Jency Maria Koshy

Spectrum of neurological manifestations in dengue virus infection in Northwest India.

Summary The objective of this study was to study the spectrum of neurological manifestations in patients with dengue infection. This was a prospective study undertaken at the Departments of Medicine and Neurology, Christian Medical College, Ludhiana, India. All patients diagnosed with dengue fever during an epidemic (1 September 2010–31 December 2010) were screened for neurological manifestations. There were a total of 799 patients with dengue infection. Neurological manifestations were present in 21 (2.63%),19 of whom were men with a mean age of 33.7 ± 13.9 years. The neurological diagnoses were hypokalaemia with: quadriparesis (7); myositis (4); encephalopathy (4); Guillain–Barre syndrome (2); acute disseminated encephalomyelitis (2); lumbosacral plexopathy (1); and intracranial haemorrhage (1). Three of these patients died. Clinicians should be aware that neurological manifestations in dengue fever are not uncommon.

Dengue infection: An emerging cause of neuromuscular weakness.

evokes an immune response which aff ects the myelin or the axon of peripheral nerves has been elucidated as the mechanism for GBS in these patients.[4] The diagnosis of myositis is based on clinical presentation, raised creatinine phosphokinase (CPK), electromyography (EMG) evidence, and muscle biopsy. Misra et al., reported fi ve patients presenting with acute pure motor weakness with raised CPK.[5] EMG and muscle biopsy were consistent with myositis in one of those patients.

Clinical profile of cerebral malaria at a secondary care hospital

Introduction: Cerebral malaria (CM) is one of the most common causes for non-traumatic encephalopathy in the world. It affects both the urban and rural population. It is a challenge to treat these patients in a resource limited setting; where majority of these cases present. Materials and Methods: This was a prospective study carried out from September 2005 to December 2006 at Jiwan Jyoti Christian Hospital in Eastern Uttar Pradesh in India. This is a secondary level care with limited resources. We studied the clinical profile, treatment and outcome of all the patients above the age of 14 years diagnosed with CM. Results: There were a total of 53 patients with CM of which 38 (71.7%) of them were females. Among them, 35 (66%) patients were less than 30 years of age. The clinical features noted were seizure (39.62%), anemia (84.9%), icterus (16.98%), hypotension (13.2%), bleeding (3.7%), hepatomegaly (5.66%), splenomegaly (5.66%), non-cardiogenic pulmonary edema (16.98%) and renal dysfunction (37.36%). Co-infection with Plasmodium vivax was present in 13 (24.53%) of them. Treatment received included artesunin compounds or quinine. Median time of defervescence was 2 (interquartile range1-3). Complete recovery was achieved in 43 (81%) of them. Two (3.7%) of them died. Conclusion: CM, once considered to be a fatal disease has shown remarkable improvement in the outcome with the wide availability of artesunin and quinine components. To combat the malaria burden, physicians in resource limited setting should be well trained to manage these patients especially in the endemic areas. The key to management is early diagnosis and initiation of treatment based on a high index of suspicion. Anticipation and early recognition of the various complications are crucial.

Epidemiological profile of seropositive blood donors at a tertiary care hospital in North India

Background: Transfusion-transmissible infections HIV, HBV, and HCV are among the greatest threats to blood safety for transfusion recipients. Seroprevalence among blood donors is a useful source of information on their prevalence in the community. The present study was undertaken to determine the profile of the seropositive blood donors attending the blood bank at Christian Medical College, Ludhiana, Punjab. Materials and Methods: This was a 3-year cross-sectional study, (1 st January 2008 till 31 st December 2010) whereby the data of the blood donors screened during this time were analyzed. We further studied the epidemiological profile of the seropositive donors. Results: There were a total of 32,829 donations. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11% and 1.53%, respectively. Most of them were males (96.76%) and were in the age group of 18-30 years. Replacement donors constituted 95.75%. Occupation of seropositive donors included business, various services, and agriculture. There were 89 students who were seropositive. Conclusions: Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV < 0.001, HCV 0.004) decreasing trend over the 3 years. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre test and post test counselling in blood banks will identify patients at an earlier stage where treatment would be more effective. The need to shift the burden to voluntary blood donation cannot be overemphasised.

Postexposure management of occupational injuries amongst health care workers

Occupational exposure comprises of needle stick injury (NSI) and mucosal splashes. A health care worker (HCW) is at a greater risk of developing blood borne virus infection while at work. Due to high prevalence of human immunodeficiency virus, hepatitis B surface antigen and hepatitis C virus in developing countries, there is a higher risk of infection after occupational exposure to HCW. Factors such as sub-optimal infection control practices and lack of equipment, increases the risk of acquiring NSIs. Reporting of each episode of occupational exposure should be mandatory in institutions. Postexposure management policies should be included among the institutional policies.

Multiple cranial nerve palsies in an elderly diabetic

A 60-year-old man presented with multiple cranial nerve palsies on the right side. He was initiated on anti-tubercular treatment in view of lymphocytic pleocytosis on the cerebrospinal fluid study. Although he improved initially, later he worsened with cranial nerve involvement on the contralateral side. A diagnostic procedure was done, and the team reached a definitive diagnosis and patient responded to the targeted therapy.

Central nervous system manifestations in human immunodeficiency virus patients in the antiretroviral therapy era - Scenario from a developing country

Background: Central nervous system (CNS) infections associated with Human immunodeficiency virus (HIV) has decreased markedly in the developed countries. However, the scenario is different in Indian patients and is not unusual to have CNS infections as their initial presentation. Considering this, we undertook this study to look at the incidence of CNS manifestations in HIV infected patients. Materials and Methods: This was a cross sectional study conducted in the Departments of Medicine and Neurology in Christian Medical College Ludhiana, a tertiary teaching institution in North West India. All the HIV infected patients with Central nervous system manifestations who presented to our institution from 1st April 2009 to 31st of March 2014 were included in the study. The demographic and clinical profile along with the outcome of these patients was studied. Results: There were 280 patients diagnosed during this 5 year period, 43(15%) of who had CNS manifestations. The male: female ratio was 5:1. Majority of them were in the age group of 31 to 50 years of age (68.89%).In 72% of patients CNS manifestations were the initial manifestation of HIV infection.The CNS manifestations noted were cryptococcal meningitis in 20, toxoplasmosis in 3, CNS tuberculosis in 11, PMLE in 6, ischemic stroke in 4 and Diffuse B cell Lymphoma (DLBCL) with aseptic meningitis in 1. Conclusions: Even though in the era of HAART the incidence of CNS manifestations has decreased, CNS manifestations continue to be the presenting symptom for HIV infection in over 16% of the cases.

Pneumocystis jirovecii pneumonia in an immunocompetent host

Pneumocystis jirovecii pneumonia (PCP) is a potentially life-threatening infection, which predominantly occurs in the immuno-compromised host. It has been rarely reported in immunocompetent subjects. In them, the infection presents with fulminant respiratory failure along with fever and dry cough in contrast to an indolent course in the immuno-compromised population. The most significant risk factors for PCP in non-HIV infected hosts are glucocorticoid use and cell mediated immunity defects. We report a rare case of Pneumocystis jirovecii pneumonia in an immunocompetent patient.

Tophi: A pointer towards the diagnosis of gout

Tophi are deposits of monosodium crystals in people with long-standing gout. We report a case of a 34-year-old male presenting with joint pains and soft yellowish swelling over the web spaces of the toes. Aspiration of the same revealed monosodium crystals leading to a diagnosis of Tophaceous gout.

Approach to malaria in rural hospitals

Malaria is one of the most common parasitic infections in the developing countries. In Rural India, most patients would be treated by primary and secondary care physicians. This article is aimed at providing a feasible approach to the cases of malaria in mission hospitals and other rural hospitals taking into account all the resource limitations. A study done over one year on patients detected to have malaria at Jiwan Jyoti Christian Hospital in Sonbhadra district has helped the authors to identify the various challenges faced by doctors working in the rural hospitals. The article has looked at the various complications associated with malaria and their management. It has also stressed upon the increasing incidence of chloroquine resistance.