Concurrent Staphylococcus aureus bacteraemia in Plasmodium vivax malaria Infection: A report of two cases from western India

Malaria and concurrent bacteraemia cases have been reported globally, mostly in association with Plasmodium falciparum malaria. In comparison, concurrent bacteraemia with Plasmodium vivax infected patients is reported rarely. However, considering unavailability of blood culture testing and widespread community and empirical antibiotic usage in low- and middle-income countries (LMICs), the frequency of bacteraemia and P. vivax co-infection may be much higher. We reported two cases of Staphylococcus aureus bacteraemia with P. vivax malaria infection. Both patients presented with high grade fever and chills with unremarkable systemic examination. Liver enzymes were raised along with inflammatory markers. Simultaneous diagnosis of methicillin sensitive S. aureus bacteraemia was done using automated blood culture, automated identification and sensitivity testing system. P. vivax malaria was confirmed with microscopy, antigen detection test and molecular test. Patients recovered uneventfully with antimalarial drugs and antibiotics.

Identification and Antifungal Drug Susceptibility Pattern of Candida auris in India

Introduction

Candida auris has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of C. auris.

Methods

Isolates of C. auris were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method.

Results

Out of 50 isolates C. auris, 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% (n = 42) isolates were found to be resistant and 16% (n = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5-16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% (n = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% (n = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin.

Conclusion

Correct identification of C. auris can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of C. auris are on rise.

Nodular Subcutaneous Phaeohyphomycosis due to Medicopsis romeroi in an Immunocompetent Patient

Fungal infections like subcutaneous phaeohyphomycosis are uncommon but are increasing lately, especially in tropical regions like India. Identification of correct aetiologic agent is essential as different species can have different organ tropism. Here, a rare case of nodular subcutaneous phaeohyphomycosis in an immunocompetent 62-year-old male patient who developed nodule over right dorsum of foot is reported. After various diagnostic tests a rare dematiaceous fungus Medicopsis romeroi was identified as a causative agent in the nodular material by Internal Transcribed Spacer (ITS) sequencing. Surgical excision and antifungal therapy of itraconazole proved beneficial with no recurrence during a six months of follow-up. Medicopsis romeroi has been debated for its role in human infections however, it should be considered as one of the aetiologic agents of subcutaneous phaeohyphomycosis.