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Introduction: The overall changing epidemiology of fungal infections in the current scenario isbecause of an increase in immunocompromised population including cancer patients, Humanimmunodeficiency virus (HIV)-infected patients, transplant receipts, and prolonged hospitalizationwith overuse of antimicrobial agents. These infections are challenging to diagnose and subsequentlymanage as their clinical symptomatology often mimics other common diseases like tuberculosis.Rapid diagnosis is limited and culture is often delayed due to slow growth rates of the causativeagents. Objective: This is a retrospective study to know the spectrum and burden of mycoticinfections in a tertiary care hospital. Methods: All samples collected from clinically suspected casesof fungal infections were sent to the Microbiology department over one year. The common specimensreceived were respiratory samples, scrapings from cornea, skin, and nail. All samples were firstobserved under direct microscopy using Potassium hydroxide (KOH) examination for the presence offungal elements and Gram stain for yeasts. India Ink examination was performed for sterile fluids.Fungal culture was done on Sabouraud's dextrose agar. Result: A total of 900 samples from variousdepartments were included, KOH examination was positive for 380 samples (42%) and fungalgrowth was obtained in 144 samples (16%). Rare fungi like Trichosporon dohaense (blood culture),Cladophialophora bantiana (brain abscess), Scedosporium apiospermum and Candida auris (bloodculture) were also isolated. Conclusion: Similar studies are needed to estimate the actual burden ofthe fungal infections in tertiary care health facilities, to help decrease the morbidity and mortalityassociated with underdiagnosed mycotic infections.

Background: Microbial keratitis is one of the most significant causes of blindness in our country.Knowledge regarding the aetiology and antibiotic sensitivity pattern in a specific region is crucial forthe ideal management of these infections. Materials and Methods: A prospective study wherecorneal scrapings from 161 suspected cases of microbial keratitis were collected and were subjectedto direct microscopy by gram stain and bacterial culture and identification as well as antibioticsensitivity testing. Results: A total of 57 samples turned out to be positive out of the total 161 andwere shared equally by both gram-positive and gram-negative bacteria. All these culture-positivebacteria were also identified by MALDI TOF-MS and were speciated. Few rare organisms which couldnot be identified by conventional means were also recovered using the same. Most of the gram-positive isolates showed good sensitivity to vancomycin and ciprofloxacin whereas Pseudomonas sppwas found to be resistant to the aminoglycosides. Conclusion: Right knowledge about the localprofile of bacterial causes of keratitis along with its antibiotic resistance pattern will help theclinicians immensely and help them to initiate the correct empirical therapy bases on the smearresults without wasting crucial time.

Background and Purpose: Herein, we describe a rare case of fatal cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent individual without any underlying risk factors.Case report: A 55-year-old female presented with a short history of fever for 1 month, as well as headache, sudden onset of right-sided upper and lower limb weakness, and loss of speech for 10 days. Contrast-enhanced magnetic resonance imaging scan revealed large, peripherally enhancing, well-defined, cystic, space-occupying, axial lesion in the left parietal lobe with a mass effect. The patient was subjected to craniotomy, and the drained pus revealed pigmented septate hyphae in potassium hydroxide mount examination, which was identified as Cladophialophora bantiana. The patient was started on amphotericin B and voriconazole. However, she developed acute respiratory infection leading to multi-organ failure and death on day 27 post-operation. Conclusion: In the absence of comparative trials owing to the rarity of the disease, the radical resection of lesion, drainage of pus, and prolonged targeted antifungal therapy with close postoperative radiological surveillance are the therapeutic measures of choice for patients with brain abscess caused by phaeoid fungi.

Perinephric and renal abscess are very rare entities with insidious presentation and pose a great diagnostic challenge, common etiology being bacterial. Only less than 30 cases of fungal etiology have been reported in literature. Herein, we report first case of fungal perinephric abscess caused by Candida tropicalis in a young diabetic female who presented with right flank pain and vomiting. Diagnosis made by CT imaging and culture of USG guided aspiration of perinephric abscess revealed growth of Candida tropicalis. Candida tropicalis perinephric abscess requires a very high index of suspicion for diagnosis. Associated high morbidity and mortality rates are likely due to misdiagnosis, therefore fungal perinephric and renal abscess must be kept as differential diagnosis in cases of fever with abdominal pain. Prompt diagnosis and early treatment are important for better outcome. Imaging and microbiological investigations are required for diagnosis, and drainage is indicated for successful therapy.

Background: Hepatitis B and C cause serious infectious disease of the liver which affects millions of people worldwide. More than 2 billion people living today have been infected with Hepatitis B virus (HBV) at some time in their lives and about 350 million people are carriers of the virus. Aim: To detect HBV and HCV infection and assess HBV immunity status amongst healthcare workers, medical students and nursing students at AIIMS Rishikesh. Methods: 135 participants (Medical faculty, Nursing Faculty, Resident Doctors, laboratory technicians, laboratory attendants, medical and nursing students) were enrolled for the study. Serological tests HBsAg, anti-hepatitis C virus antibodies (anti-HCV), anti-HBs antibodies, were performed. None were positive for HBsAg 1.5% were positive for Anti HCV antibodies and 61.75% had protective levels of antiHBs. Conclusion: HBV vaccination and screening for HBV, HCV, and anti-HBs of all HCW and students at time of entry should be done. Yearly screening thereafter should be done to check as follow up. Regular training on HBV vaccination and safe practices should be emphasized at all levels of HCW.

Background: Hand hygiene plays a crucial role in preventing health-care-associated infections (HCAIs) by reducing the spread of antimicrobial resistance. But, its compliance with optimal practices usually remains low at most of our health-care settings. Aim: This study focused on one of the primordial, basic and low-cost practice of infection control. Materials and Methods: A cross-sectional observational study was conducted among medical faculty, senior residents, postgraduates, nursing faculty, ward sisters/matron, and staff nurses at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand. Data were collected on a pretested structured questionnaire distributed among the participants, which consisted of questions to assess the knowledge and perception toward hand hygiene. Results: A total of 171 health-care workers (HCWs) were assessed in this study. Overall response rate observed was 87.8% ± 11.6%. Majority of the participants were staff nurses. Approximately 55% of them had received formal hand hygiene training in the last 3 years. Overall correct knowledge seen among participants was 66.4% ± 27.5%. It was observed that in situations requiring hand hygiene, it was performed in approximately 70%–80% of the times. Alcohol-based hand rub was not available at every point of care, whereas single-use towel was not present at every sink. When monitored whether the HCW started hand hygiene activity or not, compliance was seen in only 32% of the total. Conclusion: It is now essential for developing countries to formulate the policies for implementation of basic infection control practices. As we are facing an era of multidrug-resistant pathogens that are rapidly increasing globally, and paucity of availability of new antimicrobials, it is been essential to look at the role of basic infection control practices at health-care settings and implement them at priority level.

Cryptococcosis is a fungal disease with worldwide distribution and wide array of clinical manifestations, caused by encapsulated basidiomycetous yeasts called Cryptococcus spp. It has traditionally been considered an opportunistic infection known to occur in immunocompromised hosts, particularly those who are infected with human immunodeficiency virus. However, this infection has also been reported in phenotypically 'normal' or otherwise clinically non-immunocompromised patients. The seemingly mysterious nature of this potentially fatal illness has always kept clinicians and diagnosticians in a dilemma. This case series reiterates this perspective.

Background and Purpose: Rhinocerebral mycosis is a rapidly invasive infection in diabetic patients with an unfavorable course. Herein, we report a rare case of orbital cellulitis caused by Curvularia lunata following fungal rhinosinusitis in a diabetic male patient. Case report: A 35-year-old male with uncontrolled diabetes presented to the emergency department of our center with high-grade fever accompanied by chills and rigors, severe diffuse headache, and projectile vomiting with swelling and loss of vision in the right eye. The tissue sample from surgical debridement showed pigmented hyphae; in addition, Curvularia lunata was isolated in culture. Imaging was indicative of orbital extension. Therefore, the patient was diagnosed with fungal rhinosinusitis with orbital cellulitis. The patient was subjected to extensive surgical debridement, along with antifungals. Rhinosinusitis resolved; however, the loss of vision was irreversible. Conclusion: Orbital cellulitis is a very rare but life-threatening complication of fungal rhinosinusitis. Very few cases of orbital cellulitis following fungal rhinosinusitis have been reported in the literature. Early and prompt diagnosis can save the life of a patient.

Background: Infectious Keratitis (Ik) Is A Potential Vision-Threatening Ocular Infection Caused By A Variety Of Microorganisms. Aim: To Explore Risk Factors And Etiological Agents Associated With Ik. Design: A Prospective Cross-Sectional Study In Which Corneal Scrapings From 120 Suspected Cases Were Evaluated At A Tertiary Health Care Institute From January To December 2019. Methods: Scrapings Were Subjected To Direct Microscopy, Culture, And Identification By Both Conventional Methods And Maldi-Tof-Ms. The Patient's Demographic Data And Predisposing Factors, If Any Were Recorded. Results: The Mean Age Of Patients Was 48.9 Years And Predisposing Factors Were Documented In 46% (55/120) Of Cases. Overall, Infective Etiology Could Be Established In 51% (N = 61/120) Of Cases. Fungal Growth In 26% (N = 31/120) Of Cases And Bacterial Growth In 22% (N = 27/120) Of Cases Was Obtained. Growth Of More Than One Species Of Fungi Or Growth Of Bacteria Along With Fungus Were Observed In 2% (N = 3/120) Of Cases. Of All The Fungal Isolates Obtained (N = 34), The Most Common Isolate Was Fusarium (18/34) Followed By Aspergillus (8/34), Curvularia (4/34), Pseudallescheria Boydii (3/34), And Geotrichum (1/34). Among The Gram-Positive Bacterial Isolates (N = 16), Staphyloccus Species (15/16) Were Isolated In Maximum Number Followed By Streptococcus Pneumoniae (1/16). Among The Gram-Negative Isolates (N = 13), Pseudomonas Species (8/13) Were Isolated In Maximum Number Of Cases, Followed By Acinetobacter (3/13), Klebsiella Pneumoniae (1/13), And Escherichia Coli (1/13). Conclusion: For Initiating Appropriate Empirical Therapy, The Knowledge Of The Epidemiological Pattern Of Infectious Keratitis Of A Particular Geographical Region Is Crucial.

Introduction Invasive fungal infections have always been a major cause of mortality and morbidity and are especially prevalent in the immunosuppressed groups of patients. Members of the Mucoracea family have an increasing incidence and prevalence. It has always been difficult to diagnose this condition due to various reasons. Materials and Methods This was an observational study carried out jointly by the Department of Microbiology and the Department of Pathology for a duration of one year. All patients who presented in various clinical departments with a high index of clinical suspicion for mucormycosis were included in this study. A total of 186 samples were received from suspected cases of mucormycosis and were all subjected to direct microscopy by potassium hydroxide (KOH), fungal culture, and histopathological examination. Results Mucormycosis was documented in 33 out of 186 cases on direct microscopy, whereas 21 were positive on fungal culture. Histopathological positivity was reduced with only 11 cases showing aseptate hyphae suggestive of mucormycosis. Conclusion As these organisms generally do not grow well on routine culture media and with the histopathological results also being not suggestive clearly of mucormycosis, direct microscopy thus becomes more important and essential in the rapid diagnosis of this deadly condition.

Background and Purpose: We report a case of disseminated cryptococcosis in a treatment-naïve patient, incidentally diagnosed with hepatitis C virus (HCV) infection and renal parenchymal disease. The patient succumbed to death given the very late diagnosis of the disease. Case report: A 54-year-old male presented with the chief complaints of abdominal pain, chest pain, and phlegmy cough for a month. There was a past history of decreased urine output, lower limb swelling, and fever lasting for 15-20 days. After a general physical examination, the differential diagnosis of hepatitis C-related liver disease with hepatic encephalopathy, disseminated tuberculosis, and septic shock was made. Radiological examination revealed renal parenchymal disease on ultrasound abdomen and opacity with reticulonodular opacity in the bilateral lung zones. In laboratory investigations, serum reactive sample was tested for anti-HCV antibodies. In addition, Cryptococcus var grubii was identified in blood culture using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient succumbed to death before the initiation of any specific antifungal therapy. Conclusion: Cryptococcosis-HCV co-infection is a fatal condition with a fulminant course that might be difficult to treat.

Background: Candida species are generally identified by conventional methods such as germ tube or morphological appearance on cornmeal agar (CMA), biochemical methods using API kits, and molecular biological techniques. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) has revolutionized the identification of fungi reducing the turnaround time of days to minutes. Purpose: To compare the performance of MALDI-TOF MS and conventional methods in the identification of clinically relevant yeasts. Materials and methods: In this study, Candida identifications on CMA are compared with the results obtained on MALDI-TOF MS (Bruker Daltonics, Bremen, Germany). Discrepant results were confirmed by sequencing internal transcribed spacer (ITS) regions of rDNA. Results: A total of 114 clinical Candida species isolated from blood cultures were isolated and identified with conventional methods as well as with the MALDI-TOF-MS system. The agreement between the two test results were analyzed using Inter-rater reliability analysis (Cohen's Kappa) in SPSS Software Version 24 (IBM Corp., Armonk, NY). Overall, there was substantial agreement (Cohen's kappa=0.763) between the two methods. A value between 0.61 and 0.80 is classified under substantial. The most frequently isolated bloodstream Candida species included Candida albicans, C. tropicalis, C. parapsilosis, C.lusitaniae, C. glabrata which were accurately identified by MALDI-TOF-MS. When compared with conventional identification methods, MALDI-TOF-MS results are more reliable and rapid for Candida identification.

Fungal infections are life threatening especially in presence of immunosuppression or uncontrolled diabetes mellitus mainly due to their invasive potential. Mucormycosis of the oculo-rhino-cerebral region is an opportunistic, aggressive, fatal and rapidly spreading infection caused by organisms belonging to Mucorales order and class Zygomycetes. The organisms associated are ubiquitous. Aspergillosis is a common clinical condition caused by the Aspergillus species, most often by Aspergillus fumigatus (A. fumigatus). Both fungi have a predilection for the immunosuppressive conditions, with uncontrolled diabetes and malignancy being the most common among them. Mucormycosis is caused by environmental spores which get access into the body through the lungs and cause various systemic manifestations like rhino-cerebral mucormycosis. Here, a case series of such concomitant infections of Aspergillus and Mucor spp from Rishikesh, Uttarakhand, India is reported.

Background Cerebral aspergillosis usually affects immunocompromised hosts and may rarely occur in immunocompetent individuals. Due to its angio-invasive nature, Aspergillus may cause various vascular complications, particularly mycotic aneurysms and infarcts. Case presentation A 22-year-old immunocompetent male with diagnosed case of sino-cerebral aspergillosis was taking voriconazole for two months. His headache worsened and repeat imaging showed an increase in the size of the lesion. The patient was managed with right frontal craniotomy and surgical debridement, and voriconazole was continued. After ten days of uneventful post-operative course, the patient developed left-sided hemispheric infarct. The patient is doing well at nine months' follow-up, and he is off voriconazole for three months after the follow-up imaging showed complete resolution of disease. Conclusion Treatment of choice for cerebral aspergillosis is voriconazole. Surgical debridement may be a useful adjunct in patients not responding to voriconazole alone.

Although Candida albicans remains the predominant species causing Blood Stream Infection (BSI), recent studies have demonstrated an emergence of Non-albicans Candida spp (NAC), such as C. glabrata, C. papapsilosis and C. krusei. Candida krusei are yeast-like microorganisms which may colonise the human skin, respiratory or gastrointestinal tract but can cause lethal infections especially in immunocompromised patients. Hereby, author’s report a case of 10-year-old male with T-cell Acute Lymphocytic Leukaemia (ALL) who reported with fever and non-productive cough caused by Candida krusei. Direct gram stain from blood culture and germ tube test was performed. Further, the isolate was initially misidentified by Matrix Assisted Laser Desorption/Ionisation Time of Flight Mass Spectrometry (MALDI-TOF MS) as Trichosporon ovoides which was later identified by molecular sequencing as Candida krusei.

Nocardiosis is a rare bacterial infection that may lead to a severe disease. These infections are rare among normal population and are showing an increasing trend worldwide attributable to the increase in the immunosuppressed population. Most of these patients present with nonspecific clinical features such as fever, productive cough, and exertional dyspnoea as seen in our series of patients which makes it difficult to be diagnosed. Pulmonary nocardiosis is rarely clinically suspected and often diagnosed very late in the course of disease resulting in high mortality. A similar observation was made in one of our cases where the patient was being treated on the lines of pneumonia, and in the end she was diagnosed with pulmonary nocardiosis. In view of the limited literature available, we report here a case series of pulmonary nocardiosis in immunosuppressed patients diagnosed incidentally by fungal KOH mount. The most common conditions causing immunosuppression were type II DM, COPD, and pulmonary tuberculosis.

Strongyloides stercoralis is a soil-transmitted helminth that occurs almost worldwide, yet estimates about its prevalence are not well documented. The spectrum of clinical manifestations of strongyloidiasis is wide, ranging from asymptomatic disease to hyperinfection or dissemination of larvae involving multiple organ systems. Immunosuppression can increase the risk of hyperinfection syndrome in patients with strongyloidiasis. Strongyloidiasis continues to remain a neglected tropical disease, the diagnosis of which is often overlooked by clinicians and diagnosticians alike. The paucity of published literature from India further accentuates this problem. We hereby present a case report with the aim of elucidating this relatively underreported infection.

Background: Cryptococcal meningitis is a fatal opportunistic neuroinfection and an AIDS defining illness. It can also occur in non-HIV patients who are immunodefecient due to chronic glucocorticoid use, organ transplantation, malignancy and sarcodiosis. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital from July to December 2018. CSF samples of 364 patients were received by Microbiology laboratory during this period for the purpose of aerobic bacterial, fungal and TB culture, respectively. All samples were subjected to examination by direct wet mount, Gram stain and India ink preparation. Ziehl Neelsen staining, solid culture for Mycobacterium tuberculosis on Lowenstein Jensen medium and Gene Xpert was also performed on all CSF samples. These samples were further subjected to fungal culture on Sabouraud's dextrose agar. Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS) was used for identifying all bacterial (except M. tuberculosis) and fungal isolates. Results: Out of 364 CSF samples received, 288 were sterile after 48 hours of aerobic incubation. Bacterial isolates, M. tuberculosis and Cryptococcus spp. were obtained in culture from 51, 21 and 4 samples, respectively. The prevalence of cryptococcal meningitis in our study was 1.09% (4/364). Cryptococcus neoformans var grubii was the most common isolate (2/4; 50%) followed by Cryptococcus neoformans var neoformans (1/4; 25%) and Cryptococcus neoformans var gattii (1/4; 25%), respectively. Conclusion: Cryptococcal meningitis is a rapidly fatal condition which requires a high index of suspicion and calls for a collective effort from family physicians and diagnosticians alike. This disease is under-reported from Uttarakhand and therefore calls for further research from this region.

Dear Editor Now-a-days, anaerobic infections are showing evidence of increasing virulence, rising incidence, unresponsiveness to metronidazole therapy and worse outcomes. Some of these infections are serious and have high mortality rate and can no longer be overlooked as in the past and need to be properly identified [1]. Anaerobic microbiology has fallen out of the spotlight of infectious disease, due to extraordinary efforts required to recognize these infections as also the availability of generally effective antimicrobials against these organisms [2]. Anaerobic culturing can be made cost efficient by strict adherences to several principles, including the selective culturing of only appropriate general specimens that are uncontaminated by normal flora; Rapid transport of specimens and use of appropriate transport system; use of a system of rejection when inappropriate and multiple samples have been received [3]. This was a prospective study conducted at a Department of Microbiology, Government Medical College and Hospital Chandigarh, India over a period of three years from June 2009 to June 2012. The study comprised analysis of 100 pus samples from patients suspected to have anaerobic infections from Diabetic foot ulcers, Head and neck, Breast, Brain, Psoas abscesses, Peritoneal aspirations, Vaginal swabs received from different Departments of hospital. These included 5 samples in 2009, 14 samples in 2010, 40 samples in 2011 and 36 samples up to June 2012. The specimens were collected by aspiration in a sterile syringe or in the form of swab which were further transferred to transport media, Robertson cooked meat media (RCM). These samples were sent to the laboratory and processed immediately within 1-2 h of collection. Cultures were put up on brain heart infusion agar supplemented with haemin and vitamin K, L-cysteine, yeast extract with preliminary disks like metronidazole (5 μg), vancomycin (5 μg) and colistin (10 μg) sodiumpolyanethol sulphonate (SPS) discs for anaerobic incubation, Blood agar and MacConkey agar were put up for aerobic incubation. Incubation of brain heart infusion agar was done at 37°C for 48-72 h in anaerobic jar. Anaerobiasis was created by automated anaerobic system (Anoxomat). Aerobic plates were examined after 24 h. Anaerobic plates were examined after 48-72 h and observed for any growth. Colony characteristics were noted and staining was done and those organisms which were sensitive to metronidazole were considered as anaerobes. However some colonies also showed resistance to metronidazole. These individual colonies were inspected and aerotolerance test was done for each of them. Those organisms which failed to grow aerobically after 24 h on blood agar are considered as anaerobes. Pure culture isolates were identified by standard biochemical methods [3]. Antimicrobial susceptibility testing was done with various commonly used antimicrobial agents that are recommended by CLSI for anaerobes by the disc diffusion method [4]. Approval for study has been taken from ethical committee of the department. Isolation rate of anaerobic bacteria was 19%. The predominant anaerobic bacteria were Peptostreptococcus species. (11%), followed by Eubacterium species (3%), Clostridium species (2%), Veillonella species (1%), Bacteroides fragilis (1%), Prevotella species (1%). Anaerobic isolates are shown in [Table/Fig-1]. [Table/Fig-1]: Anaerobic isolates from samples The susceptibility of these bacteria was as follows: all the isolates were found to be sensitive to penicillin, clindamycin, imipenem, amoxycillin – sulbactam, piperacillin – tazobactum. Sensitivity to metronidazole was 84% (n-16/19). All the three isolates resistant to metronidazole were found to be Eubacterium species. The importance of isolation and characterization of anaerobes has long been overlooked. Certain reasons being the difficulty in isolation, time required and low levels of drug resistance. In our own institution we initially found great reluctance in sending samples but over a span of 3 y the number of samples increased from a mere 5 to a maximum of 40 in 2011 and until June 2012 already 36 samples had been received. This has given a new impetus to our anaerobe section and has been indeed encouraging. Additionally, good isolation results have been achieved. The prevalence of anaerobes in this study was 19%. The most commonly isolated anaerobe was Peptostreptococcus 11% followed by Eubacterium species 3%, Clostridium species 2% and Veillonella species, Bacteroides species, Prevotella species making up 1% each. The studies of Eslami et al., Colaycoet et al., reported Peptostreptococcus as the most frequently isolated anaerobe [5,6]. Most of the anaerobes were 100% sensitive to majority of the drugs; however, sensitivity to metronidazole was 84%. The resistance to metronidazole was shown by all the three Eubacterium species which are usually resistant to this drug despite the generally excellent activity of this drug [3]. The most frequently isolated antibiotic resistant anaerobe is Bacteroides fragilis due to beta-lactamase production [7]. The another study showed, metronidazole had the highest rate of resistance among anaerobes at a high 48% [8].This poses a difficulty since metronidazole is a frequent choice for empirical anaerobic coverage over the other antibiotics. Another cause of concern is the high resistance rate to clindamycin. But in our present study, no resistance to clindamycin was noted by any of the isolates. There is necessity for precautions to be taken for proper collection and transport of specimens where ever anaerobic bacteria are suspected to be the cause. For this trained paramedical staff is required. Therefore, the greatest challenge is to sensitize clinicians to send samples followed by the second hurdle of isolation, characterization and identification and routine sensitivity testing. Hence, clinicians and microbiologists working in tandem can go a long way in decreasing mortality due to anaerobic infections.

Infection of pregnant women with Salmonella occurs as often as its infection in the general population, with an incidence of 0.2% positive rectal cultures at the time of delivery [1]. The different modes of transmission by Salmonella Typhi and S. Paratyphi A are vertical transmission from the mother and transmission from exogenous sources. There are various reports on transmission of S. Typhi and S. Paratyphi to the foetus [2]. A vertical transmission occurs either via a transplacental spread of the organism when the mother has symptomatic typhoid fever or as a result of S. Typhi or S. Paratyphi A bacteraemia during labour, with a spread to foetal circulation or via oral route during birth due to an inadvertent faecal contamination of the lower birth canal [3]. This infection leads to infection of the intrauterine contents and ultimately, foetal loss. Hereby, we are presenting a case where S. Typhi was isolated from the high vaginal swab of a pregnant woman with an adverse outcome of pregnancy.

Author(s): Dhingra, M; Kaistha, N; Bansal, N; Solanki, LS; Chander, J; Thami, GP; Sande, WW van de

Ciprofloxacin has become the antibiotic of choice for the treatment of typhoid fever with the emergence and worldwide spread of Salmonella enterica typhi strains resistant to chloramphenicol. However, the rampant use of ciprofloxacin gradually led to an increase in its minimum inhibitory concentration against S. enterica typhi. This threatened its therapeutic efficacy and resulted in the re-emergence of chloramphenicol-sensitive S. enterica typhi strains.

There is paucity of data on the invasive group A Streptococcal disease in children, especially from the developing countries. As an infection in children could take a life-threatening course, an early diagnosis and prompt treatment can go a long way in achieving positive therapeutic outcome. In the present study, 3 infants were detected to have bacteremia due to group A Streptococcus as per their positive blood cultures. There is need to create an awareness among clinicians regarding prevalence of GAS infections. The increasing isolation of organisms in this era of anti-microbial drug resistance necessitates regular epidemiological monitoring of invasive GAS infections in developing countries also.