Abdominal cocoon syndrome with enigmatic etiology

Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multiple etiologies have been defined, many are idiopathic. We had three different cases of intestinal obstruction. First one was a case of intestinal obstruction in a young female and was diagnosed to have tuberculosis. She had abdominal cocoon along with perforation where even adhesiolysis was unsuccessful. Second one was a cause of right inguinal hernia in a 62-year-old male. Bowel was enclosed in a membrane and diagnosed as localised variant of abdominal cocoon. Membrane was removed and right herniorrhaphy was done. Third one was a 35-year-old male with abdominal cocoon. No previous tuberculosis history was noted and adhesiolysis was done. Thus, abdominal cocoon can present with enigmatic etiology and presentation. Only an occasional case can be due to tuberculosis as described in literature. It must always be a differential diagnosis for a case of acute or chronic intestinal obstruction. </jats:p

A rare case of varicella gangrenosum in adult

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. It most commonly occurs in children less than 5 years of age and life threatening. This is a very rare complication of chicken pox in adults which deserves early diagnosis and management. 21-year-old male presented with blackish discoloration in the lateral aspect of right thigh for 5 days. He has positive history of chicken pox for his brother and sister following which he acquired it 15 days back. During that episode he had fever, headache and blisters which ruptured to heal by scab. But scab in right thigh coalesced to form the gangrenous area with serous discharge. On presentation he had no fever with local lesion and surrounding erythema. Patient underwent radical surgical debridement and regular dressing. Pus culture was sent which showed no growth. He gradually improved and the ulcer granulated well and split skin graft is done. Varicella gangrenosum is a life-threatening condition which can be either wet, moist or purpura fulminans. Patients who develop disseminated intravascular coagulation and have a grave prognosis. Surgical debridement is the only proven treatment which has led to better outcome. Only about 10 cases reported in literature so far regarding this condition. </jats:p

Extensive fournier gangrene with retroperitoneal involvement in a diabetic patient

Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.</jats:p

The Possible Risk of Reverse Zoonosis in COVID-19: An Epidemiological Driving Approach for the One Health Future Challenges: A Review

The emerging coronaviral infection named as COVID-19 was officially declared as pandemic on 11, March 2020 by WHO. It has so far been reported from 215 countries or territories affecting about twenty seven million people infected globally. The novel attributes on COVID-19 with sporadic reports on animal, alarms the future chances of animal mediated COVID-19 transmission. Despite lockdown in two-third of the global population, health officials are worried about the risky nature of animal infection in the current pandemic situation. The reverse zoonotic index cases in the current epidemic reported sporadically in animals through infected humans. Reported evidence suggests that bat as the major reservoir involved in COVID-19. However, still, the role of intermediate host involvement in the human COVID-19 transmission from the bat is not yet understood. It is clear that humans play a potent source of infection to transmit the disease to other humans and animals. A literature survey was conducted to a) understand the level of animal’s involvement in COVID19 pandemic and b) to measure the amount of risk of reverse zoonoses in pet animals, exposed animals etc. The epidemiological investigation suggested the need for strong surveillance on the human-animal interface area with strict advisory measures to combat this dangerous disease transmission to humans and other animals. Hence understanding animal’s role in the current pandemic is of prime importance in devising preparedness and control strategies through unique one health approach. In implementing suitable research protocol at animal-human interface along with environment by devising appropriate control strategies will reduce the future reverse zoonosis risk in the current pandemic through a holistic one health drive.</jats:p