Rakesh Kumar Mahajan

Fatal Case of Salmonella enterica subsp. arizonae Gastroenteritis in an Infant with Microcephaly

ABSTRACT Salmonella enterica subsp. arizonae is a common gut inhabitant of reptiles, with snakes as the most common reservoir. Though human cases due to this organism are exceedingly rare, it may infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Gastroenteritis is the most common presentation; others include peritonitis, pleuritis, osteomyelitis, meningitis, and bacteremia. We report a fatal case of S. enterica subsp. arizonae gastroenteritis in a 3-month-old child with microcephaly, with a review of earlier cases and problems encountered in identification of this rare human pathogen.

Female genital TB and HIV co-infection

HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeficiency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Case of sparganosis: a diagnostic dilemma.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

Pantoea agglomerans infection behaving like a tumor after plant thorn injury: An unusual presentation

Pantoea agglomerans infections in humans are uncommon. Most common infections reported are septic arthritis or synovitis. We report the case of a 25-year-old, healthy male, who presented with indurated swelling over the posterolateral aspect of his right thigh, associated with pain for one month. Magnetic resonance imaging (MRI) revealed muscle edema with cystic areas in the posterior-most part of the vastus lateralis of the right thigh. The condition was clinically diagnosed as a right-sided benign tumor of the vastus lateralis muscle. However, Pantoea agglomerans was isolated on a culture of the excised muscle tissue. On the basis of the awareness of the common association of Pantoea with penetrating trauma by vegetation, the patient was asked to recollect any prior such injury. He then gave a history of a fall in the field and a plant thorn prick in the thigh four years back, when he was an agricultural worker. We emphasize the importance of Pantoea agglomerans infection of the soft tissues that can have an atypical presentation as a non-suppurative, indurated, muscle cyst in our case. Thorn injuries are usually ignored as trivial incidents, however, Pantoea infections should always be borne in mind when encountering soft tissue lesions, as antibiotic treatment is required for complete resolution of the lesion.

Septic arthritis due to Salmonella Typhi in children—A case series

In this work, we isolated and characterized the first factor X activator from Bothropoides jararaca (= Bothrops jararaca ) venom, Bojaractivase X, which is probably involved in the genesis of the envenomation process. Bojaractivase X was purified by a combination of gel filtration and ion exchange chromatographies on Superdex HR 75 10/30 and HiTrap SP FF, respectively. Bojaractivase X consists of a single polypeptide chain with molecular mass of 28 kDa determined by SDS-PAGE. The enzyme shows maximum activity on factor X activation at pH 7.0 and 37°C. The activator converts factor X to its active form, factor X a , in the presence of Ca 2+ ions. Bojaractivase X also degrades the Aα, Bβ and γ -chain of fibrinogen molecule as well as casein. Inhibition of Bojaractivase X amidolytic activity by benzamidine suggests that it is a serine proteinase. Mass spectrometry analysis showed similarity between Bojaractivase X and a venom serine protease homolog from B. jararacussu .C. parapsilosis and C. orthopsilosis emerged as fungal pathogen with significant worldwide prevalence, particularly in causing nosocomial and skin infections. In this study, we aimed to develop molecular assay based on real-time PCR for sensitive and accurate detection of C. parapsilosis and C. orthopsilosis . A pair of primers that specifically target on both of these yeast species was designed and real-time PCR amplification assay was optimized using EvaGreen as the DNA binding dye. The optimized assay could detect and quantify up to 1 pg concentration of C. parapsilosis and C. orthopsilosis DNA with amplification efficiency of 104% and 103%, respectively. Both the designed primers and the quantitative assay will have a great potential as molecular diagnosis tool for early detection of fungal infection caused by either C. parapsilosis or C. orthopsilosis , which merits future clinical study prior to use in diagnosis.Sirenomelia or the “mermaid syndrome” is a rare entity. Malformations of almost every system have been reported in sirenomelia and it is invariably incompatible with survival; most babies are stillborn, or die shortly after birth. Isolated levocardia is an extremely rare condition in which the heart is located in the normal position while abdominal viscera are inverted .We report a case of symelia unipus having situs inversus of abdominal viscera with isolated levocardia, a ventricular septal defect, bilateral genitourinary agenesis and thoracic vertebral defects.[Abstract] Objective To explore the expression of IL-27, Th17 cells and their related cytokines IL- 17 in peripheral blood of patients with allergic rhinitis (allergic rhinitis, AR). Method 18 Cases of allergic rhinitis patients (10 males, 8 females) whose allergen was dust mite were collected from April to June 2012 as the AR group, and 10 cases of healthy volunteers (4 males, 6 females) without allergic diseases were put into the control group. IL-27 and IL-17 levels in serum of peripheral blood of the two groups were detected by ELISA, and the percentage of Th17 cell was detected by flow cytometry. Result IL-27 levels of AR group and control group were (21.69 ± 12.62) pg / ml and (53.10 ± 12.55) pg / ml respectively, and the difference was statistically significant (P <0.01); IL-17 levels of AR group and control group were (672.82±63.45) pg / ml and (576.62±22.81) pg / ml respectively, and the difference was statistically significant (P <0.01); Th17 cell percentage of AR group was 1.76 ± 0.60%, and in the control group it was 0.59 ± 0.17%. The difference between the two groups was statistically significant (P <0. 01). IL-27 was negatively correlated to Th17 cell and IL-17 (r was -0.361 and -0.435 respectively, P <0 05). Conclusion The reduction of IL-27 level in the peripheral blood of patients with allergic rhinitis, the increase of Th17 cells percentage and IL-17 level, as well as the negative correlation of IL-27 with Th17 cell and IL-17 suggest that decline of IL-27 suppression to Th17 cell may play an important role in the pathogenesis of allergic rhinitis.

An unusual case of reversible mild cognitive impairment

ABSTRACT Mild cognitive impairment (MCI) is cognitive dysfunction greater than expected for age and education in either a single cognitive domain or in multiple domains without impairment of activities of daily living. The present case report describes the case of an elderly male patient of 71 years who presented with MCI and was Venereal Disease Research Laboratory test reactive in serum. This was confirmed by Treponema pallidum Hemagglutination Assay. After a complete course of antibiotic therapy, his memory complaints disappeared completely. Though syphilis is termed as reversible dementia; to the best of our knowledge, this is the first case of MCI with reactive syphilis serology who responded to antimicrobial therapy.

Primary tubercular chest wall abscess in a young immunocompetent male.

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

Antimicrobial Resistance Profile of Bacterial Isolates in Patients of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in India

Introduction: CSOM is a massive public health problem with incidence higher in developing countries like India, especially among low socio-economic society because of malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infections. It is associated with various complications like persistent otorrhoea, hearing impairment, mastoiditis, labyrinthitis, facial nerve paralysis to more serious intracranial abscesses etc. The knowledge of microbiological profile is essential to enable efficacious treatment of this disease & thereby reducing the potential risk of complications. Methodology: This study was aimed to determine the microbial profile & their antimicrobial resistance pattern using Kirby Bauer disc diffusion method among the patients suffering from CSOM between April 2013 to March 2014. Results: Out of 216 samples processed, isolates were Original Research Article Mahajan et al.; IJTDH, 5(2): 165-169, 2015; Article no.IJTDH.2015.017 166 seen in 145 (67.1%) cases with male to female ratio of 1.5: 1 and age group affected was 10-20 years. Most common organism isolated was Pseudomonas spp. (49%) followed by S. aureus (35.9%). Pseudomonas spp. showed high degree of resistance to gentamicin (57.7%) and ciprofloxacin (53.5%). Also, S. aureus was found resistant to ciprofloxacin (61.5%) and cotrimoxazole (40.4%). Conclusion: Management of CSOM consists mainly of eradicating infection and closure of tympanic membrane. Periodical monitoring of bacterial isolates and their antibiotic susceptibility pattern is necessary for administering appropriate antibiotics for empirical treatment and also helps in reducing the potentially disabling and fatal complications of CSOM.

Ludwig's angina by Salmonella Typhi: A clinical dilemma

Salmonella Typhi has rarely been associated with focal abscesses; and in literature, there is no evidence of its association with abscesses in the neck spaces. Ability of Salmonella Typhi to invade and localise in the neck spaces not only poses a diagnostic challenge but also underscores the necessity to understand the mechanisms that facilitate Salmonella Typhi to establish infections at sites completely non-traditional to the organism.

Pyogenic liver abscess caused by Salmonella Enteritidis: A rare case report

Salmonella Enteritidis is one of the most important serovars transmitted from animals to humans and a serovar most commonly reported worldwide. Infection with Enteritidis is mainly limited to the intestinal tract, but under certain circumstances may cross the mucosal barrier to disseminate and get established as some localized infectious focus. Although cited as one of the very uncommon causes, Enteritidis may involve the liver and evolve into an overt abscess. Pyogenic liver abscess by a gas forming organism like Enteritidis usually follow a serious fulminant course and associated morbidity and mortality is unacceptably high unless immediate therapeutic interventions are initiated.