Tropical Doctor最新文献

Splenectomy (elective or emergency) increases susceptibility to life-threatening infections, particularly overwhelming post-splenectomy infection (OPSI) from encapsulated organisms. Despite clear guidelines recommending pneumococcal, meningococcal, haemophylus, and influenza vaccinations, coverage remains suboptimal, especially in low-resource settings such as India. Poor vaccine uptake is driven by a lack of awareness among patients and providers, financial constraints, limited availability, and weak post-operative follow-up systems. Adults face greater challenges due to out-of-pocket costs and emergency surgery, while children, despite receiving pentavalent vaccines, often miss boosters. Ethically, systemic failures in providing recommended vaccines represent breaches in distributive justice and accountability. Strengthening vaccine counselling, training healthcare providers, and integrating adult vaccines into national programmes are essential. Clinical trials should explore the safety and cost-effectiveness of paediatric pentavalent vaccines in adults when isolated haemophilus vaccines are unavailable. Bridging the gap between guidelines and practice is not only clinically necessary but an ethical imperative to protect these vulnerable.

A 56-year old immuno-competent male from a non-endemic region in India presented with progressive weight loss, hoarseness of voice and widespread cutaneous lesions, including leonine facies, genital nodules and diffuse scaling. Magnetic resonance imaging of the neck revealed oedematous thickening of the false vocal cords, epiglottis and aryepiglottic folds, suggesting laryngeal involvement. All routine investigations were normal. Urine Histoplasma antigen levels were markedly elevated. Skin biopsy revealed granulomatous inflammation with intracellular yeast-like organisms, and polymerase chain reaction confirmed Histoplasma capsulatum DNA. A diagnosis of disseminated histoplasmosis with probable laryngeal involvement was made. The patient responded well to liposomal amphotericin B followed by itraconazole for 12 months. Although histoplasmosis commonly affects immunocompromised individuals, its rising incidence in immuno-competent patients from non-endemic regions necessitates greater clinical vigilance and emphasises the role of dermatological assessment and targeted fungal testing in systemic mycoses.

Acute kidney injury (AKI) is a serious complication of tropical infections and a major contributor to morbidity and mortality. Renal outcomes vary across dengue, malaria, leptospirosis, and scrub typhus but are often poorly distinguished in practice. To compare clinical features, risk factors, and outcomes of AKI in four tropical infections. In this retrospective cohort study, 149 patients with AKI were included: dengue (34), malaria (34), leptospirosis (36), and scrub typhus (45). Clinical and laboratory data, dialysis requirement, and outcomes were analyzed over three months. Recovery rates were highest in dengue (85%) and malaria (91%), while leptospirosis (61%) and scrub typhus (67%) showed greater risks of CKD (20 -28%) and mortality (11 -13%). Poor outcomes correlated with older age, hypertension, elevated creatinine, and thrombocytopenia. Dengue and malaria are associated with better renal recovery, whereas leptospirosis and scrub typhus carry higher risks of CKD and mortality. Early recognition of predictors is essential. This study underscores the need to train healthcare learners to identify early predictors of AKI in tropical infections and to recognize that patients, especially with leptospirosis and scrub typhus, remain at risk for CKD, making structured post-discharge follow-up essential.

Hepatitis A is usually a self-limiting infection in children, commonly presenting with jaundice. However, rare extra-hepatic manifestations may complicate the course, including cardiac and pancreatic involvement. We report two paediatric cases of hepatitis A virus (HAV) infection with such atypical presentations. A 6-year-old boy presented with lethargy, vomiting, and bradycardia; an electrocardiogram revealed complete heart block progressing to Mobitz type I block, with bilateral pleural effusion. Also, a 10-year-old boy presented with acute abdominal pain and was found to have elevated pancreatic enzymes and imaging findings consistent with pancreatitis. Both improved with conservative management. These cases highlight the importance of recognising unusual systemic complications of HAV. They also reinforce the urgent need to integrate hepatitis A vaccination into the national immunisation schedule in India.

Amoebic liver abscess (ALA) remains a major health burden in tropical regions. Our observational study evaluated the association between serum lipid profiles and disease severity in 118 patients with ALA. Patients were classified into uncomplicated and complicated ALA groups. Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in ALA patients compared to controls and further reduced in complicated cases. HDL-C emerged as an independent predictor of complicated ALA and demonstrated better predictive value than conventional inflammatory markers such as total leucocyte count and C-reactive protein. Lower HDL-C levels were also linked to an increased need for percutaneous catheter drainage and longer hospital stay. Post-treatment assessments showed significant improvement in HDL-C levels. These findings suggest that HDL-C is a valuable, low-cost biomarker for assessing ALA severity and guiding clinical decisions, especially in resource-limited settings.