Lingual cysticercosis.

Cysticercosis is a disease caused by larval form of tapeworm. Cysticercus cellulose primarily develops in tissues of pigs. Infection of human tissues is unusual and affliction of the oral cavity is rare. We, herein, present a case of lingual cysticercosis without involvement of any other site. A 5‑year‑old male, non‑vegetarian child presented with a painless, pearly white, solitary nodular swelling on posterior dorsal side of tongue since 3 months. Excision biopsy was done. Histopathology revealed cysticercous cellulose in tongue muscles.

A rare case of Histoplasma fungemia in an AIDS patient.

Disseminated cases of histoplasmosis in acquired immune deficiency syndrome (AIDS) are rarely reported from India. Most of these cases report isolation of this fungus from the bone marrow, lymph node aspirate, spleenic aspirate, and biopsies. We report isolation of Histoplasma capsulatum from the blood of an AIDS patient. A 30-year-old male from Utter Pradesh was admitted with fever, loss of appetite, and nausea since two months. Few intracellular and extracellular budding cells were observed on bone marrow examination on the fifth day of admission. Diagnosis was confirmed by blood cultures taken on the 11th day of admission. Amphotericin B was started, but the patient's condition deteriorated and he died.

Acute necrotizing pancreatitis with pancreatic abscess due to Prevotella species in a diabetic.

Acute pancreatitis occasionally presents as pancreatic abscess with complications like pleural effusion and ascites. There are several pre-disposing factors, the most common being cholelithiaisis, alcohol abuse, infective causes, trauma, and metabolic causes such as diabetic ketoacidosis, while some cases are idiopathic. Here, we report a rare case of acute necrotizing pancreatitis in a 40-year-old male who presented with pain in the abdomen, ascites and left basal pleural effusion. A computerized tomography (CT) scan showed findings suggestive of pancreatic necrosis, with abscess formation and free-fluid surrounding area. The aspirated pus sample was processed for Gram staining and culture, which yielded growth of Prevotella species in an anaerobic culture. Exploratory laparotomy was performed and intra-abdominal collection drained. Necrosectomy of the distal tail and body of the pancreas was performed. The patient was started on antibiotics and along with supportive treatment, responded well.

Hichrom candida agar for identification of candida species.

Chromogenic media are frequently used in direct and rapid identification of yeasts because different Candida species produce unique colors on these media. We used 60 isolates of Candida species including 30 C. albicans, 10 C. parapsilosis, 11 C. glabrata, five C. tropicalis, and four C. dubliniensis, isolated from various clinical specimens, to evaluate the performance of HiChrome Candida agar. These strains had been identified by germ tube test, morphology on cornmeal agar, chlamydospore formation on tobacco agar and sugar assimilation tests. The sensitivity and specificity results were: C. albicans (96.55 and 96.42%); C. parapsilosis (80 and 98.03%), C. glabrata (90.90 and 88.23%), C. tropicalis (100 and 100%) and C. dubliniensis (60 and 96.55%) respectively. HiChrom Candida agaris medium has been useful and capable of presumptive, rapid identification of Candida species within 48 hours.

A rare case of tubercular cerebellar abscess.

Tubercular brain abscess are uncommon and tubercular cerebellar abscess are rarely reported. Most of these cases occur in immunocompromised patients. We report a case of multiple cerebellar abscesses in a 55-year-old HIV seronegative non-diabetic female, who complained of headache, neck pain and unsteadiness of gait since two months. She had been on treatment for pulmonary tuberculosis, diagnosed earlier. Diagnosis was made by CT scan of brain and confirmed by bacteriological examination of drained pus obtained by suboccipital craniotomy. The patient showed signs of recovery.

Uncommon presentation of pulmonary aspergilloma.

Cases of pulmonary aspergilloma without any predisposing factors are rarely reported. Clinical presentation varies from case to case. Here, we report a case of pulmonary aspergilloma in a 60-year-old male patient who was admitted to the Intensive Respiratory Care Unit with spontaneous pneumothorax. The patient had a history of dyspnea on exertion since 9 months and mild haemoptysis since the last 6 months. A computerised tomographic scan of the lungs showed a lesion in the left main bronchus along with obstructive emphysema of the right lung, moderate pneumothorax and mediastinal emphysema. Bronchoscopy was performed and the biopsy samples were processed for histopathological examination and culture on Sabouraud's dextrose agar, which yielded growth of Aspergillus flavus. Repeat sputum samples also yielded the growth of A. flavus . The patient responded to intravenous liposomaamphotericin B and intercostal drainage.

Tuberculous synovitis in a HIV positive patient.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tubercular synovitis of the knee joint in a 30-year-old HIV seropositive male. The diagnosis was done by Ziehl-Neelsen stain and culture on Lowenstein Jensen medium, of the synovial fluid along with the X-ray findings of the knee joint. The X-ray of the chest showed findings suggestive of pulmonary tuberculosis. The patient was responding well to the antitubercular treatment at the last follow up.

Cerebral Candida abscess in an infant.

Brain abscess is uncommon in the pediatric population. Here, we report one such case due to Candida albicans in one-year-old infant, without any predisposing factors. The child presented with progressively increasing size of head circumference. The diagnosis was confirmed by CT scan of brain and microbiological investigations on the drained pus material. The patient responded to combination of surgery (drainage) and intravenous amphotericin B. Neurological development six months after hospital discharge was normal. The organism being a rare cause of cerebral abscess in pediatric population is reported here.

A case of tuberculous pericardial effusion.

Tuberculosis accounts for up to 4% of acute pericarditis and 7% cases of cardiac tamponade. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 30-year-old male who presented with fever, chills, and dry nonproductive cough since one month. The case was diagnosed by radiological findings, which were suggestive of pulmonary tuberculosis, followed by acid fast staining and culture of the aspirated pericardial fluid. The patient was responding to antitubercular treatment at the last follow up.

Phaeohyphomycosis of subcutaneous tissue caused by Phaeoacremonium parasiticum.

Though Phaeoacremonium parasiticum is an unusual cause of human disease, subcutaneous infection, eumycetoma, osteomyelitis, arthritis and even disseminated diseases, such as fungemia and endocarditis have been reported. Here, we report a case of subcutaneous abscess on the forearm due to P. parasiticum in a 26-year-old woman. There were no obvious predisposing factors. The patient was treated with surgical debridement followed by intravenous amphotericin B and itraconazole to which she responded well. We report this case, being rare and the first from India.

Fatal rhino-orbito-cerebral infection caused by Saksenaea vasiformis in an immunocompetent individual: first case report from India.

A 56-year-old female patient presented with history of nasal blockage, nasal bleeding, headache, since one month. On admission the patient developed severe headache, decreased vision of eyes and blindness. Clinical diagnosis of rhino-orbital involvement was confirmed by computerized tomography of the paranasal sinuses. The diagnosis of fungal infection was confirmed by KOH examination, haematoxylin and eosin examination and Gomori's methanamine silver stain of the biopsy material. Diagnosis was confirmed by culture on Sabouraud Dextrose agar, slide culture on Czapek Dox medium and the isolate was identified as Saksenaea vasiformis. The patient was started on intravenous amphotericin B (received only one dose before succumbing), but she did not respond to the treatment, developed hemiparesis, slurred speech, diminished reflexes and ultimately died. The involvement of the brain was confirmed by computerised tomographic scan. We believe this case to be the first case of rhino-orbito-cerebral infection due to Saksenaea vasiformis and that of second case in an immunocompetent patient in the world.

Neonatal septicaemia in a premature infant due to Candida dubliniensis.

Candida dubliniensis is a recently described species that shares many features with Candida albicans. There are very few reports of isolation of this species from bloodstream in adults and paediatric population. Here we report a case of neonatal septicaemia produced by C. dubliniensis in a premature infant admitted to neonatal intensive care unit. The preterm male neonate with a gestational age of 30 weeks and a birth weight of 1.2 kg presented with respiratory distress syndrome for which mechanical ventilation was provided. In spite of receiving antibiotics, the patient developed fever. C.dubliniensis was repeatedly isolated from the blood culture of the patient collected aseptically from different sites. The patient was successfully treated with amphotericin B.

Prostatic abscess by Staphylococcus aureus in a diabetic patient.

Prostatic abscess is uncommon and difficult to diagnose because the clinical presentation may mimic symptoms of lower urinary tract infection. We report here a case of prostatic abscess in a 50-year-old known diabetic male patient, who presented with urinary retention. Clinical diagnosis was done by clinical presentation and ultrasonography. The causative agents i.e., Staphylococcus aureus was isolated from the aspirate and the patient responded to intravenous Ciprofloxacin therapy. No other surgical intervention was required to treat the patient.

Sporotrichoid pattern of cutaneous nocardiasis due to Nocardia asteroids.

Cutaneous nocardiosis is a rare disease, only a few cases of which have been reported from the world as well as in India. This infection, when in the lymphocutaneous form, may clinically resemble sporotrichosis, hence causing a diagnostic dilemma. Here, we report a case of primary cutaneous, sporotrichoid pattern of cutaneous nocardiosis caused by Nocardia asteroides in immunocompetent host. The patient was a 32-year-old farmer, with no predisposing factors, who presented with cutaneous nocardiosis. The diagnosis was confirmed by culture of the biopsy, after which the patient was treated successfully with antibacterial agents.

Thoracic empyema due to Candida albicans.

Few cases of empyema thoracis due to Candida species have been reported from the world and India. A 46-year-old male with esophageal carcinoma, who had taken radiotherapy, presented with fever and dyspnea. The chest X-ray showed findings suggestive of empyema. The diagnosis was confirmed by culturing Candida albicans from aspirated fluid and blood culture. The patient responded to antifungal treatment. High index of suspicion is required to diagnose such rare cases.