Primary Anterior Thoracic Wall Abscess with Osteomyelitis by Salmonella paratyphi A : Case Report.

Salmonella enterica serovar Typhi and Paratyphi have been imputed in the causation of enteric fever. Cardiovascular and extraintestinal Salmonella infections have been documented among immunocompromised individuals. Rarely these pathogens are ascribed in the causation of extraintestinal infections among immunocompetent hosts due to hematogenous seeding. We report a case of anterior chest wall abscess with osteomyelitis in an immunocompetent adult by Salmonella paratyphi A without any prior predisposing conditions or gastrointestinal symptoms. The patient underwent incision and drainage of the loculated pus and the involved costochondral junction was curetted. Medical management was guided by automated antibiotic susceptibility testing. Patient responded well to treatment and was discharged with no residual morbidities. Prompt diagnosis complements appurtenant treatment and thereby averts defunct consequential sequelae.

Health system resilience: Ensuring TB services during COVID-19 pandemic in Kerala, India.

COVID-19 pandemic has affected TB case detection and continuity of care globally. Kerala, the southern Indian state has experienced a reduction in TB notification during second and third quarter of 2020. Through (1) causal analysis (2) meticulous planning and establishment of systems (3) locally customised guidelines (4) better management of resources (5) integration with other programs and (6) good partnership with private sector, Kerala was able to catch up the TB notification and ensure that TB services remain intact even during the COVID-19 pandemic. Approach to catch up TB diagnosis included (1) Field based active case finding among the vulnerable individuals, (2) bilateral screening for TB and COVID-19, (3) enhancement of biosafety in laboratories, (4) strengthening of specimen collection and transportation systems, (5) targeted advocacy and communication to find out missed cases and (6) effective partnership with the private sector. Current experiences also show that TB case finding could be improved and delay in diagnosis could be averted by integrating TB case finding into the screening and testing systems established for COVID-19. The experiences of ensuring TB services during pandemic in Kerala also affirms the importance of maintaining an integrated and strong TB control component in the public health sector and vesting ownership of the TB control programme with the primary health care team. Community-based and community-led responses that take diagnosis, care, and support to the doors of those affected have much potential in delivering TB services in the subsequent years of pandemic.

Neonatal Meningitis with Septicemia by Elizabethkingia meningoseptica : A Case Report.

Elizabethkingia is ubiquitary aerobic bacillus abundantly found in the community as well as hospital environments. Elizabethkingia meningoseptica is an emerging nosocomial pathogen with an elemental ability to acclimate and survive in diversified environmental circumstances. Prompt diagnosis and an early therapeutic intervention are preponderant in the management of these infections. We report a case of meningitis with septicemia caused by E. meningoseptica in a 1-day-old outborn neonate. The child was stabilized with anticonvulsants and, based on laboratory findings, the neonate was started on ciprofloxacin in addition to symptomatic management. The child responded well to the treatment and was discharged on day 7 after treatment initiation. Perceptive treatment protocols backed with accurate laboratory evidence remain instrumental to avert unpropitious outcomes while combatting rare multidrug-resistant opportunistic infections.

Case Report: Pharyngeal Diphtheria in a Pregnant Woman from South India.

Diphtheria is a vaccine-preventable disease and is caused by toxigenic strains of Corynebacterium diphtheriae. Several case reports have been published in the recent years, and this resurgence of cases has occurred mainly in adolescent and adult populations. Also, several research articles have reported waning immunity against diphtheria in adults who have completed childhood immunization. Thus, it is an important need to conduct larger sero-surveillance studies to understand the cause of rising diphtheria cases. Here, we report a case of a 23-year-old pregnant women of 8 weeks' gestation who presented to the outpatient department with fever, severe throat pain, odynophagia, dysphagia, neck pain, and neck swelling of 3 days' duration. On clinical examination, a gray, leathery membrane was noted on the soft palate. An Albert's stain from the membrane revealed organisms resembling Corynebacterium diphtheriae. Appropriate treatment was initiated immediately, and follow-up examination at 2 weeks from date of discharge was uneventful. The gray membrane had completely resolved. Contact tracing was done and the appropriate antimicrobial agent was administered. This case study indicates the importance of timely clinical and microbiological diagnosis and reinforces the previously reported resurgence of diphtheria infection.