Vasudeva Acharya

Plasmodium vivax remains responsive to chloroquine with primaquine treatment regimen: a prospective cohort study from tertiary care teaching hospital in southern India

We conducted this prospective study among 110 symptomatic Plasmodium vivax patients attending the Kasturba Hospital, Manipal, India, in order to evaluate their clinico-laboratory profile during July 2007–July 2009. Complications observed among patients were: anaemia (46.4%; 95% confidence interval [CI], 37.08–55.72%); thrombocytopenia (68.2%; 95% CI, 59.5–76.9%); leucopenia (29.1%; 95% CI, 20.61–37.59%); hyperbilirubinaemia (20%; 95% CI, 12.53–27.47%); non-oliguric renal failure (10.9%; 95% CI, 5.08–16.72%); elevated serum transaminases (33.6%; 95% CI, 24.77–42.43%); hypotension (8.2%; 95% CI, 3.07–13.33%); hepatomegaly (27.3%; 95% CI, 18.97–35.63%); and splenomegaly and jaundice in 12.7% (95% CI, 6.48–18.92%). The 99% chloroquine response and zero mortality observed in this study of vivax malaria are encouraging points for practicing physicians.

An unusual presentation of pulmonary cryptococcosis with co-existing disseminated tuberculosis in an AIDS patient.

Although cryptococcosis with lung involvement is not rare in patients with HIV, it is rarely considered in the differential diagnosis of an abnormal chest roentgenogram. Pulmonary cryptococcosis with concomitant opportunistic infections is frequently seen among AIDS and its association with tuberculosis (TB) has been previously reported. Untreated pulmonary cryptococcosis in immunocompromised hosts usually becomes disseminated and results in considerable mortality despite antifungal therapy. We report a case of cryptococcosis with pulmonary involvement in a patient with coexisting disseminated TB in HIV infection.

Parietal bone osteomyelitis in melioidosis.

We report a case of a 55-year-old man with uncontrolled diabetes who presented with pneumonia. During his hospital stay his clinical status worsened and he had a focal seizure. MRI showed central nervous system involvement and parietal bone osteomyelitis. As the patients blood culture and endotracheal aspirate grew Burkholderia pseudomallei, melioidosis was diagnosed. He was treated with meropenem after failure to respond to ceftazidime. He gradually improved over a period of 4 weeks and was discharged. Early diagnosis and therapy resulted in improved outcome.

A Pregnant Woman with Lactococcus lactis Meningitis: To Treat or Not to Treat?

Lactococcus lactis is generally considered a pathogen of lesser significance and usually treated only when isolated in cases like bacterial endocarditis [1, 2]. Due to their low pathogenicity and infrequent isolation in immune-competent persons, it is often disregarded by clinicians especially from the therapeutic stand point. This poses an important question—should we treat the infection or disregard it as a harmless pathogen?

Primary presentation with acute flaccid quadriparesis in Sjogren's syndrome sans sicca

We report the case of a 40-year-old housewife, who presented with vomiting since past 5 days and weakness of all four limbs since 1 day. Clinical examination confirmed the presence of flaccid quadriparesis with preserved tendon reflexes. Routine laboratory parameters showed severe hypokalaemia. On further evaluation she was diagnosed to have type 1 renal tubular acidosis secondary to Sjogrens syndrome. Sicca symptoms were conspicuous by their absence.

Pulmonary nocardiosis presenting with cardiac tamponade and bilateral pleural effusion in a HIV patient

Nocardiosis induces a high mortality rate in those infected with HIV. It is now being increasingly described in patients with AIDS. Nocardia infection usually involves the lungs. In immunocompromised individuals it tends to disseminate. It mimics pulmonary TB both clinically and radiologically and many a time is wrongly treated with anti-tubercular drugs. Involvement of the pericardium is uncommon, having only been reported infrequently in the past. We describe a patient who presented with a cardiac tamponade and was confirmed as having pulmonary parenchymal and pleural disease.

Community-acquired multidrug-resistant Gram-negative bacterial infective endocarditis

We describe two cases of bacterial endocarditis secondary to multidrug-resistant Gram-negative organisms. In both cases, the diagnosis was made in accordance with the modified Dukes criteria and confirmed by histopathological analysis. Furthermore, in both instances there were no identifiable sources of bacteraemia and no history of contact with hospital or other medical services prior to the onset of symptoms. The patients were managed in similar fashion with prolonged broad-spectrum antibiotic therapy and surgical intervention and made complete recoveries. These cases highlight Gram-negative organisms as potential agents for endocarditis, as well as expose the dissemination of such multidrug-resistant bacteria into the community. The application of an integrated medical and surgical approach and therapeutic dilemmas encountered in managing these cases are described.

Simultaneous occurrence of internal capsule infarct and cerebellar haemorrhage in a patient with hemiplegia.

A 68-year-old woman with hypertension with no history of cerebrovascular events presented with a left-sided hemiplegia which had developed acutely 2 days ago. She was not on maintenance therapy with antiplatelets or anticoagulants. A CT scan showed acute ischaemic infarction of the right internal capsule and cerebellar haemorrhage. Cardiac evaluation was normal. Doppler ultrasonography of the extracranial carotid and vertebral arteries showed diffuse arteriosclerotic changes, but did not reveal any haemodynamic occlusion. The simultaneous development of dual strokes was considered to be an extension of the same arteriosclerotic process to the intracranial carotid and basilar arteries.

Primary presentation of chronic calcific pancreatitis with massive unilateral pleural effusion.

We described a 45-year-old previously healthy man presenting with progressively worsening breathlessness for 10 days. Physical examination was suggestive of a left-sided pleural effusion. A chest X-ray was confirmatory. Analysis of aspirated fluid showed a lymphocytic exudate with grossly elevated amylase and lipase levels. CT revealed chronic calcific pancreatitis as the underlying cause of effusion. Retrospective questioning failed to identify classical symptoms of chronic pancreatitis including abdominal pain and steatorrhoea. The patient was managed with intercostal drainage and supportive care. Although unusual, chronic pancreatitis should be kept as a differential diagnosis in patients with unilateral exudative pleural effusion. Elevated fluid levels of amylase and lipase are useful clues to this uncommon diagnosis.

Severe unconjugated hyperbilirubinaemia: one and one makes three?

A 38-year-old housewife presented with a 3-month history of gradually progressive fatigue and deepening jaundice as well as a history of mild fluctuating jaundice since childhood. General examination revealed an obvious icterus. Systemic examination was normal. Laboratory tests confirmed unconjugated hyperbilirubinaemia. Further evaluation yielded a diagnosis of vitamin B12 deficiency on a background of Gilberts syndrome.