Sarita Mohapatra

Drug resistance in leishmaniasis: Newer developments.

Leishmaniasis is a vector borne protozoan disease and it remains a major public health problem world-wide. Lack of an effective vaccine and vector control program makes the chemotherapy as the primary tool for leishmaniasis. Antimonials were used as the first line of treatment for many years. Emergence of resistance against this drug has become a major concern. Literatures and studies published on anti-leishmanial drug resistance, newer drug discovery for leishmanial resistance etc., in PubMed, Medline and Google search and reviewed thoroughly. Various newer drugs have been identified but, are in limited use because of high cost, toxicity, resistance etc., Recently, many newer mechanisms of drug resistance have been identified which may boost in future designing and development of drugs.

Association of Mycobacterium tuberculosis in the causation of Eales' disease: an institutional experience.

Background: Eales′ disease is an idiopathic retinal vasculitis characterized by retinal inflammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales′ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales′ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fibrosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales′ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales′ disease. The PCR positivity was significantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology.

A simple and rapid staining method for detection of hemozoin pigment by methylene blue stain

Filariasis is transmitted by the Culex mosquito and the adult worms live in the lymphatic vessels of the definitive host. The microfilariae are released into the peripheral circulation. Filariasis causes a spectrum of diseases including the following conditions: Asymptomatic microfilaria, acute lymphangitis and lymphadenitis, chronic lymphadenitis, edema of the limbs and genitalia, and tropical pulmonary eosinophilia.[4]

Disseminated intravascular coagulation following malaria due to Plasmodium vivax: a thromboelastography-based study

BackgroundDisseminated intravascular coagulation (DIC) due to Plasmodium vivax is scarcely reported in comparison to Plasmodium falciparum. In complicated malaria, thrombocytopaenia and haemostatic alterations lead to increased activation of coagulation cascade and fibrinolytic system. Thromboelastography (TEG) is a haemostasis system which measures the viscoelastic strength of blood clot in the coagulation pathway. It detects the initial derangement in clotting cascade involving in platelet interaction and fibrinolysis. Hence, it can document the early changes in coagulation in vitro, and thereby guide the management. The current study was aimed at detection of DIC in patients with P. vivax malaria based on TEG.MethodsEthylene diamine tetraacetic acid (EDTA) blood samples from acute febrile patients were tested by microscopy and immunochromatographic test for malaria. A total of 31 confirmed cases of vivax malaria were enrolled for this study. All the samples were tested by thromboelastography and conventional tests parameters for detection of any coagulation derangement.ResultsOf 31, 17 (55%) were classified as complicated and 14/31 (45%) were uncomplicated. Among 23 cases with thrombocytopaenia, non-overt (early stage) DIC was detected in 18 cases by TEG and 17 cases by the conventional methods.ConclusionIt seems that the burden of DIC in vivax malaria is much higher than the world literature reported. TEG can be utilized as an important tool for early detection of DIC and guiding the management in malaria patients.

Bacteriological profile of patients and environmental samples in burn intensive care unit: A pilot study from a tertiary care hospital

Objective: Prevention of nosocomial infection in burn patient is a major challenge. Endogenous flora or the colonizers of the surrounding environment are the main source of infection in this group of patients. Continuous monitoring of infection in burn patients is necessary to evaluate the source and pattern of distribution of microorganisms. The study was planned to assess the bacteriological and antimicrobial resistance profiles of burn patients in our intensive care unit (ICU). Materials and Methods: Wound swabs from 100 consecutive burn patients were collected on days 1, 4 and 7 of admission to the burn ICU. Environmental samples were also collected from the surroundings of burn ICU and studied for the bacteriological and anti-microgram profiles. Results: Acinetobacter baumanni, Pseudomonas aeruginosa remained the major isolates from the wound swabs. Acinetobacter baumanni and Staphylococcus aureus found to be the common isolates from the environmental samples. In both the instances the strains were found to be multidrug resistant (MDR) type. Majority of the environmental colonizers were isolated from sink, bed cradle and patient′s bed. Conclusion: In this study, colonizers of the environment appeared to play a major role in causation of nosocomial infection in burn patients. Hence, periodic monitoring and assessment should be done to strengthen the infection control practices in burn unit.

Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma

Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients.

Lipid derangement as diagnostic and prognostic indicator for visceral leishmaniasis patients.

T a p e w o r m c a r r i e r s m u s t b e t r e a t e d w i t h praziquantel (PZQ) as such persons are the immediate common source of infection in both humans and pigs. No treatment is recommended for asymptomatic, nonviable cysticercal lesions in subcutaneous tissue, and muscle. However, surgical excision is preferred for solitary symptomatic lesion. For neurocysticercosis, symptomatic therapy is the mainstay for treatment and includes analgesics, corticosteroids to control inflammation and antiepileptic drugs to control seizures. Anti‐parasitic agents, either albendazole or PZQ are effective in killing live cysticerci; however, many patients develop an exacerbation of neurologic symptoms, attributed to intense local inflammation due to the death of the larvae. Therefore, it is recommended to give anti‐parasitic treatment under hospital conditions and prime the patient with steroids before starting cysticidal drugs.[7]

Diagnostic dilemma in hookworm infection: an unusual case report.

Hookworm infection is acquired by penetration of the 3rd stage larvae (L3) through the skin. L3 migrates through the body, entered to the lungs and later swallowed to reach the intestine where it grows to adult form. The disease is manifested as iron defi ciency anaemia with reduced haemoglobin, serum ferritin, which is in direct co-relation with the number of parasite (as measured by quantitative egg count).[3] In the present case, although presence of blastomere was highly suggestive of hookworm, the larval forms may create confusion between the identifi cation of the hookworm and Strongyloides stercoralis infection. Srongyloides stercoralis is viviparous and only larval forms are excreted in stool. The large number of eggs containing larvae as seen in the present case was unusual. Modifi ed Harada Mori larval culture method helped in confi rmation of identifi cation of larvae. In the present case, the characteristics morphological features were noted and compared with the Srongyloides stercoralis larva (laboratory preserved stool sample). The long mouth part of the larvae in the test sample was distinctive [Figure 2]. Moreover, genital primordium and double bulb oesophagus were more prominent in the larvae of S. stercoralis.[3] Hence, the above case was confi rmed as hookworm infection. The patient was treated with Albendazole (400 mg OD ×3 days).

Genital tract infection of women in Southern Orissa with special reference to pelvic inflammatory disease

The occurrence of both Behcet’s disease and HIV infection may be coincidental, a Behcet’s‐like presentation of the complications of HIV disease, or HIV infection causing or predisposing to a Behcet’s‐like illness. HIV‐induced disturbances in the immune system may result in clinical or immunological findings usually associated with autoimmune diseases and increased susceptibility to certain viral infections.[4,5] Improvement of Behcet’s disease with zidovudine and with triple drug ART has been reported.[5,6] In our patient, good response to dapsone and colchicine was seen. However, patient was lost to follow‐up.