Multiple subcutaneous cysts due to Exophiala spinifera in an immunocompetent patient

Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 μg/ml) and itraconazole (0.125 μg/ml) had the highest and caspofungin (4 μg/ml) and anidulafungin (2 μg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.     

Acute bioprosthetic mitral valve stenosis in a patient with HITS

Acute thrombosis involving the left atrium and a bioprosthetic valve during the early postoperative period is an extremely rare complication of heparin-induced thrombocytopenia syndrome (HITS). We present a patient with early bioprosthetic mitral valve stenosis complicated by HITS in a patient with severe mitral regurgitation, atrial fibrillation, and severe left ventricular dysfunction.     

Salmonella-salmonellosis-rare presentations of a common pathogen

Salmonella are most commonly associated with gastroenteritis and enteric fever in humans. Occasionally, dissemination of bacilli throughout the body results in establishment of localized foci of persistent infection especially in patients with debilitating diseases and immunosuppressive states. Infection at various aberrant sites due to Salmonella has been reported relatively seldom. It has perfected the art of intracellular survival in niches from where they can cause myriad of effects. Six cases with Salmonella infection at unusual sites without any preexisting or underlying disease diagnosed over a period of two years are presented here. Salmonella etiology was not suspected in these patients and the diagnosis was made microbiologically only after culture isolation.     

Surviving Ventricular Standstill for 111 Seconds during Holter Monitoring

Holter electrocardiogram recording revealed symptomatic prolonged ventricular standstill lasting for about two minutes which terminated without any external cardiopulmonary resuscitation. Ann Noninvasive Electrocardiol 2012;17(1):61–62     

Surgical correction of congenital heart disease at 76 years of age

The management of adult congenital heart disease is challenging and poses specific problems. We report a patient with ventricular septal defect and pulmonary stenosis who underwent successful repair and coronary artery bypass grafting at the age of 76 years.     

Metallo- β - lactamase producing nonfermentative gram-negative bacteria: an increasing clinical threat among hospitalized patients

ObjectiveTo detect and evaluate the various methods for metallo- β -lactamases (MBL) production in Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter species.MethodsA total of 109 P. aeruginosa and 85 Acinetobacter species were screened for imipenem resistance by Kirby-Bauer disc diffusion methods. Detection of MBL production was done by imipenem-EDTA combined disc test, double disc synerygy test (DDST) and imipenem-EDTA MBL E test.ResultsA total of 63 (57.8%) strains of P. aeruginosa and 46 (54.1%) strains of Acinetobacter spp. were found to be resistant to imipenem. Of the 63 imipenem resistant P. aeruginosa tested for MBL production, 44 (69.8%) were found to be positive and among 46 imipenem resistant Acinetobacter, 19 (41.3%) were shown to be the MBL producers.ConclusionsImipenem-EDTA combined disc test and MBL E test are equally effective for MBL detection in both P. aeruginosa and Acinetobacter spp., but given the cost-constraints, combined disc can be used as a convenient screening method in the clinical microbiology laboratory.