Acute disseminated encephalomyelitis--another cause of post malaria cerebellar ataxia.

The aetio-pathogenesis of delayed onset cerebellar ataxia following Plasmodium falciparum malaria is uncertain. An autoimmune demyelinating pathology has been suspected though not yet definitively substantiated. In the present communication we report a case of delayed onset cerebellar ataxia following acute falciparum malaria, where magnetic resonance imaging revealed demyelinating lesions in the pons and cerebellar peduncles which disappeared after resolution of symptoms.

Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme.

BACKGROUND: An estimated 68 million Indians are above the age of 60 years; however, information on their health status and needs is limited. Experience in developed countries shows that multiple chronic illnesses, nutritional deficiency and functional disability are common features of old age. For the development of any health programme, reliable situational information is essential. We therefore assessed the health and functional status of older Indians seeking health services. METHODS: We carried out a prospective cross-sectional observational study on 1586 subjects > or = 60 years of age (1035 men and 551 women), who attended the Geriatric Clinic of the All India Institute of Medical Sciences, New Delhi. A clinical and laboratory evaluation was carried out through a pre-designed protocol evolved after reviewing the relevant literature. The protocol included a questionnaire on demographic details, personal habits, socio-economic variables, family structure, past and present medical history, use of medications and aids, presence of certain common symptoms and perceived functional disability. Evaluation included a detailed physical examination, functional assessment, psychiatric assessment and a set of laboratory tests. RESULTS: Ninety-five per cent of the subjects were < 80 years of age and 87% of them sought medical attention for an acute illness that had occurred in the month prior to their coming to our clinic. One or more chronic illnesses were present in 96% and each subject had a mean of 2.5 diagnoses. However, they suffered from a limited number of illnesses of which the 10 most common accounted for 80% of the diagnoses. Hypertension, cataract and osteoarthritis were the 3 most common illnesses. About one-third of a subset of 209 subjects had a psychiatric illness; depression accounted for 50% of all psychiatric illnesses. A detailed functional assessment was carried out in 1268 subjects which showed that deficits of vision and hearing were the most frequent disabilities. Impairment of daily activities and cognition accounted for 6.9% and 5.1% of the diagnoses, respectively. A majority of them considered their home free from the hazard of accidents and were sure of support from their families at times of need. CONCLUSION: Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India. It is difficult to assess the total service needs of the population from this study because of its unrepresentative character, though it provides a fair picture of the expectations of care of older people in India.

Mycoplasma pneumoniae and community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia is an important cause of mortality and hospitalization in all age groups. In temperate climates, Mycoplasma pneumoniae is a common respiratory pathogen causing pneumonia. Information on human Mycoplasma infection in India is scarce. METHODS: We aimed to determine the frequency of Mycoplasma pneumoniae infection among patients with community-acquired pneumonia in a prospective cross-sectional study. The assessment included clinical and radiological evaluation followed by microbiological evaluation for the specific pathogen. Microbiological investigations included aerobic and anaerobic blood culture, anti-Mycoplasma IgM antibody detection by gelatin particle agglutination test and ELISA, culture of respiratory tract secretions for Mycoplasma pneumoniae and other organisms, and detection of specific Mycoplasma pneumoniae antigen by indirect immunofluorescence. RESULTS: Sixty-two patients (42 men and 20 women; mean age 41.7 years) with community-acquired pneumonia were investigated prospectively. They included 42 immunocompetent and 20 immunocompromised patients. Six patients had definitive evidence of Mycoplasma pneumoniae infection and an additional 16 patients had a probable diagnosis. In all, 22 (35.5%) patients with pneumonia had Mycoplasma pneumoniae infection. Of these, 12 patients belonged to the immunocompromised group and 10 to the immunocompetent group. Patients with Mycoplasma pneumoniae infection also had secondary bacterial infection as evidenced by organisms isolated from blood in 50% and from respiratory tract secretions in 68%. CONCLUSION: Community-acquired pneumonia has a polymicrobial aetiology, of which the prevalence of Mycoplasma pneumoniae is 35%. The study has two implications: (i) Mycoplasma pneumoniae infection is frequently associated with secondary bacterial infection; and (ii) initial empirical antibiotic therapy for community-acquired pneumonia in India must include antibiotics with activity against Mycoplasma pneumoniae.

Tuberculosis: a rare cause of splenic abscess.

Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.

Prolonged pyrexia in a diabetic due to systemic aspergillosis.

Immuno-compromised patients are susceptible to a variety of opportunistic infections. Systemic aspergillosis is one such common infection in neutropenic subjects. A case of primary cutaneous aspergillosis with fungimia in a diabetic is reported.

Clinical presentation and predictors of outcome in adult patients with community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia in adults has a morbidity and mortality ranging between 10% and 25%. Increasing age is associated with a higher mortality. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We, therefore, studied the clinical profile and predictors of outcome in adults with community-acquired pneumonias. METHODS: Seventy-two consecutive patients with community-acquired pneumonia were included in the study over a period of 18 months. A detailed history was obtained and physical examination done. A chest X-ray was done to establish the diagnosis and haematological, biochemical and arterial blood gas estimations were carried out. The data of survivors and non-survivors as well as those > or = 50 years of age and < 50 years were analysed to determine the clinical profile and outcome in these groups. RESULTS: The clinical features, laboratory parameters and complications from pneumonia were similar in 43 elderly (group I, age > or = 50 years) and 29 young (group II, age < 50 years) subjects. Thirty-five per cent of elderly patients and 14% of young patients succumbed to fulminant sepsis or respiratory failure (p < 0.05). Old age, history of smoking, presence of chronic obstructive airways disease, late presentation to hospital, systolic and diastolic hypotension, high blood urea, low serum albumin and development of septic shock were associated with a higher incidence of complications and a poorer prognosis. In addition, older patients with a poor outcome also had symptoms for a longer duration and a poor neutrophilic response to infection. CONCLUSIONS: The presence of certain factors leads to a higher incidence of complications and a poorer prognosis. These factors are good predictors of outcome in adults of all age groups.

Flowcytometric assessment of intracellular interferon-γ production in human CD4 + ve T-cells on mycobacterial antigen stimulation.

Interferon- (IFN-γ ) has been considered to be a critical protective immunomodulatory component against Mycobacterium tuberculosis (M. tb.) infection. In this study T-cell proliferation and IFN-γ production upon stimulation with M. tb. were assessed in patients of pulmonary tuberculosis and healthy contacts. The studies were based on lymphocyte transformation test and detection of intracellular IFN-γ production by CD4 + ve T-cells by flowcytometry. Patients showed lower levels of proliferation, the stimulation index being in the range of 2·17 1·1 (mean + SD) compared to the contacts (SI = 4·59± 1·6) (P < 0·01). The kinetics of intracellular induction of IFN-γ on M. tb. stimulation showed a proportional increase in the CD4 + ve T-cell population. The increase was maximal between 96-120 h of culture. In healthy contacts the number of IFN-γ expressing CD + ve T-cells increased to 2·5 to 41 × 104 cells/ml in M. tb. stimulated cultures compared to control cultures (0·1 —15 × 104). In contrast patients showed no/marginal increase in CD4 + ve T-cell population expressing intracellular IFN- γ Thus the lack of induction of IFN in CD4 + ve T-cells in patients could be a critical shortcoming in their ability to combat tubercle bacilli infection.

Multi drug resistant tuberculosis.

The prevalence of multi-drug resistant tuberculosis is increasing globally which has upset tuberculosis treatment and control programmes. The problem has been further complicated by co-infection with HIV virus. Treatment of multi drug resistant tuberculosis is difficult, expensive and requires long duration chemotherapy. The long term prognosis is poor with frequent relapses following cessation of treatment. Health care workers are at considerable risk of contacting the disease. New, potent and less toxic drugs are required for management of multi drug resistant strains. Directly observed therapy of tuberculosis seems to be promising but demands enormous resources. Finally strengthening of tuberculosis control programmes for prevention and control of tuberculosis is essential.