Scrub typhus is largely ignored in India particularly during outbreaks of viral fever. The disease course is often complicated leading to fatalities in the absence of treatment. However, if diagnosed early and a specific treatment is initiated, the cure rate is high. We report here five cases of scrub typhus to highlight the fact that high clinical suspicion for such a deadly disease is an absolute necessity.

Background & objectives:Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India.Methods:A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2 with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA).Results:IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive.Interpretation & conclusions:The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider Bartonella infection in the differential diagnosis of febrile illnesses and chronic diseases.

Introduction: Clostridium Difficile Associated Diarrhoea (CDAD) is a significant cause of morbidity in hospitalised patients worldwide. The data on clinical epidemiology of this disease in Indian subcontinent is scarce.

Systemic infections caused by Clostridium sordellii are rare. They are usually reported in cases of skin and soft tissue infections and sometimes in cases of toxic shock syndrome involving exotoxins. We report here the first case of Clostridium sordellii infection associated with acute constrictive pericarditis and with pyopericardium and tamponade. CASE REPORTThe patient, an 8-month-old infant, was admitted to a local hospital with a history of about 2 months of fever and an abscess in the right thigh that had developed following hepatitis B vaccination. The abscess was drained, and the pus culture revealed Staphylococcus aureus, for which the patient was given vancomycin intravenously per the antimicrobial susceptibility report. The abscess subsequently healed; however, the patient remained sick, with development of a dry cough and swelling of legs. Echocardiography and chest X-ray results showed a pericardial effusion with an increased cardiothoracic ratio, and the patient was referred to our institute. On admission, the patient was afebrile, with mild pedal edema, tender hepatomegaly, and liver palpable to 4 cm below the costal margin. Routine investigations showed hemoglobin at 12.8 g/dl; total leukocyte count at 14,100/l; differential leukocyte counts of neutrophils at 50, lymphocytes at 46, eosinophils at 3, and monocytes at 1; an erythrocyte sedimentation rate at 5 mm in the first hour; blood urea at 35 mg/dl; serum creatinine at 0.4 mg/dl; serum sodium at 128 mEq/liter; serum potassium at 4.3 mEq/liter; serum aspartate transaminase (SGOT) at 115 U/liter; serum glutamic pyruvic transaminase (SGPT) at 235 U/liter; total bilirubin at 1.8 mg/dl; total protein at 5.1 g/dl; and serum albumin at 2.8 g/dl. The urine output was within normal limits. Central nervous system and respiratory system examinations showed no abnormalities. The patient's heart rate was 128 beats per min. Electrocardiogram showed low-voltage complexes, and echocardiography revealed organized pericardial effusions with features of tamponade. A chest X-ray showed a cardiothoracic ratio of 0.65. A computerized tomography (CT) scan of the chest showed features suggestive of effusive constrictive pericarditis, and a diagnosis of constrictive pericarditis with pyopericardium and tamponade was made. Pigtail drainage of pericardial pus was performed, and the patient was empirically administered intravenous piperacillintazobactam and linezolid. On examination, the pericardial fluid was turbid, with protein at 40 mg/dl; sugar at 45 mg/dl; a total leukocyte count of 2,600/l; and differential leukocyte counts of neutrophils at 90 and lymphocytes at 10. Gram staining on a direct smear showed no organisms, and Ziehl-Neelsen staining showed no acid-fast bacilli. Aerobic cultures of pericardial fluid and blood were sterile; however, pericardial fluid was not sent for anaerobic culture. Meanwhile, the patient had stabilized. A follow-up computerized tomography angiogram showed a localized constriction at the atrioventricular groove, and pericardiectomy wa...

Determination of different carbohydrate and nitrogen fractions was made in tomato (Lycopersicum esculentum Mill.) and mustard (Brassica campestris L.) serving as hosts for Orobanche cernua and O. aegyptiaca respectively. Shoots of Orobanche were also subjected to such analyses. Infection raised the level of total reducing and total sugar in the host with a simultaneous decrease in the level of acid‐hydrolyzable and total carbohydrates in the constituent organs of infected hosts. This has been explained to be due to predominance of hydrolytic activity in the infected host. Infection also brought about a depression in the proportion of sucrose to the pool of total sugar in the host. This was also possibly due to predominance of hydrolytic processes and retardation in the synthetic processes. Higher concentration of acid‐hydrolyzable and total carbohydrates in Orobanche than in the host indicated a high demand for sugars by the parasite. The insignificant differences between the relative proportions of different nitrogen fractions to the pool of total nitrogen in healthy and infected hosts indicated that nitrogen metabolism was not deranged in any way due to infection. Orobanche always had a lower concentration of total soluble and total nitrogen than the host root.