ABSTRACT
We report a case of pulmonary nocardiosis in an immunosuppressed patient having vasculitis who presented with fever, cough and chest pain. A suspicion of nocardiosis was made on auramine O staining of material procured by CT guided fine needle aspiration cytology right lung. Modified Ziehl-Neelsen staining was useful in confirming the diagnosis. The patient showed remarkable recovery after treatment with co-trimoxazole. Quick identification of this uncommon pathogen in the cytological material using special stains helped in timely diagnosis and successful treatment of the patient.
Subject(s)
Biopsy, Fine-Needle , Immunocompromised Host , Lung Diseases, Fungal/diagnosis , Nocardia Infections/diagnosis , Nocardia/isolation & purification , Benzophenoneidum , Female , Humans , Lung/pathology , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/pathology , Middle Aged , Nocardia/cytology , Nocardia Infections/microbiology , Nocardia Infections/pathology , Staining and Labeling/methodsABSTRACT
Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.
Subject(s)
Amebiasis/diagnosis , Amebiasis/parasitology , Central Nervous System Protozoal Infections/diagnosis , Central Nervous System Protozoal Infections/parasitology , Naegleria fowleri/isolation & purification , Adult , Amebiasis/drug therapy , Amphotericin B/therapeutic use , Animals , Ceftazidime/therapeutic use , Central Nervous System Protozoal Infections/drug therapy , Cerebrospinal Fluid/parasitology , Drug Therapy, Combination , Fatal Outcome , Humans , Male , Rifampin/therapeutic use , Tomography, X-Ray Computed , Treatment RefusalABSTRACT
Central nervous system infection with free-living amoebae is rare. We present a fatal case of Acanthamoeba encephalitis in a 63-year-old female from India where acanthamoebae were demonstrated and cultured from CSF. In spite of treatment with amphotericin B, fluconazole and rifampicin the patient did not survive. Amoebic infection should be suspected in a patient of encephalitis of unexplained aetiology as timely diagnosis can lead to a favourable outcome.
Subject(s)
Acanthamoeba/isolation & purification , Amebiasis/diagnosis , Amebiasis/parasitology , Encephalitis/parasitology , Amphotericin B/therapeutic use , Animals , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Cerebrospinal Fluid/parasitology , Fatal Outcome , Female , Fluconazole/therapeutic use , Humans , India , Middle Aged , Rifampin/therapeutic useABSTRACT
The human urinary tract is able to combat with the microbial invasion under normal circumstances. To cause urinary tract infection the organism has to evade the host defense mechanisms by possessing distinct properties which contribute to the virulence of the organism hence called virulence determinants Ninety percent of uncomplicated urinary tract infections are caused by Escherichia coli, hence the knowledge of the virulence determinants of this organism can be extrapolated to other uropathogenic organism as well. Virulence determinants of uropathogenic E. coli include adhesins, siderophore production, polysaccharide coating, hemolysin production, outer membrane proteins etc. The intestinal E. coli, which are the reservoir of E. coli for causing UTI, lack these virulence determinants. On the other hand these virulence determinants enable the organism to colonize and invade the urinary tract. In addition these are important in acquiring the nutrients in other wise nutrient deficient environment. Further, they also help the organisms in triggering an inflammatory response and hence bringing about pathological changes which leads to symptomatic UTI. Severity of symptomatic infections and tissue damage during the infective process depends upon the magnitude of the inflammatory response triggered by the uropathogen which in turn is dependent upon the amount of extrcellular release of reactive oxygen species by the phagocytic cells; hence role of antioxidants as an adjunct to antibiotics in the treatment of infective process needs to be evaluated further.
Subject(s)
Bacteria/pathogenicity , Reactive Oxygen Species/metabolism , Urinary Tract Infections/metabolism , Urinary Tract Infections/microbiology , Adhesins, Bacterial/metabolism , Humans , Iron/metabolism , Virulence , Virulence Factors/metabolismABSTRACT
Summary A case of mucocutaneous sporotrichosis presenting as mycotic pansinusitis with polyposis with intracranial and intraorbital extension in a patient from Punjab, India is described. The patient had nasal discharge, sneezing and nasal obstruction for 12 years, had undergone repeated surgeries (for endoscopic clearance) but had recurrence. Computerized tomography (CT) and magnetic resonance imaging (MRI) findings revealed pansinusitis. A definitive diagnosis of sporotrichosis was established by culture of Sporothrix schenckii, verification of its dimorphic character and a positive pathogenicity test. The patient was successfully treated with potassium iodide and itraconazole.