title: Tuberculous Otitis with Proteus mirabilis Co-Infection: An Unsuspected Presentation Encountered in Clinical Practice.
abstract: Tuberculosis, a contagious bacterial disease which is caused by Mycobacterium tuberculosis, primarily involves the lungs.Though Pulmonary tuberculosis (PTB) is the commonest clinical presentation, there is a need for alertness towards uncommon presentations which involve other organs. Tuberculous otitis media (TOM) is one such rare presentation seen in paediatric practice. It is characterized by painless otorrhoea which fails to respond to the routine antibacterial treatment. TOM usually occurs secondary to PTB. Here is a case of tuberculous otitis media with Proteus mirabilis co-infection, with no evidence of PTB. In the sample of ear discharge obtained from the patient, acid fast bacilli were demonstrated on direct microscopy after Ziehl-Neelsen staining. Culture done on Lowenstein-Jensen medium demonstrated slow-growing Mycobacterium. Bacteriological culture and identification helped in isolating Proteus mirabilis. PCR, followed by Line- Probe Assay for early identification and susceptibility testing to primary drugs, was done. Further, patient tested negative for the Mantoux test. Patient was enrolled in National Tuberculosis programme- RNTCP. This case emphasizes on one of the less common presentations of a common disease. A high clinical suspicion and laboratory confirmation are required for appropriate patient management.
authors.affiliation: Professor, Department of Microbiology, Padmashree Dr DY Patil Medical College, Hospital and Research Centre , Pune -18, India .
authors.forename: Nageswari
authors.initials: N
authors.lastname: Rajesh Gandham
authors.affiliation: PG Student, Department of Microbiology, Padmashree Dr DY Patil Medical College, Hospital and Research Centre , Pune -18, India .
authors.forename: Moumita
authors.initials: M
authors.lastname: Sardar
authors.affiliation: Associate Professor, Department of Microbiology, Padmashree Dr DY Patil Medical College, Hospital and Research Centre , Pune -18, India .
authors.forename: Savita Vivek
authors.initials: SV
authors.lastname: Jadhav
authors.affiliation: Assistant Professor, Department of Microbiology, Padmashree Dr DY Patil Medical College, Hospital and Research Centre , Pune -18, India .
authors.forename: Chanda
authors.initials: C
authors.lastname: Vyawahare
authors.affiliation: Professor and HOD, Department of Microbiology, Padmashree Dr DY Patil Medical College, Hospital and Research Centre , Pune -18, India .
authors.forename: Rabindranath
authors.initials: R
authors.lastname: Misra
keywords: Mantoux test; Mycobacterium tuberculosis; Otitis media; Proteus mirabilis