Primary amoebic meningoencephalitis is a rare fatal meningitis caused by free living amoeba Naegleria fowleri, found in freshwater ponds and lakes. It infects children and young adults with exposure due to swimming or diving. We report a case of N. fowleri meningitis in a 6-year-old boy who presented with signs and symptoms of acute bacterial meningitis. No history of travelling or swimming was present. However, the boy frequently played with water stored from a "kuhl" (diversion channels of water). Wet mount of cerebrospinal fluid (CSF) revealed amoeboid and actively motile flagellate forms of trophozoites. CSF culture done on 1.5% non-nutrient agar plates with a lawn culture of Escherichia coli kept at 37°C for 15 days did not reveal any growth. The test of flagellation on passing CSF in distilled water was however positive in 3 h. Water of the "kuhl" from the stored tank also showed actively motile trophozoites similar to the forms obtained from the CSF. Based on our reports, the boy was immediately treated with amphotericin B, rifampicin and fluconazole for 21 days. Repeat CSF examination after 14 days did not reveal any trophozoites in wet mount and patient was discharged after 3 weeks of successful treatment.
The genus Naegleria comprises of free living ameboflagellates found in soil and fresh water. More than 30 species have been isolated but only N. fowleri has been associated with human disease. N. fowleri causes primary amoebic meningoencephalitis (PAM), an acute, often fulminant infection of CNS. Here we report a rare and first case of PAM in an immunocompetent elderly patient from this part of the country. Amoeboid and flagellate forms of N. fowleri were detected in the direct microscopic examination of CSF and confirmed by flagellation test in distilled water, demonstrating plaques /clear areas on 1.5% non nutrient agar and its survival at 42°C. Keywords: Meningitis; Naegleria fowleri; primary amoebic meningoencephalitis DOI: http://dx.doi.org/10.3126/joim.v32i2.4949 Journal of Institute of Medicine, August, 2010; 32: 56-59
We describe a case of keratitis with acute presentation and without any history of trauma caused by Scedosporium prolificans; a rare cause of fungal keratitis, from a tertiary care hospital. To the best of our knowledge this is the first such case reported from the region. Because of early diagnosis and prompt treatment the patient could be managed well.
Aim:To evaluate the efficacy of nonoperative treatment in blunt trauma liver.
Materials and methods:A 1-year prospective study was conducted in the Department of Surgery, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India, on 31 patients with blunt trauma with liver injuries proved on ultrasonography (USG) focused assessment with sonography for trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen. Once admitted, patients with grades I or II liver injury with no other comorbidities and other associated injuries were managed conservatively. Patients with grades III, IV, or V liver injury or lower grade liver injury with other associated injuries were observed and monitored strictly. Patients were considered a failure if the patient developed signs of peritonitis.
Results:Out of 83 patients with blunt abdominal trauma, 31 patients fulfilled the inclusion criteria for nonoperative management (NOM). The incidence of blunt liver trauma (BLT) was 37.34% Out of these, one patient required operative management (OM). Average age was 27 years. Out of 31 patients, 25 (80.6%) patients were males and 6 (19.4%) were females. Totally, 24 (77.4%) patients acquired injury due to road side accidents. Totally, 25 (80.6%) patients reported to the hospital within 6 hours of injury and 5 (16.1%) within 7 to 12 hours. On grading of liver injuries depending on CECT findings, 6 (19.4%) patients presented with grade I injury, 7 (22.6%) patients with grade II injury, 11 (35.5%) with grade III injury, and 6 (19.4%) with grade IV injury. Grade V injury was noted in 1 (3.2%) patient. Sixteen patients required blood transfusion. The NOM was successful in 96.8% of the patients. Liver-specific success rate of NOM was 100%. Mean hospital stay was 10.8 days for NOM.
Conclusion:Patients of blunt liver injury who are hemodynamically stable should be considered for NOM.
Clinical significance:The NOM is a highly feasible and safe method for being cost-effective, requiring shorter hospital stay, and avoiding high morbidity.
Extended Spectrum Beta Lactamases (ESBLs) are beta-lactamases that hydrolyze extended-spectrum cephalosporins. They confer resistance to all β-lactam antibiotics with the exception of carbapenems. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins in routine antibiotic susceptibility testing. The detection of ESBL's in 175 clinical isolates of Escherichia coli was done by a screening test, followed by comparison between two confirmatory tests i.e. double disc synergy test (DDST) and the Disc on disc (DOD) test. ESBL production was detected by DDST in 45% and by DOD in 23% of cases. The antibiotic susceptibility pattern by Kirby Bauer technique showed that 54% isolates were resistant to all the six first line antibiotics. Maximum drug resistance with ampicillin and no resistance with meropenem was seen. The results show that there is a high frequency of ESBL producing E.coli in our hospital . We recommend that an appropriate antibiotic policy should be framed in every hospital to check for indiscriminate use of drugs and that ESBL detection by DDST should be mandatory for every laboratory as it a easy and convenient way to detect drug resistance.
The genus Naegleria comprises of free living ameboflagellates found in soil and fresh water. More than 30 species have been isolated but only N. fowleri has been associated with human disease. N. fowleri causes primary amoebic meningoencephalitis (PAM), an acute, often fulminant infection of CNS. Here we report a rare and first case of PAM in an immunocompetent elderly patient from this part of the country. Amoeboid and flagellate forms of N. fowleri were detected in the direct microscopic examination of CSF and confirmed by flagellation test in distilled water, demonstrating plaques /clear areas on 1.5% non nutrient agar and its survival at 42°C.
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