ABSTRACT
           Background and Objective: Strongyloides infection is usually asymptomatic in healthy individuals; however, immunocompromised patients are subject to potential hyperinfection involvement. Hereby, we report disseminated and hyperinfection strongyloidiasis in two immunosuppressed patients from north of Iran, an endemic region for Strongyloides stercoralis.
           Case description: After assessment of clinical symptoms, disseminated strongyloidiasis            was identified in the first case with pemphigus vulgaris by the presence of abundant larvae in direct stool smears and gastric biopsy. The second patient had metastatic carcinoma and was hospitalized with complicated symptoms. The infection was diagnosed by detection of numerous first-stage larvae in wet mount stool smears and agar plate analysis. Despite antiparasitic treatment, both patients died during the hospitalization.
           Conclusion: Delayed diagnosis of active strongyloidiasis in immunosuppressed patients can lead to hyperinfection syndrome. Thus, screening for S. stercoralis infection in these patients is recommended in endemic regions to reduce mortalities.
           Keywords: Strongyloides stercoralis, Disseminated strongyloidiasis, Hyperinfection.

Background: Tigecycline susceptibility testing and reporting remain enigmatic due to the lack of established guidelines. Disc diffusion, as a method of performing susceptibility testing, is more widely accepted worldwide due to its ease of use. Limited published literature is available from India on the utility of this method, especially in a cancer care setting. Hence, this study was conducted to evaluate the performance characteristics of disc diffusion by comparing its results with those of the VITEK-2 COMPACT, considering the latter as the standard.
Methods: Disc diffusion was performed using Kirby-Bauer’s method on Mueller-Hinton agar with a HiMedia 15 mcg TGC disc, following FDA and EUCAST breakpoints. According to CLSI criteria, disc diffusion breakpoints can be considered acceptable when categorical agreement is ≥ 90%, the very major error is ≤ 1.5%, and the major error is ≤ 3%.
Results: Using Cohen’s kappa coefficient, the kappa value was 0.328, with a p-value of <0.05. The agreement percentage observed was 60.84%. Two strains reported as resistant by VITEK-2 COMPACT were misclassified as sensitive by disc diffusion, resulting in a very major error rate of 0.76%. A major error rate of 9.5% and a minor error rate of 27.7% were noted, as 25 strains reported as susceptible were identified as resistant.
Conclusion: Since poor agreement was observed, exceeding the acceptable performance rate, the disc diffusion method was unacceptable according to CLSI criteria. There is a gap in uniformity and a lack of streamlined, harmonized TST, which might become an alarming cause for concern.