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Background: Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in Human Immunodeficiency Virus (HIV) positive patients. It is associated with a high mortality rate. Hence early diagnosis is necessary to start appropriate treatment. Cryptococcosis is generally found in association with acquired immunodeficiency syndrome (AIDS) although it has been reported to cause disease in HIV-seronegative patients also. Objective:Prevalence of Cryptococcal meningitis in a tertiary care centre. Material & Methods: A total of 93 Cerebrospinal fluid samples from suspected cases of fungal meningitis were received in the microbiology department of GB Pant Hospital(GIPMER) from January to June 2018. Samples were subjected to direct microscopy- wet mount, India ink preparation and Gram stain, Cryptococcal antigen detection(Latex agglutination), and Fungal culture. In vitro susceptibility of Cryptococcus isolates to Fluconazole, Voriconazole, 5- Flucytosine and Amphotericin B was performed using standard broth microdilution method. Results: Out of 93 CSF samples, 6 were positive for India ink preparation and showed gram positive budding yeast cells by gram staining. All 6 samples were positive for the cryptococcal antigen test and fungal culture. Five were identified as C. neoformans and one C. gatti. All strains were susceptible to Amphotericin B. Four patients were HIV reactive and succumbed to the diseaseduring treatment. Two patients were found to be coinfected with Hepatitis B virus. Ashish Bajaj1, Bibhabati Mishra2, Poonam S Loomba2, Archana Thakur3, Abha Sharma4, Prachala G Rathod1, Madhusmita Das1, Ashna Bhasin1 1Senior Resident, 2Director Professor, 3Director Professor & Head, 4Assistant Professor, Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India ABSTRACT Cryptococcal meningitis has emerged as an important opportunistic central nervous system (CNS) infection in immunosuppressed patients.It is associated with a high mortality rate(>30%) in immunosuppressed patients especially those infected with HIV, hence early diagnosis is necessary to start appropriate treatment. Prevalence of cryptococcal infection is increasing in developing nations including India as per some recent studies.(1) Conclusion: Index of suspicion of Cryptococcus infection as a possible cause of meningitis must be considered in chronic meningitis cases. Microscopy (India ink preparation) may be used as a cheap and rapid diagnostic tool.

Purpose: To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years. Methods: It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed. Results: Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase-negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non-fermenting gram-negative bacilli (0.57%). In Staphylococci , 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram-negative isolates were susceptible to carbapenems and polymyxin B. Conclusion: To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.

Background and Purpose: Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy. Case report: We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient’s outcome was good with surgical excision and voriconazole therapy. Conclusion: Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.