B-01

CHROMOBACTERIUM VIOLACEUM: A RARE CAUSE OF INFECTED PANCREATIC PSEUDOCYST.

Kavitha Dinesh , Anil Kumar, Surendran Sudhindran, Sreeja Janardhanan , Shamsul Karim. Department of Microbiology & Gastrointestinal surgery, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India-682041. Background: Though Chromobacterium violaceum is a common inhabitant of soil and water in tropical and sub-tropical regions, human infections are rare but when they do occur result in high mortality. Pancreatic pseudocyst infection with C. violaceum has not been reported before. Management is complicated as sepsis due to C. violaceum has high mortality rate. Surgical drainage along with appropriate antimicrobial therapy is required for complete resolution. Case report: We report here a case of C. violaceum infection of pancreatic pseudocyst. The patient, a 32 year old male alcoholic was a known case of chronic calcified pancreatitis, was admitted with constipation, recurrent vomiting and abdominal pain with a mass palpable in the epigastrium. MDCT revealed a thick-walled cystic lesion measuring 16x9 cm in cross section with hyperdense contents within, suggestive of bleed, causing compression over the distal aspect of CBD. Patient was treated by Cysto - jejunostomy with Rou-en-Y jejunal loop. The pseudocyst was found filled with blood clots which on culture grew C. violaceum which was resistant to cephalosporins. Concurrent blood cultures were negative. Parenteral ciprofloxacin and amikacin were given for seven days followed by oral ciprofloxacin for two weeks which resulted in complete resolution.Conclusions: Pancreatic pseudocyst infection with C.violaceum is extremely rare and given the fact that sepsis due to this organism is associated with high mortality, initial empiric therapy with drugs such as fluoroquinolones and aminoglycosides is recommended, jointly with proper surgical management to bring about complete resolution.

B-02 Rhodococcus equi bacteremia from Lung abscess in an immunocompetent child Sushma Krishna, Subramanium TS, Kavitha Dinesh, Manubhai, Shamsul Karim, Department of Microbiology, Department of Pediatrics, Amrita Institute of Medical Sciences, Cochin-682041, Kerala. Background: Rhodococcus equi is a rare zoonotic pathogen causing infection in immunocompromised humans. Literature on the infections caused in the immunocompetent hosts, more so with pulmonary involvement are limited. We present one such case of bacteremia in an immunocompetent child with Lung abscess. Case report: A four year old female child with complaints of unresolving high grade fever and productive cough of 5 months duration was admitted with chest findings of bilateral coarse crepitations and wheeze. CT chest done showed homogenous shadow on right lower and middle zone, suggestive of lung abscess. Blood and sputum culture were done, while the Pulmonlogists considered Mycobacterial, Nocardia, Mycotic etiology. Blood culture on the second day grew gram positive coccobacilli, identified biochemically as Rhodococcus equi, following which culture sensitive Amikacin and ofloxacin combination was administered for 14 days. Serial chest X-rays showed a resolution of opacity and child was discharged as the condition improved. There was no elicitable history of animal contact. Conclusion: Increased awareness among microbiologists and pulmonologists is required to identify and administer adequate antibiotic therapy for potentially curable lung infections respectively. R.equi may be considered as differentials whenever Mycobacterial and Nocardial etiologies are suspected in a case of chronic lung disease in an immunocompetent host too.

B-03
PCR BASED DETECTION OF VIRULENCE GENES FROM SALMONELLA SPECIES- A STUDY FROM CHENNAI. G.Muthul, A.Sureshl, D.VishnuPrabu 2, AK.Munirajan2, R.Srivani*l 1Dept. of Microbiology, Dr ALM PG IBMS, University of Madras, Chennai-113, 2Dept. of Genetics, Dr ALM PG IBMS, University of Madras, Chennai-113 Objective: The pathogenesis of Salmonellosis depends upon a large number of factors controlled by an array of genes that synergise into the actual virulence of Salmonella. The present study was undertaken to detect the two genes, namely, Salmonella enterotoxin (stn) and plasmid encoded fimbrial (pef) genes, among three different clinical Salmonella isolates from human. Materials and Methods: A total of 176 isolates belonging to Salmonella enterica serovar Typhi (133), Salmonella enterica serovar paratyphi A (41) and Salmonella enterica serovar Typhimurium (2) serovars were analyzed by polymerase chain reaction (PCR) using their specific primers for the detection of stn, and pef genes. Varying pattern of these two genes was observed amongst the isolates. Result and Conclusion: The stn gene was found in 140/176 Salmonella strains, the pef gene was not found in the all three different clinical Salmonella enterica isolates. PCR findings indicated that the stn gene is widely distributed among Salmonella irrespective of the serovars and source of isolation. Since the stn gene is found in maximum Salmonella isolates, which can be a feasible target gene to search the chance of direct PCR based detection of Salmonella from samples from biological sources.

B- 04 BILATERAL MIDDLE EAR INFECTION BY STREPTOMYCES: A RARE ENTITY R.Latha, Kavitha Kannaiyan, Anushella Howlander and R.Lall, Department of Microbiology, Aarupapadai Veeedu Medical and Hospital, Puducherry. BACKGROUND: Organisms belonging to the genus Streptomyces are classified among the aerobic actinomycetes, but unlike other members of the group, such as Nocardia spp and Rhodococcus spp., they are not weakly acid fast. Streptomyces are well known for production O: antibiotics as secondary metabolites. These are saprophytic soil organisms rarely known to caus human infections other than mycetoma. However our experience with a recent patient with bilateral streptomyces infection of the middle ear has stimulated us to call attention to this very rate disease. CASE REPORT: We report the case of a 10 year old boy who presented with bilateral clinical, audiometric and radiologic fining consistent with bilateral chronic suppurative otitis media. Findings on evaluation of the specimens from both the ears demonstrated gram positive branching non fragmentary, non acid fast and aerobic organisms consistent to make a presumptive identification of streptomyces spp. Repeat specimens also yielded the same organism taken on two different days. The organism was sensitive to linezolid, amikacin, and chloramphenicol but resistant to penicillin, and cotrimoxazole. The patient was started on parenteral amikacin and chloramphenicol ear drops. Patient responded well after two weeks. Now the patient is on follow up. CONCLUSION: Streptomyces isolated from pus cultures should not be dismissed as contaminants without careful consideration of the clinical situation; the isolation of Strepyomyces from repeat cultures strongly suggests a pathogenic role as seen in our case.