orynebacterium diphtheriae is well known as an agent of localized respiratory tract disease potentially complicated by systemic effects of exotoxin. The non-toxigenic strains can produce atypical manifestations of the disease as they are able to cause diseases such as mild diphtheria-like pharyngitis, cutaneous infections, septic arthritis, abscesses, septicemia, and infective endocarditis (IE) [1]. IE is a grave disease with a high incidence of complications and adverse events. IE caused due to the non-toxigenic strain of C. diphtheriae is uncommon. However, there have been increasing numbers of reports of IE being caused by this organism [2]. The current vaccine against diphtheria contains the toxoid, so it protects only against the toxigenicity but not the invasiveness of C. diphtheriae. 1 Most of the patients with C. diphtheria endocarditis have underlying cardiac diseases, especially prosthetic heart valves [3]. Pathogenic mechanisms of non-toxigenic C. diphtheriae is not well known, and a possible mechanism may be related to an increased ability to adhere to vascular endothelium. It is a universally fatal disease if left untreated with nearly 100% mortality. CASE REPORT A 34-year-old prosthetic valve in situ male patient who underwent double valve replacement surgery in 2005 presented to our hospital with a 1-week history of high-grade fever with rigor and chills. He woke up 1 day noticing that the entire visual field (both eyes) was obscured. This prompted him to come to the emergency department. No other non-visual neurologic symptoms were present. He was a chronic alcoholic and was on oral anticoagulants. On general examination, he was conscious and alert. His temperature was 100.5°F, blood pressure 140/80 mmHg, and pulse rate 80/min. Ophthalmic examination revealed only light perception with both eyes and apparently normal fundus. Investigations revealed that the total leukocyte count was elevated with neutrophil predominance, and erythrocyte sedimentation rate was also elevated. To rule out the acute cerebrovascular accident, plain axial computed tomogram head was done, which could not detect any intracranial pathology. Echocardiography showed normally functioning valves and small particles in the left ventricular outflow tract and the left ventricle. Suspecting prosthetic valve endocarditis (PVE) for the patient, three blood culture samples were taken and sent to our laboratory. Two samples were taken on the 2 nd day of admission and the third sample on the following day after starting the empirical antibiotics. The patient's vision got restored on the 2 nd day of admission to the hospital without any interventions. The blood culture samples were incubated in an automated BacT/ALERT (bioMerieux) blood culture system. After 24 h of incubation, the two samples, which were taken on the 2 nd day, flagged positive and Gram staining showed Gram-positive bacilli ABSTRACT Corynebacterium species or "diphtheroids" are often considered as non-pathogenic components of the normal skin flora when isolated from blo...
Introduction: Various emerging and re-emerging infectious diseases have made the existence of mankind in this world a great challenge. In the midst of these havocs, some important diseases has undermined in the dark. Brucellosis is an endemic zoonotic disease in most of the developing world and it has far-reaching and deleterious effects on humans and animals alike. In humans, brucellosis shows a variety of non-specific clinical signs. To recognise and diagnose this neglected but debilitating disease, the awareness and alertness of medical personnel has to be enhanced. Aim: To determine the prevalence of brucellosis in Tertiary Care Hospital. Materials and Methods: A retrospective study was conducted from June 2011 to May 2019, all culture proven cases of human brucellosis admitted in a Tertiary Care Hospital in central Kerala, India were reviewed. Demographic data, clinical presentations, laboratory parameters, treatment and outcomes of the same were analysed in Microsoft excel sheets as percentages. Results: Of the 12 culture proven Brucella cases, 11 presented as Pyrexia of Unknown Origin (PUO) cases and one was a soft tissue infection. Eleven patients had history of either consumption of unpasteurised milk products or had contact with animals before the symptoms developed. A 75% cases were imported cases from middle-east countries. In one case the route of entry was by close personal contact probably sexual transmission. All the patients complained of fever and malaise (100%), while low backache and arthralgia was noted in 83%. Most common clinical and laboratory findings associated with brucellosis were hepatosplenomegaly (41.7%) and anaemia (66.6%). Oral doxycycline for six weeks combined with either aminoglycoside or rifampicin was used for treatment. There was no death or relapses noted. Conclusion: This study emphasises the close collaboration of an alert clinician and an experienced microbiologist to correctly diagnose and treat an infection with multiple presentations as brucellosis, in endemic areas also.
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