Cerebral toxoplasmosis in an HIV positive patient: a case report and review of pathogenesis and laboratory diagnosis

Toxoplasmosis is a worldwide infection. It may have acute or latent clinical presentations. Because of defective cell mediated immunity, patients are at a higher risk of developing toxoplasma encephalitis. We report the first biopsy diagnosed case of cerebral toxoplasmosis in an HIV positive patient from the Kingdom of Bahrain and review the pathogenesis, pathology and laboratory diagnosis

Medical Quiz

A twenty-six year old Indian labourer had arrived in Bahrain since seven days. He presented to accident and emergency department of Salmaniya Medical Complex with a history of abdominal pain in the right iliac fossa, loss of appetite, vomiting and watery loose motions of five days duration. There was no history of passing mucus or blood in the stools. He denied any past history of similar complaints. The patient was afebrile with a pulse rate of 82 per minute. General physical examination was normal. The abdomen felt soft, non-distended with mild tenderness and guarding. Rebound tenderness was also elicited in the right iliac fossa with the possibility of a mass. The liver was not enlarged. Investigations showed haemoglobulin-14.5 g/dl, total leucocyte count is 20.5 X10 9 cells, differential leucocyte count showed polymorphs 76%, lymphocytes 8%, monocytes 14%, band forms 1% and atypical lymphocytes 1%. Liver function tests showed Serum albumin of 29 g/1 and serum globulin of 41 g/1. Total bilirubin was 15 umol/L and mildly raised alkaline phosphatase of 188 u/L. Serum electrolytes showed mild lowering of sodium 136 mmol/L and serum chloride 98 mmol/L. Abdominal ultrasound has suggested the possibility of an appendicular mass. The patient underwent an emergency appendectomy. Peri-operatively, a discrete retrocaecal appendicular mass with thickened peritoneum and meso-appendix was noted. There was no pus found in the mass or the abdominal cavity. Large bowel was unremarkable except for mild thickening of the caecum. The patient did not report during the follow-up period. Pathological findings showed appendix grossly measured 10.5 X 1x 1 cms and looked brownish with exudate on the outer aspect. Histology revealed inflammatory exudate covering patchy areas of ulcerations Ql. What is the histologic finding? Q2. What is your diagnosis? Q3. What is the characteristic finding ? How do you confirm such a diagnosis ? Q4. How do you distinguish Entamoeba histolytica from non-pathogenic Entamoeba coli? Q5. Name the complications of this condition? What are the other abdominal sites where such a pathology can occur?

Skin Cancer

Study the incidence and pattern of skin cancer diagnosed in Bahrain among the indigenous Arabs and expatriate population. Review of histopathology archives in Bahrain between 1952-1999.Skin cancer account for 6.7% of all malignancies among Bahrain! Arabs with 70.2% of the patients above the age of 60 years as compared to 43.8% in the expatriate group. It is 2.5 times more common in the expatriate population in their 4[th] and 5[th] decades of life than the Bahrain group. There were no Bahrain patients with MM in their 4[th] decade as compared to 52.9% in the expatriate group. In both groups, skin cancer particularly BCC, predominantly affected the sun-exposed parts of the body. However, BCC and MM of the trunk and lower extremities is 3 times more common among the expatriate group than the Bahraini. Similarly the former group develop 7 times more non-invasive cancers than the Bahraini and also show 9 times more multicentric lesions than Bahraini. Four percent of skin cancers in Bahraini are lymphomas as compared to 0.4% in the expatriate group. The incidence of skin in Bahrain and the Arabian Gulf countries is low as compared to those of Europe, North America and Australasia. The differences between the Arabs and expatriate population are due to the influence of genetic and ethnic background, local cultural habits of avoiding exposure to the biological effect of solar radiation and the protection provided by local costumes worn by men and women

Patterns of malignant tumors of the brain and spinal cord in Bahrain: Fifty two year period

To review malignant neoplasms of the brain and spinal cord in Bahrain, and to compare the incidence with other parts of the world. A retrospective study. All Histopathology Departments in Bahrain. Data relating to all malignant CNS neoplasms which were diagnosed histologically in Bahrain were extracted from the relevant patient medical records. All tumors were histologically diagnosed in Bahrain between 1952 and 2004. There were 103 malignant CNS tumors representing 1.4% of all malignancies histologically reported during the same period. Of the 103 patients, 77 [74.8%] were Bahraini. Of the Bahraini patients, thirty-one [40.3%] were female and the male: female ratio was 1.48:1. Sixty-two of the 77 Bahraini tumors [80.5%] were primary brain tumors, nine [11.7%] were primary spinal cord tumors, and six [7.8%] were secondary tumors. Astrocytoma and medulloblastoma were the commonest primary malignant CNS neoplasms in both adults and children. The apparent incidence of malignant brain and spinal cord neoplasms in Bahrain is very low. The small Bahraini population, inefficient registration of cancers, and the lack of routine hospital autopsies are contributory factors for the low numbers observed

Spectrum of malignant lymphomas in Bahrain. Leitmotif of a regional pattern

To determine the clinicopathologic features of malignant lymphomas in Bahraini patients. A retrospective hospital-based study was conducted. All new cases of malignant lymphoma diagnosed during the period January 1996 to December 2001 at the Salmaniya Medical Complex in Bahrain were included in the study. Seventy-two cases met the inclusion criteria. This included 24 [33.3%] cases of Hodgkin's disease [HD] and 48 [66.7%] cases of Non-Hodgkin lymphomas [NHL]. A young age at presentation [median 20 years] mixed cellularity histology, lack of extra nodal involvement and rare marrow involvement characterized HD. The majority of NHL showed diffuse high or intermediate grade lesions. A high number of primary extra nodal neoplasms [41.7% of NHL] and frequent involvement of the gastrointestinal tract with Helicobacter pylori-associated gastric lymphomas were notable features among NHL cases. Immunohistochemical staining in 30 cases showed 26 cases [86.7%] of B cell and 4 cases of T cell origin. The study highlights common features that distinguish malignant lymphoma reported from countries of the Arabian Gulf region. This pattern distinguishes them from the disease encountered in the Western world

Haematological Malignancies in Bahrain

To provide an estimate of the prevalence and shift of different types of haematological malignancies over 10 years time period from 1986 to 1995. Relevant laboratory based data of all cases of haematological malignancies in Bahrainis diagnosed between January 1986 to December 1995. Results expressed as age specific and age adjusted incidence rates per 100,000 population per year during the periods 1986 to 1990 and 1991 to 1995. Observed prevalence of haematological malignancies increased from 3.3 in 1986 to 9.8 in 1995 per 100,000 population. In children the peak incidence was 8.7/100,000 population in less than 5 years of age. In adults the peak incidence was 40/100,000 in the 65-75 years age group. The lowest incidence of 1.8/100,000 was in the 20-30 years age group. An abrupt increase in prevalence of acute lymphatic leukaemias was observed in 1991 [post Gulf War]. A three times increase in prevalence rate at the end of 10 year [1986-1995] is alarming. This may be due to an increase in detection rate, though the effect of other factors such as the Gulf war cannot be completely ignored. However this study will now provide base data to observe shift in occurrence over time

frequency, embryogenesis and functional significance of ectopic adrenocortical tissue

Ectopic adrenocortical nodules have frequently been found along the embryologic path of the urogenital ridge. The present paper reports 15 new cases occurring within this confine. The frequency rate of these nodules based on surgical or autopsy files is not reliable because of sex-bias of the samples studied. Their removal, however, whenever encountered during surgery is warranted because although the majority of the nodules undergo atrophy during childhood, some may become hypertrophic and functional after adrenal abalation. They rarely become neoplastic