Unusual presentations of malaria in children: an experience from a tertiary care centre in north east India.

Objective. To identify cases of malaria with unusual presentations. Methods. The medical record of all the cases of malaria admitted to PICU and pediatric general ward from Oct 2006 to Sep 2009, were reviewed and cases with unusual presentations were identified. The study design was retrospective descriptive study. Results. Sixteen (10%) out of 162 malaria cases had unusual presentations - three had hemiplegia, two each with viral hepatitis-like presentation, acute abdomen, gastrointestinal bleed, generalized edema and hyperglycemia and one each with ptosis, severe headache and subacute intestinal obstruction-like presentation. Eleven cases had mixed parasitemia and two each with P. vivax and P. falciparum. One case was diagnosed on clinical grounds. Conclusions. Malaria is a common disease, but both typical and atypical presentations deserve attention for early diagnosis and management.

Fatal haemophagocytic syndrome and hepatitis associated with visceral leishmaniasis.

Haemophagocytic syndrome (HPS) secondary to infections occurs due to excessive, non-malignant proliferation of histiocytes, with resultant haemophagocytosis. The syndrome is essentially treatable, provided timely etiological diagnosis is achieved. In this report, we present a rare case of a child who hailed from Uttaranchal and presented with severe hepatitis. Bone marrow examination revealed an unexpected diagnosis of HPS secondary to visceral leishmaniasis. Despite initiating appropriate antileishmanial treatment, the child had a fatal outcome.

Malarial hepatitis as a component of multiorgan failure--a bad prognostic sign.

A prospective study among the patients (n = 301) belonging to the coastal districts of Orissa having complicated falciparum malaria with multiorgan failure fulfilling modified APACHE II criteria, for a period of two years in this hospital setting was carried out with particular emphasis on hepatic involvement. There were 206 males and the rest females. Hepatic involvement in the form of raised serum bilirubin levels > or = 6 mg% and prothombin time > 4 compared to controls was found in 192 cases (63.8%). On analysis out of 192 cases predominantly conjugated hyperbilirubinaemia, mixed patterns and unconjugated hyperbilirubinaemia were seen in 115 (59.9%), 64 (33.3%) and 13 (6.8%) cases respectively. Serum bilirubin ranged from 6 to 38 mg%. Aminotransferase aspartate (AST, SGOT) and aminotransferase alkaline (ALT, SGPT) were raised almost two-fold in 98% cases of multiorgan failure with hepatic failure with mean values of 78 +/- 30.4 IU/l and 81 +/- 29.06 IU/l respectively. Nearly three-fold elevation of alkaline phosphatase was observed in 80% cases with mean (315 +/- 39.4 IU/l). Prothombin time was prolonged with mean 7 +/- 3 seconds. Serum proteins and albumin/globulin ratio were normal. There was no difference in glycaemic status over controls. In selected cases, liver histopathological study showed abnormalities in the form of Kupffer cell hyperplasia, mononuclear cell infiltration, hepatocyte necrosis, fatty changes and cholestasis. Majority of patients in multiorgan failure who died, had hepatic failure.

Modelo da fibrose septal hepática por Capillaria hepatica / Model of hepatic septal fibrosis by Capillaria hepatica

Vários modelos têm sido utilizados na tentativa de melhor se compreender a etiologia e a patogenia da fibrose hepática, bem como para se fazer ensaios com drogas anti¬fibrosantes. O rato infectado pelo helminto Capillaria hepatica desenvolve com regularidade, e em relativamente pouco tempo, um processo de fibrose septal progressiva, que chega até à cirrose. Por estas características, este modelo foi escolhido para testes com algumas drogas anti-fibrosantes, não só para testar tais drogas, como, através do presumido modo de ação de cada uma, inquirir sobre a patogênese da fibrose septal. Os objetivos desse trabalho foram: testar o potencial antifibrosante de algumas drogas, tais como: Pentoxifilina, Cio reto de Gadolínio, Vitamina A e Interferon-a; determinar a ação tanto preventiva, como curativa, das referidas drogas sobre a fibrose septal. Para isso, foram infectados 40 ratos Wistar com 1.500 ovos embrionados de C. hepatica, os quais foram subdivididos em 08 grupos experimentais, que receberam diferentes tratamentos com as drogas já mencionadas, excetuando o grupo controle, que foi tratado apenas com solução salina. Foram utilizadas técnicas histológicas, bioquímicas e morfométricas para a avaliação e mensuração da quantidade de colágeno e do grau de fibrose em amostras do tecido hepático obtidas em diferentes fases da infecção, por vezes, de um mesmo animal, através de hepatectomias parciais. As melhores respostas terapêuticas foram obtidas com Pentoxifilina, administrada por via intraperitoneal, mas não por via intravenosa, e com o Interferon-a nas doses de 500.000 e 800.000 U.I. O Cloreto de gadolínio mostrou moderada ação antifibrosante, mas apenas quando usada preventivamente. Os achados foram verificados através de análise estatística e mostraram significância com p<0,05, utilizando-se o teste Student-Newman-Keuls. O modelo animal empregado revelou-se útil para os testes com drogas com potencial antifibrosante. Inferiu-se que a pentoxifilina tem uma ação provável através inibição do TNFa e comprovou-se que o Interferon tem de fato uma ação direta anti-fibrosante. Os resultados apontaram para a importância da via de administração e da dose das drogas testadas.

Reliability of some biochemical parameters as prognostic factors for hepatitis in schistosomiasis patients

The early diagnosis of hepatitis in patients is sometimes difficult and despite adequate studies may remain undetected. To carry out this point, 4 selected groups of patients were investigated. Group 1 included patients with chronic liver cirrhosis due to schistosomiasis with a positive ELISA and PCR tests for HCV and showed a very high level of iron and ferritin as compared with the control group. Group 2 consisted of patients with chronic liver cirrhosis due to schistosomiasis with negative ELISA for either HBV or HCV antibodies and revealed a significant increase in copper and decrease in zinc as compared with the control group. Group 3 composed of patients with HCV infection, confirmed by antibody detection through third generation ELISA, RIBA III. Patients in this group showed a significant increase in the iron and ferritin level compared with the control group. Moreover, group 4 encompassed patients with HBV infection showed a positive ELISA for antibody detection [HBsAb] and immunochromatographic reaction for detection of surface antigen [HBsAg]. The results suggested that reduced level of Zn ++ and increased level Cu ++ might be a reflection of the incidence of HBV more than HCV infection, while a high level of iron and ferritin are potential biomarkers for schistosomiasis patients with early HCV infection