Ishwar Chandra Behera

Isolated cutaneous leishmaniasis over face – A diagnostic dilemma

Abstract Cutaneous Leishmaniasis (CL) is a disease caused by an intracellular protozoa belong to the genus Leishmania, transmitted by the bite of a sandfly. It has diverse clinical presentation and may create a public health problem in endemic countries. CL is often confused with lepromatous leprosy, pimples and fungal dermatitis. This case is an isolated cutaneous variety in facial region which was mistaken and treated initially for fungal dermatitis and then for leprosy by local physicians. Smears examined from the skin lesion confirmed Leishmania amastigotes. The isolated localized CL may create confusion and its many differential diagnoses made delaying in the diagnosis.

Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis – Our experiences at a tertiary care teaching hospital of eastern India

INTRODUCTION Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. MATERIALS AND METHODS This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. RESULTS There was no significance difference according to the age (P=0.134), gender (P=0.760) and causative agents (P=0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching (P=0.0001), otorrhoea (P=0.0033), fullness (P=0.0432) and earache (P=0.0259), whereas no statistical significant on hearing loss (P=0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema (P=0.0045), tragal tenderness (P=0.0012) and congestion of tympanic membrane (P=0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. CONCLUSION Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment.