[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
July-September 2015
463
Correspondence
Table 1: Positive predictive value of different diagnostic methods in suspected fungal keratitis Diagnostic test Positive Negative Positive predictive value* Gram’s stain 26 89 22.6% 10% KOH wet mount 56 59 48.7% CFW+10% KOH 114 1 99.1% wet mount Culture 73 42 61.35
from a north Indian tertiary care hospital. Indian J Pathol Microbiol 2008;51:304‑6. 4. Rautaraya B, Sharma S, Kar S, Das S, Sahu SK. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. BMC Ophthalmol 2011;11:39. 5. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211‑15.
MK Gupta, A Chandra, P Prakash, T Banerjee, OPS Maurya, *R Tilak
*Calculations based on composite gold standard, i.e., n=115. KOH: Potassium hydroxide, CFW: Calcofluor white fluorescent staining
Hyaline fungi, with Aspergillus spp from northern and eastern India and Fusarium spp. from south India, have been reported as the commonest cause of fungal keratitis.[2‑5] As emphasized previously, though culture is the most definitive method and direct visualization by KOH is most frequently used, a large number of cases that are missed can be easily detected by CFW stain with 10% KOH.
Department of Microbiology (MKG, PP, TB, RT), Department of Ophthalmology (AC, OPSM), Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India *Corresponding author (email: ) Received: 23-05-2014 Accepted: 21-06-2014
References
Access this article online Quick Response Code:
1. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: A global perspective. Bull World Health Organ 2001;79:214‑21. 2. Sherwal BL, Verma AK. Epidemiology of ocular infection due to bacteria and fungus‑ A prospective study. JK Science 2008;10:127‑31. 3. Chander J, Singla N, Agnihotri N, Arya SK, Deep A. Keratomycosis in and around Chandigarh: A five‑year study
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158609
Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report Dear Editor, Mycoplasma pneumoniae (M. pneumoniae) causes 6–20% of the community‑acquired lower respiratory tract infections in older children and adults.[1] One of the most common extrapulmonary manifestations is central nervous system (CNS) complications with encephalitis as the most common pediatric manifestations.[2] We report M. pneumoniae infection in an 11-year-old boy presented with fever, accompanied by bifrontal headache and nonprojectile, nonbilious vomiting for the last 12 days. A diagnostic lumbar puncture revealed colourless CSF, pleocytosis with total lymphocyte count of 27 cells/mm3 (polymorphs 6% and lymphocytes 94%). The CSF sugar was within normal limits (50–80 mg/dl) and proteins (normal range 15–45 mg/dl) were raised. No organisms were seen on direct microscopy or culture. Magnetic resonance imaging (MRI) scan of the brain was suggestive of hemorrhagic encephalitis.
The CSF specimen tested by polymerase chain reaction to amplify a 345 base pair region on the P1 adhesin gene of M. pneumoniae was negative. The serum was positive by ELISA (Calbiotech, CA, USA) for IgM antibodies to M. pneumoniae and by M. pneumoniae Serodia Myco II gelatin particle agglutination test (Fujirebio, Japan). The child was managed with mannitol, ceftazidime, azithromycin and amikacin. Two weeks after admission, the patient was discharged from the hospital. M. pneumoniae is responsible for at least 6.9% of cases of acute childhood encephalitis.[3] A study reported CNS manifestations associated with serologic evidence of acute infection with M. pneumoniae.[4] Several potential mechanisms include direct invasion of the CNS, immune complex formation, vascular injury, hypercoagulable state and toxic effects.[5] We suggest that M. pneumoniae should be considered as a potential cause of encephalitis in children. Serologic testing is more reliable for the diagnosis
www.ijmm.org
[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
464
Indian Journal of Medical Microbiology
*S Kumar, S Kapoor, SR Saigal
of the association between pediatric encephalitis and M. pneumoniae and should be used as a part of protocol for evaluation of the cause of encephalitis in this age-group.
Department of Microbiology (SK, SRS), Department of Pediatrics (SK), Maulana Azad Medical College, New Delhi - 110 002, India.
References 1. Kumar S, Saigal SR, Sethi GR. Rapid diagnosis of Mycoplasma pneumoniae by polymerase chain reaction in community acquired lower respiratory tract infections. Trop Doct 2011;41:160‑2. 2. Christie LJ, Honarmand S, Talkington DF, Gavali SS, Preas C, Pan CY, et al. Pediatric encephalitis: What is the role of Mycoplasma pneumoniae? Pediatrics 2007;120:305‑13. 3. Bitnun A, Ford‑Jones EL, Petric M, MacGregor D, Heurter H, Nelson S, et al. Acute childhood encephalitis and Mycoplasma pneumoniae. Clin Infect Dis 2001;32:1674‑84. 4. Lerer RJ, Kalavsky SM. Central nervous system disease associated with Mycoplasma pneumoniae: Report of five cases and review of the literature. Pediatrics 1973;52:658‑68. 5. Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005;51:343‑54.
vol. 33, No. 3
*Corresponding author (email: ) Received: 27‑01‑2014 Accepted: 02‑12‑2014
Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158610
In vitro activity of ceftaroline against methicillin-resistant Staphylococcus aureus isolates Dear Editor, Ceftaroline, an advanced generation cephalosporin antibiotic, widely described in the literature as fifth generation cephalosporin, has been recently approved for the treatment of complicated skin and skin structure infections and community‑acquired bacterial pneumonia.[1,2] This is the first cephalosporin antibiotic approved for the treatment of methicillin‑resistant staphylococci (MRSA). This antibiotic differs from other cephalosporin group of antibiotics in possessing high affinity for PBP2a protein, which mediates resistance to all the β lactam antibiotics in MRSA. As ceftaroline is a newer agent with only limited knowledge about its resistance surveillance, the present study was designed to know the susceptibility patterns of MRSA against this agent. A total of 50 non‑duplicate methicillin‑resistant staphylococcus aureus strains isolated from various clinical samples were included in the study. Methicillin resistance was detected by using cefoxitin 30‑µg disc. Ceftaroline minimum inhibitory concentrations were detected for all these 50 isolates by using the E strips of ceftaroline (biomerieux). The Clinical and Laboratory Standards Institute (CLSI) clinical break points were applied for interpretation of ceftaroline MIC (sensitive ≤ 1 mg/L,
2 mg/L intermediate, resistant ≥4 mg/L).[3] S. aureus ATCC 29213 was used as control strain for MIC detection. All the 50 MRSA isolates tested against ceftaroline were sensitive to this antibiotic. Ceftaroline MIC values ranged from 0.125 to 1.5 mg/L. Only two isolates showed the maximum MIC of 1.5 mg/L, which is in the intermediate susceptible range. And all the remaining isolates showed MIC ≤ 1 mg/L. The MIC50 and the MIC90 of the isolates were 0.5 mg/L and 1 mg/L, respectively. In our study, all the MRSA isolates have shown uniform susceptibility to this drug with the MIC90 ≤ 1 mg/L [Figure 1]. Our findings correlate well with the surveillance studies of other geographical areas. In the Assessing Worldwide Antimicrobial Resistance Evaluation (AWARE) [4] programme, 98.4% of the MRSA were inhibited at MIC value of 1 mg/L. The highest MIC in their study was 2 mg/L. In a study by Jones et al.,[5] 94.8% of the MRSA isolates from USA were inhibited at a concentration of 1 mg/L, whereas only 82.6% European isolates were inhibited at 1 mg/L and 99.5% isolates at 2 mg/L. To conclude, ceftaroline showed good in vitro activity against MRSA isolates and can be considered as an effective alternative for the treatment of these infections.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
July-September 2015
463
Correspondence
Table 1: Positive predictive value of different diagnostic methods in suspected fungal keratitis Diagnostic test Positive Negative Positive predictive value* Gram’s stain 26 89 22.6% 10% KOH wet mount 56 59 48.7% CFW+10% KOH 114 1 99.1% wet mount Culture 73 42 61.35
from a north Indian tertiary care hospital. Indian J Pathol Microbiol 2008;51:304‑6. 4. Rautaraya B, Sharma S, Kar S, Das S, Sahu SK. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. BMC Ophthalmol 2011;11:39. 5. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211‑15.
MK Gupta, A Chandra, P Prakash, T Banerjee, OPS Maurya, *R Tilak
*Calculations based on composite gold standard, i.e., n=115. KOH: Potassium hydroxide, CFW: Calcofluor white fluorescent staining
Hyaline fungi, with Aspergillus spp from northern and eastern India and Fusarium spp. from south India, have been reported as the commonest cause of fungal keratitis.[2‑5] As emphasized previously, though culture is the most definitive method and direct visualization by KOH is most frequently used, a large number of cases that are missed can be easily detected by CFW stain with 10% KOH.
Department of Microbiology (MKG, PP, TB, RT), Department of Ophthalmology (AC, OPSM), Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India *Corresponding author (email: ) Received: 23-05-2014 Accepted: 21-06-2014
References
Access this article online Quick Response Code:
1. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: A global perspective. Bull World Health Organ 2001;79:214‑21. 2. Sherwal BL, Verma AK. Epidemiology of ocular infection due to bacteria and fungus‑ A prospective study. JK Science 2008;10:127‑31. 3. Chander J, Singla N, Agnihotri N, Arya SK, Deep A. Keratomycosis in and around Chandigarh: A five‑year study
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158609
Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report Dear Editor, Mycoplasma pneumoniae (M. pneumoniae) causes 6–20% of the community‑acquired lower respiratory tract infections in older children and adults.[1] One of the most common extrapulmonary manifestations is central nervous system (CNS) complications with encephalitis as the most common pediatric manifestations.[2] We report M. pneumoniae infection in an 11-year-old boy presented with fever, accompanied by bifrontal headache and nonprojectile, nonbilious vomiting for the last 12 days. A diagnostic lumbar puncture revealed colourless CSF, pleocytosis with total lymphocyte count of 27 cells/mm3 (polymorphs 6% and lymphocytes 94%). The CSF sugar was within normal limits (50–80 mg/dl) and proteins (normal range 15–45 mg/dl) were raised. No organisms were seen on direct microscopy or culture. Magnetic resonance imaging (MRI) scan of the brain was suggestive of hemorrhagic encephalitis.
The CSF specimen tested by polymerase chain reaction to amplify a 345 base pair region on the P1 adhesin gene of M. pneumoniae was negative. The serum was positive by ELISA (Calbiotech, CA, USA) for IgM antibodies to M. pneumoniae and by M. pneumoniae Serodia Myco II gelatin particle agglutination test (Fujirebio, Japan). The child was managed with mannitol, ceftazidime, azithromycin and amikacin. Two weeks after admission, the patient was discharged from the hospital. M. pneumoniae is responsible for at least 6.9% of cases of acute childhood encephalitis.[3] A study reported CNS manifestations associated with serologic evidence of acute infection with M. pneumoniae.[4] Several potential mechanisms include direct invasion of the CNS, immune complex formation, vascular injury, hypercoagulable state and toxic effects.[5] We suggest that M. pneumoniae should be considered as a potential cause of encephalitis in children. Serologic testing is more reliable for the diagnosis
www.ijmm.org
[Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]
464
Indian Journal of Medical Microbiology
*S Kumar, S Kapoor, SR Saigal
of the association between pediatric encephalitis and M. pneumoniae and should be used as a part of protocol for evaluation of the cause of encephalitis in this age-group.
Department of Microbiology (SK, SRS), Department of Pediatrics (SK), Maulana Azad Medical College, New Delhi - 110 002, India.
References 1. Kumar S, Saigal SR, Sethi GR. Rapid diagnosis of Mycoplasma pneumoniae by polymerase chain reaction in community acquired lower respiratory tract infections. Trop Doct 2011;41:160‑2. 2. Christie LJ, Honarmand S, Talkington DF, Gavali SS, Preas C, Pan CY, et al. Pediatric encephalitis: What is the role of Mycoplasma pneumoniae? Pediatrics 2007;120:305‑13. 3. Bitnun A, Ford‑Jones EL, Petric M, MacGregor D, Heurter H, Nelson S, et al. Acute childhood encephalitis and Mycoplasma pneumoniae. Clin Infect Dis 2001;32:1674‑84. 4. Lerer RJ, Kalavsky SM. Central nervous system disease associated with Mycoplasma pneumoniae: Report of five cases and review of the literature. Pediatrics 1973;52:658‑68. 5. Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005;51:343‑54.
vol. 33, No. 3
*Corresponding author (email: ) Received: 27‑01‑2014 Accepted: 02‑12‑2014
Access this article online Quick Response Code:
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.158610
In vitro activity of ceftaroline against methicillin-resistant Staphylococcus aureus isolates Dear Editor, Ceftaroline, an advanced generation cephalosporin antibiotic, widely described in the literature as fifth generation cephalosporin, has been recently approved for the treatment of complicated skin and skin structure infections and community‑acquired bacterial pneumonia.[1,2] This is the first cephalosporin antibiotic approved for the treatment of methicillin‑resistant staphylococci (MRSA). This antibiotic differs from other cephalosporin group of antibiotics in possessing high affinity for PBP2a protein, which mediates resistance to all the β lactam antibiotics in MRSA. As ceftaroline is a newer agent with only limited knowledge about its resistance surveillance, the present study was designed to know the susceptibility patterns of MRSA against this agent. A total of 50 non‑duplicate methicillin‑resistant staphylococcus aureus strains isolated from various clinical samples were included in the study. Methicillin resistance was detected by using cefoxitin 30‑µg disc. Ceftaroline minimum inhibitory concentrations were detected for all these 50 isolates by using the E strips of ceftaroline (biomerieux). The Clinical and Laboratory Standards Institute (CLSI) clinical break points were applied for interpretation of ceftaroline MIC (sensitive ≤ 1 mg/L,
2 mg/L intermediate, resistant ≥4 mg/L).[3] S. aureus ATCC 29213 was used as control strain for MIC detection. All the 50 MRSA isolates tested against ceftaroline were sensitive to this antibiotic. Ceftaroline MIC values ranged from 0.125 to 1.5 mg/L. Only two isolates showed the maximum MIC of 1.5 mg/L, which is in the intermediate susceptible range. And all the remaining isolates showed MIC ≤ 1 mg/L. The MIC50 and the MIC90 of the isolates were 0.5 mg/L and 1 mg/L, respectively. In our study, all the MRSA isolates have shown uniform susceptibility to this drug with the MIC90 ≤ 1 mg/L [Figure 1]. Our findings correlate well with the surveillance studies of other geographical areas. In the Assessing Worldwide Antimicrobial Resistance Evaluation (AWARE) [4] programme, 98.4% of the MRSA were inhibited at MIC value of 1 mg/L. The highest MIC in their study was 2 mg/L. In a study by Jones et al.,[5] 94.8% of the MRSA isolates from USA were inhibited at a concentration of 1 mg/L, whereas only 82.6% European isolates were inhibited at 1 mg/L and 99.5% isolates at 2 mg/L. To conclude, ceftaroline showed good in vitro activity against MRSA isolates and can be considered as an effective alternative for the treatment of these infections.
www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
