In this era of immune suppression and potential biological warfare, we need to be aware of cutaneous manifestations of relatively uncommon bacterium, their atypical variants, and the early treatment protocols. We present atypical presentation of Indian possible tick typhus diagnosed clinically and confirmed both by biopsy of the lesion and serological tests.

Background: The prevalence of sexually transmitted infections (STI) varies widely from region to region in India. Objective: To study the pattern of STIs and the profile of STI patients with HIV co-infection. Materials and Methods: A retrospective record-based case study of patients attending STI clinic, JNMC, Aligarh, from May 2008 to May 2013 was carried out. Results: A total of 4876 patients attended the STI clinic, out of whom 2764 (56.7%) had proven STI. STIs were more common in men, with a male (2201): female (563) ratio of 3.90:1. Their age ranged from 16 years to 55 years (mean age = 26.38 years) with the maximum number of patients in the age group of 16-25 years. Genital scabies 1466 (53.0%) constituted the most common STI followed by genital warts with 588 (21.2%) of patients. Human Immunodeficiency Virus (HIV) infection was noted in 36 (1.3%) of all STI cases.

Introduction: In the early nineties, infections due to methicillin-resistant Staphylococcus aureus (MRSA) in patients without previous healthcare exposure were reported. The continued evolution of MRSA is illustrated by the infections caused by community acquired MRSA and the majority of these infections are nonlife-threatening infections of the skin and soft tissues. We carried out the retrospective study of bacterial isolates obtained from pus specimens of community-acquired skin and soft tissue infections in our set up with special reference to MRSA. Materials and Methods: The isolation rate of various organisms isolated from pus specimens was recorded for the years 2007 to 2012. The antibiotic susceptibility patterns of S. aureus strains (MRSA and MSSA) were also reviewed. Results: 47.48% of the total pus samples received from patients with a clinical diagnosis of community acquired SSTI during the period of 6 years, that is, from 2007 to 2012, showed culture positivity. Mixed organisms were isolated from five samples. 30.21% of them were S. aureus strains out of which 23.80% demonstrated the presence of methicillin resistance (MRSA). All the MRSA strains (100%) screened from clinical specimens were resistant to penicillin, cephalexin and cefazolin; 40% to erythromycin, clindamycin and amikacin; 80% to gentamicin; 90% to ofloxacin. The isolation rate of MRSA is far outnumbered by that of MSSA that remains fairly sensitive to the first line drugs against S. aureus. Conclusion: Abscesses are the most common clinical presentation caused by CA-MRSA in this study and we recommend that physicians should consider obtaining cultures and antimicrobial susceptibility tests in all such patients.

Background: The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia but have limitations. Materials and Methods: The study evaluated if procalcitonin in community-acquired pneumonia provides prognostic information with the PSI and CURB-65 in sickle cell adult patients. Twenty sickle cell positive adult patients with a clinical and radiographic diagnosis of community acquired pneumonia were scored using PSI and CRUB-65, and measured procalcitonin levels. Results: They were 12 female 60% and 8 males 40%with mean of age 46.0 ΁ 10.26 and were stratified with PSI, CRUB65 and sampled for procalcitonin level for PSI class I (3) patients 15%, class II (10) patients 50%,class III (3) patients 15%, class IV( one) patient 5% & class V (3) patients 15% with mean of 2.55 ΁ 1.276 were CRUB65 0 (2) patients 10% 1 (11) patients 55% two (3) patients 15%, three (4) patients 20%with mean of 1.45 ΁ 0.94 proclacitonin >0.25 (8) patients 40% and >0.50 are (12) patients 60% with mean of 1.098 ΁ 1.346. Conclusion: Procalcitonin levels on admission predict severity of community-acquired pneumonia in sickle cell patients with a similar prognostic accuracy as PSI and CRUB65 and use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients as sickle cell positive patients, further studies must address whether adding PCT to risk scores can increase their safe implementation in clinical practice. This was the scope for patients with sickle cell.

Atypical pathogen, especially Mycoplasma pneumoniae is a common and important pathogen of community-acquired pneumonia. Physicians should pay more attention on them. Compared with bacteria, the clinical treatment of atypical pathogens is different, as beta-lactams are not effective for atypical pneumonia. Therefore, laboratory diagnostic methods and clinical biology research is particularly important for the diagnosis and treatment of atypical pneumonia. In order to provide more theoretical basis for clinical diagnosis of atypical pathogens infection, we performed a review of the research progress of prevalence, laboratory testing of atypical pathogens related infections.

The novel mechanism of action of macrolides was discovered when a significant improvement in the survival of patients with diffuse panbronchiolitis (DPB) receiving low dose of erythromycin was observed, and when their beneficial effect was found to be independent of their anti-microbial activity. Macrolides that are members of the 14- and 15-ring groups show beneficial effects against DPB but not those of the 16-ring groups. We could recognize these effects of macrolides because their administration was associated with reduced inflammatory response in chronic airway diseases including upper- and lower-respiratory tract infections. The anti-inflammatory action of macrolides during infections by bacteria and virus with high virulence has been recently the focus of several studies. Thus, this interesting anti-inflammatory effect of macrolide is currently being assessed not only in the rare condition of DPB but also in common diseases such as viral airway infection. In this review, we will summarize the use of macrolides in common and rare diseases during the past 25 years.