The Journal of Infection in Developing Countries <p>A peer-reviewed open access journal, focusing on global health.</p> The Journal of Infection in Developing Countries en-US The Journal of Infection in Developing Countries 1972-2680 <p>Authors who publish with this journal agree to the following terms:</p> <ol type="a"> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="Creative Commons Attribution License" href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a title="The Effect of Open Access" href="" target="_new">The Effect of Open Access</a>).</li> </ol> Genetic diversity and biofilm formation analysis of Staphylococcus aureus causing urinary tract infections in Tehran, Iran <p>Introduction: Over the past decades, prevalence of biofilm-forming <em>Staphylococcus aureus </em>strains has significantly increased in urinary tract infections. The aim of this study was to investigate prevalence of biofilm forming and adhesion encoding genes and to analyze distribution of different <em>agr</em> and <em>spa</em> types in <em>S. aureus</em> isolates.</p> <p>Methodology: In the present study, 75 <em>S</em>.<em> aureus</em> isolates obtained from patients with urinary tract infections were examined for susceptibility to antimicrobial agents. Adhesion, biofilm, and <em>spa</em> encoding genes were detected by PCR screening; <em>agr</em> types were determined using multiplex PCR.</p> <p>Results: Among the 75 isolates, 72% were biofilm producers and 28% were non-biofilm producers. Notably, the ability to produce biofilm was higher among MRSA strains ompared to MSSA strains. The most prevalent biofilm forming gene was <em>icaD </em>(77.3%), followed by <em>icaA </em>(76%), <em>icaB </em>(57.3%) and <em>icaC </em>(50.7%). Adhesion genes <em>clfA, clfB</em>, <em>fnbB, can,</em> <em>fnbA</em>, <em>ebp</em> and <em>bap</em> were detected in 94.7%, 92%, 68%, 64%, 64%, 60% and 5.3% of the isolates, respectively. The <em>spa</em> types t426 and t7789 were found among the non-MDR isolates. It was found that t790, t084, t7789 and t325 <em>spa</em> types were biofilm producers, while t426 and t1339 <em>spa</em> types were non-biofilm producers.</p> <p>Conclusion: Biofilm encoding genes <em>icaD </em>and <em>spa </em>type t790 and<em> agr </em>type III were the most prevalent factors among MDR biofilm producer isolates. The study emphasized that identification of genes and characterization of molecular types involved in biofilm formation should be considered.</p> Mehdi Goudarzi Anis Mohammadi Anahita Amirpour Maryam Fazeli Mohammad Javad Nasiri Ali Hashemi Hossein Goudarzi Copyright (c) 2019 Mehdi Goudarzi, Anis Mohammadi, Anahita Amirpour, Maryam Fazeli, Mohammad Javad Nasiri, Ali Hashemi, Hossein Goudarzi 2019-09-30 2019-09-30 13 09 777 785 10.3855/jidc.11329 Pathological and clinical investigations of an outbreak of Blackleg disease due to C. chauvoei in cattle in Punjab, Pakistan <p>Introduction<em>: Clostridium chauvoei </em>(<em>C. chauvoei</em>) is an anaerobic, histotoxic Gram-positive, bacterium causing fatal myonecrosis in livestock with high mortalities. The disease is common in dairy animals, but little is known about the pathophysiology of the disease in exotic (non-native) animals kept under local conditions in Pakistan.</p> <p>Methodology: Diagnosis of blackleg was made based on hematological and serum biochemical analysis, PCR, necropsy and histopathology.</p> <p>Results: Clinically sick animals exhibited fever, lameness, subcutaneous gaseous swelling and edema particularly in hindquarter and front legs. Hematological analysis showed increases in erythrocyte sedimentation rate and reduces in number of red blood cells, packed cell volume, leukocytes and differential leukocyte count. Serum aspartate aminotransferase, lactate dehydrogenase, alkaline phosphates, alanine aminotransferase, urea, creatinine, creatine kinase, and creatinine phosphokinase were significantly (P &lt; 0.05) higher in the infected animals. At necropsy, swelling areas contained straw-colored fluid with gas bubbles. The muscles were swollen, dark to black and exhibited crepitation sounds at the time of incisions with a rancid odor. Severe pulmonary edema, myocarditis along with petechial hemorrhages, as well as enlargement and congestion of liver and spleen have been observed. Microscopic examination revealed severe inflammatory reaction, edema, and disruption of the myofibrils. Examination of heart, spleen, liver, kidneys, intestine, and lungs showed congestion, severe inflammatory changes with neutrophilic infiltration and necrosis accompanied by dissociation of the normal tissue structure. PCR confirmed <em>C. chauvoei</em> in exudates and different samples of muscles.</p> <p>Conclusion: The pathophysiology should be considered in diagnosis of blackleg. The disease is exist in the non-native cattle farms and biosecurity measures have to be elevated.</p> Riaz Hussain M Tariq Javed Iahtasham Khan Abu Baker Siddique Bilal Aslam Abdul Ghaffar Narmeen Tariq Abdul Qayyum Gamal Wareth Copyright (c) 2019 Gamal Wareth 2019-09-30 2019-09-30 13 09 786 793 10.3855/jidc.11635 High prevalence of TEM, VIM, and OXA-2 beta-lactamases and clonal diversity among Acinetobacter baumannii isolates in Turkey <p>Introduction: <em>Acinetobacter baumannii</em> is an opportunistic pathogen that causes nosocomial infections with high mortality. Treatment options are limited owing to its resistance to numerous antibiotics. Here, we sought to determine the antibiotic susceptibilities of <em>A. baumannii </em>isolates, investigate clonal relationship among the strains, and determine the frequency of beta-lactamase resistance genes.</p> <p>Methodology: The identification and antibiotic susceptibilities of 69 <em>A. baumannii</em> strains were determined using a BD-Phoenix automated system. The presence of <em>bla</em><sub>OXA-2</sub>,<em> bla</em><sub>OXA-10</sub>,<em> bla</em><sub>OXA-23</sub>,<em> bla</em><sub>OXA-24/40</sub>,<em> bla</em><sub>OXA-51</sub>,<em> bla</em><sub>OXA-58</sub>,<em> bla</em><sub>TEM</sub>,<em> bla</em><sub>SHV</sub>,<em> bla</em><sub>IMP</sub>,<em> bla</em><sub>VIM</sub>, and<em> bla</em><sub>GIM</sub> genes were investigated using polymerase chain reaction (PCR), and clonal relatioships among the isolates were determined using pulsed-field gel electrophoresis (PFGE).</p> <p>Results: All strains were resistant to ampicillin–sulbactam, gentamicin, cefepime, ciprofloxacin, and ceftriaxone. While 65 of the 69 strains (94.2%) were resistant to piperacillin-tazobactam, amikacin, imipenem, and meropenem, all strains were susceptible to tigecycline and colistin. The frequencies of <em>bla</em><sub>OXA-51</sub>, <em>bla</em><sub>OXA-23</sub><em>, bla</em><sub>TEM</sub><em>, bla</em><sub>OXA-2</sub><em>, bla</em><sub>VIM</sub><em>, and bla</em><sub>SHV</sub> were 100%, 94.2%, 53.6%, 21.7%, 14.5%, and 2.9%, respectively. Based on PFGE results, 56 of the 69 strains were clonally related, and the clustering rate was 81.2%. No common outbreak isolate was detected.</p> <p>Conclusions: The most prevalent OXA genes were <em>bla</em><sub>OXA-51</sub>, <em>bla</em><sub>OXA-23</sub>, and <em>bla</em><sub>OXA-2</sub>. Furthermore, <em>bla</em><sub>TEM</sub>, <em>bla</em><sub>SHV,</sub> and <em>bla</em><sub>VIM</sub>, which are common in Enterobacterales and <em>Pseudomonas </em>spp, were detected<em>,</em> suggesting horizontal gene transfer had occurred between bacteria. No single clone outbreak was detected by PFGE. However, multiclonal spread and the high clustering rate suggest cross-contamination. Therefore, in future, more effective infection control measures must be implemented.</p> Nergis Asgin Baris Otlu Elcin Kal Cakmakliogullari Betul Celik Copyright (c) 2019 Nergis Asgin, Baris Otlu, Elcin Kal Cakmakliogullari, Nafia Canan Gursoy, Betul Demir 2019-09-30 2019-09-30 13 09 794 801 10.3855/jidc.11684 Antimicrobial resistance and molecular characterization of Streptococcus agalactiae from pregnant women in southern China <p>Introduction: This study aimed to characterize antimicrobial resistance (AMR), molecular determinants of AMR and virulence, as well as clonal relationship of <em>Streptococcus agalactiae</em> isolates from women at 35-37 weeks of gestation in the Chaoshan metropolitan area of southern China.</p> <p>Methodology: Bacterial strains isolated from vaginal swabs were identified and antimicrobial susceptibility tests were performed by using a Vitek 2 Compact system (BioMérieux, France). Resistance and virulence genes were detected by polymerase chain reaction (PCR) and the clonal relationship was analysed by multiple locus variable number tandem repeat analysis (MLVA). Statistical analysis was carried out by using SPSS software, version 19.0.</p> <p>Results: All GBS were susceptible to benzylpenicillin, ampicillin, quinupristin/dalfopristin, tigecycline, linezolid and vancomycin, but a considerable proportion was resistant to clindamycin (29.67%), erythromycin (46.15%), azithromycin (63.74%), tetracycline (84.62%) and quinolones (25.27%). The carrier rates of <em>ermB (69.04%)</em> and <em>mefA/E (64.28%) </em>were detected in these GBS strains resistant to erythromycin. In terms of MLVA detection, 91 GBS strains were categorized into 43 genotypes and 6 clusters. All GBS harboured <em>hylB</em> and <em>cylE</em> genes<em>, </em>most of which carried a combination of<em> PI-1</em> and <em>PI-2a</em> genes as a common virulence gene profile.</p> <p>Conclusions: The high level of resistance conferred by some corresponding resistance genes to macrolides, lincosamides and quinolones of GBS isolates from pregnant women in southern China, has reinforced the necessity for monitoring GBS strain resistance to the above agents. Comparative genetic studies of GBS isolates, especially efforts to understand the relationship between pilus islands and genotype, were essential for conducting infection control and epidemiological comparisons between countries.</p> Huiwu Guo Maozhang Fu Qing Peng Zhuoran Chen Jun Liu Yingkun Qiu Yuanchun Huang Copyright (c) 2019 Huiwu Guo, Maozhang Fu, Qing Peng, Zhuoran Chen, Jun Liu, Yingkun Qiu, Yuanchun Huang 2019-09-30 2019-09-30 13 09 802 809 10.3855/jidc.11395 High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit <p>Introduction: Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU). This study analyzed microbiology, epidemiology and clinical aspects of<em> Staphylococcus</em> spp. colonizing neonates.</p> <p>Methodology: Nasal or periumbilical swabs were evaluated from 175 newborns admitted to a NICU of a Rio de Janeiro hospital from March to September 2009. Clinical data were obtained from the medical records. SCC<em>mec</em> typing and the <em>mecA</em> and Panton-Valentine Leukocidin (PVL) genes were detected by PCR. Clonal diversity was evaluated by pulsed-field gel electrophoresis.</p> <p>Results: <em>Staphylococcus </em>spp. isolates were detected in 98 (56%) neonates, 66.3% of them had birth weight ≤ 2500 g, 62.2% were preterm (˂ 37 weeks) and the mean length of hospitalization was 14.9 days. Among the 133 isolates identified, 48.1% were <em>S. epidermidis, </em>23.3% <em>S. haemolyticus</em> and 13.5% <em>S. aureus</em>. Methicillin-resistant <em>Staphylococcus</em> isolate was detected in 77.6% of neonates. The methicillin-resistant <em>S. aureus</em> isolates carried the SCC<em>mec</em> type IV, while 94.6% of <em>S. epidermidis</em> and 85.7% of <em>S. haemolyticus</em> presented non-typeable cassettes. Among the <em>S. aureus</em>, 55.6% had PVL genes and the USA800 genotype was prevalent. Two genotypes of<em> S. epidermidis </em>and one of <em>S. haemolyticus</em> clustered 42.2% and 25.8% of the isolates, respectively. <em>S haemolyticus</em> colonization was associated with the use of parenteral nutrition and mechanical ventilation.</p> <p>Conclusion: High rate of neonates colonized by methicillin-resistant <em>Staphylococcus</em> species and the permanence of clones circulating in the NICU highlight the importance for continuous and preventive surveillance in this high-risk population.</p> Vivian Carolina Salgueiro Milena D’Angelo Lima Seixas Lorrayne Cardoso Guimarães Dennis de Carvalho Ferreira Denise Cotrim da Cunha Simone Aranha Nouér Kátia Regina Netto dos Santos Copyright (c) 2019 Kátia Regina Netto dos Santos, Vivian Carolina Salgueiro, Milena D’Angelo Lima Seixas, Lorrayne Cardoso Guimarães, Dennis de Carvalho Ferreira, Denise Cotrim da Cunha, Simone Aranha Nouér 2019-09-30 2019-09-30 13 09 810 816 10.3855/jidc.11241 Endocan serum concentration in uninfected newborn infants <p>Introduction: Endocan is a specific endothelial mediator involved in the inflammatory response. Its role in the diagnosis of sepsis has been studied in adult patients and late onset neonatal sepsis. The clinical signs of early onset sepsis (EOS) are nonspecific and routinely used biomarkers, such as C-reactive protein and procalcitonin, have low sensitivity, specificity and positive predictive value. Endocan could be useful as a biomarker for diagnosis of EOS, but at present normal range values for this molecule have not been reported. The aim of this study is to establish the normal values range for serum endocan in term and preterm newborns without risk factors for EOS and to characterize the variation pattern of its levels at different postnatal moments.</p> <p>Methodology: Mean endocan serum concentration (ESC) was measured in term and preterm newborns without clinical suspicion of EOS at different moments from birth.</p> <p>Results: ESC (ng/mL) in term newborns was 1.74+/-0.13 on day 1 and 2.02+/-0.41 on day 3 respectively, (p=0.09). In preterm newborns ESC (ng/mL) was 2.02+/-0.11 and 1.97+/-0.18, (p=0.8) for day 1 and 3 respectively. ESC was not significantly influenced by sex, mode of delivery, evidence of fetal distress or presence of minor birth trauma.</p> <p>Conclusions: ESC (ng/mL) between the first and third day of life in either term or preterm infants don’t appear to be significantly influenced by factors that are associated with elevation of inflammatory markers, thus using this biomarker for the diagnosis of EOS might reduce the false positive results.</p> Gabriela I Zonda Radu Zonda Andrei T Cernomaz Luminita Paduraru Bogdan D Grigoriu Copyright (c) 2019 Luminita Paduraru, Gabriela Ildiko Zonda, Radu Zonda, Andrei Tudor Cernomaz, Bogdan Dragos Grigoriu 2019-09-30 2019-09-30 13 09 817 822 10.3855/jidc.11660 Comparison of the clinical and laboratory characteristics of pertussis or viral lower respiratory tract infections <p>Introduction: Whooping cough-like respiratory tract infections (WCLRTI) caused by factors other than the <em>Bordetella pertussis</em> are available. Clinical picture is difficult to differentiate between the <em>B. pertussis </em>and viral respiratory infections.</p> <p>Methodology: Eighty-five patients with the diagnosis of WCLRTI were divided into 3 groups. Group 1 involved patients with pertussis shown by nasopharyngeal aspirate culture (NAC) and/or PCR. Group 2 consisted of patients who B. pertussis was not detected by NAC however, clinicians still evaluated them as potential patients of pertussis. Group 3 involved patients with the diagnosis of WCLRTI and those with VRTI detected by antigen detection/PCR.</p> <p>Results: Patients with pertussis had longer duration of the symptoms prior to admission. Paroxysmal cough, whooping, vomiting after coughing, cyanosis, apnea, seizures and abdominal hernias were more common in patients with pertussis. Fever, wheezing, tachypnea, retraction, fine crackles and rhonchi were more common in Group 3. Chest radiographs of patients in Group 3 revealed more bronchopneumonic infiltration, increased aeration, and atelectasis. CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) were significantly higher in Group 3. Of the patients 43.6% had no pertussis vaccination due to being &lt; 2 months in age and 29.4% had 1 dose.</p> <p>Conclusions: Pertussis should be thought in differential diagnosis of children with complaints of episodes of paroxysmal cough, cough accompanied by gasping, vomiting after coughing; with leukocytosis, lymphocytosis and a normal chest X-ray. The majority of children with pertussis infection are those who have not had the opportunity for vaccination.</p> Suna Selbuz Ergin Çiftçi Halil Özdemir Haluk Güriz Erdal İnce Copyright (c) 2019 Suna Selbuz, Ergin Çiftçi, Halil Özdemir, Halil Özdemir, Haluk Güriz, Erdal İnce 2019-09-30 2019-09-30 13 09 823 830 10.3855/jidc.10558 First report on seroprevalence and risk factors of Toxoplasma gondii infection in sheep and goats in North Lebanon <p>Introduction: Toxoplasmosis is of dual importance in both public and veterinary health due to the respective risk of transplacental transmission in primo-infected pregnant women and economic losses caused by abortions in mammals. One of the main routes of <em>Toxoplasma gondii</em> transmission to humans is the consumption of raw or undercooked meats containing parasitic cysts. Here, we performed the first epidemiological study to determine the seroprevalence and the risk factors of toxoplasmosis in livestock in Lebanon.</p> <p>Methodology: Using a modified agglutination test with a cut-off of 1:40, we tested the positivity rate of Immunoglobulin G antibodies in the sera of 100 sheep and 80 goats collected from 18 different livestock farms located in North Lebanon between March and June 2018.</p> <p>Results: Anti-<em>Toxoplasma gondii</em> IgG antibodies were detected in 42% of sheep and 34% of goats. Adults (&gt; 1 year) were significantly more infected by <em>T. gondii</em> than the lambs (&lt; 1 year) in both species (p &lt; 0.05).</p> <p>Conclusions: These findings indicated that food animals are highly exposed to <em>T. gondii</em> in Lebanon and could be potentially a major risk factor of <em>T. gondii</em> infection to humans. Consequently, national prophylactic strategies should be implemented to control and to prevent <em>T. gondii </em>transmission between animals and humans.</p> Dima El Safadi Dany Abi Chahine Alissar Al Tarraf Omar Raii Karim Mesto Mohamad Bachar Ismail Monzer Hamze Copyright (c) 2019 Dima El Safadi, Dany Abi-Chahine, Alissar Al Tarraf, Omar Raii, Karim Mesto, Mohamad Bachar Ismail, Monzer Hamze 2019-09-30 2019-09-30 13 09 831 836 10.3855/jidc.11425 First detection of vanB phenotype-vanA genotype vancomycin-resistant enterococci in Egypt <p>Introduction: Enterococci have emerged in last two decades as serious hospital acquired pathogens particularly vancomycin resistant strains (VRE). The study aimed to identify the prevalence of enterococcal isolation from hospital infections and colonization as well as determine vancomycin resistance phenotypes and genotypes. Methods: Sixty <em>enterococcus</em> isolates were isolated from patients, health care workers and hospital environment, identified and tested for antimicrobial susceptibility. <em>Enterococcus</em> species were identified by Real-time PCR and vancomycin resistance was assessed by agar dilution method and Real-time PCR.</p> <p>Results; out of 300 samples (20%) were enterococci (53.3% were <em>E. faecium</em>, 31.7% <em>E. faecalis</em> and 10% other <em>enterococci)</em>. Among of them 40/60 (66, 6%) were isolated from infections and 33.3% were isolated from colonization. multiple drug resistance was reported in (100%) of isolates, while (95%) and (45%) of isolates were resistant to vancomycin and ticoplanin respectively. VanA phenotype, <em>vanA</em> genotype was identified in (47.4%) of isolates, while vanB phenotype, <em>vanA</em> genotype was identified in (33.3%) of vancomycin resistant isolates.</p> <p>Conclusion; VanB phenotype-<em>vanA </em>genotype was identified in (33.3%) of vancomycin resistant enterococcal isolates. To our knowledge it is the first identified incidence of such strains in Egypt and Africa.</p> Rasha MM Khairy Mahmoud Shokry Mahmoud Mona Abdel Monem Esmail Aya Nabil Gamil Copyright (c) 2019 Rasha M Khiry, Mahmoud Shokry Mahmoud, Mona Abdel Monem Esmail, Aya Nabil Gamil 2019-09-30 2019-09-30 13 09 837 842 10.3855/jidc.10472 High seroprevalence of pathogenic Yersinia spp. in sheep and goats across nine government farms in the Pakistani Punjab <p>Introduction: Seroprevalence of <em>Y. enterocolitica</em> and <em>Y. pseudotuberculosis</em> infections in animals and humans is not established in Pakistan. There are only a few reports on the prevalence of pathogenic<em> Yersinia </em>spp<em>.</em> and infections in small ruminants, however, the role of sheep and goats in the transmission of pathogenic <em>Yersinia</em> remains unclear.</p> <p>Methodology: A primary survey investigated the presence of anti-<em>Yersinia </em>antibodies among a small population of ruminants detected by recombinant antigen targets in nine government farms dispersed throughout the Punjab province of Pakistan.</p> <p>Results: Antibodies specific for <em>Y. enterocolitica</em> were detected in 7/9 sheep flocks and in 4/4 goat flocks. Antibodies specific for <em>Y. pseudotuberculosis</em> were detected in 4/9 sheep flocks. Two sheep flocks revealed the presence of both <em>Y. enterocolitica</em> and <em>Y. pseudotuberculosis</em> specific antibodies.</p> <p>Conclusion: Due to the high number of the population involved in raising small ruminants the risk to veterinary and public health must be rapidly determined.</p> Qudrat Ullah Tariq Jamil Muhammad H Hussain Huma Jamil Muhammad Saqib Usman Tahir Heinrich Neubauer Lisa D Sprague Copyright (c) 2019 Qudrat Ullah, Tariq Jamil, Muhammad Hammad Hussain, Huma Jamil, Muhammad Saqib, Usman Tahir, Heinrich Neubauer, Lisa D. Sprague 2019-09-30 2019-09-30 13 09 843 846 10.3855/jidc.11289 Levels of different cytokines in women and men with asymptomatic genital infection caused by Chlamydia <p>Introduction: Immune response to genital <em>Chlamydia trachomatis</em> infection is involved in both immunity and pathology. The cytokine profile during infection has been implicated in the disease outcome, either resolution or severe sequelae.</p> <p>Methodology: In total, 3900 patients were analyzed for presence of genital infections caused by <em>Chlamydia </em>using molecular assays. Interleukins (IL) IL-10, IL-17, IL-6, IL-2 and chemokine IP-10 were estimated by ELISA in urine, cervical swabs and semen samples. Statistical analysis was performed using the T student test.</p> <p>Results: A total of 47 out of 3900 samples (1.2%) were found to be positive for <em>Chlamydia trachomatis </em>based on the Real Time (RT) PCR results. Statistical analysis revealed that the differences between <em>Chlamydia trachomatis</em> positive and negative samples regarding levels of cytokines were not significant.</p> <p>Conclusions: Our results demonstrated that no significant difference in cytokine concentrations exists in <em>Chlamydia trachomatis </em>infected patients when compared to healthy controls. In further study, we aim to test on a greater number of positive samples a greater number of cytokines involved in the immune response to <em>Chlamydia trachomatis</em> infections.</p> Alessandra Bua Sara Cannas Stefania Zanetti Paola Molicotti Copyright (c) 2019 Alessandra Bua, sara cannas, stefania zanetti, paola molicotti 2019-09-30 2019-09-30 13 09 847 850 10.3855/jidc.9810 Extended Spectrum Beta-lactamase producing Salmonella Lindenberg gastroenteritis <p>Introduction: Increasing antimicrobial resistance among non-typhoidal <em>Salmonella</em> (NTS) is a major public health issue especially in developing countries and is partly due to the use of antimicrobials in animal feeds as growth promoters. NTS are often associated with self-limiting acute gastroenteritis (AGE). Nevertheless, fluoroquinolones and third-generation cephalosporins are currently used in the treatment of severe diarrhoeal infections.</p> <p>Methodology: We report the case of a 30-year-old male who presented with clinical symptoms of moderate gastroenteritis. Stool culture and antibiotic susceptibility was performed as per standard microbiological methods. Molecular detection of <em>bla</em> genes was carried out by PCR.</p> <p>Results: The isolate was confirmed as <em>S. Lindenberg </em>by serotyping<em>. </em>The isolate exhibited dual resistance to fluoroquinolone and third generation cephalosporins. The isolate was an ESBL producer and harboured<em> bla<sub>SHV. </sub></em>Based on the antibiotic susceptibility pattern, the patient was successfully treated with ceftriaxone-tazobactam.</p> <p>Conclusion: Presently, there are no Indian reports on the <em>bla<sub>SHV</sub></em> positive ESBL producing<em> S. Lindenberg </em>gastroenteritis. We report on the successful management of the first case of acute gastroenteritis caused by <em>S. Lindenberg </em>that exhibited dual resistance to fluoroquinolone and third generation cephalosporins. Continued surveillance of the antibiotic resistance pattern of the Non-typhoidal <em>Salmonella </em>serovars circulating in the geographical region is warranted.</p> Rajan Prabhurajan Rajasekharapanicker Kiran Kesavaram Padmavathy Copyright (c) 2019 Kesavaram Padmavathy, Rajan Prabhurajan, Rajasekharapanicker Kiran 2019-09-30 2019-09-30 13 09 851 853 10.3855/jidc.11409 Nocardia farcinica meningitis in a patient with high-grade astrocytoma <p>We describe a case of 91-year-old male with astrocytoma who developed meningitis caused by <em>Nocardia farcinica</em>. He had a past medical history of anaplastic astrocytoma grade III. Endocranial computed tomography (CT) scan revealed mass lesion in the left occipital region associated with perilesional edema, without evidence of midline shift issue. The analyses of cerebrospinal fluid (CSF) revealed neutrophilic pleocytosis, hyperproteinorrachia and hypoglycorrhachia. Combined antimicrobial therapy was initiated (vancomycin, meropenem, acyclovir). CSF culture revealed <em>Nocardia farcinica</em>. Susceptibility testing revealed intermediate sensitivity to meropenem and antibiotic treatment was switched to trimethoprim-sulfamethoxazole and imipenem. After 7 days of treatment the patient developed progressive dyspnea. The chest CT scan revealed bilateral pleural effusion and alveolar infiltrate mostly in the right lobe. Ceftriaxone was added to the therapy, but the outcome was lethal. <em>Nocardia</em> spp. should be considered as differential diagnosis in the patients with brain tumor or meningitis in the setting of immune suppression and corticosteroid use. CSF cultures should be incubated longer with aim to allow fastidious organisms to grow, such as <em>Nocardia </em>spp.</p> Elahe Nasri Hamed Fakhim Aleksandra Barac Saber Yousefi Kouros Aghazade Darko Boljevic Massoud Mardani Copyright (c) 2019 Hamed Fakhim, Elahe Nasri, Aleksandra Barac, Saber Yousefi, Kouros Aghazade, Massoud Mardani 2019-09-30 2019-09-30 13 09 854 857 10.3855/jidc.11582