Farzanah Ismail

Plasmodium ovale: a case of not-so-benign tertian malaria

Severe malaria is most commonly associated with Plasmodium falciparum. Plasmodium vivax is increasingly recognized as being capable of causing severe disease. In contrast, Plasmodium ovale is considered as a cause of benign disease and evidence supporting the occurrence of severe or complicated ovale infection is rare. This report describes a case of severe P. ovale infection in a patient presenting with jaundice, respiratory distress, severe thrombocytopenia, petechiae, and hypotension. He had no apparent underlying risk factors for severe disease.

Comparison of Three Commercial Molecular Assays for Detection of Rifampin and Isoniazid Resistance among Mycobacterium tuberculosis Isolates in a High-HIV-Prevalence Setting

ABSTRACT In a head-to-head comparison of the MTBDRplus version 2.0 (Hain Lifescience), the Xpert MTB/RIF (Cepheid), and the Anyplex MTB/NTM (Seegene) assays, we demonstrated equal sensitivity (59/61; 96.7%) and specificity (53/54; 98.1%) for detecting rifampin resistance with further analysis of discordances. The Xpert assay does not detect isoniazid resistance while the Anyplex assay showed high false positivity.

Agenesis of the dorsal mesentery presenting in an adolescent

Clinical presentation A 16-year-old boy presented with acute pancreatitis. His serum amylase level was raised at 292 U/l (normal 25 125 U/l) and serum lipase level was raised at 142 U/l (normal 0 60 U/l). He also presented with severe vomiting causing dehydration and clinical features in keeping with obstruction of the proximal gastro-intestinal tract. At this stage he was thought to have a congenital abnormality such as a pancreas divisum or an auto-immune pancreatitis. Antibody tests were negative. There was no previous medical or surgical history or any previous presentations to healthcare facilities with similar episodes. Erect abdominal radiographs (Fig. 1) confirmed proximal bowel obstruction with the presence of dilated small-bowel loops and multiple dynamic air-fluid levels. A contrast meal and follow-through was performed which showed an abnormal configuration of the duodenum at the D2 D3 junction suggestive of a malrotation with volvulus. The visible proximal duodenum was dilated and the mucosal pattern demonstrated a ‘stacked coin’ appearance that might have been due to ischaemia (Fig. 2). On delayed images, many small-bowel loops were clustered in the right hypochondrium (Fig. 3). Computed tomography (CT) with intravenous contrast (Fig. 4) demonstrated the classic sign of whirling of the mesenteric vessels around the superior mesenteric artery (SMA). The normal relationship of the superior mesenteric vein (SMV) on the right of the SMA was also distorted. The proximal duodenal bowel loops were distended and demonstrated diffuse wall enhancement. The pancreatic duct was also found to be prominent (not shown) and this was thought to be secondary to obstruction from the midgut volvulus. At laparotomy, it was found that the dorsal mesentery was absent, which caused spontaneous intermittent volvulus of the duodenum with intermittent occlusion of the common bile duct, causing pancreatitis. The duodenum was surgically fixed to the posterior abdominal wall and the patient remained asymptomatic thereafter. He has subsequently done well and has had no further recurrence or further symptoms or complications. Agenesis of the dorsal mesentery presenting in an adolescent

Idiopathic carpal tarsal osteolysis (ICTO) with additional elbow involvement

ICTO is a rare congenital disorder characterized by bone resorption affecting mainly the carpal and tarsal bones [1]. Previously it was known as idiopathic multicentric osteolysis and was first described in 1838 by this term [2]. Tyler et al. also preferred the term idiopathic multicentric osteolysis (1976) as this encompassed the wide array of descriptive terminology used to describe this condition in the literature [3]. The term idiopathic carpal tarsal osteolysis was first used by Froelich and Coerret in 1937 [1, 4]. It is also known as multicentric carpal-tarsal osteolysis with and without nephropathy, and the association of renal failure was first described by Marie et al. in 1951 [2, 4]. The condition may occur sporadically or is inherited as an autosomal dominant or recessive condition [4]. Knowledge about the genetics of this condition is still evolving. It was divided into five subtypes by Hardegge et al. in 1985. Type I is inherited as an autosomal dominant condition and is infrequently associated with renal involvement. Type II is inherited as autosomal recessive with no renal involvement. Type III is sporadic with frequent renal involvement [2]. Type IV is also known as Gorhams disease and is unicentric and caused by haemangiomatosis. Type V is also known as Winchester syndrome and is associated with a different clinical presentation, corneal clouding, contractures, and skin lesions [2, 3]. Patients with ICTO present in early childhood with progressive acromelic joint pain, limitation of movement, swelling, and deformity [2, 4]. The onset of disease usually begins around age 2 or 3. Laboratory findings are normal with no evidence of inflammatory, metabolic, or autoimmune diseases [2, 4]. This was the case with our patient. The radiologic findings are characteristic with osteolysis of the carpal and tarsal bones and adjacent tubular bones [2]. The involvement of the adjacent metacarpals is described as “sucked candy” [3]. Osteolysis of the distal ulna (more than the radius) causes ulna deviation of the hand. Similar findings in the feet cause clubfoot deformity [2]. In this case there was asymmetry of the involvement of the hands. The changes on the right side were much more pronounced with the sucked candy appearance of the proximal metacarpals in contrast to the truncated appearance on the opposite sides. In contrast there was more The case presentation can be found at doi:10.1007/s00256-011-1233-0.

Diffuse bony involvement in disseminated BCG disease in a patient with possible severe combined immune deficiency (SCID)

BCG (bacille Calmette-Guerin) vaccination is carried out worldwide to prevent tuberculosis. It is considered to be very effective and has an excellent safety profile, but complications do occur. These may range from erythema and abscess at the site of inoculation to extensive disseminated disease including regional and distant lymphadenopathy, lymphadenitis, musculoskeletal lesions and non-fatal and fatal disseminated infections, depending upon the immune status of the patient. Osteomyelitis is a rare but serious complication that may have a fatal outcome. We report a case of severe tuberculous osteomyelitis secondary to BCG vaccination in a child with possible severe combined immune deficiency.

Whole-genome sequence of a Mycobacterium goodii isolate from a pediatric patient in South Africa

ABSTRACT We describe here the draft genome sequence of a Mycobacterium goodii isolate from a pediatric patient in Western Cape, South Africa. To our knowledge, this is the second reported genome of this rapidly growing nontuberculous mycobacterial species.

A patient from Limpopo province presenting with haematuria: what is the diagnosis?

We present a quiz-case of a 28-year-old female patient, from Limpopo province, who presented with haematuria, hepatosplenomegaly and caput medusae. Computed tomography (CT) imaging findings are provided. The diagnosis is provided in the discussion below.