Postnatal encephalitis: a diagnosis not to be missed

Viral encephalitis is a common condition but only a few studies are available on occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the frequency of postnatal encephalitis among patients presenting with cerebral neurological complications during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome of the patients. This cross-sectional descriptive study was conducted at Department of Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study. The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and MRI. Among patients 16 [84.2%] presented with fever, 13 [68.42%] with headache, 8 [42.1%] with meningeal irritation, 7 [36.84%] with hemiparesis, 18 [94.7%] with altered sensorium, 13 [68.42%] with seizures, and 7 [36.84%] with coma. Cerebrospinal fluid of 16 [84.21%] patient had the changes consistent with viral encephalitis. It was normal in 2 [10.52%] patients and showed picture of pyogenic meningitis in 1 [5.26%] cases. On CT scan of brain, 3 [15.78%] had normal scans, 3 [15.78%] had cerebral oedema, 4 [21.05%] had ischemic infarct, 3 [15.78%] had meningo-encephalitis, 2 [10.52%] had infarct plus cerebral oedema, 1 [5.26%] had encephalitis and 3 [15.78%] had infarct plus haemorrhage. On MRI brain 15 out of 17 [88.2%] had lesions consistent with encephalitis. All 19 [100%] patients were treated with 10 days course of acyclovir and a broad spectrum third generation antibiotic. After hospitalisation 11 [57.8%] patients were discharged with complete recovery, 5 [26.31%] were discharged with partial recovery and 3 [15.78%] patients expired. Clinical presentation of the patient is most important in diagnosing viral encephalitis in postnatal women especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy should be started without delay while awaiting other investigations.

Crimean congo hemorrhagic fever in hazara division

Background: Crimean-Congo Hemorrhagic fever [CCHF] is endemic in certain areas of Pakistan with 14 outbreaks in addition to many sporadic cases so far. It is highly fatal zoonotic disease caused by bite of infected tick. The objective of our study is to describe clinical features, treatment and outcome of CCHF positive cases during its outbreak in Hazara division, with the intention to bring focus to this fatal emerging disease. Methods: This study was conducted in Medical A Unit of Ayub Teaching Hospital, Abbottabad for a period of three months. All patients presenting with fever and platelet count less than 50, 000/mm3 were included in the study. Apart from baseline investigations their blood samples were sent for the detection of CCHF virus. All patients were given supportive treatment including fresh frozen plasma and were started on oral Ribavirin. All patients were isolated and barrier personal precautions were observed by health care givers Results: Eighty-eight patient with fever and thrombocytopenia were included. Among these, 8 were found to be positive for CCHF. Supportive treatment with oral Ribavirin was given to all patients. One patient with CCHF died. One left against advice and six patients recovered completely. Conclusions: All patients presenting with acute fever and thrombocytopenia should be suspected and evaluated for CCHF. Oral Ribavirin is safe and effective in the treatment of CCHF. Keywords: Crimean Congo Hemorrhagic fever, Pakistan, Ribavirin

Presentations of tuberculosis in northern Pakistan

Tuberculosis [TB], which is a very common droplet infection. If untreated, the disease may be fatal within 5 years in more than half of cases. The aim of this hospital based descriptive study was to see mode of its presentation in our set-up. The study was conducted in Medical Unit, Ayub Teaching Hospital, Abbottabad and 500 diagnosed cases of tuberculosis were included in this study. History regarding presenting symptoms, age, sex, etc. was taken. Out of the 500 patients, 277 [55.4%] were male and 223 [44.6%] were female. Two-hundred-three [40.5%] were in age group 21-35 years, 136 [27.1%] were in age group 36-50 years, 141 [28.1%] were in age group 51-65 years while 20 [4%] were above 65 years of age. Three-hundred-and-eighty [76%] presented as Pulmonary TB, 47 [9.4%] as Abdominal TB, 45 [9%] as TB Meningitis, 13 [2.6%] as Pott's Disease, 7 [1.4%] as TB Lymphadenitis, 6 [1.2%] as Constrictive Pericarditis, 1 [0.2%] as Psoas Abscess and 1 [0.2%] as TB Orchitis. TB in its various forms remains a killer disease in our part of the world. The commonest presentation is Pulmonary TB which is probably due to three major factors namely poor hygienic practices, late diagnosis and non-compliance

Frequency of anti-tuberculous therapy-induced hepatotoxicity in patients and their outcome

Tuberculosis [TB] is a very common droplet infection especially in the northern areas. If untreated, the disease may be fatal within 5 years in more than half of cases. To study the frequency of anti-tuberculous therapy [ATT] induced hepato-toxicity was the subject of the present hospital based descriptive study. The study was conducted in Medical Unit, Ayub Teaching Hospital and patients with diagnosed Tuberculosis in whom ATT was initiated were included in the study. The subsequent development of elevated liver enzyme levels and hepatitis, amongst some members of the study group; was diagnosed, with the help of clinical findings and Liver Function Tests [LFT's] and were dealt with according to severity. Out of the 500 patients studied 277 [55.4%] were male and 223 [44.6%] were female, 203 [40.5%] were in age group 21-35 years, 136 [27.1%] in age group 36-50 years, 141 [28.1%] in age group 51-65 years while 20 [4%] were above 65 years of age. Out of them 40 [8%] developed hepatotoxicity, 21 [4.2%] patients amongst the study group developed overt hepatitis, 20 [4%] of them made an uneventful recovery while 1 [0.2%] died of Fulminant Hepatic Failure [FHF]. ATT-induced hepato-toxicity, was frequently encountered in patients put on ATT