Viruses can induce myositis through persistent infections, molecular mimicry, production of immune complexes, immune dysregulation, or other mechanisms. Self limited viral myositis is more common among children and has been seen to be mostly associated with influenza A and B. We report a case of 15-year-old boy who presented with proximal muscle weakness following 3 weeks after an episode of fever. Muscle necrosis was evident from the raised creatine kinase levels and myoglobinuria. The patient improved slowly over a period of weeks without any treatment except for adequate hydration.

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Background: Escherichia coli is well known as noninvasive commensal and has been established as etiological agent of various human infections. E. coli also contributes to high rate of resistance to several antibiotics due to multiresistant antibiotic plasmid genes e.g., extended spectrum β-lactamases (ESBL). Material and Methods: To analyse the situation of antibiotic resistance, a total of 77 E.coli isolates from urine, pus, sputum and endotracheal aspirate were screened for their antibiograms for antibiotic resistance, multiple antibiotic resistance (MAR) index for evaluating the spread of resistance and plasmid profiles for the presence and characterization of plasmids. Results: Very high resistance level (> 90%) was detected against ampicillin, amoxycillin, ceftazidime, norfloxacin, tetracycline while imipenem and amikacin recorded the least resistance levels of 2.3% and 13.9%, respectively, among the isolates. An increased resistance to amoxycillin, tetracycline, cotrimoxazole and norfloxacin were observed in this geographical area which however displayed a lower resistance in other countries. The MAR index varied considerably, the lowest was 0.18 and the highest was 0.89. Plasmids of 10 size ranges were detected in the isolates. Some isolates possessed single-sized plasmid while other possessed multiple plasmids. Isolates with high MAR profiles were found to possess multiple plasmids. Conclusion: Regular antimicrobial sensitivity surveillance is necessary and acquisition of plasmid could greatly contribute in the antibiotic resistance and poses a significant risk of the spread of microbial resistance in this community. Also, it was observed that route of administration of antibiotics perhaps reduced its misuse and hence led to the reduction in the emergence of resistant bacterial strains.

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Tropical pulmonary eosinophilia (TPE) is an easily diagnosed and treatable disease. Patients with TPE usually present with respiratory symptoms that include paroxysmal cough, breathlessness, wheeze and chest pain, often misdiagnosed as bronchial asthma. This case highlights one of the unusual presentations of TPE and discusses the association between TPE and pulmonary hypertension.

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Non-invasive ventilation as an alternative to the endotracheal intubation is associated with less infectious complications and injury to the airways. In a study cohort that included 50 patients with type II respiratory failure with the commonest diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation with or without associated co-morbidities, mechanical ventilation with non-invasive positive pressure ventilation (NIPPV) was applied and the response was observed in terms of change in various clinical and laboratory parameters after 1 hour, at the time of weaning, and 6 hours after weaning. There was significant improvement with NIPPV in form of increase in pH and PaO ₂ and decrease in PaCO2 and HCO3 after 1 hour of NIPPV application, which also persisted after successful weaning. The patients who failed NIPPV had significantly high respiratory rate, low pH value, and high PaCO ₂ on admission.

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Background: The Human Immunodeficiency Virus (HIV) epidemic has posed major challenges to tuberculosis (TB) control efforts globally. The combined TB-HIV epidemic demands effective and urgent action. Aim: To estimate the prevalence of HIV infection among patients reporting at TB clinic and prevalence of TB infection among patients reporting at the Integrated Counseling and Treatment Center (ICTC). Setting and Design: Longitudinal study of 6 months duration from August 2010 to January 2011 at Urban Health Center located in an urban slum of Malwani, Mumbai. Materials and Methods: All patients attending ICTC who were diagnosed as seropositive and those with HIVnegative status but considered as TB suspects based on symptoms of TB were referred to TB clinic for ruling out TB. Similarly, all patients attending TB clinic who were diagnosed with TB (sputum positive TB/sputum negative TB/extra-pulmonary TB [EPTB]) were referred to ICTC for their HIV status. Both categories of patients were followed up till initiation of their treatment. Statistical Analysis: SPSS version 16 using Chi-square test and percentages. Results: Out of the 305 patients referred from ICTC to TB clinic, 61 (20%) were diagnosed with TB. Out of 264 TB patients referred from TB clinic to ICTC, 27 (10.2%) were diagnosed as seropositive. Married subjects and subjects staying with their family were having less chances of TB or HIV than unmarried subjects or those who were staying away from their family. Conclusion: Referral of seronegative TB suspects from ICTC to TB clinic should be strengthened as it was found in the study that prevalence of seronegative TB was higher in TB suspects than in HIVpositive patients.

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Cysticercosis is a very common disease in tropical countries like India. Cysticerci can be found anywhere in the body, but are most commonly detected in the brain, cerebrospinal fluid (CSF), skeletal muscle, subcutaneous tissue, or eye. Neurologic manifestations are the most common clinical feature. Isolated extra-central nervous system (CNS) involvement in cysticercosis is extremely rare. Herein, we have presented an interesting case of a young boy with a combination of hepatic and muscular cysticercosis without any evidence of CNS involvement.

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Cysticercosis is an important disease of the developing world and is a common cause of seizures and neurological morbidity. Neurocysticercosis (NCC) is the most common manifestation of the disease involving the central nervous system (CNS). Disseminated cysticercosis (DCC) is an uncommon manifestation of this disease and less than 50 cases have been reported; the majority being from India. Here we report a case with extensive dissemination of C cellulosae, involving all possible sites, namely, the brain, eyes (extra- and intraocular), muscles, tongue, and subcutaneous tissues. She had innumerable cerebral cysts giving a starry sky appearance on imaging, and subcutaneous nodules, as yet unreported in the existing literature, to the best of our knowledge. The patient developed an anaphylactic reaction on receiving albendazole, despite being properly preconditioned with steroids. Presently she is in follow-up and is asymptomatic.

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Malaria is a common parasitic disease caused by Plasmodium spp. and transmitted by anopheles mosquito. Every year several million people are affected and killed due to this infection in the endemic regions of the world. Recently, drug resistance to the common antimalarial drugs has pressurized upon the development of an effective vaccine for the elimination of malaria along with other control measures. A number of vaccine trials are in the pipeline. Indeed, some were proven to have potential efficacy as therapeutic vaccine. We searched all the articles in heading malaria vaccine, recent advances in malaria vaccine, review on malaria vaccine, efficacy trials on malaria vaccine published in pubmed and google website and, review the current status and the unresolved challenges regarding malaria vaccine.

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Ophthalmomyiasis can present as external, internal or orbital infestation. Oestrus ovis is the commonest cause of conjunctival myiasis. Myiasis is a disease usually caused due to poor hygiene and responds to removal of the larvae. We are reporting a case of conjunctival myiasis caused by Oestrus larvae in a medical college student with persistent symptoms after removal of the larvae. The symptoms resolved with ivermectin.

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Amoebiasis is a common infection in the tropical areas, which commonly presents to the physician as colitis or liver abscess. Invasive amoebiasis is associated with high morbidity, and its presentation in the form of cecal perforation following fulminant colitis with appendicitis and a ruptured liver abscess is an extremely rare entity. We would like to report one such rare case where the patient presented with all these three amoebic manifestations together. Their concomitant presentation is an indicator towards invasive amoebiasis and is associated with a dismal outcome despite aggressive management.

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Background: Malaria has protean clinical manifestations and acute kidney injury (AKI) is one of its serious and life threatening complications. This study was carried out to describe the clinical characteristics, and factors associated with adverse outcomes, in patients with malarial AKI. Materials and Methods: Data of 100 patients with AKI and smear positive malaria was retrospectively analyzed to evaluate the incidence, clinical profile, outcome and predictors of mortality among all cases presented to us at the Nephrology unit of Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh between November 2010 to October 2011. Results were expressed as mean, standard deviation (SD) and range. Results: One hundred (22.1%) (68 males, 32 females) cases of malaria induced AKI, amongst 452 total cases of AKI, were evaluated. The mean age (± SD) was 30 ± 11.23 years. Male to female ratio was 3.3:1. Plasmodium falciparum was reported in 76%, P. vivax in 11%, and both in 13% patients. The mean serum creatinine was 8.7 ± 3.7 mg%, and oligo/anuria was present in 84% of the patients. 78% of the patients required hemodialysis. 67% of the patients recovered completely, 12% did not show full recovery, and 6% developed chronic kidney failure. Mortality occurred in 15% of the patients. Conclusion : Malarial AKI most commonly occurs in patients infected by Plasmodium Falciparum. Falciparum malaria associated with AKI is a life threatening condition. Prolonged disease duration, low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coagulation, and high serum creatinine were the main predictors of mortality in our study.

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Autoimmune hemolytic anemia (AIHA) is a rare complication of chicken pox. It is described mainly in children. Even in children it is a rare complication and the long-term prognosis remains to be elucidated. Herein we report an adult, a 23-year-old male who developed AIHA secondary to chicken pox.

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Aspergillosis, an opportunistic infection, is a major cause of morbidity and mortality in immunocompromised patients. But, Aspergillus is also known to cause Pulmonary aspergillosis in immunocompetent host too. Only few cases have been reported in literature of Aspergillosis in Immunocompetent individuals so far. Here, we report 4 different cases of Pulmonary Aspergillosis , who have presented with acute symptoms.The possibility of pulmonary mycosis needs to be considered in patients with acute pulmonary symptoms like breathlessness , hemoptysis, etc with signs of infection even in immunocompetent individuals, without underlying pulmonary disease.

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Systemic lupus erythematosus (SLE) is reportedly becoming a common condition among Black Africans in the sub-Saharan countries like Nigeria. Generally, clinical evidence of renal disease occurs in approximately half of the cases of SLE at presentation. The severity of the renal involvement determines the morbidity and mortality of the disease. We report the first documented case of lupus nephritis in an 11-year-old boy in South-East Nigeria. The diagnosis was based on the clinical presentation of a malar rash, photosensitivity rash, discoid skin lesion, oral ulcer, hematuria and massive proteinuria with anasarca; renal biopsy histology revealed lupus nephritis class IIB and constitutional symptoms. He is responding slowly and steadily to corticosteroids and oral cyclophosphamide. SLE with renal involvement is not an unusual disease and accessibility to diagnostic facilities may bring a major change in the approach of the disease in the sub-region.

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Resurgence of kala-azar in India has posed many problems. Apart from endemic areas, cases are being reported from nonendemic area. Other than diagnostic difficulties, resistance to stibogluconateand relapses are common problem in sporadic visceral leishmaniasis (VL). We present one case in detail and give brief description of nine other cases, hailing from nonendemicarea, Uttarakhand, during the period from December 2005 to September 2011, diagnosed in our teaching hospital. The patients in our study were diagnosed as VL by clinical findings and confirmed by demonstration of LD bodies in splenic or bone marrow smears. Six cases were treated successfully with amphotericin. One case died during treatment and three cases lost to follow up.Clinician should suspect and investigate for VL in patients with pyrexia of unknown origin even when the disease is not endemic in a specific region for early diagnosis.

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Cysticercosis is the most common parasitic disease of the central nervous system. Although seizure is the most common presenting feature, the presentation depends upon the location of the cysts. Orbital cysticercosis presents with limitations of ocular motility in 75% of patients. We describe a case of orbital cysticercosis where the patient presented with isolated unilateral painless progressive ptosis and showed complete resolution after 1 month of treatment with Albendazole.

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The common perception and belief among general medical fraternity about vivax malaria is its benign nature and rare association with any known complications. Even, the literary evidence is scarce regarding the devastating complications of malaria due to vivax but is abundant with complicated reports of falciparum malaria. Therefore, any such complicated case of vivax malaria throws diagnostic challenges to the attending physician and is very difficult to exclude the presence of other type of infections and falciparum infestation. Among various complications associated with malaria, pulmonary complications are rare and the possibility of acute respiratory distress syndrome (ARDS) is even rarest with vivax infection. The present case is a description of rare pulmonary complication of vivax malaria resulting in ARDS and its successful management.

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Sjogren's syndrome (SS) is a multi-systemic autoimmune disorder characterized especially by lymphocytic infiltration of exocrine glands. Renal involvement in SS is commonly manifested by tubular dysfunction. A 35 years old female presented to the emergency department with weakness of all four limbs. The baseline investigations in Emergency Department (ED) revealed hypokalemic normal anion gap metabolic acidosis. On further questioning there was history of dryness of mouth, eyes and multiple dental extractions for the last two years. Clinical and biochemical assessment confirmed a diagnosis of SS with type 1 Renal Tubular Acidosis (RTA). Hypokalemic quadriparesis associated with SS is mainly due to type 1 RTA and it can precede the sicca symptoms. We hereby report a case of primary SS with long standing sicca symptoms in which the diagnosis of SS was suspected only after the hypokalemic paralysis. The case highlights the significance of presentation of acute hypokalemia in the ED as it can unmask SS even if it is associated with sicca symptoms. Hypokalemic paralysis if associated with normal anion gap metabolic acidosis should prompt towards diagnosis of SS.

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Toxic shock syndrome is an acute febrile illness, which leads to multi-organ dysfunction and has a high mortality and morbidity. We report a case of toxic shock syndrome in a patient with underlying chronic liver disease associated with multiple satellite abscesses in elbow, peri-nephric region, psoas and neck.

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Rhinoentomopthoromycosis usually presents as a chronic inflammatory or granulomatous disease characterized by swelling of nose, paranasal sinuses, and mouth. We present a case of a 43-year-old male who presented with right nasal blockade and paranasal sinus pain since two months. The clinical picture was further complicated by the fact that neither the patient could tolerate plain amphoterecin B nor could he afford its liposomal derivative. Species identification enabled us to successfully treat the patient with cheaper and less toxic alternative like itraconazole and potassium iodide. Our case highlights the importance of species identification in making appropriate choice of therapy in resource poor settings in developing countries.

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Dengue fever is an acute mosquito-borne infection caused by dengue viruses belonging to the family Flaviviridae. It is an important public health problem in tropical and subtropical climates. Acute motor quadriparesis during the course of dengue infection is quite unusual and uncommonly reported. We hereby report two cases of acute motor quadriparesis during the course of dengue infection due to hypokalemia.

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Context: An outbreak of fever with severe joint pain started in the Palam area of Delhi in August 2010. An entomological and epidemiological investigation of this outbreak was conducted to ascertain the nature and cause of the outbreak. Aim: Aim of the study was to investigate the nature and cause of the outbreak and to contain its further spread. Settings and Design: It was a cross-sectional study conducted in the Palam area of south-west Delhi, situated at a distance of about 20 km from Medical College. It is one of the field practice areas for training of undergraduate and postgraduate students of Department of Community Medicine of Medical College of Delhi. Materials and Methods: All patients attending OPD of Primary Health Center (PHC) Palam, complaining of ever with incapacitating joint pain, were screened for chikungunya fever. Of the 750 suspected chikungunya patients, 130 blood samples were randomly drawn amongst these patients. Out of the 130 tested, 97 (70.8%) were positive for the IgM antibodies against chikungunya virus. House-to-house survey was conducted in the affected area for more cases and to find out the vector-breeding sites. Statistical Analysis: Frequency distributions were calculated for age and sex. Results: The main breeding sites of the mosquitoes were the desert coolers of houses, water stored in metal and plastic containers, and water collections at construction sites. Aedes mosquito was present in almost all the houses surveyed in the area. Conclusions: It was concluded that the routine campaigns need to be organized regularly within the community highlighting the potential breeding grounds of mosquitoes and the possible control methods. Source reduction strategies like cleaning of desert coolers on weekly basis, emptying of water containers, and close monitoring of construction sites for potential breeding of the vector needs to be done on a regular basis to avoid future outbreaks.

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Calvarial tuberculosis (TB) is a rare manifestation of extra-pulmonary TB, scantily reported in literature and accounting for 0.2% -1.3% of all cases of skeletal TB. The incidence of calvarial TB is rare, even in developing countries where TB is endemic. We describe a case of skull TB in a 16 year old male presenting as scalp swelling with a sinus in the occipital region. The diagnosis was established on histo-pathological examination with demonstration of Acid Fast Bacilli.

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Calvarial tuberculosis is a rare entity forming 0.2-1.3% of skeletal tuberculosis. Primary calvarial tuberculosis without evidence of tuberculous lesion elsewhere in the body is still rarer and sometimes clinically mimics cutaneous neoplasm. We describe a case of young girl who presented with swelling on the scalp in the region of the left frontal bone. She was suspected to be case of cutaneous neoplasm. Diagnosis was confirmed by Fine Needle Aspiration Cytology supplemented by radiological and microbiological investigations. The patient responded well to Anti-tubercular therapy without any surgical intervention.

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Cystic Echinococcosis is endemic in middle- East it may present in different sites mostly liver, but children show atypical signs in uncommon sites. A 4 years old boy presents with urinary retention, his imaging demonstrates a 6cm cystic mass displaced and compressed bladder outlet during survey another asymptomatic cyst found in chest but his liver was not involved. Retroperitoneal Cystic Echinococcosis is a rare event especially in children if present with urinary obstruction it may be due to rectum penetration and dislodged to lymphatic drainage head to chest. Cyst growth rapidity rate is 2-3 cm/year as our study.

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Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, mainly affecting the mucous membrane of nose, nasopharynx, and eyes. Involvement of bone though rare has been reported along with other mucocutaneous lesions. But bony involvement without any mucocutaneous lesion is very rare and only few cases are documented. Here we report a case of rhinosporidiosis of distal radius without any other lesion, which has not been reported in English language-peer reviewed literature, to the best of our knowledge.

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Actinomycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by fungus-like bacteria, that is, Nocardia sp, Actinomyces sp. This infection is common in tropical countries like India, though the disease is worldwide in distribution. A 22-year-old female who presented with multiple fistulas, sinus tracts, and pain and swelling over left foot following trauma 6 years back. A diagnosis of actinomycetoma was made based on clinical and microbiological ground. Two years after amputation there was recurrence and finally took multiple antibiotic therapies but was left without cure. Another case was that of a 37- year-old male who presented with multiple fistulas, sinus tracts, and pain and swelling on the right sole 6 months after prick of bamboo stick. There was a recurrence after amputation. Both the patients were treated with a Wallace regimen (Amikacin with Cotrimoxazole/Minocycline/Ciprofloxacin). Patient showed excellent response with healing of all sinuses after 2 months of therapy.

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Aspergilloma represents one of the many manifestations of fungus Aspergillus and usually occurs in preexisting lung cavities. It may be asymptomatic or presents sometimes with massive hemoptysis requiring urgent intervention. This patient was not suffering from any predisposing factors for acquiring fungal ball except chronic tobacco use and possible development of COPD. His symptoms and radiological features were suggestive of pulmonary tuberculosis. However as his tuberculin test and sputum were negative, a possibility of fungal ball was kept which was later confirmed by CT scan of chest. The case highlights the role of tobacco in compromising immune status of patient giving way for acquisition of fungal ball in lungs and the role of imaging in early diagnosis of these disorders.

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A 5-month-old infant with an uneventful perinatal period was presented with lower respiratory tract symptoms and abnormal X-ray findings of 1-month duration. At admission, the baby was in respiratory distress requiring oxygen therapy and supportive care. Despite optimal supportive care and antibiotic therapy, he continued to be symptomatic necessitating further investigations for nonresolving pneumonia. His bronchoalveolar lavage and urine were positive for cytomegalovirus (CMV) and workup for immunodeficiency showed undetectable immunoglobulin A(IgA) levels. Rest of the workup was inconclusive. We investigated the mother for a carrier status, but the workup was negative for CMV and/or other intrauterine infections. In view of severe CMV-associated lung disease, the baby was started on ganciclovir therapy for 6 weeks on which he recovered completely. Although the associated isolated IgA deficiency may be an incidental finding in this case, it is indeed intriguing and requires further research.

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