Introduction: Cervical lymph node infection due to nontuberculous mycobacteria in a immunocompetent patients are emerging problem globally. It is presented as chronic enlargement of gland with pain and pus discharge sometimes. Traditionally diagnosis is done through clinical examination, lymph node aspirated samples pathological finding or ZN microscopy, which altogether indicate mycobacterial infection only, unable to differentiate MTB from NTM infection.Increasing incidence of LNTB cases not responding to antituberculous treatment prompted us to pinpoint the etiological agent by doing liquid culture of FNA samples in microbiology laboratory. Materials and Methods: In this study 154 cases were recruited having chronic cervical lymph node swelling of suspicion of mycobacterial infection during January - December, 2014. Therein detailed history and thorough clinical examination of patients were reviewed. All patients were subjected for fine needle aspiration (FNA) using 10 ml syringe fitted with 21 G needle. The aspirated samples were subjected to smear microscopy byZiehlNeelsen (ZN) stain examination, May Grunwald - Giemsa stain and MGIT culture. Positive cultures were primarily identified by cord formation in ZN smear examination, detection of MPT-64 antigen by immuno-chromatographic test (Capilia test). Results: A total 154 lymph node samples were received and processed for culture during the study period. Out of total suspects 7/154 (4.5%) were identified as non-tuberculous mycobacterial lymphadenitis. Clinical examination showed that all the seven cases were presented with lymph node swelling and fever and previous ATT history. Other features seen were pain (2/7 28%), pus discharge (3/7 42%) and montoux positive (3/7 42%). The most common species identified was M. chelonae (3/7, 42%) followed by M. fortuitum (2/7, 28%), M. abscessus (1/7, 14%) and M.terricomplex (1/7, 14%). Four patients were managed surgically, one with surgical resection and medical treatment and 2 patients were lost tofollowup. Conclusion: Definitive and detailed microbiological examination is vital for diagnosing the nontuberculous lymphadenitis. M.chelonae is an important etiological agent.NTMs are important definitive etiological agents in cervical lymph node swelling. Clinical and pathological findings help in suspecting the infection.
Pesticides include insecticides, herbicides, and rodenticides. Pesticide poisoning can be intentional, accidental, or occupational. Around 385 million cases of unintentional acute pesticide poisoning occur annually worldwide, with approximately 11,000 fatalities. Herbicides are used to kill weeds and can include chlorophenoxy compounds, bipyridyls, urea-substituted herbicides, organophosphates, and glyphosate. Paraquat is a bipyridyl nonselective contact herbicide with high mortality rates upon exposure in humans. Paraquat poisoning causes acute lung injury, rarely leading to pneumothorax and pneumomediastinum, referred to as Daisley Barton Syndrome. We report a case of a 22-year-old female from Uttarakhand, India, who accidentally ingested paraquat. She was initially asymptomatic, but later developed lung, liver, and kidney injuries as well as pneumomediastinum and pneumothorax.
Organophosphate compounds are used as insecticides in agricultural and domestic settings throughout the world. Acute organophosphorus (OP) poisoning is a major public health issue. Early diagnosis of OP poisoning and prompt atropinization can save lives. Respiratory failure may occur in patients with OP poisoning for many reasons, including aspiration of gastric contents, excessive secretions, pneumonia, and sepsis complicating acute respiratory distress syndrome. Till date, however, spontaneous pneumothorax and pneumomediastinum have not been reported in cases of OP poisoning. This report presents two similar cases of OP poisoning in which spontaneous pneumothorax and pneumomediastinum developed following OP ingestion.
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