Delayed diagnosis of leprosy in a Kuwaiti child

Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, and some visceral tissues. The skin lesions take the form of macules, papules, plaques, nodules and diffuse infiltration. If hypo-pigmented macules are the only manifestation of leprosy in patients living in non-endemic areas, they may be misdiagnosed as other more common skin diseases. We report the case of an 8-year-old Kuwaiti boy who presented with hypo-pigmented macules for the last four years. He was given various diagnoses until neurologic manifestations set in. That was when the diagnosis of leprosy was suspected and confirmed by biopsy. Awareness of leprosy should be raised in non-endemic countries like Kuwait which have a sizeable expatriate work force coming from endemic areas

Herpes zoster infection in an infant

Herpes zoster in infancy is rare but can develop following intrauterine or postnatal exposure to Varicella zoster virus. We report a case of herpes zoster in a 5-month-old male baby, whose mother had varicella infection at 5-months of gestation. He was treated with acyclovir and first generation cephalosporin for herpes zoster with staphylococcal skin infection

Relationship between leptin levels and suppressed CD4 counts in HIV patients

To examine the relationship between serum leptin levels and suppression of CD4 count in HIV-infected individuals with highly active antiretroviral therapy [HAART]. Thirty seropositive HIV male patients selected from the Infectious Disease Hospital were classified into two groups according to their immunological and virological response to HAART. The first group included 15 male patients with low viral load and low CD4 counts; the second included 15 male patients with low viral load and high CD4 counts. Morning serum leptin and tumor necrosis factor-alpha levels of HIV patients were measured and correlated with fasting serum insulin, Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], HIV viral load and CD4 count. Serum leptin levels were significantly higher in patients with high CD4 counts than in patients with low CD4 counts [mean serum leptin level 47.3 vs. 10.9 ng/ml, respectively; p < 0.0001]. A positive correlation was observed between serum leptin levels and CD4 counts [r = 0.697; p < 0.0001]; positive correlations were also seen between leptin levels and fasting serum insulin and HOMA-IR [r = 0.633, p < 0.0001, and r = 0.537, p < 0.003, respectively]. Serum leptin level was higher in HIV patients with high CD4 count and correlated with fasting serum insulin and HOMA-IR, thereby indicating that HAART treatment could lead to decreased levels of leptin in HIV patients, which might lead to impaired immunological recovery

Congenital plasmodium falciparum in a neonate in Kuwait

We report the case of a newborn infant who was diagnosed with congenital malaria. This baby was admitted for evaluation of fever which began four days prior to admission. The newborn was pale and had spleenomegaly and normal neonatal reflexes. Laboratory tests, including a peripheral blood smear, revealed Plasmodium falciparum in the red cells. His mother had suffered from malaria eight months back in India for which she took quinine for seven days. The newborn was successfully treated with quinine. He was discharged from the hospital in a good condition with negative blood smears

25-year-old woman with petechial rash and acute hepatitis following a febrile illness

As the spread of dengue and dengue hemorrhagic fever are increasing, atypical manifestations of dengue, such as dengue encephalitis, dengue myocarditis, and dengue hepatitis and dengue cholecystitis are also on the rise. These manifestations are under-reported because of lack of awareness. Dengue is endemic in India and the last epidemic occurred in Delhi in 2003. We report a case of a 25-year-old female Indian patient who presented to our hospital with complaints of fever and rash. In addition, she developed ascites during her stay in the hospital. She was diagnosed as having dengue hemorrhagic fever [DHF] with acute hepatitis. She made a complete recovery with supportive management

Atypical presentation of vibrio cholera

Cholera is known to be one of the most infectious diseases and is characterized by profuse watery diarrhea, vomiting and muscular cramps leading to dehydration, collapse and high mortality. Cholera is not endemic in Kuwait. We report a case of a Kuwaiti patient with atypical presentation of cholera that was diagnosed accidently by detection of Vibrio cholera in constipated stool. The patient was given treatment and discharged after clinical and laboratory cure. This patient is considered the first Kuwaiti cholera carrier over last ten years [documented by prevention control department in Kuwait]