Fever of Unknown Origin Attributable to Haematocolpos Infected with Salmonella enterica Serotype Typhi Resistant to Nalidixic Acid: A Case Report.

The prevalence of nalidixic acid-resistant Salmonella Typhi (NARST) infection is increasing worldwide. We are reporting an unusual case of infected haematocolpos presenting as urinary obstruction in a patient with fever of unknown origin (FUO). This case report highlights the importance of quinolone-resistant typhoid fever in the differential diagnosis of any acute febrile illness in countries, like India, where Salmonella infection is endemic.

Conjunctivitis in the newborn- A comparative study.

Background: Conjunctivitis of the newborn is defined as hyperemia and eye discharge in the neonates and is a common infection occurring in the neonates in the first month of life. In the United States, the incidence of neonatal conjunctivitis ranges from 1-2%, in India, the prevalence is 0.5-33% and varies in the world from 0.9-21% depending on the socioeconomic status. Aim: To study the organisms causing conjunctivitis of the newborn and to correlate the etiology with the mode of delivery. Design: Single center, prospective, observational study. Materials and Methods: A total of 300 mothers and their newborns, born over a period of one year, were included in the study. Of these 200 newborns were delivered through vaginal route (Group A) and 100 (Group B) delivered by lower segment caesarean section (LSCS). At the time of labour, high vaginal swabs were taken from the mothers. Two conjunctival swabs each from both eyes of the newborn were collected at birth and transported to Microbiology department in a candle jar immediately. Results: Eight babies in Group A, developed conjunctivitis at birth. None of the babies in Group B developed conjunctivitis, this difference was statistically highly significant (P<0.000). The organisms found in the conjunctiva of the newborns in Group A were Coagulase negative Staphylococcus, α hemolytic Streptococcus, Escherichia coli and Pseudomonas spps. However, the commonest organism leading to conjunctivitis in the newborn in this study was Coagulase negative Staphylococcus. It was observed that the mothers of 5 out of 8 babies (60%) developing conjunctivitis gave history of midwife interference and premature rupture of membranes so the presence of risk factors contribute to the occurrence of conjunctivitis in the newborn. Conclusions: It is inferred that the mode of delivery and the presence of risk factors is responsible for conjunctivitis in the newborn.

Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal.

This pilot case-control study at a tertiary-care hospital over a four-month period was aimed at evaluating the possible usefulness of screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virus) in females with bad obstetric history. The study included 12 women with bad obstetric history and a similar number of matched controls with previous normal pregnancies. A serological evaluation of TORCH infections was carried out by detecting IgG and IgM antibodies against these infections by ELISA test-kit. Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study. Ten (83.3%) of the 12 cases with bad obstetric history and two (16.7%) of the 12 healthy controls were serologically positive at least for one of the TORCH agents. The seropositivity rate in women with bad obstetric history was quite high compared to that in the normal healthy controls. The results suggest that a previous history of pregnancy wastage and the serological evaluation of TORCH infections during current pregnancy must be considered while managing cases with bad obstetric history.

A Study of Clinical Profile and Spontaneous Course of Eosinophilia

Aim of the study was evaluation of symptoms and signs in patients with eosinophilia, to try to find its etiology and to study the natural course of eosinophilia during the period of study. Fifty patients with absolute eosinophil count (AEC) more than 350/mm3 or differential count more than 3% irrespective of their age, sex and medical condition were included. The patients were divided into mild (AEC-350 to 1500), moderate (1500 to 5000) and severe (>5000/mm3 of blood) eosinophilia. They underwent a series of routine and special hematological and biochemical investigations including bone marrow aspiration, serum IgE estimation, and pulmonary function tests. The patients were studied for a period of 3 months. Most of the patients (52%) fell in the category of mild eosinophilia. Minimum AEC at the entry of patients into the study was 600 and maximum was 22500. Commonest presenting symptoms were anorexia (40%), pain abdomen (38%), fever (32%), and breathlessness (30%). Etiology of eosinophilia was undiagnosed in 70% of the patients. Parasitism was more common than allergic rhinitis and bronchial asthma. On follow up investigations, eosinophilia resolved on its own even without specific antieosinophilic treatment. Extensive work up of patients was not associated with significant change in the management of any patients with eosinophilia. The etiology of eosinophilia remains unrevealed in majority of the patients. Extensive work up of patients with eosinophilia is not recommended.

Cladosporium bantianum meningitis in a neonate.

Cladosporium bantianum meningitis has been reported mostly in adult farmers between 20 and 30 years of age. We report a 6-day-old male neonate who was admitted with fever, focal seizures and not accepting feeds. Initial investigations suggested a diagnosis of pyogenic meningitis but antibiotic therapy for 14 days did not result in any significant clinical improvement. Repeat CSF examination after 14 days suggested a diagnosis of C. bantianum meningitis which was supported by presence of multiple abscesses in the cerebral cortex on CT scan of the head and confirmed by CSF culture. Clinical response to antifungal therapy remained unsatisfactory.