optimal management of the condition still remains debatable. We hereby present a case of prosthetic valve endocarditis caused by Candida parapsilosis , managed empirically with liposomal amphotericin B and later on was shifted to combination therapy with high dose echinocandin and fluconazole, but had a fatal outcome because he could not undergo timely surgical intervention. Treating Candida parapsilosis endocarditis cases are difficult because of their ability of biofilm production on native and prosthetic heart valves. A combined approach consisting of high index of clinical suspicion, early diagnosis by using serological markers followed by culture or ...
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction Invasive aspergillosis is... more Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction Invasive aspergillosis is one of the potentially life-threatening diseases in immunocompromised patients. Early diagnosis and prompt treatment improve patient survival. The gold standard method—conventional microscopy and culture have low sensitivity and a long turnaround time. Serum Galactomannan (GM), a polysaccharide that forms a major component of Aspergillus cell wall and is released by the fungus during invasive growth is established as a reliable biomarker, which is available as Enzyme Linked Immunoassay (ELISA). The limitations of ELISA are high cost, expertise, and difficulty in assay standardization. To overcome these limitations, a qualitative Galactomannan Lateral Flow Assay (GM-LFA) a sandwich immunochromatographic test, recently approved by European CE, is evaluated in our study. Objective To establish the diagnosis of Invasive Aspergillosis according to EORTC/MSGERC Definitions of Invasive Fungal ...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and Objective Invasive aspe... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and Objective Invasive aspergillosis (IA) is known to occur in immunocompromised patients including neutropenic patients. But, recently increasing cases have been reported in patients with non-classical risk factors and non-neutropenic patients like diabetes mellitus, chronic lung disease, HIV infection, critically ill patients, etc. According to ISHAM these non-classical risk factors should be included in EORTC/MSG host criteria for diagnosis of invasive aspergillosis. India has a high tuberculosis (TB) burden, and this is always considered as the first differential for any patient with fever, cough, hemoptysis, and weight loss. Post-tubercular chronic pulmonary aspergillosis common reported condition. However, co-infection of active TB and invasive aspergillosis is less reported. This co-infection could be one of the contributors of high morbidity and mortality in cases with tuberculosis. We hereby present a ser...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Cryptococcosis is an opportu... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Cryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis. Methodology We performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient. Results Of 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression an...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction The rare but increasingly... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction The rare but increasingly identified infections caused by Mucorales are always detrimental to the patient due to rapid vascular invasion and the need for thorough surgical debridement and definitive antifungal therapy for its cure. Among the Mucorales, maximum cases have been reported among Mucor spp. and Rhizopus spp. Case: Here we present a case of a 9-year-old immunocompetent child presenting with abdominal pain and distension of 1-month duration followed by swelling of bilateral lower limbs, which was gradual in onset. Ultrasonography of the abdomen and pelvis was done which revealed a pelvic mass on the left side. The child developed acute urinary retention during the hospital stay, which was evaluated to reveal a fistulous connection between urethra and rectum for which transverse colostomy was done. The USG-guided biopsy of the left pelvic mass showed broad aseptate hyphae in Hematoxylin and Eosine staini...
Background: We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (... more Background: We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (ROCM-CAM) during India's second wave of COVID-19. This helped formulate novel suggestions for improving laboratory output, applicable anywhere in the world. Method: To diagnose ROCM-CAM by microbiological methods, we used direct microscopy and conventional culture on various clinical samples within the shortest turn-around time. Design: Prospective single-center observational study Participants: patients with ROCM-CAM Results: Of 113 suspected cases of ROCM-CAM during May 2021, direct microscopy and culture could confirm the disease in 87.61% and 44.25% of patients, respectively. The highest pathogen isolation was seen from maxillary bone fragments, FESS-guided biopsy from pterygopalatine fossae, nasal turbinates and nasal mucosal biopsy. Direct microscopy could diagnose the disease in almost 40% of patients within 24 hours and 60% within two days. Conventional cultures yielded Rhizo...
Streptococcus mitis/oralis corneal ulcer occurred in a case of corneal transplantation reducing v... more Streptococcus mitis/oralis corneal ulcer occurred in a case of corneal transplantation reducing vision to hand movements close to face in the right eye. Treatment with 5% vancomycin eye drops led to healing of corneal ulcer followed by scar formation. Fresh corneal graft transplanted after three months resulted in clear graft well opposed to the host cornea accompanied with visual acquity of 6/24 and -2 170° refractive correction. While viridans Streptococci have been implicated in corneal infections, this is the first case of S. mitis/oralis corneal ulcer of its kind. S. mitis/oralis is expanding in pathogenicity crossing the barriers of commensalism to cause opportunistic infection in susceptible hosts. It is difficult to identify and differentiate it to species level through conventional, molecular and mass spectrometry due to limitations of phenotypic expression, genotypic sequence and spectra databases. Both penicillin and high level gentamicin resistance has been reported. S. ...
Novel Coronavirus, SARS-CoV-2 is responsible for the global pandemic of COVID-19. It has been sho... more Novel Coronavirus, SARS-CoV-2 is responsible for the global pandemic of COVID-19. It has been shown to spread through respiratory droplets, direct contact and environmental fomites. The possibility of its spread by other modes viz. airborne, fecal-oral, vertical, etc. is being explored and can have implications in planning preventive strategies and disease management. A systematic analysis was carried out using the keywords; “COVID 19 vertical transmission”, “SARS-CoV-2 pregnancy”, and “SARS-CoV-2 vertical transmission”, and the cases suggestive of possible vertical transmission of SARS-CoV-2 were studied in detail. The available evidences point at a possibility of vertical transmission of SARS-CoV-2. (www.actabiomedica.it)
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective To determine the species dis... more Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective To determine the species distribution of causative agents causing dermatophytosis, and their antifungal susceptibility pattern for terbinafine and itraconazole in trichophyton spp among samples collected in patients with dermatophytosis clinical suspicion during the period of December 1, 2020 to January 31, 2022. Materials and Methods This is a prospective study conducted in the Department of Microbiology of a tertiary care super specialty and referral Centre of western Rajasthan from December 1, 2020 to January 31, 2022. Skin scraping, nail clipping, and hair pluckings were collected in mycology lab from clinically suspected cases of dermatophytosis presenting to the department of dermatology for conventional identification, and antifungal susceptibility testing. The specimens were subjected to direct KOH and calcofluor white microscopy and conventional fungal culture on SDA at 25 ͦ C and 37 ͦ C. The cultures posi...
Chryseobacterium indologenes is a known colonizer of inanimate objects in the hospital environmen... more Chryseobacterium indologenes is a known colonizer of inanimate objects in the hospital environment. C. indologenes is not a part of human microflora, but it has been increasingly isolated from patients with bacteremia, pneumonia, and artificial shunt infections, especially in those who are admitted with long-term indwelling devices and prolonged exposure to broad-spectrum antibiotics. Opportunistic infections due to this organism, often arising from colonization of indwelling mechanical devices, are on the rise. It has increasingly been reported from Southeast Asia, mainly from Taiwan. However, there is a paucity of data regarding its occurrence and associated risk factors in the Indian healthcare set ups. The present study was aimed to quantify the burden of C. indologenes infections among the patients admitted in different disciplines. Consecutive specimens of blood, respiratory secretions, and urine received between February 15 and August 15, 2016, in the bacteriology laboratory of our hospital, were evaluated for the presence of Chryseobacterium spp. on routine culture. Blood specimens were cultured in BACTEC plus aerobic and anaerobic bottles (BD Diagnostics, Sparks, MD) followed by subculture on blood agar and MacConkey agar plates. Respiratory specimens (endotracheal aspirate, sputum, bronchial washing, and bronchoalveolar lavage fluid) were cultured onto blood, MacConkey, and hemin agar plates, incubated overnight at 37°C. Urine specimens were cultured on blood agar and CHROMagar (HiChrome, HiMedia, Mumbai, India) plates using semiquantitative calibrated loop technique. Background: Chryseobacterium indologenes is a hospital environment contaminant and can cause healthcare-associated infections. Methods: Patients with C. indologenes infections in a tertiary care center in North India for 6 months were evaluated for susceptibility patterns, comorbidities, mechanical devices, risk factors, and treatment outcomes. The organism was provisionally identified phenotypically, and identification was confirmed by the BD Phoenix automated microbiology system. Minimum inhibitory concentration values of antibiotic susceptibility were determined. Results: A total of 12 isolates of C. indologenes were recovered from 11 patients. Five patients had C. indologenes bloodstream infection (BSI), one had ventilator-associated pneumonia (VAP), and one had both BSI and VAP. In four others, the organism was isolated from the catheterized urinary tract. All VAP and BSI patients were admitted to the Intensive Care Units and mechanically ventilated; all had central lines and history of colistin therapy during the past 15 days. The common underlying risk factors were diabetes, hypertension, and coronary artery disease. Conclusions: C. indologenes infections are increasing because of higher use of carbapenems and colistin, to which it is intrinsically resistant.
M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differ... more M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Skin and soft tissue infections due to this organism can be acquired by direct contact with contaminated material through traumatic injury, surgical wound and environmental exposure or by secondary involvement of skin/soft tissue during disseminated disease. We report a case of Mycobacterium abscessus infection recovered from a post-operative mid-line abdominal wound to illustrate the diagnostic and management difficulties encountered in such patients.
BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the ... more BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the antibiotics of choice for urinary tract infections (UTIs). The choice of carbapenem prescription is strongly influenced by antimicrobial susceptibility testing (AST) report. With the publication of recent AST guidelines by the European Committee on AST (EUCAST), we were curious to evaluate the difference in results between Clinical and Laboratory Standards Institute (CLSI) and the EUCAST guidelines for the interpretation of carbapenems. During a period of 1 year, midstream urine specimens received in the laboratory were cultured by conventional techniques and 2932 of them grew significant colony counts of Escherichia coli. Out of them, 501 E. coli isolates which were resistant to at least six first-line antibiotics were further subjected to second-line antimicrobials imipenem and meropenem, reported by E-tests (bioMerieux, France). The E-test results were interpreted by both CLSI 2016 and EUCAST 6.0 (2016) guidelines. Weighted kappa was used to determine absolute agreement, and McNemar's Chi-square test was used to test the difference in proportions of susceptibility between two methods, respectively. Taking CLSI guidelines as a gold standard, there was 100% sensitivity in a susceptible category by the EUCAST guidelines for both the carbapenems. Weighted kappa showed good and moderate agreement between them for imipenem and meropenem, respectively. However, McNemar Chi-square test in the nonsusceptible category between the two tests was 9.38% and 33.03% for imipenem and meropenem, respectively, and they were highly significant (P < 0.001). A laboratory can follow EUCAST guidelines as well and the guidelines are more useful in urinary concentrated antibiotics such as carbapenems. Further other antibiotics need to be evaluated by both these guidelines.
Reviewing "zoonotic diseases" classically brings to mind human infections contracted in close ass... more Reviewing "zoonotic diseases" classically brings to mind human infections contracted in close association with animals, where outdoor occupations and afforested lands usually play a key role in the epidemiological triad. However, there is a very common, yet overlooked route of infection where humans may not come in direct contact with animals or implicated environments. Milk-borne diseases are a unique set of infections affecting all age groups and occupational categories of humans, causing 4% of all the foodborne diseases in the world. The infection reservoir may lie with milch animals and associated enzootic cycles, and the infectious agent is freely secreted into the animal's milk. Commercial pooling and processing of milk create unique environmental challenges, where lapses in quality control could introduce infective agents during downstream processing and distribution. The infectious agent is finally brought to the doorstep of both rural and urban households through such animal products. The domestic hygiene of the household finally determines human infections. One health approach can target preventive measures like immunization in animals, pasteurization and stringent quality control during the commercial processing of milk, and finally, hygienic practices at the level of the consumer, to reduce the burden of milkborne diseases. This review hopes to draw the attention of policymakers to this unique route of infection, because it can be easily regulated with cost-effective interventions, to ensure the safety of this precious food product, permeating the life and livelihood of humans from all walks of life.
BackgroundExtrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 1... more BackgroundExtrapulmonary tuberculosis (EPTB) is quite prevalent in India, ranging from 8.3% and 13.1%. Diagnosis of EPTB is often challenging as it resembles other granulomatous conditions pathologically. TB culture remains the gold standard for definitive diagnosis, but it takes longer time and WHO has recommended the use of GeneXpert Ultra for rapid diagnosis. This study aims the utility of GeneXpert Ultra for diagnosis of tubercular adenitis.MethodsThis prospective study included the suspected tubercular adenitis patients with lymphnode size of ≥ 20mm. Patients diagnosed with other aetiology of adenitis were excluded. Excision biopsy was performed in all patients. Tissue samples were sent for Ziehl Neelson (ZN) stain, GeneXpert Ultra, histopathology and mycobacterial culture (BACTEC). The sensitivity, specificity, positive predictive value (PPV), and Negative predictive value (NPV) of GeneXpert Ultra were analysed in comparison with culture results.ResultsA total of 85 patients Lymph node were included, of which 60% (n=51) had cervical LN, 15%(n=13) abdominal LN, 12%(n=11) mediastinal LN, and 15%(n=11) others. Most of the patients (97%) HPE findings of granulomatous inflammation of which only 20%(n=17) were ZN stain Positive. TB culture showed positivity of 56.47%(n=48) . Mycobacterial tuberculosis was detected in 69%(n=59) of patients by GeneXpert Ultra & none of them showed Rifampicin resistance. The Sensitivity, specificity, PPV & NPV for GeneXpert Ultra were found 85.4%, 51.3%, 25.06% and 94.8%, respectively.ConclusionGeneXpert Ultra showed excellent sensitivity and negative predictive value for the diagnosis of TB Lymphadenitis. Further this method detects Rifampin sensitivity which is crucial for initiation of appropriate antitubercular drugs.Disclosures All Authors: No reported disclosures.
Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing... more Background Early diagnosis and initiation of antitubercular treatment are vital steps to reducing the impact of TB in high burden countries. The molecular method like GeneXpert has significantly improved the diagnosis of TB. GeneXpert Ultra is more sensitive to the diagnosis and helps in paucibacillary samples like cerebrospinal fluid (CSF). This study aims to provide its utility in diagnosis of central nervous system tuberculosis (CNS TB) in high TB burden geography. Methods This prospective observational study included the suspected cases of CNS TB with age ≥12 years. Patients who presented with ≥ 5 days history of CNS symptoms suggestive of tuberculosis with a lancet score of ≥ 6 on combination of clinical, CSF and imaging criteria were included in the study. Patients diagnosed with aetiology other than tuberculosis for CNS disease were excluded. CSF was analysed for GeneXpert Ultra and mycobacterial culture. The sensitivity, specificity, positive predictive value (PPV), and Nega...
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Introduction Mucormycosis and Aspergillosis are opportunistic fungal infections causing significa... more Introduction Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted. Case report Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence. Discussion The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.
Cerebral toxoplasmosis remains the most common cerebral focal lesion with to high morbidity and m... more Cerebral toxoplasmosis remains the most common cerebral focal lesion with to high morbidity and mortality in HIV-AIDS. A 55 year old G 2 P 1 female being treated for abnormal uterine bleeding presented with fever, paresthesia, altered sensorium, headache and progressive loss of vision in both eyes. She was referred for neurocysticercosis on account of multiple intracranial space occupying lesions and was subsequently diagnosed to have cerebral toxoplasmosis through stereotactic brain biopsy and imaging, finally leading to the diagnosis of HIV infection. Such patients with unknown immunocompromised status in low HIV-prevalence developing countries may present late on account of seeking delayed medical attention. Cerebral toxoplasmosis is an asymptomatic latent infection known to lead to the diagnosis of HIV infection.
Association of mucormycosis with COVID-19 disease is emerging as a matter of concern, with multip... more Association of mucormycosis with COVID-19 disease is emerging as a matter of concern, with multiple reports of rhino-cerebral-orbital and pulmonary involvement. The association of isolated renal mucormycosis in a patient with a history of COVID-19 infection is unknown. The immune dysregulation associated with COVID, along with the use of steroids, mechanical ventilation, and interleukin-6-directed therapies, predisposes to the development of mucormycosis. We report a rare case of primary renal mucormycosis in a young male following recovery from COVID-19. The unusual mode of presentation, rapidly progressive disease course, and the ensuing dilemmas in diagnosis and treatment merit critical analysis.
Fungal endocarditis is a rare and fatal condition , most frequently caused by the Candida an... more Fungal endocarditis is a rare and fatal condition , most frequently caused by the Candida and Aspergillus species. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging, especially that of prosthetic valve endocarditis is extremely difficult. The optimal management of the condition still remains debatable. We hereby present a case of prosthetic valve endocarditis caused by Candida parapsilosis , managed empirically with liposomal amphotericin B and later on was shifted to combination therapy with high dose echinocandin and fluconazole, but had a fatal outcome because he could not undergo timely surgical intervention. Treating Candida parapsilosis endocarditis cases are difficult because of their ability of biofilm production on native and prosthetic heart valves. A combined approach consisting of high index of clinical suspicion, early diagnosis by using serological markers followed by culture or ...
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction Invasive aspergillosis is... more Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction Invasive aspergillosis is one of the potentially life-threatening diseases in immunocompromised patients. Early diagnosis and prompt treatment improve patient survival. The gold standard method—conventional microscopy and culture have low sensitivity and a long turnaround time. Serum Galactomannan (GM), a polysaccharide that forms a major component of Aspergillus cell wall and is released by the fungus during invasive growth is established as a reliable biomarker, which is available as Enzyme Linked Immunoassay (ELISA). The limitations of ELISA are high cost, expertise, and difficulty in assay standardization. To overcome these limitations, a qualitative Galactomannan Lateral Flow Assay (GM-LFA) a sandwich immunochromatographic test, recently approved by European CE, is evaluated in our study. Objective To establish the diagnosis of Invasive Aspergillosis according to EORTC/MSGERC Definitions of Invasive Fungal ...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and Objective Invasive aspe... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and Objective Invasive aspergillosis (IA) is known to occur in immunocompromised patients including neutropenic patients. But, recently increasing cases have been reported in patients with non-classical risk factors and non-neutropenic patients like diabetes mellitus, chronic lung disease, HIV infection, critically ill patients, etc. According to ISHAM these non-classical risk factors should be included in EORTC/MSG host criteria for diagnosis of invasive aspergillosis. India has a high tuberculosis (TB) burden, and this is always considered as the first differential for any patient with fever, cough, hemoptysis, and weight loss. Post-tubercular chronic pulmonary aspergillosis common reported condition. However, co-infection of active TB and invasive aspergillosis is less reported. This co-infection could be one of the contributors of high morbidity and mortality in cases with tuberculosis. We hereby present a ser...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Cryptococcosis is an opportu... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective Cryptococcosis is an opportunistic fungal infection causing high morbidity and mortality in patients, preferentially affecting immunocompromised. It can cause a wide array of clinical manifestation, which includes meningitis, pulmonary, as well as disseminated infection. Cryptococcus neoformans causes more than 90% cases of cryptococcal meningitis. Methodology We performed a retrospective review of patients with confirmed cryptococcal meningitis during 1 year period from 2021 to 2022 in tertiary care center, AIIMS Jodhpur. We assessed clinical, radiological, microbiological, and biochemical parameters along with treatment provided and outcomes of the patient. Results Of 189 patients screened for suspected cryptococcal meningitis, 6 were microbiologically confirmed positive. All the patients were immunocompromised, of which four were HIV positive and one was a solid organ transplant recipient on immunosuppression an...
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction The rare but increasingly... more Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction The rare but increasingly identified infections caused by Mucorales are always detrimental to the patient due to rapid vascular invasion and the need for thorough surgical debridement and definitive antifungal therapy for its cure. Among the Mucorales, maximum cases have been reported among Mucor spp. and Rhizopus spp. Case: Here we present a case of a 9-year-old immunocompetent child presenting with abdominal pain and distension of 1-month duration followed by swelling of bilateral lower limbs, which was gradual in onset. Ultrasonography of the abdomen and pelvis was done which revealed a pelvic mass on the left side. The child developed acute urinary retention during the hospital stay, which was evaluated to reveal a fistulous connection between urethra and rectum for which transverse colostomy was done. The USG-guided biopsy of the left pelvic mass showed broad aseptate hyphae in Hematoxylin and Eosine staini...
Background: We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (... more Background: We diagnosed various cases of rhino-orbital-cerebral- COVID-associated Mucormycosis (ROCM-CAM) during India's second wave of COVID-19. This helped formulate novel suggestions for improving laboratory output, applicable anywhere in the world. Method: To diagnose ROCM-CAM by microbiological methods, we used direct microscopy and conventional culture on various clinical samples within the shortest turn-around time. Design: Prospective single-center observational study Participants: patients with ROCM-CAM Results: Of 113 suspected cases of ROCM-CAM during May 2021, direct microscopy and culture could confirm the disease in 87.61% and 44.25% of patients, respectively. The highest pathogen isolation was seen from maxillary bone fragments, FESS-guided biopsy from pterygopalatine fossae, nasal turbinates and nasal mucosal biopsy. Direct microscopy could diagnose the disease in almost 40% of patients within 24 hours and 60% within two days. Conventional cultures yielded Rhizo...
Streptococcus mitis/oralis corneal ulcer occurred in a case of corneal transplantation reducing v... more Streptococcus mitis/oralis corneal ulcer occurred in a case of corneal transplantation reducing vision to hand movements close to face in the right eye. Treatment with 5% vancomycin eye drops led to healing of corneal ulcer followed by scar formation. Fresh corneal graft transplanted after three months resulted in clear graft well opposed to the host cornea accompanied with visual acquity of 6/24 and -2 170° refractive correction. While viridans Streptococci have been implicated in corneal infections, this is the first case of S. mitis/oralis corneal ulcer of its kind. S. mitis/oralis is expanding in pathogenicity crossing the barriers of commensalism to cause opportunistic infection in susceptible hosts. It is difficult to identify and differentiate it to species level through conventional, molecular and mass spectrometry due to limitations of phenotypic expression, genotypic sequence and spectra databases. Both penicillin and high level gentamicin resistance has been reported. S. ...
Novel Coronavirus, SARS-CoV-2 is responsible for the global pandemic of COVID-19. It has been sho... more Novel Coronavirus, SARS-CoV-2 is responsible for the global pandemic of COVID-19. It has been shown to spread through respiratory droplets, direct contact and environmental fomites. The possibility of its spread by other modes viz. airborne, fecal-oral, vertical, etc. is being explored and can have implications in planning preventive strategies and disease management. A systematic analysis was carried out using the keywords; “COVID 19 vertical transmission”, “SARS-CoV-2 pregnancy”, and “SARS-CoV-2 vertical transmission”, and the cases suggestive of possible vertical transmission of SARS-CoV-2 were studied in detail. The available evidences point at a possibility of vertical transmission of SARS-CoV-2. (www.actabiomedica.it)
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective To determine the species dis... more Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objective To determine the species distribution of causative agents causing dermatophytosis, and their antifungal susceptibility pattern for terbinafine and itraconazole in trichophyton spp among samples collected in patients with dermatophytosis clinical suspicion during the period of December 1, 2020 to January 31, 2022. Materials and Methods This is a prospective study conducted in the Department of Microbiology of a tertiary care super specialty and referral Centre of western Rajasthan from December 1, 2020 to January 31, 2022. Skin scraping, nail clipping, and hair pluckings were collected in mycology lab from clinically suspected cases of dermatophytosis presenting to the department of dermatology for conventional identification, and antifungal susceptibility testing. The specimens were subjected to direct KOH and calcofluor white microscopy and conventional fungal culture on SDA at 25 ͦ C and 37 ͦ C. The cultures posi...
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Papers by Dr Vidhi Jain