There are reports that the neglected zoonotic tropical disease brucellosis is reemerging today. Serological tests are being widely used in the diagnosis of brucellosis. In the present study, we performed a standard agglutination test (SAT) on 1348 suspected cases of brucellosis during the period of four years from April 2018 to March 2022. We noticed an increase in seropositivity from 2.6% in the year 2018-19 to 7.4% in the year 2021-22. We also noticed a spike in seropositivity in the years 2019-20 (12.5%). Our study shows the recent trend in seropositivity of the disease in Chandigarh and, hence, can be a meaningful addition to the existing serological diagnostic data related to brucellosis.

Background & Aims: A lot is being heard regarding monkeypox, which is currently an emerging disease. The sole purpose of this publication is to enlighten the world regarding epidemiology in the context of recent outbreaks, etiopathogenesis, clinical features, diagnosis, and management, depicting an overview of this underreported disease so that the concerned microbiologists and clinicians can diagnose and manage the disease as soon as possible. Materials & Methods: In this review study, we searched Google Scholar, PubMed, and Scopus databases to keywords regarding the main objective of the study, and collected the most recent and novel studies less than 10 years about the objectives of the study. Results: Recent outbreaks, etiopathogenesis, clinical features, diagnosis, and management, depicting Monkeypox were collected and categorized to highlight the importance of the disease in recent communities. Conclusion: Although and underreported disease, Monkeypox is a disease with important effects in today's societies, and it is needed that health officials be aware of its importance and have programs to control it. With improved knowledge, monitoring of the exposed cases, and better infrastructure, we can successfully contain this emerging and potentially re-emerging viral disease.

Background:Lower respiratory tract infections (LRTIs) are associated with significant morbidity and mortality in all age groups, especially young children and the elderly population. Various gram-positive and gram-negative organisms such as Streptococcus spp., Pseudomonas spp., and Klebsiella spp. have been implicated as a pathogen in bronchoalveolar lavage (BAL) specimens collected from such patients. Aims and Rationale of the Study:The present study is aimed at assessing the spectrum of the bacterial isolates and determining the antimicrobial resistance obtained from the BAL fluid from admitted patients at various wards and intensive care units (ICUs) of a tertiary care hospital in Dehradun. This will be the stepping stone in our efforts toward becoming a future antimicrobial steward and framing local antibiograms based on such data. Material and Methods:Two hundred BAL specimens were collected from patients admitted to various wards and ICUs of the hospital who were suffering from LRTI. The BAL specimens were subjected to direct microscopy and culture. Identification and susceptibility testing were performed. Results:The most predominant isolates were Pseudomonas aeruginosa (16/39 (41.02%)) followed by Klebsiella pneumoniae (7/39 (17.94%)) and Acinetobacter spp. (6/39 (15.38%)). Sixty-five percentage of Pseudomonas aeruginosa, 71% of Klebsiella pneumoniae, and 83% of Acinetobacter spp. showed intermediate results with colistin. Conclusion:Nonfermenters constitute a significant group of organisms isolated from bronchoalveolar lavage (BAL) specimens in patients with lower respiratory tract infections (LRTIs). Hence, it is extremely important to correctly identify and determine the resistance pattern of such isolates so that appropriate empirical therapy can be initiated for the benefit of the patient.

INTRODUCTION:Correct and prompt antimicrobial prescription modifications by the treating team based on the culture and antimicrobial susceptibility test (AST) reports are crucial. Pathogen-directed antimicrobial stewardship (PD-AMS) audit rounds are a clinical microbiology-driven approach to combine prompt appropriate patient management goals with goals of preventing irrational and improper use of antimicrobials. METHODS:The study was a prospective before-after interventional study to evaluate the effectiveness of PD-AMS audit rounds in modifying antimicrobial usage by prescribers on an individual patient basis. It is divided into a two-month pre-intervention phase (no active advice is given with passive monitoring) and an intervention phase for four months, with antimicrobial therapy-related advice during PD-AMS rounds taken as "Intervention." Antimicrobial advice was objectively classified into various categories. The PD-AMS audit round was conducted for all inpatients with a culture-proven bloodstream infection with a pathogen, and objectively classified antimicrobial advice was given through bedside rounds, telephonically, and/or written advice forms. Compliance with the advice was monitored on the next day (or at the end of 24 hours) of the PD-AMS round. RESULTS:The compliance with culture AST report regarding antimicrobial prescription modifications improved significantly in the intervention phase compared to the pre-intervention phase as follows: overall (83.8% (612/730) vs. 56.7% (242/427)); medicine alliance (87.4% (263/301) vs. 57.8% (115/199)); surgery alliance (87.2% (170/195) vs. 54.0% (87/161)); pediatric alliance (87.3% (138/158) vs. 66.7% (26/39)); oncology alliance (53.9% (41/76) vs. 28.6% (8/28)); critical care locations (82.0% (260/317) vs. 62.7% (89/142)); and in-patient departments (85.2% (352/413) vs. 53.7% (153/285)). CONCLUSION:The clinical microbiology team should mandatorily conduct an objectively planned PD-AMS audit round to improve patient care and management and antimicrobial prescriptions through a mutual discussion with prescribers and to help address their doubts.

Osteomyelitis, an infection related to bone and bone marrow, is very diverse in its pathophysiology and clinical presentation; hence, it is considered one of the most difficult-to-treat infections. The present study is aimed at assessing the microbiological profile of osteomyelitis and related antimicrobial susceptibility patterns in patients attending a tertiary care center in Uttarakhand, India, over a period of one year (January to December 2019). In aerobic culture, 58/105 (55.2%) bacterial isolates were detected. In addition, Staphylococcus aureus was the most common isolate, and amongst Gram-negative bacilli, most isolates that grew on culture were Escherichia coli (22.4%). Out of 21 S. aureus isolates, methicillin resistance was detected in nine [9/21 (42%)] cases, which is a matter of concern. Hence, proper training and application of antimicrobial stewardship are the need of the hour so that clinicians can initiate targeted therapy as early as possible.

Scrub typhus, which is prevalent in the Asia Pacific region is most feared owing to its life-threatening neurological complications. We present four cases of scrub typhus with acute encephalitis, including one with multiorgan failure and another serologically proven co-infection with Hepatitis C. Treatment of scrub typhus is not, however, so difficult, so its early diagnosis is paramount.

Intra-abdominal infections are often implicated in the causation of liver abscesses, and the transmission occurs via the vascular route. We report a rare case of abscess of the liver, Stenotrophomonas maltophilia being the etiological agent, in a 25-year-old female residing in Lucknow, India. S. maltophilia is a common nosocomial pathogen responsible for causing pneumonia, bacteremia, meningitis, endocarditis, gastrointestinal, ocular, skin, soft tissue, bone, joint, urinary tract infections, and even septic shock, especially in intensive care units. However, very few case reports are from India and globally, highlighting it as a pathogen in a liver abscess case. Hence this study is relevant in the context of providing case details that can help clinicians and microbiologists to suspect and diagnose more such cases that might be missing in history.

The diagnosis of Scrub Typhus is now improving with the availability of an array of serological tests at the majority of diagnostic centres and of molecular tests at advanced laboratories. Our study focuses on evaluating the spectrum of Scrub Typhus and its coinfection with Leptospirosis in patients presenting with acute febrile illness. A total of 1743 blood samples were collected from both In and Out Patient Department (OPD) patients and analyzed for anti Orientia tsutsugamushi and anti-Leptospira IgM antibodies. Our study showed the presence of Scrub Typhus IgM antibodies in 20.7% of all the cases of acute febrile illness. We also found an interesting correlation of Scrub Typhus with Leptospirosis owing to the presence of co-infection in 8.4% of Scrub Typhus cases paving a way for future research in this regard.

Present study retrospectively analysed the serological data of patients suspected of cystic echinococcosis (CE) attending the outpatient clinics or admitted in our hospital. An enzyme-linked immunoassay was used to analyse anti-CE antibodies in serum samples of 3680 patients. Microscopy of aspirated cystic fluid was performed on 170 cases only. CE seropositive cases were 595 (16.2%), of which 293 (49.2%) were males and 302 (50.8%) were females. A higher percentage of seropositivity was found in adults within age range of 21-40 years of age. There has been a decrease in seropositivity in the study years (2016-2021) in comparison to previous years (1999-2015).

According to World Health Organization (WHO), in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a variant of concern (VOC) is defined as a variant with any of the associated changes which include: increase in transmissibility/detrimental change in coronavirus disease 2019 (COVID-19) epidemiology; or increase in virulence/change in clinical disease presentation; or decrease in the effectiveness of public health and social measures/available diagnostics, vaccines, therapeutics.[1] The currently designated variants of concern of SARS-CoV-2 as documented by WHO are Alpha, Beta, Gamma, Delta, and the most recent Omicron.[12] Alpha variant (B.1.1.7 Pango lineage) was first reported in the United Kingdom in September 2020. Beta variant (B.1.351 Pango lineage) was first documented in South Africa in May 2020. Gamma variant (P. 1 Pango lineage) was earliest documented in Brazil during November 2020. Delta variant (B.1.617.2 Pango lineage) was first detected in India in October 2020. The most recent Omicron variant (B.1.1.529 Pango lineage) was first reported from South Africa on November 24, 2021. Apart from VOC, there is another terminology in the context of SARS-CoV-2 that is, a variant of interest (VOI). It is defined by WHO as a variant with genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; and identified to cause significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence alongside the increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health. The currently designated VOIs are Lambda (C.37 Pango lineage)) first reported from Peru in December 2020 and Mu variant (B.1.621 Pango lineage), first documented in Colombia during January 2021.[1] To date, 3,47,26,049 COVID-19 cases have been recorded in India. There are 20 cases of infection with the Omicron variant of SARS-CoV-2 in Delhi only. As of December 17, 2021, 91 countries from all over the world have reported the Omicron variant.[3] It is found in various recent reports that people are contracting the infection due to the Omicron variant even after taking full doses of vaccines.[4] Amongst the various types of vaccines available in the market, which one is effective, is still doubtful and needs to be further studied before reaching any conclusion in this regard. Cases due to the Omicron variant are increasing day by day and there is a dire need to address this problem before the situation goes out of hand. Health authorities need to be more vigilant in checking whether people are following all the preventive measures to halt the progression towards the third wave of the pandemic in India. These measures include social distancing, following cough etiquettes, wearing masks, hand washing, avoiding non-essential travel, and mass gatherings. Lowering the guard can bring back the pandemic situation, hence utmost precaution needs to be taken in this regard by combined efforts of health authorities and the general population. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

For more than two decades, antifungal susceptibility testing and interpretation haunted the medical professionals in diagnostics and management. This article mainly focuses on the three most widely used methods: broth microdilution, E test, and disc diffusion. It also focuses on the fact that clinicians should switch from empirical treatment to susceptible drugs as early as possible to combat antifungal resistance and newer mutations that horrify us every single day with poor patient outcomes. Many factors need to be taken into account during the interpretation of results but the positive side of the story is that they have been well documented in the literature. Though many methods have come up in testing antifungal susceptibility, still there is a scope for a rapid yet accurate testing modality to flourish and take the lead.

The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.

Background and Purpose: Rhinosinusitis (RS) is a clinical and radiological diagnosis that rarely reaches a proper infective etiological diagnosis. The most dreaded fact about invasive fungal rhinosinusitis is its poor prognosis in immunocompromised patients with a 60-80% mortality rate. The present study highlights and compares the various diagnostic techniques to establish a fungal etiological diagnosis in clinically suspected cases of RS from nasal biopsy specimens, with the emphasis on the molecular diagnostic approach. Materials and Methods: This prospective study included a total of 34 clinically suspected cases of RS who had recently undergone functional endoscopic sinus surgery (FESS)/biopsy from nasal polyps. Various laboratory methods (microbiological and histopathological) were utilized, including direct microscopic examination of clinical samples and fungal culture isolation. The molecular detection method of polymerase chain reaction (PCR) from clinical samples was also explored simultaneously. Serum immunoglobulin-E (IgE) testing of patients was also performed. Results: Out of 34 clinically suspected RS cases, fungal etiology was established in a total of 18 cases, 17 of whom were culture-proven. A total of 15 and 14 culture-proven cases were also detected on direct microscopic examination by potassium hydroxide (KOH) mount and histopathological staining, respectively. One case was additionally identified by molecular method. Aspergillus flavus complex was the most common pathogen isolated in culture. Allergic fungal RS was the most common type, followed by acute and chronic invasive types among all fungal RS cases. Conclusion: Accurate and prompt etiological diagnosis of fungal RS is still lagging with fewer options for quick results. Although microscopy and culture isolation can’t be replaced, PCR is a sensitive and specific method that should be incorporated as a supplementary tool for the early diagnosis and management, considering the delayed growth of fungi.

Cyclospora spp. is an important cause of traveler's diarrhea or water and food-borne diarrhoeal diseases. We present an interesting but rare case report of cyclosporiasis in a 51-year-old male who had undergone renal allograft transplant six years ago. He also had a past history of tuberculosis, cytomegalovirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and hepatitis C infection and was being treated with immunosuppressants. The patient had a prolonged history of gastrointestinal manifestations with recent acute onset of watery diarrhea associated with abdominal cramps. Stool examination after modified Ziehl-Neelsen staining revealed oocysts of Cyclospora spp. The patient was successfully treated with cotrimoxazole.

Rhinosporidiosis is a granulomatous disease with a chronic course, the etiological agent being Rhinosporidium seeberi which usually causes the development of localized lesion in the mucosa of the nose, conjunctiva, and urethra. The disease is prevalent in South India and Sri Lanka although case reports are evident from many parts of the world like Europe, America, and Africa. In the present study, we are reporting a case of rhinosporidiosis elaborating its clinical features, diagnostic modalities, and treatment. Since R.seeberi is not a successfully cultivable organism, in vitro susceptibility of drugs remains a concern. The main focus of the present study is on molecular detection of R. seeberi which can be helpful in the future for early diagnosis and prompt treatment of such cases.