Staphylococcus aureus (S.aureus) and coagulase negative Staphylococci (CONS) are the commonest pathogens that lead to severe bacterial infections. It is a bacterium with consistent resistance development against commonly used antibiotics, with emergence of Methicillin resistant staphylococcus aureus (MRSA) causing several infections in patients following hospitalization. Glycopeptides like vancomycin is used as primary drug for treating infectious diseases caused by MRSA. Due to indiscriminate use of vancomycin to treat MRSA, several strains with variable susceptibility to the same have emerged. Evaluation of Vancomycin Minimum Inhibitory Concentration (MIC) in the MRSA isolates obtained from clinical samples received in the diagnostic microbiology laboratory. About 120 Staphylococci obtained from different clinical samples in the diagnostic Microbiology laboratory, at tertiary health care center, South India, were included in the study. The isolates were identified and susceptibility to the relevant antibiotics was done by Vitek 2 an automated system. Vancomycin MIC was detected by Vitek 2 and E-test strip technique. Out of 120 Staphylococcal strains, 79(65.8%) S. aureus and 41(34.1%) CONS were isolated. Methicillin resistance was observed in 38 (48.1%) strains of S. aureus. Almost all 38 MRSA isolates were vancomycin sensitive with MIC range of 0.5-2µg/ml. Maximum isolates had MIC of 1 µg/ml i.e. 65.78% and 71% by E-Test and Vitek 2 respectively. The reported increased MIC of Vancomycin, though within the susceptible range, might experience poor clinical outcomes. Emergence and spread of resistance to glycopeptides like vancomycin needs to be kept in check by rapidly detecting the strains for resistance and strictly obeying the infection control practices.

Nocardiosis is an acute, subacute or chronic bacterial infection caused by several species of geophilic aerobic bacteria of the genus Nocardia. Cutaneous nocardiosis is an uncommon infectious disease that presents as primary cutaneous infection or as a sequale of disseminated pulmonary nocardiosis. Its rarity and as nocardiosis is not an AIDS defined disease it is often underreported. The global incidence of cutaneous nocardiosis is not exactly known. The frequency of nocardiosis in HIV patients has increased from 0.3 to1.85%. In Immunocompetent persons Primary Cutaneous Nocardiosis is more commonly seen among gardeners and agriculturists. We report a case of extensive primary facial cutaneous nocardiosis due to Nocardia asteroides, in an adult immunocompromised lady who had no pulmonary focus. The lesions were seen as sinus tracts on the zygomatic arch, preauricular and Infraauricular regions. Bacteriological examination of the pus confirmed the presence of N. asteroides. The rarity of the presentation and Cutaneous nocardiosis in India is reviewed.

COVID-19 detection via lateral flow antigen assays (LFA) are rapid and economically acquiescent to infrastructure facile healthcare settings. Early, prompt identification of cases to facilitate patient isolation and supportive management is the essence of rapid diagnostic tests. Given the backdrop of post COVID-19 pandemic-molecular testing still remains a costly affair. Additionally, molecular assays are incapable of distinguishing remnant RNA from replication competent viruses. In this scenario, we explore the diagnostic consonance of SARS-CoV-2 LFAs with RT-PCR cycle threshold, in a likelihood that it could be used as a surrogate marker for infection transmissibility. Rapid COVID-19 LFA results were compared with Real-time PCR for detection of SARS-CoV-2 in nasopharyngeal swabs. Two hundred rapid antigen positive nasopharyngeal swabs obtained from COVID-19 suspects/contacts/preoperative/screening patients were subjected to RT-PCR to study the correlation with cycle threshold (CT) values obtained for all the antigen positive cases. 200 Rapid COVID-19 LFA positive samples were analyzed in the present study. Amidst the LFA positive samples included in the study 187 (93.5%) were found to have concordant results when subjected to the gold standard Real-time PCR. Discordant results were documented in 13 (6.5%) COVID-19 LFA positive samples which were found to be negative by RT-PCR. The average Cycle threshold values were found to be 23.75 for E gene, 25.36 for N gene and 24.07 for RdRp gene. The average PCR Cycle threshold of LFA positive cases remained significantly undeterred (p<0.5) throughout the time period of the study stipulating the undaunted viral load across the different waves of the pandemic. Maximum association of LFA positivity with symptom-manifestation was seen during the 1st wave of COVID-19 (September-December 2020 in India). The association of symptoms with LFA test positivity reduced to a significant extent during the 3rd wave of the pandemic in January 2022 (p<0.5) indicating the reduced clinical severity but not infectivity of the SARS-CoV-2 infection during the 3rd wave of the pandemic. Lateral flow assay based diagnostic tests are technically & economically convenient modalities with significant interest concordance in comparison with RT-PCR. Definitive advantage in terms of achieving quick patient triage and thereby patient management can be achieved with the use of these tests.

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