Study of clinical profile and antibiotic response in typhoid fever.

The objective of the present study is to evaluate the clinical profile and pattern of various drugs used in the treatment of typhoid fever. A retrospective analysis of adult patients suffering from typhoid fever was done at Kasturba Medical College hospital, Attavar during the year 1999-2001. Diagnosis of patients was based on clinical features, widal test and blood culture. The sensitivity pattern of isolates from blood culture was recorded. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antibiotic administered, response to therapy and the complications were recorded. Total number of 44 cases of typhoid fever were studied. Out of these 21(47.7%) were males and 23(52.3%) were females. Average age of presentation was 23.9 years. Average duration of hospital stay was 10.8 days. Fever was present in all patients. Resistance of S. typhi to amoxicillin, chloramphenicol, ampicillin and co-trimoxazole were significantly high. Ciprofloxacin also showed resistance in 18.1% of cases. Sensitivity to cephalosporin was 100% in our study. Ciprofloxacin was the most commonly used antibiotic in our study (23 patients). Chloramphenicol alone was used in 2 patients and in 3 patients it was given after 6 days of ciprofloxacin treatment. Third generation cephalosporins (ceftriaxone) alone were used in 16 patients. Indiscriminate use of drugs in typhoid fever should be discouraged. Appropriate antibiotic as indicated by sensitivity tests should be employed to prevent the development of resistant strains of S. typhi.

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.

Evaluation of safety and efficacy of azithromycin in lower respiratory tract infections (LRTI)

Azithromycin was given to 55 cases of lower respiratory tract infections in the doses of 500 mg on day 1, followed by 250 mg on days 2-5. It produced bacteriological cure in 70.8% patients and clinical cure or improvement in 69.09% of patients. 4.27% of patients had throat colonisation with new organisms, of which 9.09% needed a second antibiotic. The drug was well tolerated and minor side effects were noted. Gastrointestinal disturbances (16.36%) headache and giddiness (14.55%), rash (3.64%) were the noted side effects. Reduction of platelet count by 50% occurred in 12.29% of the cases compared to 0.2% reported earlier. But this thrombocytopenia was clinically not significant, as it did not cause any symptoms.

The 1993 epidemic of dengue fever in Mangalore, Karnataka state, India.

An epidemic of febrile illness with hemorrhagic manifestations occurred in certain parts of Mangalore city, Karnataka state, India, from the last week of July 1993. The epidemic reached its peak by mid-August and then started declining. Sporadic cases, however, continued to occur till early December. About 200 cases were reported covering all age groups and both sexes. The cases presented with pyrexia, myalgia, arthralgia and headache. Palatal petechiae, magenta colored tongue with central coating, maculopapular rash and facial flush were observed as classical signs. The tourniquet test was positive in 12% of the cases. Hemorrhage was observed in the form of epistaxis (2 cases), subconjunctival hemorrhage (2 cases) or purpura (3 cases). There were no deaths which were attributable to the epidemic. Five strains of dengue (DEN-2) virus were recovered from the acute-phase sera. Dengue virus-specific IgM type of antibodies were detected in 29/116 (25%) sera. Breeding of Aedes aegypti was observed in some of the areas where cases had occurred. No virus was isolated from any of the field-caught Ae. aegypti mosquitos.