Background. Infective endocarditis (IE) is an uncommon but life-threatening infection. It is commonly associated with diseased or damaged valves. Patients with congenital heart disease are more prone to getting IE than the general population. The typical organisms that cause IE include Staphylococcus , Coagulase-negative Staphylococcus, Streptococcus viridians and Enterococci. However, the importance of rare micro-organisms like Kocuria kristinae should not be underestimated especially when isolated from multiple blood cultures in patients suspected of IE. Case presentation. We report a rare case of right-sided infective endocarditis due to K. kristinae in a young non-diabetic, non-addict female of low socioeconomic class who presented with undiagnosed fever for 1 year. She was investigated and treated for fever by several general practitioners without relief. Later on, she was diagnosed by a local cardiologist to have perimembranous ventricular septal defect with a small pulmonary valve vegetation. She was referred to a tertiary care cardiac hospital in Rawalpindi, Pakistan for further management. Transthoracic and transesophageal echocardiography confirmed IE secondary to preexisting congenital heart disease complicated with a small pulmonary vegetation. Her blood cultures yielded growth of K. kristanae, a rare micro-organism to cause IE. The patient responded to the antibiotic therapy. Conclusion. Clinicians should have a high index of suspicion for K. kristanae IE as a possible cause of a prolonged fever especially in the presence of congenital heart disease. Antibiotic susceptibility is required for adequate therapy.

Background. Francisella tularensis is a rare zoonotic bacterium that spreads sporadically by various routes, including infected arthropod bites, ingestion of contaminated water and inhalation of contaminated dust. However, its occurrence in postoperative chest infection has never been reported. Pathogen isolation, serology and molecular detection methods are commonly used for the diagnosis of tularaemia. Case presentation. We present the first case report of the isolation of F. tularensis from a patient with a chest infection (a boy in his teens) following cardiac surgery for closure of a ventral septal defect. It was isolated on blood and chocolate agar on the third day after the subculture of drain fluid collected in a blood culture bottle incubated in Bact T/Alert 3-D (bioMerieux, France). The organism was identified as F. tularensis by Vitek GN ID Cards (Vitek 2 Compact, bioMerieux, France). The patient made a smooth recovery with antibiotic therapy. Conclusion. F. tularensis can cause post-operative infection, especially in patients with a rural background.

Shewanella is Gram-negative motile bacillus, non fermentative and facultative anaerobe. Its natural habitat is all forms of water and soil, but has also been isolated from fish, dairy products, oils, and carcasses. Often found with microflora of the marine environment. Bacterial infections with Shewanella spp. are rare. The exposure to the marine environment, sea and diary food are considered as a risk factor for Shewanella spp. infection. Clinical infections seen are otitis, soft tissue infection, bacteremia, ear infection, eye infection, infective arthritis, osteomyelitis, infective endocarditis and peritonitis.

Background Staphylococcus aureus (S. aureus) is a virulent pathogen that is currently the most common cause of infections in hospitalized patients. Health care workers (HCWs) play a significant role in the epidemiology of Methicillin Resistant S. aureus (MRSA) infection. HCWs act as a vector for transmission of MRSA as they work at the interface between hospital and the community. Transmission of MRSA in health care environment is usually by contact between patients through hands, cloths or equipment of HCWs. Objectives To determine the percentage of HCW’s having MRSA carriage at a tertiary care hospital in Rawalpindi Pakistan. Materials and methods Nasal swabs from anterior nares of HCWs were cultured on Blood agar and Macconkey Agar and Mannitol Salt Agar (MSA) and incubated at 35°C for 24-48 hours. S. aureus growth was confirmed by colony morphology, gram staining and biochemical tests. MRSA were identified by observing zone of inhibition around Cefoxitin disc on Mueller Hinton Agar (MHA) according to CLSI guidelines. Results The frequency of nasal carriage of MRSA was 6.5%. High nasal carriage was seen in ITC among the nursing staff. Conclusion High frequency of MRSA nasal carriage in ITC staff reflects poor hand hygiene and urgent need for infection control measures.

A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic valve endocarditis. A 40-year old female presented with low threshold exertional dyspnea and fever. Transthoracic and transesophageal echocardiography showed ruptured sinus of Valsalva aneurysm in right ventricle with multiple vegetation at the aortic root. Initial blood cultures were negative and an empirical antibiotic therapy was started. Patient was operated for surgical repair of sinus of Valsalva aneurysm. An aortic root abscess with rupture of sinus of Valsalva was found at operation. However, postoperatively she developed sepsis and multiorgan failure leading to her death. J Microbiol Infect Dis 2018; 8(2):69-72