Disseminated histoplasmosis usually affects immunocompromised and immunosuppressed individuals and may involve various organ systems of our body. The definitive diagnosis of histoplasmosis is very challenging because it usually presents with nonspecific symptoms such as malignancies, tuberculosis, sarcoidosis, and other chronic infections. Hereby, we report a culture-proven case of bilateral adrenal histoplasmosis in a diabetic but immunocompetent patient. The patient showed good response to treatment with antifungal drugs.

Background: Susceptibility testing for polymyxins is a great challenge for a Clinical Microbiology laboratory. There are several methodological issues associated with MIC (Minimum Inhibitory Concentration) determination of colistin. Methods: In our study, we have compared the results of colistin susceptibility testing by Automated system (Vitek-2, Biomerieux, France) with the reference Broth Microdilution method (BMD) to identify the type of discrepancies by Vitek-2 method and thus develop a practical and accurate approach for colistin susceptibility testing in a Clinical Microbiology laboratory. A total of 730 strains of Gram negative bacteria [Escherichia coli (325), Klebsiella sp.(346), Acinetobacter baumanii complex (37) and Pseudomonas aeruginosa (22)] from 485 patents were tested simultaneously by BMD and Vitek-2 method for colistin susceptibility testing. Results: The Essential agreement (EA), Categorical agreement (CA), Very major error (VME) and Major error (ME) rates for Klebsiella sp. were 87.3%, 89.3%, 8% and 2.3% respectively, for Escherichia coli were 88.3%, 89.5%, 9.2% and 1.2%  respectively, for Acinetobacter baumannii complex were 89.1%, 91.8%, 8.1% and 0% respectively, for Pseudomonas aeruginosa were 68.1%, 72.7%, 0% and 27.2% respectively. Conclusions: Colistin susceptibility testing by Vitek-2 method is an easily adoptable method and the results of Vitek-2 with reference to BMD are acceptable to a great extent in Klebsiella sp., Escherichia coli and Acinetobacter baumanii complex. So, we believe that Vitek-2 method may be used for colistin susceptibility testing in low risk patients. However, BMD should be used in high risk immunosupressed and immunocompromised patients who are admitted in critical care units. For Pseudomonas aeruginosa, BMD should be routinely used.

Background: Consideration of non-diphtheriae Corynebacteria as an infective organism in mastitis, is usually neglected. So, infections due to Corynebacterium species may remain undiagnosed or misdiagnosed. The aim of our study was to focus on non-diphtheriae Corynebacterium as causative organisms in breast infections using scientific logic and technology of Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectrometry (MALDITOF MS) to categorize the isolates upto species level. The clinical correlation and response to management especially targeted antimicrobials was also recorded. Methods: All the consecutive pus/tissue samples from Breast abscess received during study period were processed as per the standard guidelines. The identification of the isolate was done by automated methods.  The cytopathological/histopathological and clinical details of the patients with infection due to Corynebacterium sp. were recorded and analyzed. Results: Out of 52 non-duplicate samples, five showed growth of non-diphtheriae Corynebacteria.  These were identified as C. kroppenstedtii and C. amycolatum. The antimicrobial susceptibility testing showed 100% susceptibility to Amoxicillin-clavulanate, Tetracycline, Vancomycin and Linezolid for all the five isolates. Histopathological examination was suggestive of chronic inflammatory mastitis/Granulomatous mastitis. Conclusion: Non diphtheriae Corynebacteria particularly lipophilic Corynebacteria have a predilection to cause infections of breast tissue and Breast abscess which may mimic as tubercular abscess or chronic non-specific mastitis leading to unnecessary usage of antimicrobials. So, these isolates from breast tissue/pus should not be ignored rather definitely identified. This would also ensure diagnostic stewardship.