Melioidosis: an emerging infectious disease.

Infectious diseases account for a third of all the deaths in the developing world. Achievements in understanding the basic microbiology, pathogenesis, host defenses and expanded epidemiology of infectious diseases have resulted in better management and reduced mortality. However, an emerging infectious disease, melioidosis, is becoming endemic in the tropical regions of the world and is spreading to non-endemic areas. This article highlights the current understanding of melioidosis including advances in diagnosis, treatment and prevention. Better understanding of melioidosis is essential, as it is life-threatening and if untreated, patients can succumb to it. Our sources include a literature review, information from international consensus meetings on melioidosis and ongoing discussions within the medical and scientific community.

Transitory alexia without agraphia: a disconnection syndrome due to neurocysticercosis.

We describe a 65-year-old male who presented with acute onset inability to read, without any difficulty in writing. A clinical diagnosis of alexia without agraphia was made and the patient was subjected to routine investigations including contrast MRI. MRI showed a ring-enhancing lesion in left occipital area, suggestive of neurocysticercosis supported by quantitative enzyme-linked immunosorbant assay from purified cell fraction of taenia solium cysticerci (PCF-ELISA). Patient was treated with albendazole and prednisolone for one week. The clinical manifestation as well as the radiological finding resolved after treatment.

Early white matter changes in Wilson disease.

We describe a 12 years old male who presented with one year history of cognitive decline with extrapyramidal features. Wilson disease was diagnosed on basis of biochemical studies and MRI. MRI showed increased signal intensity on T2 weighted images in basal ganglia and supratentorial with infratentorial gray and white matter. Our patient developed white matter changes early in course of disease.

Neurocysticercosis presenting as Weber's syndrome.

This case report describes a rare, non-epileptic manifestation of neurocysticercosis where a 22-year-old male presented with acute onset right 3rd nerve palsy with left hemiplegia (Weber syndrome). Computerized tomography and magnetic resonance imaging revealed cysticercus granuloma. The patient improved and became asymptomatic with steroid treatment. Recognizing this clinical entity would avoid unnecessary antituberculous treatment and surgical intervention.

Patient with limb girdle dystrophy presenting with dopa-responsive dystonia--a case report.

Dopa-responsive dystonias are rare. We report a 14-year-old male who was diagnosed as a case of limb girdle dystrophy and had features suggestive of dopa-responsive dystonia.

Cauda-conus syndrome resulting from neurocysticercosis.

A 60-year-old male, presented with insidious onset, gradually progressive, burning paresthesia over the saddle area, sphincteric disturbance, impotence and paraparesis. Investigations revealed a ring-enhancing lesion in the conus medullaris suggestive of neurocysticercosis. This was supported by quantitative enzyme-linked immunosorbant assay from purified cell fraction of taenia solium cysticerci. On treatment with steroids he showed marked improvement.

Sertraline in chronic tension-type headache.

OBJECTIVES: To study the effect of Sertraline, a selective serotonin reuptake inhibitor in chronic tension type headache (CTTH) in a double blind placebo controlled randomized trial. MATERIAL AND METHODS: The study design was a double blind placebo controlled randomized study of 50 patients, over a period of 10 weeks including run-in period of two weeks, treatment period four weeks, and follow-up four weeks. The diagnosis of CTTH was based on criteria given by International Headache Society (IHS). The overall response was graded in terms of headache index, analgesic intake per week and percentage reduction in headache frequency using chi-square and 't' test. Anxiety and depression was assessed using Hamilton Rating Scale. RESULTS: The mean analgesic intake per week declined from 4.34 +/- 0.736 tab/week to 1.07 +/- 0.592 tab/week in sertraline group (p < 0.01) while reduction in placebo group was not significant (3.98 +/- 0.729 tab/week to 2.94 +/- 0.665 tab/week) (p > 0.05). The reduction in headache index and percentage reduction in frequency of headache was not significant in drug treatment group. Side effects were seen in 24.4% of patients nausea, nervousness and dizziness being the commonest. CONCLUSION: The drug treatment group showed a significant decline in analgesic intake per week. The study result shows that sertraline can be a useful alternative to amitryptiline in those patients who fail to respond or cannot tolerate it.

Management of status epilepticus.

Status epilepticus is a medical emergency, if not treated in time and effectively may cause significant mortality and morbidity. Medical therapy has been the mainstay of treatment but in refractory status surgical resection, multiple subpial transection, electroconvulsive therapy, caudate stimulation and acupuncture play important role. The present operational definition for adults and older children considers status as > or = 5 minutes of continuous seizure or two or more discrete seizures without regaining of full consciousness. Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy. Physiological changes in generalised convulsive status epilepticus include transient or early (0-30 minutes) and late (after 30 minutes) changes. Temporal changes occur as tonic-clonic status epilepticus progresses. Management can be considered in two ways--out hospital management and inpatient management. Benzodiazepine is considered 1st line of treatment outside hospital. Emergency/inpatient management includes basic life support (0-10 minutes) and pharmacological management (10-60 minutes). Drugs used in pharmacological management are lorazepam, midazolam, propofol, phenobarbital, phenytoin, fosphenytoin, i.v. valproate, rectal diazepam, etc. The classical definition of refractory status epilepticus includes seizure that has not responded to sequential treatment of lorazepam, phenytoin or phenobarbitone or seizure continuing > 60-90 in spite of adequate treatment.

Herpes simplex virus-1 encephalitis in eastern Uttar Pradesh.

OBJECTIVE: To study the proportion of HSV-1 encephalitis in acute viral encephalitis. METHODS: One hundred and five patients presenting with clinical diagnosis of acute viral encephalitis and with exclusion of other possible causes of acute inflammatory brain disease prevalent in the area by relevant laboratory investigations were included in the study. Ninety single CSF samples were tested for HSV-1 IgM antibodies by ELISA test supplied by Dia Medix Corporation, USA. CT Scan and EEG studies were carried out in 25 patients. RESULTS: Clinical and neuro investigational profile of patients suggested a low incidence of HSV-1 encephalitis in the study group. IgM antibodies were present in CSF sample of one patient only. CONCLUSION: HSV-1 encephalitis constitutes a very low proportion (1.1%) of acute viral encephalitis cases seen in Eastern Uttar Pradesh (India).

Role of macrophages in experimental malaria: IV--Bioassay of silica in immunity against Plasmodium berghei infection.

Silica treated mice when challenged with Plasmodium berghei showed increase in duration of prepatent(PP) and survival period (SP) and median survival day(MSD) as compared with controls. Daily parasite density curve during the course of infection was similar to control. Response to the parasite challenge, however, was dependent on the dose of silica. No increase in SP at 0.7 mg and in PP at 35 mg (cumulative doses) dose was observed. A dose upto 5 mg per mouse before challenge resulted in protection of the animal. No mortality was recorded in mice which received silica alone (35 mg; 5 mg/day x 7 days). Death due to lethal P.berghei infection could be delayed or prevented by altering/reducing the functional activities of macrophages during the course of infection.