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Whipple's disease is a rare infectious disorder affecting mostly middle aged men. The causative organism, Tropheryma whipplei, recently has been cultivated and phylogenetically identified as an actinomycete. The rareness of the disease despite the ubiquitous occurence of T. whipplei presumably is related to a predisposing defect in cellular immunity. The diagnosis usually can be established by small bowel biopsy, but is frequently delayed due to protean clinical manifestations. The initiation of antibiotic treatment in most cases results in clinical remission, however, a significant number of patients is refractory to antimicrobial therapy or has a relapsing course.
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A prospective clinical and microbiological study was conducted in 145 blood culture positive cases of enteric fever below the age of 18 years over a period of eleven months (June 2004 to April 2005). It aimed to study the clinical profile, the relative magnitude of enteric fever in children, especially in those below the age of two years and to determine the current antibiotic sensitivity pattern of Salmonella typhi and S paratyphi. Enteric fever is a significant problem in the preschool years. Sixty-five per cent of cases were in the age group of 2 to 9 years, 27% in 0-5 years and 13% in age group 0-2 years. Ninety-two per cent of the cases were caused by S typhi. Paratyphoid fever is less common (8%), when occurs is caused by S paratyphi A. In-vitro sensitivity, using the Bauer-Kirby agar disc diffusion method, to ceftriaxone was 99%, cefixime-99%, cefotaxime-99%, cefpodoxime-72%, cefoperazone-93%, among quinolones, ciprofloxacin-95%, ofloxacin-83%, norfloxacin-79%. Sensitivity to the originally used antibiotics is reappearing: Ampicillin-87%, amoxicillin-89%, trimethoprim-sulfamethoxazole-76%, chloramphenicol-86%. Among other drugs, sensitivity to imepenam-100%, azithromycin-49%, aztreonam-65%, amikacin-98%. Nalidixic acid resistance is very high ie, 88%.
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The incidence of Moraxella catarrhalis in sputum encourages routine culture and sensitivity of sputa from patients suffering from lower respiratory tract infection, especially the elderly and immunocompromised, for tailored drug prescription.
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Two case reports of rapid decreases in valproic acid levels after initiation of meropenem in patients who developed new-onset seizure activity during treatment with cefepime are presented.
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Enteric fever is a major cause of concern in developing countries across the globe. The primary choice of antibiotics remains fluoroquinolones, followed by cephalosporins. Resistance to third-generation cephalosporins is rarely reported in Salmonella enterica serovar Typhi. This study reports the whole genome sequence of an S. Typhi isolate resistant to cefixime [minimum inhibitory concentration (MIC)=512μg/mL] by microbroth dilution. Interestingly, the isolate was negative for the cephalosporin resistance gene blaCTX-M by PCR, which is a known mechanism for higher cephalosporin resistance. The isolate was further subjected to next-generation sequencing that identified blaTEM-1B and blaDHA-1 genes in association with qnrB4 and sul1. blaTEM is a known gene coding for β-lactam resistance. In certain cases, overexpression of blaTEM was reported to result in cephalosporin resistance. This suggests that the high cefixime MIC would have been contributed by overexpression of blaTEM-1B. The blaTEM-1B gene was found to be associated with a promoter Px with -35 and -10 regions as TTAATA and TAAAGT, respectively. The promoter regions were unique, but the -10 region was similar to that found in Pa/Pb (previously reported promoter for blaTEM) with a single nucleotide change. In addition, an IncN plasmid was identified, which is usually reported in association with the most prevalent extended-spectrum β-lactamase (ESBL), metallo- and non-metallo-carbapenemase, and plasmid-mediated quinolone resistance (PMQR) genes. Plasmids such as IncN might possibly confer resistance and enhance spread. It is imperative to continuously monitor the drug resistance profile and evolving genetic elements.
Enrichment culture in modified buffered peptone water followed by immunomagnetic separation (IMS) with magnetic beads coated with an antibody against Escherichia coli O157 was compared with direct culture on cefixime rhamnose sorbitol MacConkey agar (CR-SMAC) and cefixime tellurite sorbitol MacConkey agar (CT-SMAC) for the isolation of E. coli O157 from human faeces. In total, 690 samples were examined; E. coli O157 was isolated from 25 samples by IMS but from only 15 and 12 by direct culture on CT-SMAC and CR-SMAC, respectively. The difference in sensitivity of detection was at its most marked on screening repeat faecal samples from known cases and samples from asymptomatic contacts, when of 12 strains of E. coli O157 isolated by IMS, only five were isolated by direct culture. IMS is a sensitive and simple technique for the isolation of E. coli O157 from human faecal samples and should prove useful in elucidating further the epidemiology of this micro-organism.