ABSTRACT
Scrub typhus is a multisystem disease, caused by genera orientia tsutsugamushi and is currently endemic in India. In children, the disease may vary from a mild to a severe form. Complications include encephalitis, myocarditis, disseminated intravascular coagulation, acute kidney injury, atypical pneumonia, etc. The pathophysiologic mechanisms of renal involvement in scrub typhus include prerenal failure, septic shock, vasculitis, acute tubular injury and direct renal invasion by rickettsia. Here, authors present the case of a previously well 5-year old female child who was admitted to our hospital with a history of high-grade fever and pain abdomen. IgM scrub typhus turned out to be positive and she was adequately treated with doxycycline. She turned afebrile but then gradually developed anasarca, hematuria, proteinuria and persistent stage 2 hypertension. Kidney biopsy was done which revealed focal segmental glomerulosclerosis (FSGS). Further workup of the patient by whole exome sequencing revealed missense mutations in TBX18, INF2 and NPHS1 genes. Mutations in INF2 gene is a recently discovered cause of autosomal dominant FSGS. In our case, the scrub typhus mediated kidney injury probably acted as a trigger in unmasking FSGS in the already genetically susceptible child.
ABSTRACT
Background: The prevalence of type 2 diabetes mellitus(T2DM) is growing worldwide, and these patients may beasymptomatic and present with complications at the time ofdiagnosis. Diabetic neuropathy is the most commoncomplication affecting the patients who may present with distalpolyneuropathy at the time of diagnosis and also poorglycaemic control. The Diabetic peripheral polyneuropathyaffects approximately 1 in every 10 newly diagnosed patients,whereas two third of patients with diabetes mellitus haveclinical or subclinical neuropathy.Objective: This study is designed to find prevalence of diabeticperipheral neuropathy in Newly Diagnosed Patients of T2DM ina tertiary care hospital.Materials and Methods: This observational study was carriedout in patients diagnosed with T2DM as per ADA criteria. Athorough clinical examination; Nerve conduction velocitytesting; evaluation of plasma glucose and glycosylatedhemoglobin and assessment of neuropathy by using theDiabetic neuropathy index and diabetic neuropathy score wasperformed on all patients.Results: 18% of patients had signs of peripheral neuropathyas shown by NCV testing at the time of diagnosis. Thesepatients had elevated levels of glycosylated hemoglobin,fasting plasma glucose and 2-hour plasma glucose and lowerscores of DNI and DNS which were statistically significant. Themost common type of neuropathy seen in these patients wassensorimotor involvement with demyelinating type ofneuropathy with more involvement of lower limbs. The NCVstudies showed reduced distal latency and prolongedamplitude as well as conduction velocity in patients withdiabetic neuropathy.Conclusion: Our study showed that approximately 1 in 5newly diagnosed patients with type 2 diabetes mellitus are atrisk of developing diabetic peripheral neuropathy.