An intertidal mollusk found in a boy's skin abscess.

Skin abscesses are commonly seen by primary care physicians in the outpatient setting. The majority of these soft tissue infections arise from penetration wounds by inanimate objects, but rarely, a living organism may present as a contributing factor. We present a case of an 11-year-old boy with an unusual skin abscess containing a chequered periwinkle marine snail (Littorina scutulata). The unique characteristics of this intertidal mollusk appear to have enabled it to survive in the subcutaneous tissue for a week, despite the hostile environment of a skin abscess. This case emphasises adherence to current professional guidelines that recommend incision and drainage of suspected skin abscesses and encourages clinicians to take a careful history of present illness which may aid in identification of subsequent cases of marine snails, or other living organisms, residing in skin abscesses.

Human subcutaneous dirofilariasis in India: a report of three cases with brief review of literature.

Human subcutaneous dirofilariasis is a rare infection caused by filarial worms of the genus Dirofilaria. The parasites are transmitted to man by mosquitoes and the infection is manifested as subcutaneous nodules. Excision of the lesion is both diagnostic and therapeutic. Hereby we report three cases of human subcutaneous dirofilariasis. The worms were sent to our department for identification over a period of four years (2006-2009). Of these three patients, two men and one woman were between 15 and 45 years of age. In two cases, the infection manifested as a nodule on face, in one case near lower eyelid and in the other on the cheek, while in the third case as an itchy nodule on the abdomen. It is emphasized that both clinicians and microbiologists should have an increased awareness of this entity and include dirofilariasis in the differential diagnosis of patients presenting with subcutaneous nodules.

Dilemmas in cytodiagnosis of subcutaneous swellings: mimics and look-alikes of cysticercosis.

BACKGROUND: Fine needle aspiration (FNA) is the modality of choice in the initial characterisation of subcutaneous swellings. The site, distribution, number and clinical association of such swellings determines to a large extent the clinical diagnoses rendered in these cases. AIMS AND METHODS: 15 unusual cases of subcutaneous cysticercosis, diagnosed by FNA, which clinically simulated diverse aetiologies, are reported. RESULTS: Three cases occurred in patients with known malignancies which were thought to be metastatic deposits. In another nine cases the clinical diagnoses included lymphoma, squamous cell carcinoma, neurofibroma and lipoma. Two cases strongly mimicked tubercular lymphadenitis, while one case occurred in a renal transplant recipient. CONCLUSIONS: FNA may help diagnosis of a parasitic aetiology in cases where malignancy or tuberculosis is a clinical probability. Cysticercosis should be an integral part of the differential diagnosis of all subcutaneous swellings, regardless of the clinical setting. Helpful cytological clues are discussed.

An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis.

BACKGROUND: Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis. OBJECTIVE: The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis. MATERIALS AND METHODS: It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated. RESULT: There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in fi ve of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in fi ve cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles. CONCLUSION: Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis.

[Unusual localization of echinococcosis in Cukurova (134 cases)]. / Cukurova Yöresinde Seyrek Yerlesimli Ekinokokkozis (134 olgu ).

Echinococcosis is a parasitic disease frequently occurring in societies where agriculture and raising animals are common. In Turkey, it is more commonly observed in eastern and middle Anatolia and in Marmara and Trakya regions. While there is a high rate of occurrence in the liver and lungs, Echinococcosis can occasionally be present in other tissues and organs. In this study which was carried out in the Cukurova region, we found 962 echinococcosis cases in a ten year period. Of these, 134 (13.9%) were located outside the liver and the lung. Our aim was to determine the rate of unusual location of echinococcosis cases in our region and draw attention to the issue.

Cysticercosis of soft tissue.

Cysticercosis is a systemic illness caused by dissemination of the larval form of the pork tapeworm, Taenia solium. A high prevalence has been reported from the developing countries because of the co-existence of poor sanitary conditions and domestic pig raising. Human cysticercosis occurs when eggs are ingested via faecal-oral transmission from a tapeworm host. The human then becomes an accidental intermediate host, with development of cysticerci within organs. Cysticercosis is a preventable faeco-oral transmitted infection and it is possible to prevent infection by avoiding undercooked food and pork (which is an unlikely cause in muslim countries), and, water contaminated with human faeces.

Primary soft tissue hydatidosis: aspiration cytological diagnosis in two cases.

The most common sites of cysts caused by hydatid disease are liver and lung. In the absence of visceral involvement, the disease rarely affects musculoskeletal and soft tissues. In such locations, hydatid cyst mimics commoner soft tissue tumors. A 12-year-old girl presented with a gradually increasing painless right shoulder swelling. With a clinical diagnosis of lipoma, fine needle aspiration cytology was performed, which showed cytomorphological features of a hydatid cyst. Another patient, a 20-year-old man, presented with a right paravertebral soft tissue swelling. Radiological investigations did not reveal any bony abnormality or features of intervertebral disc prolapse and thus, a clinical diagnosis of a paravertebral soft tissue tumor was considered. Fine needle aspiration from the soft tissue swelling showed laminated membrane, compatible with hydatid cyst. No visceral involvement was detected in either of the cases. Parasitic cysts, although rare, should be kept in the list of cytological differential diagnosis of soft tissue lesions. Occurrence of hydatid cyst in a soft tissue location is extremely rare. Aspiration cytology can be used efficiently in the diagnosis without the risk of spillage of contents.

Laboratory diagnosis of bone, joint, soft-tissue, and skin infections.

The diagnosis of infections of bones, joints, skin, and soft-tissues requires the combined use of a number of laboratory and pathology tests. The diagnosis of most infections requires microbiological cultures, both for isolation and for identification of causative organisms, as well as for antimicrobial susceptibility testing. Chemical analysis of joint fluids and histopathologic examination of infected tissues are often necessary to distinguish infections from other causes of inflammation, as well as to provide information as to the type of infection before the results of cultures are available. At this time, the use of molecular amplification tests is of limited value in the diagnosis of these infections, their value primarily being as adjunct tests for the diagnosis of rare or unusual infections.

A varied presentation of hydatid cyst: a report of four cases with review of literature.

Contrary to the popular perception, hydatosis does not remain restricted to certain geographical locales but is a global health concern, particularly in the rural countryside. Although liver and lung involvement account for the majority of the lesions, primary breast, bone, kidney and soft tissue hydatosis with features of cystic echinococcosis are extremely rare. We report four such rare cases of cystic echinococcosis which were diagnosed and treated in our institute.

An audit on pediatric hydatid disease of uncommon localization: incidence, diagnosis, surgical approach, and outcome.

BACKGROUND/PURPOSE: Infestation of sites other than the liver and lungs by the parasite Echinococcusgranulosus is rarely encountered in clinical practice. The present study aims to determine the incidence of hydatid disease of uncommon localization in children and to document the clinical and radiologic findings, the types of the operations performed, and the postoperative course of the disease. METHODS: A retrospective review of the demographical data as well as preoperative and postoperative clinical findings of children who underwent surgical treatment of hydatid disease was done. RESULTS: Hydatid disease of uncommon localization was encountered in 15 (7%) of 207 children reviewed. The sites in which the cysts were located were as follows: spleen (n = 4, 1.9%), kidney (n = 4, 1.9%), retroperitoneum (n = 3, 1.4%), omentum (n = 2, 1%), anterior abdominal wall (n = 1, 0.5%), and anterior thigh (n = 1, 0.5%). Radiodiagnostic tools such as ultrasonography were used in all. Partial pericystectomy was the surgical procedure of choice in most cases. There was 1 recurrence in a patient with splenic disease, with no mortality. CONCLUSIONS: Pediatric hydatid disease can involve any body part. Radiologic imaging techniques are helpful in diagnosis. Surgery should aim to preserve as much tissue as possible while precautions to prevent recurrences are undertaken.

Hyperbaric oxygen therapy reduces the size of Leishmania amazonensis-induced soft tissue lesions in mice.

In this study we determined whether exposing mice to hyperbaric oxygen (HBO) would alter various disease parameters of a susceptible mouse strain infected with Leishmania amazonensis. BALB/c mice exposed to HBO (100% O2 at a pressure of 2.5 ATA, 1h before parasite inoculation and subsequently for 20 days) showed significant delay in lesion development and reduction in lesion parasite burdens compared with HBO-unexposed mice. Circulating levels of interferon gamma (IFN-gamma) and tumor necrosis factor (TNF-alpha) were significantly elevated in HBO-exposed as compared to HBO-unexposed mice. Concanavalin A-stimulated lymph nodes cultures from HBO-exposed mice released significantly more IFN-gamma and less interleukin 10 (IL-10) than cultures from HBO-unexposed mice, consistent with a skewed Th1 response. These results demonstrate, for the first time, that HBO can play a pathogen control role during leishmaniasis. Further studies are needed to elucidate whether hyperoxia alone or increased atmospheric pressure alone can exert a similar effect.

Unusual sites of hydatid cysts in India.

Hydatid disease usually affects liver and lungs, but may affect any organ, posing a diagnostic and therapeutic dilemma. We analysed 110 patients with hydatid cyst over 21 years in our general surgical unit, which included 24 cases in unusual sites. The spleen was the most common, followed by skin and soft tissues.