Nirmal Kumar

Trypanosoma lewisi or T. lewisi-like infection in a 37-day-old Indian infant.

Trypanosomes were observed in the peripheral blood smear of a 37-day-old Indian infant admitted off feeds, with fever and convulsions. Trypanosoma (Herpetosoma) lewisi was identified in the blood. The species identification was confirmed by morphometry, polymerase chain reaction, and sequencing. Human infection with this organism is rare. Only seven cases of this infection have been reported previously in humans. The cases reported are reviewed to develop a composite picture of this disease.

The clinical risk index of babies (CRIB) score in India.

Objective : To assess the usefulness of clinical risk index of babies (CRIB score) in predicting neonatal mortality in extremely preterm neonates, compared to birth weight and gestation.Methods : 97 preterm neonates with gestational age less than 31 weeks or birth weight less than or equal to 1500 g were enrolled for the prospective longitudinal study. Relevant neonatal data was recorded. Blood gas analysis results and the maximum and the minimum FiO2 required by babies in first 12 hours of life were noted. Mortality was taken as death while the baby was in nursery. The prediction of mortality by birth weight, gestational age and CRIB score was done using the Logistic model, and expressed as area under the ROC curve.Results : The area under the ROC curve for birth weight, gestational age and CRIB score was almost the same, the areas being 0.829, 0.819 and 0.823 respectively. Hence CRIB score did not fare better than birth weight and gestational age in predicting neonatal mortality.Conclusion : The CRIB score did not improve on the ability of birth weight and gestational age to predict neonatal mortality in the study.

Death of Twins After Intravenous Varicella Zoster Immunoglobulin

TO THE EDITOR: Nitrofurantoin was introduced in 1953 for treatment of gram-positive and gram-negative pathogens common to the genitourinary tract. Hematologic reactions associated with nitrofurantoin are considered rare.1,2 We describe a case of agranulocytosis associated with a short course of nitrofurantoin. Case Report. A 74-year-old white man in long-term care complained of right lower-quadrant pain and urinary retention. Vital signs upon examination were BP 118/62 mm Hg, pulse 93 beats/min, respiratory rate 24 breaths/min, and temperature 37.7 ̊C. Urine culture and sensitivity test reported methicillin-sensitive Staphylococcus aureus. The patient did not exhibit renal insufficiency, with estimated creatinine clearance 64 mL/min. The patient was diagnosed with a urinary tract infection and treated with nitrofurantoin 100 mg 4 times a day. Baseline blood cell count 2 months earlier had shown a total white blood cell (WBC) count of 5.7 × 103/mm3 and granulocyte count of 4.2 × 103/mm3. On the fifth day of nitrofurantoin therapy, total WBC and granulocyte counts decreased to 1.9 × 103/mm3 and 0.5 × 103/mm3, respectively (Figure 1). No signs of hypotension or allergic reaction were illustrated upon examination of the patient. Nitrofurantoin was discontinued after 5 days of therapy and replaced with cefuroxime. Two days following discontinuation of nitrofurantoin, the total WBC and granulocyte counts increased to 2.5 × 103/mm3 and 1.1 × 103/mm3, respectively (Figure 1). Twenty days later, the total WBC and granulocyte counts continued to improve. The Naranjo probability scale showed a probable relationship between agranulocytosis and nitrofurantoin.3 Discussion. According to worldwide adverse drug reaction data, approximately 0.0004% of nitrofurantoin treatments have resulted in hematologic reactions.1 In an evaluation of 921 patients, 20 patients presented with blood dyscrasias associated with nitrofurantoin. None of those patients demonstrated renal insufficiency associated with nitrofurantoin. Two of the 20 cases resulted in fatal agranulocytosis associated with nitrofurantoin, but a second drug was a contributing factor (sulfamerazine, sulfaproxyline, levomepromazin).2 Another case of fatal nitrofurantoin-induced agranulocytosis involved a 14-year-old black female with systemic lupus erythematosus and renal failure.4 In one case, recurrent agranulocytosis occurred after a short course of nitrofurantoin 150 mg/day.5 The 62-year-old woman was rechallenged, and agranulocytosis developed within 3 days. The patient recovered after discontinuation of nitrofurantoin. In comparing these cases, agranulocytosis seemed to occur independently of renal function, but creatinine clearance <60 mL/min would be a risk factor.2,5 Due to our patient’s short course of therapy and adequate renal function, agranulocytosis induced by nitrofurantoin may favor an immunologic reaction rather than a toxic effect as the pathogenetic mechanism. However, accumulation may still play a role in the development of agranulocytosis.2,4,5 Most studies report nitrofurantoin as a treatment option for urinary tract infections; it is well tolerated and has a relatively low risk of adverse effects. According to the literature, agranulocytosis rarely occurs, but still needs to be considered as a possible adverse effect.1,2 Monitoring the total WBC, granulocyte count, and renal function may prevent agranulocytosis in patients treated with nitrofurantoin.

Congenital Dengue and Myocarditis: A Case Report and Systematic Review of Literature

AbstractWe report a newborn with congenital dengue infection and cardiomyopathy. Congenital dengue is known to occur owing to vertical transmission of the virus from an infected mother to her baby through the placenta. Dengue-related cardiomyopathy has been reported previously. This is arguably the first time cardiomyopathy is being reported in the context of congenital dengue. A systematic review of literature on congenital dengue as cited in Pubmed is also presented.

Long QT syndrome manifesting as pulseless epilepsy

A-10-year-old child admitted with repeated seizures due to the long QT syndrome is described. The cardiac origin of the epilepsy was suggested by the fact that during the episode of convulsions his peripheral pulses were not palpable