Tropical Doctor最新文献

Scabies is a neglected tropical disease and its florid form, crusted scabies, although rare, may have life-threatening complications. It is described in both immuno-competent and immuno-compromised individuals. When an individual harbours millions of mites, it manifests as crusted scabies, which mimics various dermatologic disorders and can potentially cause community outbreaks. This report describes two cases of crusted scabies and differentiates it from common dermatologic mimics.

Chronic kidney disease (CKD) is a growing public health concern, frequently diagnosed at advanced stages owing to delayed presentation, particularly in low- and middle-income countries. Our cross-sectional study was conducted at a tertiary care centre in Andhra Pradesh, India, to estimate the prevalence and identify factors associated with late-stage presentation of CKD to nephrologists. Among 200 newly diagnosed CKD patients, 116 (58%) presented in stage IV or V, indicating late referral. A high proportion of these (60.3%) were males and from urban areas (62.1%). They also had significantly lower mean haemoglobin levels. There is need for early screening, improved referral pathways, and targeted interventions to reduce the burden of late-stage CKD.

Chikungunya fever is an arboviral disease and remains a major public health concern in India ever since its first emergence in 1963 in Kolkata. Delhi has witnessed several outbreaks over the years. This retrospective study was performed to examine the epidemiological dynamics on all clinically suspected Chikungunya cases tested by ELISA for anti-CHIK virus IgM antibodies from 2010 to 2020 at a tertiary care hospital in Delhi. Archived data of suspected patients screened for CHIKV IgM by ELISA were retrieved for the period 2010-2020. Epidemiological data was used in the study. GIS mapping was done for the positive cases. Among the 445 samples tested, 57.3% were positive with the greatest number of cases (76.5%) in 2016 and significantly higher number of cases in monsoon & post-monsoon periods (p < 0.005). Seropositivity was highest in patients aged 45-54 years (69.6%); however, the disease did not show predilection for a specific gender. GIS mapping showed the burden of Chikungunya infection was concentrated in a 5-10 km radius from the study site with significant presence of cross-border cases. Our study indicates a geographically concentrated burden of Chikungunya in East and South East Delhi with ebbs and flow over time in the past decade. In view of non-availability of any licensed vaccine for this disease, surveillance of active cases, vector management and mapping of disease may help in prevention strategies.

A seemingly straight-forward case of community-acquired pneumonia revealed underlying Eisenmenger syndrome. This case highlights the relevance of this condition to tropical practice as well as some useful diagnostic and therapeutic considerations.

We report a case of a 35-year old woman with prolonged fever, cytopenia and massive splenomegaly, initially misdiagnosed as steroid-refractory auto-immune haemolytic anaemia with thrombocytopenia. Whole-exome sequencing revealed pathogenic variants in three genes, none of which explained the clinical picture. A subsequent bone marrow examination identified Leishman-Donovan bodies, confirming visceral leishmaniasis (VL). This case illustrates the pitfalls of over-reliance on next-generation sequencing and immunologic tests in the absence of a clear clinical hypothesis. In cost-conscious healthcare settings such as India, simpler and less expensive diagnostic modalities, such as bone marrow microscopy, remain crucial, especially for endemic infections such as VL. High-end molecular diagnostics should be interpreted with caution, with clinical correlation and an awareness of the limitations and incidental findings common to such testing.

We report a case of Calloselasma rhodostoma bite in a 22-year old male who kept the snake as a household pet, which resulted in a severe coagulopathy with markedly reduced fibrinogen levels. Antivenom (Queen Saovabha Memorial Institute, Thailand) was administered at 33 h post-bite, after which coagulation recovered completely. This report highlights the risks of private venomous snake ownership and demonstrates that delayed antivenom can still effectively reverse coagulopathy when supported by close monitoring.