A rare and first report of Ochrobactrum intermedium co-infection in coxsackievirus-A24-infected acute hemorrhagic conjunctivitis patients.

Epidemic form of acute hemorrhagic conjunctivitis was reported from different geographical locations of the world, during 2023. Since the viral agents are well established behind acute hemorrhagic conjunctivitis outbreaks, this study aims to investigate the bacterial agent associated with the acute hemorrhagic conjunctivitis outbreak that occurred in the eastern Uttar Pradesh region of India. The bacterial infection was investigated in 91 conjunctival swabs collected from acute hemorrhagic conjunctivitis patients during the outbreak. Total nucleic acid was extracted from the ocular swab collected from acute hemorrhagic conjunctivitis patients, followed by the detection of human adenovirus and pan-enterovirus using PCR. Further, the isolation of bacteria was performed using these clinical samples. Characterization of the bacterial isolates was done using the VITEK-2 system and 16S ribosomal RNA sequencing. Of 64 conjunctival swabs positive for coxsackievirus-A24 samples, two clinical specimens showed bacterial growth. Both isolates were identified as Ochrobactrum anthropi via VITEK-2 with 93% and 95% confidence levels. While 16S ribosomal RNA analysis characterized the isolates as Ochrobactrum intermedium. Ochrobactrum intermedium is an emerging multidrug-resistant bacterium and is reported to cause a variety of clinical infections. This study first reported the Ochrobactrum intermedium infection in two coxsackievirus-A24 infected acute hemorrhagic conjunctivitis patients.