ABSTRACT
Background: Dhule district in Maharashtra (India) has snake bite as a common medical emergency. There are 168 villages in Dhule district and its majority of the population is engaged in farming and snakebite is a major occupational hazard particularly during the harvesting season. The available data on the epidemiology of snake bite from the here is sparse. Poisonous and nonpoisonous snake bites accounts approximately 30 admissions per month which increase to 35-40 admissions in rainy season in Civil Hospital. Methods: Fifty patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to medical ICU for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of antisnake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. Results: 60% of patients affected were in the age group of 21-40 years. Maximum numbers of bites were during April to September (84%). All patients had severe manifestations such as ptosis, ophthalmoplegia, neck muscle weakness, limb and respiratory muscle weakness. 200 ml ASV was administered to all, along with atropine and neostigmine. Mechanical ventilation was required for a median duration of 26.60 hours. All victims in the study group survived with complete neurological recovery except one mortality for a patient who had suffered irreversible hypoxic cerebral injury prior to arrival in hospital and needed ventilatory support for 9.58 days. Conclusions: Timely institution of ventilatory support and fixed dose of 200 ml of ASV along with anticholinesterase treatment was sufficient to reverse neuroparalysis in severe elapid bites.
ABSTRACT
Background: The protean manifestations of enteric fever make this disease a true diagnostic challenge. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. This is a prospective study of fifty confirmed enteric fever adult patients done in Kasturba Hospital Mumbai. Methods: Fifty enteric fever patients with clinical and laboratory diagnosis were included in the study. They were admitted in wards with the aim of documenting the epidemiological pattern, clinical picture, therapeutic response and complications of Salmonella. Their history and detailed physical examination were recorded and tests including antibiotic sensitivity and resistance were done. Results: In the study incidence of fever 100%, chills 26%, vomiting 44%, diarrhea 28%, abdominal pain 64%, headache 26%, and signs as splenomegaly 36%, hepatomegaly 42%, rose spots 6%, relative bradycardia 34% were reported. Anemia, leukocytosis and leukopenia and elevated liver enzymes were found in 42.9%, 10%, 21% and 45% respectively. Incidence of Salmonella Typhi, Salmonella Paratyphi was 80% and 20% respectively. There was no mortality in the study. Conclusion: Clinical presentation, signs and symptoms of Typhoid fever patients are varying. For the confirmatory diagnosis in addition to a high index of suspicion, Widal test and blood culture are required. For the proper treatment of Typhoid fever in view of emergence of resistant strains of S. Typhi antibiotic sensitivity and resistance test should be done whenever facilities available.
ABSTRACT
Neurologic involvement of brucellosis is common but exact prevalence of it is unknown due to difficulty in diagnosis and inadequate reporting all over the world. Neurologic involvement may manifest as chronic meningitis, lymphocytic meningoencephalitis, a variety of cranial nerve deficits, or ruptured mycotic aneurysms. We report a case of young male who had history of fever and headache on and off for 2 years and later developed signs of meningitis, lateral rectus palsy, altered sensorium and bilateral papilledema. He did not respond to anti-tubercular therapy and antibiotics. CT scan and MRI brain were normal. He had hepato-splenomegaly with small hypoechoic lesions in the spleen. CSF culture grew gram negative bacilli. Brucella IgG antibodies in serum by EIA 7, IgM negative, Brucella antigen titer was positive, 1:160. Patient received inj. streptomycin 0.75 g for 21 days and doxycycline 100 mg twice daily doxycycline for 6 weeks. The complete improvement in patient’s condition after a long lasting illness motivated authors to report this case. Delay or failure in diagnosis of this treatable disease may lead to significant morbidity and mortality so high index of suspicion should be kept in such cases.