Anaerobic infections in an Indian tertiary care hospital with special reference to bacteroidaceae

i

Letters

to the Editor

Letters

to the Editor

55

M’~IS no el~idence ol’ neck stillhess. eyes mw-e opening spontaneousty. pupils were equal and reacting to tight and kmdoscop~ revested no abnormati(y. ‘I’hc patient had a mortted cxpr&i\re dysphasia. increased tone. no movement and brisk reflexes in the right upper limb. A t’utl blood count LV;IS normal with haemoglobin IL. 3 g/d. white hloott cells 7.5 x t ()“/I and platctels 145 x 1 ()“/I Biochemical prolile LV;IS normal with sodium 14 I niniot/t. potassium 1.7mniot,/l. chtoritie 102 mmol/ I. hicarbonatt3 1, 3 mniot/t. crcatinine hX ~iniol/t. urc’a h. 3 ininol/ I and

Brain

Abscess

Due

to

Corynebacterium

xerosis

Sir.

(‘o~~/rlc’brrc,lt~~.il,rrl Ilasopharylx

scr-osis and

is

ii conmlellsill. colonixing at sac. All bough not

sickred to he a pathogen thcrc have rqmrtcd iI1 the literalwe Lvhere the ciiusc’ 01‘ sigiiilicanl ciiscwsc. otien iti patienls niuno~omt~roi~iiscd. Wc describe ii case of brain (‘or~!/,rc~/~trc~~c~~-;~~~~~ ,wr-osis

\kusty

the

skin.

usuallr c‘ollbeen a number ol’cases organism has been the

conjuncti\

\vhich

v,‘ta belie\

c‘ has

who

are

abscess not been

ini-

with pre-

reporled.

,,I 7 1 -year-old inan \‘viis rekrrcd (0 the neurosurgicat \l.ith a history of two Jacksonian tits atIding his right mild ~~wtcness of the right arni and mild tiysarthria. ‘I’here no history 01’ hdaches. ;\ computed tomography (C’I’J

\zxs wporled tiwntoparietat remo\wi. opcra(i\~et~~

iis dimzing craniotomg

Histology he

a Ml

parietal

t&c

bvas performed

showed

de\~etopcd

it

to

;I right-sided

be

and

:I

tuniour. t hc turnour

nieningioina.

deep

Irein

unil

;II~. WYIS scan A left was Post-

thrombosis

ivhich cz~as ~reatrd M.ii II an(icoagulant therap!,. and steroid intiuccd diabetes mcttitus Irhich responded to did. A( the (ime ot’ ttischargc lit‘ \\;Ix atc,rl. had sutkrcd no t’urthcr lits and his right-sided \vc‘almcss had improved such that hc required minimal assiskance when M-aking. Ile \vas xen as an outpatient atier discharge and the \vound was sa(islac~ory. Sel,cw monlhs later hc ~kriis rcadnii(ted fotlowing a seizure. ‘I’herc was IIO history 01‘ neck stit’fncss or headaches. The leti cmniotomy wo~rntl had brottcn down and it was noled that Iherr U’;IS so~nc discharge t’rom the anterior end of the expound. On exami~~aiion hc was apyrexiat lvith a pulse of 84 beats/ min. l~looci prwsurc 110/70. jugular venous pressure was not raised. there was no pcripharal oedema and the heart sounds wcw nortnat \z’ilh no added sounds. f\hdoniinat and respirator> syslcm euanlinatiorl LZ’;IX LIiirCiiiiirt~iible. Neurologicatty there

glucose

4.4n1rnot/1.

1201towing :I CT scan which ww suggestive of a leti parktat tobc abscess. burrhotc surges-y was perlimned and 1 O-1 5 ml 01 creamy odourtcss pus wcrf2 drained. The patient was conmenced on intra\wious cetkizidine 75Omg e\w-y S h. metroniciazote 5OOmg clw-y 8 h and Iludoxacitlin Ig tvtq 6 h pending the rosults 01’ Ini~robiologic~II investigations. 11 (km stain 01’ lhc pus revealcti the presence 01 (;rarn-positi\,e bacilli. Since the patient \z’as stable. the antibiotic treatment IV;IS continued pending tix1her idenlilication 01‘ the organisni and anlibiotic sensitivities. ‘I‘ht~ (km-posilkre bacillus (‘or.!/rlc~blfc~lt~~;~~~t~ scwsi.s was subscquentty cultured and identified as a single isola(e kom the lirst specimen of pus. I( gre~v aerobicdly on blood agar m.ith no haemotysis and was catalasc posili\re and oxidase negciti\~e. It \z’iis idcntilieti using conventional tests and ltic Al’1 C’oryne (bioVcrieux sa. hlarcy-I‘Eloite. France) systcin (API I’rolilc 10: = 5 122 32 I ) M,hich biochemicallv lcsts for the presence 01‘ a selection OF enxymes. The identiiication 01’ the organism \~‘;Is subsquenttg conlirmed by the I)iphtheria Kdaw~ce llllit. C’cnli-al Public lteatth Laboratory. C’olindale. I.o~ido~i. ‘I’tw organism. as tested by Stokes disc tiil’llrsion method.’ LV;IS sensiti\rc 10 \~aticoniycin. fusidic acid aiid rifritnpicin. resistant to penicillin. crgthromycin , gentamicin and had intcrmediale sensili\?Iv lo lluctoxaciltin. klininiuin inhibitory concenlrations were pcr~~mmxi by a broth dilution method (Sensi(i(re. I,aunch IXagnos~ics. Longnior~. I4.0. ctindamycin > lh.0. erythromycin > 16.0. ampicillin > 16.0. cephalothin > 32.0. sulphamethosaxolc >72.0. trimcthoprim >4.0. imipenem 31.0, (elracgcline t 6.0. \~mconiyki < 1 .O. gentamicin > 32.0. ril;rmpicin