Genomic and RT-qPCR analysis of trimethoprim-sulfamethoxazole and meropenem resistance in Burkholderia pseudomallei clinical isolates

Background Melioidosis is an endemic disease in southeast Asia and northern Australia caused by the saprophytic bacteria Burkholderia pseudomallei, with a high mortality rate. The clinical presentation is multifaceted, with symptoms ranging from acute septicemia to multiple chronic abscesses. Here, we report a chronic case of melioidosis in a patient who lived in Malaysia in the 70s and was suspected of contracting tuberculosis. Approximately 40 years later, in 2014, he was diagnosed with pauci-symptomatic melioidosis during a routine examination. Four strains were isolated from a single sample. They showed divergent morphotypes and divergent antibiotic susceptibility, with some strains showing resistance to trimethoprim-sulfamethoxazole and fluoroquinolones. In 2016, clinical samples were still positive for B. pseudomallei, and only one type of strain, showing atypical resistance to meropenem, was isolated. Principal findings We performed whole genome sequencing and RT-qPCR analysis on the strains isolated during this study to gain further insights into their differences. We thus identified two types of resistance mechanisms in these clinical strains. The first one was an adaptive and transient mechanism that disappeared during the course of laboratory sub-cultures; the second was a mutation in the efflux pump regulator amrR, associated with the overexpression of the related transporter. Conclusion The development of such mechanisms may have a clinical impact on antibiotic treatment. Indeed, their transient nature could lead to an undiagnosed resistance. Efflux overexpression due to mutation leads to an important multiple resistance, reducing the effectiveness of antibiotics during treatment.

Gallbladder-duodenal fistula detected by ultrasound – a case report

Gallbladder-duodenal (cholecystoduodenal) fistula is an uncommon bilioenteric fistula between the gallbladder and the duodenum. It usually occurs following a chronic case of cholecystitis upon which the gallbladder adheres to the adjacent duodenum, and a stone penetrates through the wall. The case presented herein is that of a gallbladder-duodenal fistula detected primarily with the use of ultrasound imaging, and subsequently confirmed by computed tomography. The patient is a 54-year-old woman who was admitted with upper abdominal pain. The fistula was caused by chronic cholecystitis, however no gallstones were present in the duodenum. Surgical management was undertaken for the patient, and the recovery was uneventful.

AN AYURVEDIC APPROACH FOR THE MANAGEMENT OF IDIOPATHIC ERYTH-ROCYTOSIS - A CASE REPORT

An erythrocytosis occurs when there is an increased red-cell mass. The causes of erythrocytosis are divided into primary, when there is an intrinsic defect in the erythroid cell, and secondary, when the cause is ex-trinsic to the erythroid cell. An idiopathic erythrocytosis occurs when the increased red-cell mass has no identifiable cause. Primary and secondary defects can be further classified as either congenital or acquired causes. According to Ayurveda classics IE can be correlated as Rakta Pradoshaja Vikara due to Kapha Dushti leading to increased Picchilatwa (hyper viscosity) in Rakta. The present case study deals with chronic case of IE to stop the persistent increase of red blood cells mass & viscosity of blood. In this case, an effort was made to treat 38 years old male patient presenting with headache, pain in heel, weakness, in-creased RBC mass, increased Hemoglobin % with hyper viscosity in blood, was advised a regular medical-ly prescription of phlebotomy every 8th week since 3yrs.This patients was treated with Shuddh Tamra Bhasma, Panchakola Choorna, Dashamoola Madhudak, Tab. Liv-52DS orally in BD Dose with Ushna Jala as Anupana. for a duration of 3months. During the treatment it was observed that patient showed much improvement in his symptoms, reports yielded Hb% & HCT (measure of hyper viscosity) maintained under normal limits.

Chronic Functional Tremor: Positive Signs in the Management, Including Mirror Therapy

Functional tremor (FT) is a common functional neurological symptom disorder (FNSD) and difficult to treat. Diagnosis is often delayed in FNSD, which reinforces maladaptation and chronicity. The presented case, who had suffered from FT for 2 years, demonstrates the value of positive neurological symptoms in the diagnosis and treatment of FNSD, even in a chronic case. The patient improved well during integrated inpatient rehabilitation, which included mirror therapy (MT). He had complete suppressibility of the tremor during distraction, which was shown to him, and reversibility of the FT was emphasized. Due do the suppressibility when focusing on the contralateral arm, we installed MT as part of a combined inpatient neurological-psychotherapeutic rehabilitation treatment lasting 8 weeks. During treatment, some strong emotional themes came up. At the end of rehabilitation, the tremor almost completely subsided. Possible pathomechanisms are discussed. Future studies are recommended for determining the effectiveness of MT in FNSD with one-sided symptoms.

Genome Sequence of a Staphylococcus aureus Strain Isolated from a Dairy Cow That Was Nonresponsive to Antibiotic Treatment

Staphylococcus aureus can cause mastitis in dairy cattle. We report the genome sequence of a Staphylococcus aureus strain isolated from a dairy cow with a chronic case of mastitis. The infection with this strain of Staphylococcus aureus was not cleared from the animal with antibiotic treatment.

Treatment of Locking of the Metacarpophalangeal Joint of the Thumb

Locking of the thumb metacarpophalangeal joint is a relatively rare condition. We report successful treatment in 11 cases of locking of the thumb. Ten patients were diagnosed at an average of 3.2 days (range: 0–21 days) from the injury onset, whereas one patient was diagnosed at 4 months from the injury. Seven of 11 cases underwent successful manual reduction, whereas the other four cases required surgical treatment. Among the surgically treated cases, all cases had a sharp prominent of the radial condyle of the metacarpal head. Therefore, this case series showed 1 chronic case and 4 of 10 cases with a nonround shape of metacarpal heads requiring open reduction.

A chronic case of Madurella mycetoma involving left foot

Mycetoma is a localized chronic, suppurative, and deforming granulomatous disorder of subcutaneous tissue, skin and bones. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is completely different, a definite diagnosis after microbiological and histopathological examination, though difficult, is important. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Authors report a case of eumycetoma in a 38 year-old male from Bihar, with history of thorn prick 30 yrs back. Madurella mycetomatis was isolated from the granular discharge from sinuses and itraconazole was given followed by surgical debridement of the lesion. The patient recovered well and is still on follow up.