Role of multiple induced sputum examination in the diagnosis of Pneumocystis carinii pneumonia.

We evaluated the usefulness of repeated nebulized saline induced sputum examinations among 60 HIV infected patients clinically suspected to have Pneumocystis carinii pneumonia (PCP). We found that the first sample was positive for 15 episodes (21.4%); the second sample was positive in 33 episodes (47.1%); the third sample was positive in 22 episodes (31.4%). Repeated nebulized saline induced sputum examination imporved the yield of Pneumocystis carinii and enhanced the sensitivity of a positive result. This technique is simple, cost-effective, non-invasive, and reliable. We recommend the examination of multiple induced samples of nebulized saline induced sputum in all HIV infected patients with suspected PCP. This recommendation may decrease the need for invasive procedures.

Clinical implications of hypocalcemia in malaria.

Total serum calcium levels were estimated in 60 adult patients with malaria to know the prevalence of hypocalcemia in different types of malaria and its clinical implications. As hypocalcemia is known to cause Q-Tc interval prolongation, electrocardiograms were obtained in all patients with low calcium levels. Twenty seven (45%) patients with malaria had hypocalcemia. Majority (88.24%) of the complicated malaria patients had hypocalcemia as against uncomplicated malaria (27.91%). Mean calcium levels were significantly lower in complicated malaria (7.4 +/- 0.98 mg/dl) when compared to uncomplicated malaria (8.4 +/- 0.44 mg/dl). There was an inverse relation between calcium levels and parasite load (P < 0.05). Significant correlation was also seen between the degree of hypocalcemia and Q-Tc prolongation (P < 0.01). Return of calcium levels to normal coincided with clinical recovery and parasite clearance. Three patients who had low calcium levels and prolonged Q-Tc died of hypotension, bradycardia and heart block after quinine therapy. The exact cause of hypocalcemia could not be ascertained but renal failure, hypomagnesemia and parathyroid failure could have been contributary. In conclusion, hypocalcemia is not uncommon in complicated malaria. It can be of prognostic value as it may indicate complicated malaria or heavy parasitemia and its return to normal may indicate clinical recovery and parasite clearance.

Clinical study of 100 cases of Kyasanur Forest disease with clinicopathological correlation.

100 cases of Kyasanur Forest Disease were studied clinically and autopsy or postmortem biopsies of various organs were done in 8 cases. 1. Our study showed that KFD passes through 4 stages each lasting for about a week. i.e. a prodromal stage with fever, hypotension hepatomegaly, a stage of complication characterized by haemorrhage, neurological manifestation or bronchopneumonia, a stage of recovery followed by a li stage of fever in some cases. 2. The exact of cause of haemorrhage could not be identified though Disseminated Intravascular Coagulation was suspected. 3. Hypotension in KFD could be of Myocardial origin. 4. Encephalopathy in KFD could be due to a metabolic cause probably of hepatic origin. 5. Lung signs could be due to intraalveolar haemorrhage and secondary infection.