Introduction: A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae (K. pnuemoniae) had emerged. It has shown ability to cause serious infection in healthy ambulatory hosts as well as infect unusual sites. Though there have been numerous studies on severe infection by K. pneumoniae, little data has been documented on such infections involving Klebsiella oxytoca. (K. oxytoca). It is capable of causing metastatic spread of the infection even in healthy young individuals. This report was written to describe the clinical spectrum of a case of metastatic Klebsiella infection. Case presentation: We illustrate a case of a 73-year-old diabetic and hypertensive female presenting with headache and eye discharge. She was initially managed as the case of conjunctivitis as out-patient. After three weeks of topical ophthalmic antibiotics, she developed decrease in sensorium leading to her eventual admission. Workup pointed towards a disseminated infection to the eye, brain, and urinary tract. The patient was placed on broad-spectrum antibiotics and a vitreous tap was done. However, the patient’s sensorium decreased further, and was eventually intubated and started on inotropes. The indolent course of the disease, which unfortunately led to the demise of the patient, directed the attending physicians to suspect a more virulent infection. Discussion: Infection by hypervirulent variant of Klebsiella has been classically known to be nosocomial and opportunistic in nature. But cases have also been reported from the community setting. A common denominator in this population is that they are usually immunocompromised as in the case of our patient being elderly and diabetic. Unfortunately, there are no molecular or biochemical markers being used in the clinical setting to identify this strain. Hence, the attending physicians had to rely on the presentation of metastatic disease to diagnose our patient. Conclusion Early diagnosis, appropriate antibiotic treatment and drainage are keys in the management of these cases.
Infections

No abstract available.
Cytomegalovirus Infections*

No abstract available.
Salmonella Infections*

No abstract available.
Salmonella Infections*

No abstract available.
Cytomegalovirus Infections*

No abstract available.
Nocardia Infections*

No abstract available.
Cytomegalovirus Infections*

No abstract available.
Pneumococcal Infections*

Coxsackievirus A16 (CV-A16) is the leading cause of hand-foot-mouth disease (HFMD), which usually presents as mild and self-limiting symptoms in young children. Rarely, CV-A16 has been reported to cause severe and fatal neurological complications but little is known about these complications. In the present study, 1-day and 7-day old mouse models of CV-A16 were developed using a clinical strain via subcutaneous inoculation. All infected mice exhibited clinical signs of infection, including reduced mobility, limb weakness and paralysis between 3 to 6 days post-infection. Pathologically, the main organs involved were the central nervous system (CNS), skeletal muscles and brown fat. In the CNS, viral antigens as demonstrated by immunohistochemistry, were localized mainly to neurons in the brain stem and spinal cord, suggesting that CV-A16 is neurotropic although inflammation is very mild. The skeletal muscles showed necrosis and myositis due to viral infection as evidenced by the dense viral antigens. Focal viral antigens were also detected in the brown fat. These preliminary pathological findings indicate that our mouse models can be further developed to be useful models for pathogenesis studies, and vaccine and anti-viral drug evaluation.
Coxsackievirus Infections

Supranuclear ocular movements comprise mainly vertical and horizontal movements. Vertical movements are controlled by the centres located mainly at the rostral midbrain and horizontal movements at the level of the pons.1 Pontine tegmental lesions usually present with gaze palsies, internuclear ophthalmoplegia (INO), abducens palsy and one and a half syndrome. Usually, one and a half syndrome is produced by a unilateral caudal pontine tegmental lesion that includes the paramedian pontine reticular formation (PPRF) and medial longitudinal fasciculus (MLF) on the same side causing horizontal gaze palsy in one eye and INO in the other eye.2 Similarly, vertical one and a half syndrome has also been described. The literature on co-existence of horizontal and vertical one and a half syndrome is few. The co-existence of horizontal and vertical one and a half syndrome with ocular tilt reaction (OTR) has not been reported so far. Here, we report a patient who presented with left horizontal one and a half syndrome along with bilateral conjugate upgaze palsy and right downward palsy suggestive of vertical one and a half syndrome and left ocular tilt reaction. Magnetic resonance imaging (MRI) brain revealed infarct in left rostral midbrain with sparing of pons
Eye Infections