Mucormycosis is an emerging opportunistic fungal infection. Increasing immunocompromization, widespread use of antibacterial and antifungal agents (such as voriconazole prophylaxis), carcinomas, transplantation and lifestyle diseases such as diabetes are the main contributors to this situation. The predominant clinical manifestations of mucormycosis vary from host to host, with rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal infections being the most common. In India, the prevalence of mucormycosis is approximately 0.14 cases/1000 population, which is about 70 times the worldwide-estimated rate for mucormycosis. The present study was undertaken over a period of five years (January 2009–December 2014) to determine the prevalence of mucormycosis. The samples suspected of mucormycosis were examined by direct KOH wet mount and cultured on Sabouraud’s dextrose agar without actidione and on blood agar as per standard mycological techniques. Histopathological correlation was done for most of the cases. Antifungal susceptibility testing was performed by the EUCAST reference method. We identified a total of 82 cases of mucormycosis out of a total of 6365 samples received for mycological culture and examination during the said time period. Out of these, 56 were male patients and 27 were females. Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections. The fungi isolated were Rhizopus arrhizus (17), Apophysomyces variabilis (12), R. microsporus (9), Lichtheimia ramosa (8), Saksenaea erythrospora (5), Syncephalastrum racemosus (4), R. homothallicus (2), Rhizomucor pusillus (1), Mucor irregularis (1) and A. elegans (1). The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. Most of the patients (50) recovered, but 25 died. The rest of the patients left against medical advice. “Nip in the Bud” should be the mantra for clinicians/surgeons for a favorable prognosis. Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management.

Introduction: Stethoscope is used to assess the health of patients but can also act as a potential source of disease transmission. The study was aimed to find out the contamination rate of stethoscopes, evaluate awareness and attitude of healthcare workers (HCWs) about stethoscope cleaning, and determine the efficacy of 70% alcohol as cleaning agent. Methodology: This hospital based cross-sectional study was conducted in a tertiary care hospital in October 2015 among healthcare workers. They were asked to fill a questionnaire followed by culturing the diaphragm and bell surfaces of their stethoscopes before and after cleaning with 70% isopropyl alcohol. Results: Out of 100 stethoscopes cultured, 56 were found to be contaminated at least with one microorganism. Acinetobacter cbc was the commonest contaminant followed by Klebsiella pneumoniae. Three out of twelve S. aureus strains showed methicillin resistance. Stethoscopes used in emergency areas were more contaminated when compared to wards and out-patient departments. Despite 100% awareness among HCWs, the importance of stethoscope cleaning is realized by only 70% who practice it regularly. Conclusion: Stethoscope is a potential vector for transmission of healthcare associated infections. Hence it is vital to clean it after each use to reduce the load of iatrogenic infections.

Introduction: Dengue, chikungunya and Japanese encephalitis are the most common arthropod-borne viral diseases in India. Due to overlapping clinical symptoms, accurate, high-quality and timely laboratory-based differential diagnosis is essential for control and containment of outbreaks. This is most commonly done by detection of IgM antibodies in serum using enzyme-linked immunosorbent assays. The Resource Centre for Virus Research and Diagnostic Laboratories (VRDLs) in Pune, India organized an external quality assurance (EQA) study to check the accuracy of serological diagnostics in the VRDL network.Methods: Three panels, one each for anti-dengue virus, anti-chikungunya virus and anti-Japanese encephalitis virus IgM antibodies, comprising six human serum samples (two positive and four negative) were distributed to test the sensitivity, specificity and reproducibility of serological testing in 124 VRDLs across India in 2018-19 and 2019-20.Results: Among the 124 VRDLs, the average concordance for both 2018-19 and 2019-20 was 98%. In 2018-19, 78.33%, 13.33% and 6.66% of VRDLs reported 100% concordance, 91-99% concordance and 81-90% concordance with the reference results, respectively, and 1.66% of VRDLs had concordance < 80%. In 2019-20, 79.68%, 14.06% and 4.68% of VRDLs reported 100% concordance, 91-99% concordance and 81-90% concordance with the reference results, respectively, and 1.56% of VRDLs had concordance < 80%.Conclusion: The EQA programme was beneficial for assessing and understanding the performance of the VRDLs. The study data indicate good proficiency in serological diagnosis of dengue, chikungunya and Japanese encephalitis in the VRDL network laboratories. Further expansion of the EQA programme to cover other viruses of public health importance will increase confidence among the VRDL network, and generate evidence of high-quality testing.

Enteric fever caused by Salmonella Typhi is a global public health problem. With adequate treatment, most patients recover from the acute phase; however, 2–4% develop a chronic carrier state acting as reservoir of infection by continued shedding of bacteria in faeces and urine. Recovery of S. Typhi from urine is rare, even in endemic areas. The three main causes of bacteriuria arise following a recent episode of typhoid fever, in chronic carrier states involving the urinary system and occasionally following localised urinary tract infection (UTI) due to S. Typhi. Symptomatic Salmonella UTI is mostly encountered in an immunocompromised patient with some underlying structural abnormality involving the urinary tract. We report a case of symptomatic UTI caused by Salmonella Typhi in a 50-year-old immunocompetent woman in a chronic carrier state without any known urological abnormality.