Cases of N. farcinica infections are being reported increasingly because of recent changes in taxonomy and diagnostic methodology. This change in epidemiology has implications for therapy because of the organism's pathogenicity and natural resistance to multiple antimicrobial agents, including third-generation cephalosporins. Any delay in starting appropriate antibiotic therapy can have adverse consequences.

Coryneform bacteria belonging to the genus Brevibacterium have emerged as opportunistic pathogens. Of the nine known species of Brevibacterium isolated from human clinical samples, Brevibacterium casei is the most frequently reported species from clinical specimens. We report the first case of B. casei brain abscess in an immunocompetent patient successfully treated by surgery and antimicrobial therapy. CASE REPORTA 31-year-old man was hospitalized for recurrent right-sided focal seizures with loss of consciousness for the last 3 months. The seizures were preceded by auras in the form of vomiting and paresthesia of the right upper and lower limbs. On admission, he complained of a bifrontal headache but was fully alert with normal vital signs, including temperature. Motor system examination revealed normal tone and bulk with power grade V in all groups. Deep tendon reflex was brisk bilateral with bilateral flexor plantar and numbness present in the right lower limb. The patient had received antituberculous chemotherapy (isoniazid, 300 mg; rifampin, 450 mg; ethambutol, 800 mg; and pyrazinamide, 1,500 mg) for the last 3 months as the brain lesion was misdiagnosed as tuberculoma at a local hospital based on the imaging. Magnetic resonance imaging (MRI) revealed a dark ring enhancing lesion measuring 1.2 by 0.7 cm in the left post-central gyrus with a central mural nodules and disproportionate white matter perilesional edema (Fig. 1). Magnetic resonance spectroscopy revealed elevated lipids/lactates suggestive of infective etiology. Lab workup revealed microcytic hypochromic anemia (4.8 ϫ 10 6 erythrocytes/mm 3 ), 5,500 white cells/l (70% polymorphonuclear cells), 218,000 platelets/l, and a 1-h erythrocyte sedimentation rate of 22 mm. Other laboratory findings were unremarkable. An initial diagnosis of brain abscess of infective etiology was made, and supportive care, including administration of mannitol and dexamethasone for control of cerebral edema, was started. He underwent left parasaggital craniotomy and excision of the abscess. During surgery, lesions identified on MRI were found to contain purulent material, which was completely drained and submitted for histopathology and microbiological analysis. The cytologic findings were consistent with necrotic abscesses, and direct Gram staining revealed a few Gram-positive bacilli.Smear and culture (MB/BacT ALERT 3D system) for acid-fast bacilli were negative.

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Though pericardial disease is common in patients with renal disease, purulent pericarditis is very rare. We report a fatal case of purulent pericarditis and sepsis due to methicillin-resistant Staphylococcus aureus in a 78-year-old male with systemic hypertension and renal disease along with the molecular characterization of its resistant mechanism.

Objective: To determine the in vitro activity of daptomycin and vancomycin against 50 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from blood and pus specimens. Material and methods: Fifty consecutive MRSA were isolated from pus (n=25) and blood (n=25) were included in the study. Oxacillin susceptibility was determined by cefoxitin disc diffusion, green colored colonies on chromogenic media. Susceptibility testing for 18 antimicrobial agents was determined by a disc diffusion method. The minimum inhibitory concentration (MIC) of daptomycin and vancomycin was determined by the Etest as recommended by the Clinical and Laboratory Standards Institute (CLSI). Results: Antibiotic susceptibility pattern of the MRSA isolates showed that 38% were multi-drug resistant overall and 52% in blood and 24% in pus isolates when expressed separately. The MIC50 and MIC90 of daptomycin were 0.08 and 0.09 mg/L and of vancomycin were 1.2 mg/L and 1.3 mg/L, respectively. Ten percent of the isolates had vancomycin MIC of 2 mg/L which is the upper limit of CLSI breakpoint for sensitive isolates. None of the isolates showed intermediate susceptibility or resistance to vancomycin or daptomycin. Conclusion: Creeping MIC of vancomycin is a matter of concern and MIC of 1.5-2 mg/L of vancomycin in MRSA increases the risk of development of complicated bacteraemia. MIC's of vancomycin should be reported for all S. aureus isolates and should be used to guide treatment. Otherwise, daptomycin can be considered as an alternative antibiotic for therapy of MRSA infections in India.