Leptospirosis is one of the most common zoonotic diseases that are potentially fatal but it is quite under-diagnosed and under-reported. However, acute necrotizing pancreatitis, which is usually associated with high mortality rate, is a rare complication of leptospirosis. This is a report of leptospirosis case presenting with acute pancreatitis. A previously healthy 35-year-old male Indian farmer presented to the emergency department with chief complaints of high-grade fever, chills, and rigors but no rash for the last 3 days. There was no history of a cough, breathlessness, pain abdomen, vomiting, hemoptysis or hematemesis, altered sensorium, or burning micturition. There was no history of any addiction or previous hospitalization. Respiratory, cardiovascular and neurological system examination was normal. Leptospira IgM ELISA was undertaken on the 7 ^th day of admission, which was found to be positive. IgG negative and a Leptospira microagglutination test was also positive (at 1/200, Leptospira icterohemorrhagica) pyogenes. Severe leptospirosis may be fatal before IgM antibody is reliably produced; furthermore, leptospiremia may be difficult to detect due to negative serologic results and blood cultures. Therefore, repeat serology after the 1 ^st week of illness and empirical treatment prior to serologic results may be essential for improving outcome in patients with severe leptospirosis.

Tuberculosis (TB) is one of the known endemic diseases in this part of world; the most common organ involvement is lung. Among extrapulmonary involvements, tubercular lymphadenitis is the most common. Gastrointestinal TB is very uncommon, making up to 3.5% of extrapulmonary TB. Hepatosplenic TB with abdominal tubercular lymphadenitis is very rare form of TB, accounting <1%. We are describing a patient who had lymphoma-like presentation and at the end proved to be a rare form of TB.

Polymicrobial pneumonia may cause by combinations of respiratory viruses and bacteria in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection whereas the colonization by methicillin resistant Staphylococcus aureus coinfection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral coinfection and accounts approximately on 39% of microbiological diagnosed cases of CAP. The emergency of influenza virus H1N1 in 2009 caused the first pandemic in more than 40 years. Several studies found bacterial coinfection in a quarter and one-half of influenza infections, the pathogens more frequent isolates were S. pneumoniae and S. aureus mixed pneumonia in all patient groups. The high rate of viral bacterial infection in CAP, should suggest the consideration of new treatments, also during influenza season, the rapid detection of influenza virus (A or B) may allow physician the effective use of neuraminidase inhibitors within 36-48 h of symptoms onset, reducing the complication of secondary bacterial infection. On the other hand, prevention of mixed infection by influenza and pneumococcal vaccine should be addressed. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: No clinical signs or radiological findings help the clinician to suspicious the diagnosis. In this case series, we report five different cases of severe polymicrobial CAP: All of them required mechanical ventilation: Invasive the first two and noninvasive ventilation the last three cases.

Objective: To evaluate the clinical efficacy and safety of moxifloxacin injection in the treatment of acute exacerbation of chronic bronchitis (AECB) in daily clinical practice. Patients and Methods: From May 2009 to March 2011, a total of 1026 cases with AECB were collected from 43 hospitals in eight cities. All the patients were treated with moxifloxacin (400 mg qd) intravenously. Whether to use oral or sequential therapy was decided by the physicians according to the clinical efficacies. Patient conditions such as combined uses of drugs, efficacies and adverse events were recorded and analyzed. Results: The cure rate of infection was 83.03%, and the total effective rate of moxifloxacin injection was 93.80%. The efficacies were statistically different among subgroups with different ages, complications, forced expiratory volume in 1 s (FEV ₁ %), and combined uses of drugs, respectively. Multivariable logistic regression analysis showed that the advanced age (≥65 years) and severe obstructive pulmonary disease (FEV ₁ <50%) were significantly correlated with the clinical efficacies. A total of 15 cases of adverse events were recorded, and the incidence rate was 1.23%. Conclusion: Moxifloxacin injection can effectively control the infection of AECB patients with fewer adverse events.

Background and Objective: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB, has become a significant public health problem globally. In spite newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from the disease. The present study was aimed to study the prevalence of initial drug resistance and the treatment outcome at the end of 6 months in TB patients attending a dedicated TB outpatient department (OPD) in North India. Materials and Methods: A cross-sectional, observational study was carried out on 100 patients of newly diagnosed pulmonary TB with or without glandular involvement attending TB OPD of a tertiary care hospital over a period of 6 months. Results: Culture positivity was encountered in 82% of the cases, while 14% were smear positive though culture negative. Out of all culture positive patients, 56.1% were susceptible to all antitubercular drugs, while 43.9% were resistant to one or other antitubercular drugs (isoniazid, rifampicin, streptomycin or ethambutol). Of the 46 drug-susceptible cases, 93.48% got cured, while 2.2% defaulted and 2.2% had treatment failure. About 86.1% of the 36 initial drug resistant were cured with 2RHZE/4RH, while 5.6% (n = 2) defaulted treatment and 8.3% were treatment failures. Conclusion: Treatment outcomes of this small group of drug-resistant pulmonary TB patients treated with the standardized regimen was encouraging in this setting. Close attention needs to be paid to ensure early identification of drug-resistant cases; good laboratory methodology and quality control measures; regular supply of quality antitubercular drugs; adherence to the prescribed regimen; effective patient education and counseling; and to the timely recognition and treatment of adverse drug reactions for better treatment outcome.

Intravenous drug use (IDU), initially confined to developed countries, specifically the western countries is no more bound by boundaries. In last few decades, the prevalence has been increased several fold and is a matter of serious concern. IDUs indulge in high-risk activities like sharing of the needle and unprotected sexual activities, which make them more vulnerable to acquired human immunodeficiency virus (HIV) infection (acquired immune deficiency syndrome [AIDS]). They silently spread the infection in the community (other IDUs, spouses and sexual partners). There is an increasing trend of HIV infection/AIDS among intravenous drug abusers across the world including India being no exception. The article highlights the global epidemiological data, specific focus of India.

In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.

In the last few years, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) has become the new gold standard method for the identification of microorganisms. Nevertheless, other useful applications of mass spectrometry have recently been demonstrated including the detection of resistance mechanisms. The MALDI-TOF-MS hydrolysis assay allows rapid detection of β-lactamase activity with results available within a few hours. Rapid detection of β-lactamases is important since β-lactam antibiotics remains as the mainstay of the treatment of several community-acquired and nosocomial infections, and a steady increase has been observed of resistant microorganisms associated with the production of extended spectrum β-lactamases (ESBLs) and carbapenemases. Several studies have reported the high sensitivity and specificity of the MALDI-TOF-MS antibiotic hydrolysis assay for the detection of ESBLs - or carbapenemase-producing Gram-negative bacilli. In addition, this technique can be performed directly from positive blood culture, significantly shortening the time of resistance detection. However, the standardization of assay conditions as well as automatic analysis of the spectra obtained is required. The aim of this review was to summarize the currently available data regarding the accuracy of the detection of β-lactamase activity using the MALDI-TOF-MS antibiotic hydrolysis assay.