Kokila Banerjee

: Acanthamoeba spp. are rare etiological agents of meningoencephalitis with high mortality. We present three cases of Acanthamoeba meningoencephalitis in immunocompetent individuals from Eastern India. The first patient presented with fever and headache; the second with headache, visual disturbance, and squint; and the third presented in a drowsy state. The cases presented on March 3, 18, and 21, 2023 respectively. The first two patients had concomitant tubercular meningitis for which they received antitubercular therapy and steroid. Their cerebrospinal fluid showed slight lymphocytic pleocytosis and increased protein. The diagnosis was done by microscopy, culture, and polymerase chain reaction. They received a combination therapy comprising rifampicin, fluconazole, and trimethoprim-sulfamethoxazole. The first patient additionally received miltefosine. She responded well to therapy and survived, but the other two patients died despite intensive care. Detection of three cases within a period of 1 month from Eastern India is unusual. It is imperative to sensitize healthcare providers about Acanthamoeba meningoencephalitis to facilitate timely diagnosis and treatment of the disease.

Brucellosis is endemic in India with seropositivity rates as high as 10% in children in the eastern states, yet the disease is not on the radar when a differential diagnosis of pyrexia of unknown origin (PUO) is being considered, especially in children in urban set-up. This may be because of the non-specific multitude of systemic symptoms seen in this disease and the lack of awareness among clinicians. We present a case of a 13-year-old boy, who came with a history of undulating fever for the past three and a half months, loss of appetite, and abdominal pain. The child had visited several pediatricians and was even admitted to a tertiary care hospital for PUO evaluation, but to no avail. He presented to us after three and half months of suffering and weight loss of more than 10% of body weight. His ultrasonography revealed thickening of the terminal ileum. His blood culture grew Brucella melitensis. A diagnosis of Brucellosis with terminal ileitis was made. Brucella serology by enzyme-linked immunoassay (ELISA) was positive for both IgG and IgM. He was treated with doxycycline and Rifampicin along with syrup multivitamin and zinc, for 6 wk. There was remarkable improvement with gain in 4 kg body weight within 2 mo of completing treatment. History revealed con sumption of unpasteurized milk and contact with cattle. Clinical suspicion, detailed history, appropriate laboratory investigations are the three pillars for diagnosing Brucellosis in patients presenting with vague symp toms.

Infestation by the Dipteran insect larvae is one of the public health problems in tropical countries, including India. Calliphorid flies are reported to cause various types of myiases, including urogenital myiasis. Besides, non-myiasis-producing flies also occasionally invade human or animal tissues and cause myiasis. For the first time, we report here, an uncommon type of myiasis of the urogenital system due to an infestation by Chironomus larvae. A 19-year-old female patient from a poor socio-economic background from Kolkata, India attended the outpatient department with a complaint of passing worms in her urine with one-to-five larvae, several times a day, for four weeks. Another member of the family had a similar complaint. The larvae isolated from the patient were identified to be Chironomus crassicaudatus (Diptera: Chironomidae). It was probable that Chironomid flies breeding in and around the dwellings had infested the urethra. The patient was successfully treated with albendazole. Implementing overall environmental and personal hygienic living conditions, eliminating fly breeding habitats, and avoiding sharing of a common toilet facility are important measures to avoid such kind of fly infestation.