Suppurative supraclavicular bacille calmette-guerine lymphadenitis--a case report, awareness and management options.

Diagnosis of Bacille calmette-guerine (BCG) adenitis is clinical. Conventional laboratory tests do not differentiate BCG adenitis from tuberculous adenitis. We report a case of a 3-month-old healthy baby presenting with suppurative BCG adenitis. FNAC revealed AFB on ZN-Staining, later confirmed to be Mycobacterium bovis by multiplex PCR. The treatment of suppurative BCG adenitis is needle aspiration. Anti-tubercular treatment is unwarranted.

Intestinal myiasis.

PURPOSE: Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces. This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man. They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe. The condition is not uncommon and is often misdiagnosed as pinworm infestation. Correct diagnosis by the clinical microbiologist is important to avoid unnecessary treatment. MATERIALS AND METHODS: We had 7 cases of intestinal myiasis. In 2 cases the larvae were reared to adult fly in modified meat and sand medium (developed by Udgaonkar). This medium is simple and can be easily prepared in the laboratory. RESULTS: Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans. CONCLUSIONS: S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

Asymptomatic, isolated tubercular splenic abscess, in an immunocompetent person.

Tubercular splenic abscess in an immunocompetent person, especially when the patient is without any symptoms, is a rare clinical entity. We report a case of isolated tubercular splenic abscess in a 38-year-old asymptomatic healthy female and emphasize the importance of careful smear examination. The patient had come to the hospital for repair of vaginal vault prolapse. Her abdominal ultra sonography showed normal sized spleen with hypoechoic areas suggesting abscess. Fine needle aspiration of splenic lesion revealed tubercle bacilli on Ziehl Neelsen stain. The organisms also grew on culture. The splenic lesions cleared after six months of treatment with anti tubercular drugs at our Directly Observed Treatment centre under Revised National TB Control Programme. The patient was operated successfully for vault prolapse one year later.

Multidrug resistant non-typhoidal Salmonella infections.

Over a period of 2 years, 28 patients admitted to Government General Hospital (GGH), Sangli (which is attached to Government Medical College (GMC), Miraj) yielded multi-drug resistant non-typhoidal salmonellae from their clinical material. The pediatric age group predominated in the study, accounting for 93% of cases. Salmonella typhimurium was the main isolate (86%), the other being Salmonella newport (14%). Gastroenteritis was the commonest presentation. Septicaemia was seen with 100% mortality, in infants below 1 month of age. Two cases of meningitis were also seen.

Incidence of hepatitis B surface antigen in liver diseases and voluntary blood donors.

A total of 5,606 samples were collected during January 1978 to December 1983. Out of which 4,900 were of voluntary blood donors, 564 of acute hepatitis, 130 of liver cirrhosis and 12 from hepatocellular carcinoma cases. All these samples were studied by counter immune-electro-osmophoresis (CIEP) for the presence of hepatitis B surface antigen (HBsAg). The HBsAg were detected in 40 samples from voluntary donors (0.8%), 122 cases of acute hepatitis (21.6%), 20 cases of liver cirrhosis (15.3%) and 2 cases of hepatocellular carcinoma (16.6%).

Clinicobacteriological study of gas gangrene.

Out of 1040 cases of road side crush injuries 14 cases (1.3%) who developed gas gangrene clinically were studied bacteriologically. Clostridia accounted for 6 (42.86%) cases and non-clostridial anaerobes and aerobes for 4 (28.57%) cases each. Clostridium perfringens was found to be the commonest isolate but non-clostridial anaerobes and aerobes also formed a sizable number. It was concluded that for prevention of gas gangrene a proper surgical toilet and antibiotics at the time of injury were necessary and a smear examination might give a clue to early diagnosis.

Study of diphtheria carriers in Miraj.

Following a case of diphtheria, 131 contacts were studied for throat and nose carriage. The carriage of C. diphtheriae was found to be 19.8%, 65.3% of them were toxin producing by counter-immunoelectrophoresis (CIEP). The carriers were treated with erythromycin for 7 days. Repeat swabs found them to be negative for C. diphtheriae except in four who had erythromycin resistant and penicillin sensitive strains. Penicillin treatment eliminated the organisms.