Eschar and IgM ELISA in the diagnosis of scrub typhus

Scrub typhus is one of the leading causes of acute febrile illness in India. This study aimed to determine the best diagnostic tool for the identification of scrub typhus and study the possible association between diagnostics and clinical characteristics. Patients with fever of ?15 days admitted to the hospital satisfying the case definition of 47 kDa quantitative polymerase chain reaction (qPCR) positivity OR scrub typhus IgM ELISA positivity along with the presence of eschar OR Scrub typhus IgM ELISA positivity along with defervescence of fever within 72 h of initiation of specific therapy were recruited. Of the 116 patients satisfying the case definition, 47 kDa qPCR was positive in 43 (37%) patients, whereas IgM ELISA was positive in 104 (90%) patients and eschar was seen in 59 (51%) patients. The median duration of fever was 7.5 days (interquartile range 6� days). Multiorgan dysfunction syndrome (MODS) was described in 44 (37.9%) patients. Two patients (1.8%) succumbed to the illness. Presence of eschar and IgM ELISA positivity were detected in 106 (91%) cases. Scrub typhus, even with MODS, has low mortality because of immediate institution of specific therapy due to physician awareness. The presence of eschar and IgM ELISA positivity can be used to detect a majority of cases of scrub typhus.

Changing paradigm of Cryptococcal meningitis: An eight-year experience from a tertiary hospital in South India.

Background: Cryptococcal meningitis (CM) is a common opportunistic fungal infection causing sub-acute meningitis with the potential for complications and signifi cant mortality. We conducted this study to describe the difference in presentation and outcome between HIV-infected and HIV-uninfected patients. Materials and Methods: Patients admitted to a tertiary care centre between 2005 and 2013 with confi rmed CM were included in the analysis. Details of the clinical presentation, laboratory fi ndings, treatment details, risk factors for infection and outcome were documented and analysed. Results: During the study period, 102 (87.2%) cases of CM occurred among HIV infected individuals, whereas 15 (12.8%) occurred among HIV-uninfected patients. HIV-infected patients with CM were younger compared with HIV-uninfected patients (38.2 ± 8.5 years vs. 45 ± 11.5 years; P = 0.07). The median duration of symptoms prior to presentation was shorter in the HIV-infected group (20 ± 32 vs. 30 ± 42; P = 0.03). There was no difference between the cerebrospinal fl uid (CSF) lymphocyte counts, CSF protein counts, and CSF sugar levels in both the groups. The diagnostic yield of Cryptococcus was similar with CSF India ink smear (89% vs. 87%), CSF fungal culture (95% vs. 87%), and blood culture (100% vs. 75%) in both the groups. Case fatality rate in the HIV-infected group was 30.6%, whereas there were no deaths in the HIV-uninfected group. Conclusion: HIV-infected patients with CM have a worse outcome compared to HIV-uninfected patients. The overall trend over 3 decades shows increasingly successful rates of treatment and hence early diagnosis and treatment are of paramount importance.

Idiopathic hypertrophic pachymeningitis.

Idiopathic hypertrophic pachymeningitis is a rare form of granulomatous meningitis. It is mainly a diagnosis by exclusion. Here we are presenting a case of a young female presented with multiple cranial nerve palsies who was diagnosed to have hypertrophic pachymeningitis with the help of MRI brain. All available investigations showed negative results and so possibility of Idiopathic Hypertrophic Pachymeningitis was considered. The patient responded well to steroid therapy.

A rare manifestation of Escherichia coli septicemia.

Escherichia coli (E. coli) is an uncommon pathogen of adult bacterial meningitis. In adult patients it carries a high mortality. We are reporting a case of 65 year old diabetic male presented with fever, abdominal pain & altered sensorium. On evaluation he was found to have E. coli meningitis secondary to septicaemia following UTI by same organism. He was started on Meropenem, but later changed to Imipenem according to culture & sensitivity results. Patient responded well to treatment and got discharged after 2 weeks of hospital stay.

An unusual case of ptosis.

Blepharophimosis is a condition where the patient has bilateral ptosis with reduced lid size, vertically and horizontally. The nasal bridge is flat and there is hypoplastic orbital rim. Here I am presenting a case of a father & son with blepahrophimosis which could be a part of an uncommon condition called BPES (Blepharophimosis, Ptosis, Epicanthus Inversus, Telecanthus).

Glomus tumour of finger tip: a case report.

Glomus tumour is usually benign tumour usually accounts for a small percentage of hand tumours. Sometimes diagnosis may be delayed for years which cause significant morbidity to the patient. I present here a case of a 40 year old female with one year history of pain in her right ring finger which was diagnosed as glomus tumour and was surgically removed and was histopathological result was consistent with glomus tumour.

Development and evaluation of an enzyme immunoassay for rapid diagnosis of rabies in humans and animals.

The presently advocated tests for rapid diagnosis of rabies such as fluorescent antibody test (FAT) is expensive and requires expertise to carry out and interpret the results. In this study we have developed and evaluated a simple enzyme immuno-assay (EIA) to detect rabies antigen in the brain specimens of animals and humans. We have also evaluated the utility of this test in ante mortem diagnosis of human rabies. The brain homogenates of suspected rabid animals (n=250), humans (n=16) and clinical samples like saliva (n=16) and cerebrospinal fluid (CSF, n=16) applied on to ELISA plates coated with rabies antinucleoprotein antibody and the absorbed rabies nucleoprotein antigen was detected using biotinylated anti-nucleoprotein antibody followed by treatment with streptavidin peroxidase conjugate and colour development with OPD. Rabies infected and normal mouse brain homogenates were used as positive and negative controls respectively. The results of this test was evaluated with fluorescent antibody technique (for brain samples) and mice inoculation test (for saliva and CSF samples). A distinct dark brown color was seen in positive control and all positive samples and there was no color development in negative control and samples. The concordance between FAT and EIA was 98.4%. With brain samples, 83.3% with saliva and 91.6% with CSF samples. The specificity of the test was found to be 100%. It can be concluded that the EIA described here is a sensitive, specific and rapid test for post mortem diagnosis of rabies in animals and humans. The utility of this test for ante mortem diagnosis of rabies needs to be further evaluated.