Background & objectives: Scrub typhus, caused by Orientia tsutsugamushi , is an emerging cause of acute febrile illness (AFI) in India, transmitted by chigger mites in rural and semi-urban areas. Due to its nonspecific symptoms and limited diagnostic access, it is often underdiagnosed, leading to severe complications. Early detection and prompt treatment are essential to reduce morbidity and mortality. Methods: This retrospective study at the Virus Research and Diagnostic Laboratory (VRDL), Banaras Hindu University, analyzed data from acute febrile cases referred between December 2023 and February 2025. Results: Diagnostic testing identified Leptospira IgM (13.1%) and Scrub Typhus (ST) IgM (9.5%) as the most common infections among all the AFI cases, with co-infections accounting for 85% of total ST-positive cases. Although a higher proportion of ST-positive cases were observed in males (57%), positivity rates were higher in females. The 25-61 years age group had the highest positivity (17.81%), followed by 13-25 years (15.33%) and the lowest in 0-1 years (4.35%). The 25-61 years group was 1.71 times more likely, and 13-25 years 1.49 times more likely, to contract ST than those ≥61 years. ST infections peaked during the monsoon and post-monsoon seasons, with the highest positivity in November (25.7%) and October (24.6%). Interpretation & conclusion: The study concludes that Uttar Pradesh and Bihar are endemic for scrub typhus, and it has a major part in the aetiology of acute febrile illness, influenced by environmental factors like rains, humidity, dense vegetation and poor sanitation.

INTRODUCTION:The aim of our study was to learn about the effect of bacteriophages derived from the water of the river Ganga on Pseudomonas-induced corneal ulcer in mice. Pseudomonas aeruginosa poses a significant threat in cases of bacterial keratitis, a condition that severely hampers vision. With variable incidence rates worldwide and increasing antibiotic resistance to Pseudomonas, it is necessary to explore the potential of bacteriophages isolated from Ganga water for treating Pseudomonas aeruginosa-induced keratitis. MATERIAL AND METHODS:We used a mouse model for this study. The most potent phages targeting Pseudomonas aeruginosa that demonstrated a broad spectrum of activity against clinical strains were phenotypically and genotypically characterised. Establishing the animal model involved inducing severe keratitis in mice by inoculating them with Pseudomonas aeruginosa. After this, we administered multiple doses of bacteriophages as eye drops, 24 hours after infection. RESULTS:The results yielded significantly improved disease outcomes. The treatment not only preserved the structural integrity and transparency of the infected cornea but also suppressed neutrophil infiltration and bolstered bacterial clearance, as evidenced by histopathological analysis. CONCLUSION:These findings suggest that bacteriophage therapy can be an effective alternative therapeutic approach for treating antibiotic-resistant infectious keratitis. Also, we can use bacteriophages in combination with antibiotics already in use.

Aquaculture has become one of the fastest-growing food sectors globally, but its expansion is increasingly challenged by bacterial disease outbreaks and the rising threat of antimicrobial resistance (AMR). As conventional antibiotic treatments lose effectiveness, bacteriophage therapy – the use of viruses that selectively infect and lyse bacteria – has emerged as a promising alternative. Phages offer high specificity, minimal environmental impact, and proven efficacy against multidrug-resistant pathogens. This review provides an updated synthesis of current knowledge on the application of bacteriophages and phage-derived products, such as lysins and tail-like bacteriocins, in aquaculture systems. We explore their mechanisms of action, therapeutic advantages, and outcomes from experimental and field trials against key pathogens, including Aeromonas hydrophila, Vibrio harveyi, Edwardsiella tarda, and Streptococcus iniae. Importantly, phage therapy aligns with the One Health framework, which emphasizes the interdependence of human, animal, and environmental health. By reducing the use of antibiotics in aquatic farming, phage applications can help curb the spread of AMR, protect water ecosystems, and enhance food safety. Despite its potential, challenges such as phage resistance, endotoxin release, intracellular pathogen targeting, and standardization gaps must be addressed for broader adoption. We conclude by outlining future research priorities, including genome-guided phage selection, optimized delivery systems, and the need for standardized efficacy testing. Phage therapy thus represents a sustainable and integrative approach to aquatic disease management and global public health.

Bacterial biofilms are prevalent in clinical environments, contributing to persistent infections associated with medical devices. Enterobacter cloacae forms biofilms on nonliving surfaces, leading to drug-resistant, recurrent infections that are difficult to treat. Biofilm development in Enterobacter species, including E. cloacae, occurs through five stages: reversible attachment, irreversible attachment, microcolony formation, maturation and dispersal. Initial attachment is mediated by adhesins, including fimbriae and lipopolysaccharides, which interact with surfaces. This is followed by secretion of an extracellular polymeric substance matrix composed of polysaccharides, extracellular DNA and proteins, providing stability and protection. This study aimed to establish a standardised in vitro 0.5% crystal violet staining method to quantify biofilm production in E. cloacae isolates and classify isolates by biofilm-forming capacity. Biofilm was quantified by optical density at 570-600 nm. A 96-well microtiter plate assay quantified biofilm formation in 40 E. cloacae strains collected between July 2021 and April 2023. Growth conditions were optimised, including culture media, fixation techniques and additive concentrations of glucose and sodium chloride. Brain heart infusion broth was optimal, and heat fixation was superior; glucose had no effect, whereas 1%-2% sodium chloride enhanced biofilm production. These findings improve understanding of environmental regulation of biofilm formation and microbial persistence across habitats.

BACKGROUND:Klebsiella pneumoniae, a prominent member of the ESKAPE pathogen group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), represents a serious concern in postoperative gynaecological infections due to its multidrug resistance (MDR) and strong biofilm-forming ability. The limited efficacy of conventional antibiotics against such infections underscores the need for innovative combinatorial strategies, such as bacteriophage therapy and phototherapy. AIMS:This study aimed to evaluate the synergistic antibacterial potential of bacteriophage therapy and blue light (450 nm) phototherapy against biofilm-associated MDR K. pneumoniae isolated from a post- cesarean wound infection. METHODS:A clinically isolated MDR K. pneumoniae strain was characterised, and biofilms were treated with phage, blue light, or sequential phage-light combinations. Crystal violet assays and microscopy quantified biofilm biomass reduction, while synergy was analysed using the Bliss independence model. Phage stability under blue light and cytocompatibility with HiFi™ human PBMCs were also assessed, along with cytokine profiling. RESULTS:The combined phage-blue light treatment achieved an 82.3% reduction in biofilm biomass, significantly surpassing either monotherapy (p < 0.0001). Sequence-dependent synergy was observed, with Phage→Light treatments showing stronger early effects (6 h). Phage viability remained unaffected by blue light, and PBMC assays confirmed high cytocompatibility with no detectable cytokine induction. Mechanistically, blue light-induced ROS disrupted the biofilm matrix, facilitating enhanced phage penetration and infection. CONCLUSIONS:Bacteriophage-blue light combination therapy represents a safe, synergistic, and resistance-mitigating approach for managing MDR K. pneumoniae biofilm infections, offering promising translational potential in postoperative gynaecological wound care.

Introduction: Febrile illnesses in endemic regions often involve overlapping bacterial and viral infections, complicating diagnosis and treatment. Co-infections can alter disease severity and lead to suboptimal clinical outcomes, especially where diagnostic resources are limited. Seasonal patterns, particularly during monsoons, may drive these overlaps. Objective: This study investigated trends in bacterial–viral co-infections amongst febrile patients over a defined period, aiming to improve diagnostic approaches and enhance clinical management in resource-limited healthcare settings. Materials and Methods: We conducted a retrospective observational study using laboratory data from febrile patients whose samples were received at Virus Research and Diagnostic Laboratory, Institute of Medical Sciences, Banaras Hindu University, Varanasi, over a defined period. Co-infections were identified based on laboratory-confirmed diagnoses of bacterial and viral pathogens. Results: Dengue virus was the most frequent viral co-pathogen, with 32 and 40 co-infections identified alongside scrub typhus and leptospirosis, respectively. Chikungunya was the next most common, while Influenza and COVID-19 co-infections were rare. No cases involving Japanese Encephalitis virus were observed. Seasonal overlap of bacterial and arboviral pathogens, particularly during monsoons, likely contributed to these patterns. Shared clinical features amongst infections complicate diagnosis and may result in suboptimal treatment. Conclusion: Bacterial–viral co-infections represent a substantial and under-recognised burden in febrile illness management within endemic regions. Our findings underscore the need for integrated, multiplex diagnostic strategies to enhance clinical decision-making and improve outcomes in resource-constrained healthcare settings.

Obesity rates are rising globally, placing a significant strain on individuals, society, and economies. The gut microbiota (GM) plays a pivotal role in the development of obesity. Many studies have identified differences in GM composition between obese and normal-weight people worldwide. However, there is limited data on the GM profiles of obese and control Indian individuals. Fecal samples from 20 participants (10 obese, 10 control) underwent 16 S rRNA gene sequencing. Anthropometric analysis confirmed significant differences in weight and BMI, with no significant variance in age or height. Taxonomic profiling and diversity indices (Chao1, Shannon, Simpson) were evaluated using the NCBI database. Sequencing identified 1,359 Operational Taxonomic Units. The obese cohort exhibited an elevated Firmicutes-to-Bacteroidetes (F/B) ratio, with Firmicutes increasing to 53.78

Wound healing is a complex physiological process involving coordinated phases of inflammation, tissue repair, and scar formation to restore tissue integrity. Recently, silver nanoparticles (AgNPs) have been investigated for their potential to promote wound healing; however, their application is limited by concerns over cytotoxicity and the development of bacterial resistance. To address these limitations, this study presents the development of a silver-alginate hydrogel (AgSACip) incorporating ciprofloxacin, synthesized using green tea extract act as a biogenic reducing and stabilizing agent. Sodium alginate, a naturally derived macromolecule, serves as a biocompatible matrix to stabilize AgNPs, reduce cytotoxicity, and enhance therapeutic efficacy. The wound healing potential of AgSACip was evaluated in diabetic and burn wound models, and its antibacterial activity, cytotoxic effects, and pharmacokinetics were analyzed using in silico methods. The results demonstrate that AgSACip significantly accelerates wound healing compared to AgNPs and ciprofloxacin alone, particularly in diabetic and burn wounds. Furthermore, AgSACip exhibited enhanced antibacterial activity against bacterial strains isolated from wound pus samples and showed no cytotoxicity toward NIH-3T3 fibroblast cells. These findings highlight the potential of AgSACip, a macromolecule-based hydrogel, as a safe and effective alternative to conventional wound dressings, offering improved wound healing outcomes.

Context:Conventional treatments for caries lack microbial specificity, often failing to address the root cause. Bacteriophage therapy, which uses viruses that selectively target and lyse the bacteria, has emerged as a promising alternative.Aims:To isolate Streptococcus mutans-specific bacteriophages from saliva and other sources, and to evaluate and compare their therapeutic potential against microorganisms associated with dental caries.Materials and Methods:A purposive sampling technique was employed, and saliva and dental plaque samples were collected from healthy children aged 6-14 years for bacterial culture. Bacteriophages were isolated from saliva and various water sources. The lytic activity of the isolated phages was assessed by measuring the optical density (OD) of the biofilm mass by spectrophotometry at 24-and 72-h, followed by assessment using Tukey's post hoc analysis.Results:At both 24 and 72 h, a significant reduction in OD was observed in the bacteriophage and chlorhexidine groups compared to the control. At 72 h, the bacteriophage group showed the greatest OD reduction, followed by chlorhexidine and control.Conclusions:Bacteriophages exhibit promising antimicrobial properties that are more effective against S. mutans pathogens on long-term contact compared to chlorhexidine groups.

Antimicrobial resistance has renewed interest in Phage therapy as an alternative or adjunct to antibiotics. However, immune responses to repeated phage exposure may influence treatment outcomes, and the impact of the route of administration on these responses remains incompletely understood. This study evaluated humoral and cytokine responses following repeated administration of a lytic phage cocktail in healthy rats through different parenteral routes. A cocktail of four lytic phages targeting multidrug-resistant Klebsiella pneumoniae was administered repeatedly to healthy rats via the intraperitoneal (IP), intramuscular (IM), intravenous (IV), and subcutaneous (SC) routes. Humoral responses were assessed by measuring anti-phage immunoglobulins (IgM, IgG, and IgA) and neutralising antibodies, while systemic cytokines (TNF-α, IL-1β, IL-6, and IL-10) were quantified. Repeated phage administration elicited route-dependent humoral immune responses. Neutralising antibody levels peaked by day 14 in the IP, IM, and IV groups, reflecting early IgM responses. A second peak occurred after the seventh dose, administered 37 days later. The IP route triggered the strongest and sustained antibody response, particularly IgG, whereas responses following SC administration were weaker and delayed. IgA levels remained low across all routes. Cytokine analysis revealed only mild, transient fluctuations in TNF-α, IL-1β, IL-6, and IL-10, with no evidence of sustained systemic inflammatory activation. The observed cytokine profile warrants further investigation to determine whether the phage cocktail exerts anti-inflammatory effects. Phage-induced immune responses may be route-dependent and complex. These findings enhance our understanding of host–phage interactions and underscore the need for further pharmacokinetic and immunological studies to assess their relevance to phage therapy. Stronger humoral immune responses to phage cocktails were observed following intraperitoneal and intramuscular than intravenous and subcutaneous administration. The increase in neutralising antibodies by 2 weeks, followed by a decline despite ongoing dosing, suggests this may not hinder phage effectiveness. The innate immune response, or acute inflammatory responses, seems to have a subtle impact on the outcome of phage therapy. The phage cocktail probably exhibits anti-inflammatory effects.

IntroductionObesity is a multifactorial metabolic disorder increasingly associated with alterations in gut microbial composition and endocrine imbalance. In the present study, microbiological analyses were limited to culture-based characterization of facultative anaerobic Enterobacteriaceae. Members of the Enterobacteriaceae family, particularly Klebsiella pneumoniae (Kpn), have been implicated in metabolic endotoxemia and inflammation; however, integrated data combining microbial profiling, metabolic hormones, and dietary patterns in Indian populations remain limited.MethodsThis case-control observational study involved 49 males (27 obese, 22 normal-weight controls). Anthropometric data were collected, and fasting serum leptin, ghrelin, and insulin were measured via ELISA. Stool samples were cultured for Enterobacteriaceae, identified biochemically, and genotyped using ERIC-PCR. Dietary patterns were evaluated with questionnaires.ResultsObese participants showed significantly higher BMI, leptin (5.43±0.67 ng/mL), and insulin levels (3.21±0.27 mIU/L) than controls (p<0.05), while ghrelin levels did not differ significantly. Leptin positively correlated with BMI in obese individuals (r=0.423, p=0.028). Microbiological analysis yielded 82 isolates, with Kpn more prevalent among obese (92.86%) than controls (7.14%), whereas Escherichia coli predominated among controls (51.22%). ERIC-PCR demonstrated distinct genetic clusters among isolates. Obese participants also reported higher intake of fast food, refined carbohydrates, and soft drinks, correlating with elevated insulin levels.ConclusionThese findings suggest possible associations between Enterobacteriaceae prevalence, metabolic hormones, and dietary patterns in obesity and support microbiota-targeted and dietary interventions.

Background Prosthetic joint infections (PJIs) caused by multidrug-resistant (MDR) bacteria and biofilm formation are often refractory to standard surgical and antibiotic care. Personalized bacteriophage therapy has emerged as a targeted alternative for such cases. Methods We present a descriptive case series of three patients with chronic MDR PJIs after total knee replacement (TKR) who were treated with locally applied high-titer lytic bacteriophage preparations. Clinical isolates were identified and characterized; environmental phages were isolated, purified, titrated, and tested for host specificity before local therapy. Outcomes were assessed clinically and microbiologically during follow-up. Results All three patients (MDR Staphylococcus aureus, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa) achieved complete wound healing and resolution of infection while retaining their prostheses. Healing times were 56, 60, and 45 days, respectively; no recurrences were observed during the reported follow-up period. Phage titers ranged from 106 to 109 PFU/mL; therapy was well tolerated, with no reported adverse events. Conclusion In this series, personalized, locally applied bacteriophage therapy was as safe and effective as a prosthesis-preserving rescue strategy for refractory MDR PJIs. These findings support further clinical evaluation and protocol standardization for the use of phages in the treatment of complex orthopedic infections.

INTRODUCTION:Bacteriophages are increasingly recognized as vital modulators of the human microbiome and promising candidates for alternative antimicrobial therapies. Critics raise concerns about immune neutralization with prolonged use. This study examines the presence of bacteriophages in human body fluids and assesses their interaction with autologous and heterologous serum to evaluate immune neutralization of human phage isolates. METHODS:Inactivation and neutralization experiments were conducted by exposing samples to neat serum and complement-inactivated serum for 1 h to assess their ability to inactivate human-origin phages. RESULTS:This finding suggests that autologous bacteriophages from human subjects are recognized as self. These phages were not inactivated by either the complement system or neutralized by either homologous or heterologous antibodies. CONCLUSION:This finding indicates that endogenous phages may reduce worries that antibody or complement activation could inactivate them. It provides evidence that these phages might bypass antibody- or complement-induced neutralization, thereby strengthening their case for therapeutic use.

Multidrug-resistant Acinetobacter baumannii is a World Health Organization priority pathogen associated with hospital associated outbreaks. Its occurrence in vegetables and fruits is limited, with only a few reports till now but raising concerns regarding unnoticed community and hospital transmission. Grapes and environmental samples were screened for A. baumannii and cultured on selective media, bacteria were identified using species-specific PCR, VITEK, and biochemical testing. CLSI 2024 guidelines were used for antimicrobial susceptibility. Bacteriophages were isolated from Ganga, sewage, soil by enrichment, purification and plaque assay was done. Stability was measured throughout pH 3-10 and -80 °C to 60 °C, and transmission electron microscopy was used to analyse the morphology. A. baumannii isolates from different sources as soil and grapes showed resistance to multiple antibiotics. Five bacteriophages were isolated, ΦABGR01 and ΦABGR03, showed strong in vitro lytic activity against A. baumannii. These phages were stable and active across a wide pH (3-10) and temperature (-80 °C to 60 °C). Transmission electron microscopy revealed a podovirus morphotype with an icosahedral capsid and a short, non-contractile tail. This is the first report of MDR A. baumannii isolated from retail grapes in India, indicating a potential foodborne reservoir for this critical pathogen. Strong in vitro stability and activity were shown by environmental lytic phages, highlighting their potential as alternative treatments. These results underline the necessity of more thorough food safety monitoring as well as upcoming research that includes both in vivo and genomic validation.

We report the draft genome sequence of Staphylococcus aureus strain BHUSA01, isolated from a patient's wound (pus) at IMS, BHU, Varanasi. The genome is approximately 2.78 Mb in size, has GC content of 32.66%, and coverage of 98.67%, and contains antibiotic resistance, virulence, biofilm-related, and cadmium/zinc resistance genes.

Background and aims:Pressure ulcers (PUs) are common in physical trauma patients who require prolonged stays in the intensive care unit (ICU). Despite standard preventive and therapeutic measures, healing is often a slow process. Conventional systemic antibiotics offer limited therapeutic benefits due to inadequate tissue penetration and the associated risk of driving antimicrobial resistance. Bacteriophage therapy, with its ability to target resistant and biofilm-associated bacteria, offers a potential "alternative." We aimed to evaluate the efficacy and safety of topical bacteriophage therapy for the management of PUs in critically ill ICU patients and its comparison to conventional therapy. Patients and methods:This prospective, randomized, double-blind controlled trial was conducted in the ICU of a tertiary care center between April 2024 and May 2025. Seventy-six adult patients with grade II-IV PUs were screened, and 68 were enrolled (34 in each group). Group C received conventional therapy, while group B received conventional plus customized topical bacteriophage therapy. Healing was assessed using the Pressure Ulcer Scale for Healing (PUSH) tool; tissue type, exudate amount, and ulcer dimensions were assessed at baseline and on days 5, 7, 14, 21, and 28. The primary objective was to evaluate the efficacy of bacteriophage therapy for the management of PUs. The secondary objective was to observe the safety profile of bacteriophage therapy. Results:Both groups demonstrated healing over time, but group B demonstrated significantly greater improvement as compared to group C. The reduction in the mean PUSH score was higher in group B (p < 0.05). Group B also showed faster epithelialization, an earlier decrease in exudate, and more closed ulcers. These differences became statistically significant from day 7 onward. No adverse events were reported. Conclusion:Topical bacteriophage therapy is a safe and effective adjunct to conventional care in the management of PUs among ICU patients. How to cite this article:Meena K, Meena RK, Kumari S, Thambidurai P, Nath G. Evaluation of the Potential Efficacy of Bacteriophage Therapy for the Management of Pressure Ulcers and Its Comparison to Conventional Therapy: A Randomized Controlled Trial. Indian J Crit Care Med 2026;30(3):196-203.

Typhoid fever, a systemic disease caused by Salmonella enterica serovar Typhi (S. Typhi), remains a major global health problem, particularly in regions with poor sanitation. Despite advancements in diagnostics and treatment, S. Typhi continues to impose a heavy disease burden, worsened by the emergence of multidrug-resistant (MDR) strains. Chronic carriers, accounting for 2–5