Background: Chronic osteomyelitis (COM) is a major medical problem in most countries, mainly associated with violent trauma, modern surgery and inadequate treatment of acute osteomyelitis. Although the incidence of osteomyelitis has reduced to a certain extent with the advent of antibiotics and chemotherapeutic agents, yet it continues to be a major problem in India. Methods & Materials: A retrospective analysis of data of purulent (Pus/pus swabs, tissue) specimen received from patients with chronic osteomyelitis by the microbiology department between January 2013-0ctober 2015 was carried out. The samples were processed using standard microbiological techniques. Identification and antimicrobial susceptibility pattern of the bacterial isolates were done using the Vitek 2 (bioMerieux, Marcy l’Etoile- France) system. Results: In all, 184 patients with chronic osteomyelitis were documented during the study period. There was a male preponderance (163 / 184, 88.5%) with majority, in the age group of 10-20 years. Trauma was the major risk factor for osteomyelitis (95/ 184, 51.6%). The lower limb bones were more commonly affected of which femur (166/184, 90.2%) was the predominant bone involved. Culture was positive in 104/184 (56.6%), with the Gram positive organisms most predominant. MRSA was the predominant organism isolated in 28/104 (27%) cases. Among Gram negative bacilli, Escherichia coli was most common organism isolated in 11/104 (10.4%). Other organisms isolated included Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumanii, Proteus mirabilis, Enterobacter cloacae, Morganella morgagnii and showed a high level of antibiotic resistance. In this study no anaerobic organisms were isolated. One patient had a mixed infection with Mycobacterium tuberculosis and A.baumannii. Majority of the patients (85/184, 46%) were managed conservatively with wound care and antibiotics. No mortality was recorded. Conclusion: Prognosis of chronic osteomyelitis depends on proper microbiological techniques that help in isolation, identification and treatment of the bone-infecting, often multidrug resistant organism. Complications can be further reduced with surgical debridement and removal of the dead tissues.

Background: Background: Infective endocarditis (IE) is a microbial infection of the endothelial surface of the cardiac valves. Despite advances it is associated with morbidity and mortality. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential for good patient outcome. Methods & Materials: Materials and methods: The medical records of 191 patients clinically diagnosed with infective endocarditis were reviewed for clinical and microbiology data admitted between January 2011 to Sep 2015. Blood cultures were detected by using BacT/Alert FAN and SN aerobic bottles.68/191 cases were positive for bacterial pathogens. The isolates were identified and sensitivity was tested using API and Vitek 2 systems Results: Results: The age range of the patients were17-54 years with a female preponderance. Chronic Rheumatic heart disease (CRHD) was the most common predisposing factor followed by valvular abnormalities, mostly mitral stenosis. 24/191 cases had Prosthetic valve endocarditis (PVE), 167/191 had Native valve endocarditis (NVE).19/24(79.1%) PVE cases and 49/167 (29.34%) NVE were culture positive. Culture negative endocarditis was 123/191(64.39%). Isolates for NVE belonged to the Streptococcus species and include Streptococcus mitis (15) Streptococcus sanguinis (8) Streptococcus pyogenes (3), Streptococcus pneumonia (1), Enterococcus faecalis (5), Enterococcus faecium (6), Nutritionally variant streptococci (2),Gemella morbillorum (2) Methicillin Resistant Staphylococcus aureus (1) Methicillin Sensitive Staphylococcus aureus (2),Brucella melitensis (2),and also includes Brevundimonas diminuta (1),Corynebacterium diphtheria (1). The isolates for PVE were Methicillin Resistant Staphylococcus aureus (4),Methicillin Sensitive Staphylococcus aureus (2) Methicillin Resistant coagulase negative Staphylococcus (7), Klebsiella pneumonia (3), Achromobacter denitrificans (1), Burkholderia.cepacia (2) The NVE were treated with a combination of a B-lactam or glycopeptide with an aminoglycoside intravenously for prolonged period of 4-6 weeks with a successful outcome The PVE cases were treated with the appropriate antibiotics as per the antibiotic susceptibility report. Conclusion: Conclusion: Despite recent advances, the management of IE remains a serious and challenging problem The high morbidity and mortality rates, accurate identification of aetiological agents and appropriate antimicrobial therapy are associated with IE. Strict infection control measures will help to reduce the incidence of PVE, which is most often due to hospital acquired pathogens

Chikungunya fever is an important arboviral infection prevalent throughout Africa and Southeast Asia. Recently, in 2006, it has reemerged in many parts of India, affecting more than a million persons. A detail serological, virological, and molecular investigation of this unprecedented outbreak was carried out by collecting and studying 540 samples from all the affected regions of India during this epidemic. An in-depth investigation revealed the presence of anti-Chikungunya antibodies in 68% of the samples and genomic RNA in 49% of them. In addition 32 Chikungunya viruses were isolated from 45 representative polymerase chain reaction-positive samples. The nucleotide sequences of partial E1 gene of 25 representative Chikungunya viruses were deciphered. The sequence analysis indicated that all the isolates of this epidemic belonged to the new Indian Ocean island clade of East Central South (ECS) African genotype. This study conclusively proved the genotype shift from Asian to ECS African as the major factor in the reemergence of Chikungunya in an unprecedented outbreak in India after a gap of 32 years.

ABSTRACT The standardization and validation of a one-step, single-tube, accelerated, quantitative reverse transcription (RT) loop-mediated isothermal amplification (RT-LAMP) assay targeting the E1 gene for the rapid and real-time detection of Chikungunya virus (CHIKV) are reported. A linear relationship between the amount of template and time of positivity value over a range of 2 × 10 8 to 2 × 10 2 copies was obtained. The feasibility of CHIKV RT-LAMP for clinical diagnosis was validated with patient serum samples from an ongoing epidemic in Southern India. Optimal assay conditions with zero background were established for the detection of low levels of CHIKV in acute-phase patient serum samples. The comparative evaluation of the RT-LAMP assay with acute-phase patient serum samples demonstrated exceptionally higher sensitivity by correctly identifying 21 additional positive borderline cases that were missed by conventional RT-PCR ( P < 0.0001) with a detection limit of 20 copies. The quantification of virus load in patient serum samples was also determined from the standard curve based on their time of positivity and was found to be in the range of 2 × 10 8 to 2 × 10 1 copies. In addition, the field applicability of the RT-LAMP assay was also demonstrated by standardizing SYBR Green I-based RT-LAMP wherein the amplification was carried out in a water bath at 63°C for 60 min, which was followed by monitoring gene amplification with the naked eye through color changes. These findings demonstrated that the RT-LAMP assay is a valuable tool for rapid, real-time detection as well as quantification of CHIKV in acute-phase serum samples without requiring any sophisticated equipment and has potential usefulness for clinical diagnosis and surveillance of CHIKV in developing countries.