Tanya Sharma

Clinical Profile and Outcome of Japanese Encephalitis in Children Admitted with Acute Encephalitis Syndrome

Japanese encephalitis (JE) is an arthropod borne viral disease. Children are most commonly affected in Southeast Asian region showing symptoms of central nervous system with several complications and death. The clinical characteristics and outcomes in pediatric JE patients hospitalized with acute encephalitis syndrome (AES) are still poorly understood. A prospective study was conducted in pediatric ward of Assam Medical College Hospital to evaluate the clinical profile and outcome of JE in children. A total of 223 hospitalized AES cases were enrolled during March to December 2012. Serum and cerebro spinal fluids were tested for presence of JE specific IgM antibody. 67 (30%) were found to be JE positive. The most common presenting symptoms in JE patients were fever (100%), altered sensorium (83.58%), seizure (82.08%), headache (41.79%), and vomiting (29.85%). Signs of meningeal irritation were present in 55.22% of cases. Around 40.29%, JE patients had GCS ≤ 8. Among the JE patients, 14.7% died before discharge. The complete recoveries were observed in 63.9% of cases, while 21.3% had some sort of disability at the time of discharge. JE is still a major cause of AES in children in this part of India. These significant findings thus seek attentions of the global community to combat JE in children.Japanese encephalitis (JE) is an arthropod borne viral disease. Children are most commonly affected in Southeast Asian region showing symptoms of central nervous system with several complications and death. The clinical characteristics and outcomes in pediatric JE patients hospitalized with acute encephalitis syndrome (AES) are still poorly understood. A prospective study was conducted in pediatric ward of Assam Medical College Hospital to evaluate the clinical profile and outcome of JE in children. A total of 223 hospitalized AES cases were enrolled during March to December 2012. Serum and cerebro spinal fluids were tested for presence of JE specific IgM antibody. 67 (30%) were found to be JE positive. The most common presenting symptoms in JE patients were fever (100%), altered sensorium (83.58%), seizure (82.08%), headache (41.79%), and vomiting (29.85%). Signs of meningeal irritation were present in 55.22% of cases. Around 40.29%, JE patients had GCS ≤ 8. Among the JE patients, 14.7% died before discharge. The complete recoveries were observed in 63.9% of cases, while 21.3% had some sort of disability at the time of discharge. JE is still a major cause of AES in children in this part of India. These significant findings thus seek attentions of the global community to combat JE in children.

Changing clinico-laboratory profile of encephalitis patients in the eastern Uttar Pradesh region of India

A cross-sectional study was done on 100 consecutive paediatric patients presenting with acute encephalitis syndrome. The clinico-laboratory features of all patients were recorded in a prestructured performa. Cerebrospinal fluid and serum samples were tested for: Japanese encephalitis (JE) virus; Chandipura virus; coxsackie virus; dengue virus; enterovirus 76; and West Nile virus. Twenty-two (22.0%) patients were confirmed JE cases and 17% had parasitic or bacteriological aetiology. The remaining 61 cases (61.0%) in which no viral aetiological agent was found were grouped as non-JE cases. Peripheral vascular failure, splenomegaly and hypotonia were distinguishing clinical features found in the non-JE patients. A high mortality of 26.5% was seen in patients with confirmed or presumptive viral encephalitis (22/83). A fatal outcome was independently associated with peripheral vascular failure and pallor at the time of admission. Early recognition of these signs may help clinicians to manage these cases.

Profile of deferral of blood donors in regional blood transfusion center in North India

Out of total donations, 91.9% (88,855) were replacement donations and 8.1% (7850) were voluntary donors. There was 55.5% increase in voluntary donation from 1064 in 2008 to 2404 in 2011 as compared with only 13% increase in replacement donors from 22,749 in 2008 to 23,843 in 2011. Figure 1 shows mean seroprevalence of HIV 0.08% in replacement and nil in voluntary, HBV 0.65% and 0.5% and HCV 0.2% and 0.17% in replacement and voluntary donors, respectively of Jammu province.

Oligosecretory multiple myeloma: a case report

TO THE EDITOR: Approximately 95–97% of myelomas are of the secretory type, i.e., they exhibit monoclonal (M) band in the γ region on either urine or serum protein electrophoresis [1,2]. Non-secretory myelomas were first described in 1958 by Serre, and they constitute 1–5% of myelomas. These do not show M band on serum or urine immunofixation electrophoresis. However, on immunohistochemistry (IHC), 85% of non-secretory myelomas stain for cytoplasmic M protein, indicating immunoglobulin synthesis. The remaining 15% are non-producers. The proposed pathophysiology for non-secretory multiple myeloma includes diminished immunoglobulin synthesis, secretion defects, and rapid immunoglobulin degradation, either intracellularly or extracellularly [3]. With newer serum free light chain (FLC) assays, approximately three-fourths of these non-secretory myelomas were found to have elevated FLC levels and/or abnormal FLC ratios [4]. These cases may be considered to be minimally secretory, hyposecretory, or oligosecretory. Since these patients do not present with classical multiple myeloma symptoms, diagnoses may be delayed. We hereby present a case of non-secretory myeloma with increased kappa (κ) FLC levels, i.e., an oligosecretory myeloma. The rare and unique clinical presentation of this case prompted us to report this case. We also discuss the diagnostic and prognostic issues along with the staging dilemmas often associated with non-secretory oligosecretory myelomas.

Bilaterally enlarged parotids and sicca symptoms as a presentation of sarcoidosis: Pivotal role of aspiration cytology in diagnosis

Sarcoidosis is a chronic multisystem inflammatory disease of unknown etiology characterized by widespread noncaseating granulomas in various organs. The diagnosis of sarcoidosis is based on cytological, clinicolaboratory, and radiological findings, and requires careful exclusion of other granulomatous diseases especially tuberculosis. Involvement of parotid glands is uncommon. Presentation of sarcoidosis with sicca symptoms that include dryness of eyes and mouth is an even rarer phenomenon. We present a case of multisystemic sarcoidosis presenting with dryness of eyes and mouth along with bilateral enlargement of parotid glands. Fine-needle aspiration cytology (FNAC) smears showed epithelioid cell granulomas and multinucleate giant cells. Stain for acid-fast bacilli was negative. Careful cytological examination revealed crystalline structures inside the giant cells, which prompted us to evaluate the patient for sarcoidosis. This case report highlights the cytological features that can be useful in clinching the diagnosis of sarcoidosis in conjunction with clinicoradiological and laboratory findings in a clinically unusual case.

Prevalence of irregular red blood cell antibodies among healthy blood donors in Delhi population

OBJECTIVES To evaluate the prevalence of the anti-red blood cell antibodies among healthy blood donors. MATERIAL AND METHODS Antibody screening of all voluntary blood donor serum was performed as routine immunohematological procedure. Positive sera were further investigated to identify the specificity of irregular erythrocyte antibody by commercially available red cell panel (ID-Dia Panel, Diamed-ID Microtyping System). RESULT A total of 47,450 donors were screened for the presence of irregular erythrocyte antibodies. A total of forty-six donors showed presence of alloantibodies in their serum (46/47,450%, 0.09%), yielding a prevalence of 0.09%. Most frequent alloantibodies identified were of MNS blood group system. The results showed statistically a higher prevalence of RBC alloantibodies in females than in males. CONCLUSION Screening for presence of alloantibodies in donor blood is important to provide compatible blood products and to avoid transfusion reactions.

Isolated cold abscess of the thigh in an immunocompetent infant.

Isolated cold abscess of the thigh without active tuberculosis elsewhere in the body is a rare entity, and only a few cases have been reported in the literature. We report a case of isolated cold abscess of the thigh following DPT vaccination in an immunocompetent child. The association with DPT vaccination is intriguing and requires further research.

Lymphadenopathic form of solid variant of alveolar rhabdomyosarcoma: A rare case report

Lymph node enlargement due to metastatic rhabdomyosarcoma, without an obvious primary tumor, is rare. We report a fine-needle aspiration diagnosed and histopathologically confirmed case of solid variant of alveolar rhabdomyosarcoma in a 13-year-old female. She presented with right cervical lymphadenopathy, followed by a diffuse swelling in right forearm 2 months later.

Not a typical urinary tract infection: A case of urethritis due to an exogenous oil instillation in penile urethra of an infant

However, there are no reports of the exogenous oil instillation in penile urethra in infants or children. We report the first case of sterile urethritis caused as a result of cultural practicing of blowing oil into urethra of an infant.An 11-month-old male child was taken to the outpatient department of a tertiary care center of Central India with the complaints of increased frequency and excessive crying during micturition. There was no history of passing of loose stools, fever, and previous history of urinary tract infection or edema. There was no external gross deformity of the penis. Investigations revealed total leucocyte count of 5600/cumm (polymorphs 38%, lymphocytes 54%, monocytes 6%, and eosinophils 2%). Serum urea, creatinine, and electrolytes were within the normal limits. Urinalysis was also within normal limits except for the 40-50 white blood cells/high power field. Ultrasonogarphy of the abdomen was within normal limits. On detailed history taking from the parents it was admitted that mustard oil was instilled in the urethra of the infant. It was further admitted by the mother that this a common practice in their tribe to instill oil in urethra and blow it with mouth to relieve physiological phimosis in children. A diagnosis of sterile urethritis was made, and the parents were counseled to avoid such harmful customs. Patient was given a short course of paracetamol and prednisolone (1 mg/kg/day) for 5 days. A repeat urinalysis was done after a week which revealed no abnormality.Thus, in the present case, the urethritis was caused by the exogenous instillation of mustard oil and presented as sterile pyuria that is a common sign of intraurethral foreign body induced disorder.

Concurrent infection of Japanese encephalitis and mixed plasmodium infection

Japanese encephalitis (JE) and malaria would coexist in the areas where both illnesses are endemic with overlapping clinical pictures, especially in a case of febrile encephalopathy with hepatosplenomegaly. However, there are no published data till date showing concurrent infection of these two agents despite both diseases being coendemic in many areas. We report a case of concurrent infection of JE and mixed plasmodium infection, where the case, initially diagnosed as cerebral malaria did not improve on antimalarials and alternative diagnosis of JEV encephalitis was thought which was confirmed by a serological test. To the best of our knowledge, this is the first case report of concurrent Japanese encephalitis with mixed plasmodium infection. We report a case of 3-year-old male child, who presented with febrile encephalopathy with hepatosplenomegaly. Based on a rapid diagnostic test and peripheral smear examination, a diagnosis of mixed P.Vivax and P.falciparum infection was made and the patient was treated with quinine and doxycycline. However, besides giving antimalarials the patient did not improve and an alternative diagnosis of JE was considered as the patient was from the endemic zone of Japanese encephalitis. Cerebrospinal fluid (CSF) of the patient was sent for a virological study which came out to be positive for JE IgM in CSF, which is confirmatory of JE infection. In a patient with febrile encephalopathy with hepatosplenomegaly especially in areas coendemic for JE and malaria, the possibility of mixed infection should be kept in mind.