Tropical Doctor最新文献

Histoplasmosis, caused by Histoplasma capsulatum, is a dimorphic fungus typically endemic to parts of the Americas, Africa, and Asia. Inhalational exposure leads primarily to pulmonary infection, and extrapulmonary or isolated hepatic presentations are rare, particularly in immuno-competent individuals. We present an unusual case of hepatic histoplasmosis with no evident lung involvement, highlighting a diagnostic challenge and a rewarding pathologic discovery.

Dengue is endemic in tropical regions and bleeding, ranging from minor to life-threatening, is a dreaded complication. With the increasing incidence of atherosclerotic cardiovascular disease in low- to middle-income countries where Dengue is prevalent, whether to stop or continue antiplatelet agents in patients with thrombocytopenia is a clinical conundrum.

Amoebic liver abscess (ALA) is often associated with significant complications. Contemporary prospective data comprehensively characterizing complicated and uncomplicated ALA are limited. This prospective cohort study followed 150 patients with ALA and found that 60.7% experienced at least one complication. The significant complications were peritoneal rupture, pleural rupture, venous thrombosis, biliary fistula, secondary bacterial infection, and organ dysfunction. Patients with complicated ALA had larger abscesses, higher inflammatory markers, and greater liver dysfunction than those without complications. The types of complications were influenced by the location of the ALA. Additionally, subcapsular abscesses and lower baseline HDL-cholesterol levels were independently linked to complicated cases of ALA. Although complications were common, both groups showed favourable outcomes. Mortality was 2%, occurring only in the complicated group. At three months, both groups had comparable rates of symptom resolution, cavity disappearance, and relapse.

Actinomycosis is an uncommon, chronic bacterial infection caused by Actinomyces spp, whose abdominal form often mimics malignant disease and poses a diagnostic challenge.

In 2024, the global progress towards the 2025 End TB milestones of reducing TB incidence and mortality by 50% and 75% respectively, stood at only 12% and 29% respectively. Although the end TB strategy emphasizes both biomedical and social interventions, country-level efforts have focused more heavily on medical approaches while paying comparatively less attention to the underlying social and structural determinants that fuel TB transmission and risk. Zambia, despite achieving remarkable progress in implementing biomedical interventions as evidenced by the high TB treatment coverage, a high treatment success rate and a comparatively high uptake of TB preventive treatment among eligible populations, continues to be a high TB, high TB/HIV, and high MDR/RR TB burden country. Without tackling the root causes of TB, high-burden countries will remain trapped in a cycle of short-term gains and long-term stagnation. Implementation of the multisectoral accountability framework (MAF) offers a practical pathway forward.

Exchange transfusion remains the definitive treatment for severe neonatal hyperbilirubinaemia; yet its aetiology and outcomes in rural tropical settings are poorly characterised. This five-year retrospective analysis of 58 neonates at a North Indian rural tertiary centre reveals that Rh incompatibility accounted for 76% of cases - a striking divergence from high income-country patterns where ABO incompatibility predominates - indicating critical gaps in antenatal Rh immuno-prophylaxis. The procedure achieved a mean bilirubin reduction of 50% (424 ± 106 to 212 ± 70&mu/L, p < 0.001) with no procedure-related mortality, though clinically significant adverse events occurred in 19% of neonates. Notably, 10.2% presented with acute bilirubin encephalopathy at the time of intervention, representing potentially preventable neurological injury. These findings make a compelling case for urgent, systematic improvements in antenatal screening, Rh immuno-prophylaxis access, and early jaundice recognition in tropical resource-limited settings.

Incomplete or premature healing with retained collections after cryptoglandular fistula surgery predisposes to recurrence, making early postoperative assessment and remedial action essential. Magnetic resonance imaging is the standard diagnostic tool but is costly and often inaccessible in low- and middle-income countries. We therefore developed the Jabalpur Transperineal Ultrasonography-based Scoring System to predict postoperative healing. This paper demonstrates its potential.

Mucormycosis is a rare, aggressive fungal infection associated with high mortality, particularly in immuno-compromised individuals. Gastric involvement, though uncommon, poses significant diagnostic and therapeutic challenges that frequently result in poor clinical outcomes. Our case emphasizes the importance of including uncommon infectious aetiology in the evaluation of upper GI bleeding, particularly in immuno-compromised patients, to facilitate timely intervention and potentially improve outcomes.