Fungal corneal ulcer is common in India due to tropical climate and a large agrarian population that is at risk. Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving lower extremities. We report a rare case of corneal chromoblastomycosis caused by F.pedrosoi, which was successfully treated with topical Amphotericin B followed by a long course of oral antifungal therapy. To the best of our knowledge, this is the first case of mycotic keratitis caused by F.pedrosoi, from the foothills of Himalayas.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has become a global challenge. The shift of this organism form hospital settings to community setting and increasing resistance to non-β-lactams antibiotics have further aggravated the crisis. This trend in MRSA has necessitated the knowledge and sensitization about this agent among physicians in rural and peripheral settings. Material and Methods: Present study was undertaken at Department of Microbiology at rural medical college of North India from January 2017 to December 2019 (3 years). All the clinical samples collected with aseptic precautions were processed as per standard protocol. All the Staphylococcus aureus isolates cultured were subjected to antimicrobial susceptibility testing as per CLSI guidelines 2019. Screening for MRSA was done by CLSI recommended methods, such as cefoxitin disc (30 μg), oxacillin disc (1 μg), and oxacillin screen agar as per CLSI recommendation. Results: A steady increase in number of MRSA isolates was observed from year 2017 to 2019 with overall prevalence being 33.7%. Most MRSA isolates were obtained from pus samples. Cefoxitin disc diffusion method is a dependable detection method compared to oxacillin disc diffusion and oxacillin screen agar for identification of MRSA. Conclusion: The rising trend of MRSA impresses upon the acute need of stringent infection control practices namely strict compliance to hand hygiene, prevention of misuse and overuse of antibiotics and a continuous surveillance program for MRSA. Also sensitization about this agent among the primary health physician is the need of hour to implement the control measures and limit its spread in communities.

A 30-years-old male, driver by occupation, was admitted to neurology department with chief complaints of high-grade fever, intermittent, moderately severe headache lasting for 30 days associated with multiple episodes of vomiting. He had no history of seizures, ear discharge or earache, nor any focal neurological deficit, head trauma, weight loss, chronic cough, drug abuse including steroids, blood transfusion, or high-risk behavior. He did not have any history of cutaneous or respiratory manifestations neither he had any history of tuberculosis, diabetes, malignancy or any other such chronic illness.On examination, the patient was febrile (39°C) and conscious, alert, oriented to time, place and person. Higher motor functions were intact and speech was normal. Signs of meningeal irritation (nuchal rigidity and Kernig's sign) and bilateral papilloedema was present. Examination of other systems revealed no obvious abnormality.Laboratory investigations revealed Haemoglobin of 11mg/dl, raised total leukocyte count (13,000/mm cu.) with 78% lymphocytes. Serum electrolytes, renal function tests, and liver function tests were within normal limits. A Cerebrospinal Fluid (CSF) examination revealed 210 cells/mm 3 , predominantly lymphocytes, with protein 92mg/dl and glucose 22 mg/dl (corresponding blood glucose was 136 mg/dl). A Computerized Tomography (CT) scan of the head and a Chest X-ray were both normal. The CSF specimen was received in laboratory for microbiological investigations such as staining, culture and sensitivity. Macroscopically, the CSF was clear and without coagulum. On microscopy, Gram stain showed round budding yeast cells varying in size [Table/ Fig-1a]. There were no acid fast bacilli on Ziehl-Neelsen (ZN) stain. India ink preparation showed characteristic round budding yeast cells varying in size with distinct halos [Table /Fig-1b]; a bacterial culture was sterile. The CSF Cryptococcal Latex Agglutination Test (CALAS, Meridian Diagnostics, Cincinnati, Ohio) for Cryptococcal Antigen (CRAG) was positive, with a titer of 1:1024. Serum was also tested for CRAG and was positive. A presumptive diagnosis of cryptococcal meningitis was given to the clinicians and patient was promptly put on Amphotericin B and Flucytosine. Subsequently, culture on Sabouraud's dextrose agar yielded smooth colonies of yeast after five days of incubation at 37°C, with no growth at 30°C. With a battery of tests and biochemical reactions performed [Table/ Fig-2], [Table/ Fig-3a and b] the isolate was characterized as C.gattii. Serotyping of the organism was not possible at this point.The anti-fungal susceptibility testing of the isolate was performed by using microbroth dilution technique and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines [1]. The Minimum Inhibitory Concentration (MIC) values for fluconazole, Amphotericin B (Amp B), and voriconazole were ≤ 1 μg/ml, 0.50 μg/ml, and ≤ 0.12 μg/ml respectively. Also E-Test (AB Biodisk, Sweden) was used for Amphotericin B, which show...

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