Lumpy Bumpy Weepy Face - A Rare Case Report of a Frequently Misdiagnosed Disease

.Infectious clinical conditions that can present with swellings and sinuses more commonly, include cutaneous tuberculosis, and subcutaneous and deep fungal infections. One of the differentials that should be considered in such a scenario is actinomycosis. Actinomyces are filamentous gram-positive bacteria that are facultative anaerobes which can form endospores. The individual bacterium is rod shaped filamentous organism. After its discovery in 1890, a misconception was that it is a mycosis that affected individuals who chewed grass or straw. The pathogen is still known as the ‘great masquerader’.1Many entities can mimic cutaneous mycobacterial infections and deep cutaneous mycosis. One such great mimicker is actinomycosis – a bacterial infection caused by Actinomyces israelii. Though it is sensitive to many antibiotics, the duration of treatment for effective clearance of the lesions is long.

Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India, 2006.

Outbreaks of cholera are common in West Bengal. In April 2006, Garulia municipality reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of >3 loose/watery stools a day among the residents of Garulia since April 2006. We searched for cases of diarrhea in health care facilities and health camp. We conducted a gender- and age-matched case–control study to identify risk factors. We inspected the sanitation and water supply system. We collected rectal swabs from diarrhea patients and water specimens from the affected areas for laboratory investigation. Two hundred and ninetyeight cases of diarrhea were reported to various health care facilities (attack rate: 3.5/1000, no deaths). The attack rate was highest among children (6.4/1000). Vibrio cholerae El Tor O1 Inaba was isolated from two of 7 rectal swabs. The outbreak started on 10 April 2006, peaked on 26 April and lasted till 6 May. Cases clustered in an area distal to leaking water pipelines. Drinking municipal water exclusively was significantly associated with the illness (OR 13, 95% CI=6.5–27). Eight of the 12 water specimens from the affected area had fecal contamination and poor chlorine content. This outbreak was due to a contaminated municipal piped water supply and V. cholera 01 Inaba was possibly the causative organism.