Pancytopenia--a six year study.

All cases of pancytopenia seen over a six year period in two hematology centres were analysed. Patients receiving myelotoxic chemotherapy or those with leukemic cells in peripheral smear were excluded. There were a total of 166 cases. The four major causes were: aplastic anaemia in 49, megaloblastic anaemia in 37, aleukemic leukemia or lymphoma in 30 and hypersplenism in 19 cases. Bone marrow aspiration was often unsuccessful in obtaining an adequate sample, while biopsy was usually diagnostic. Both bone marrow aspiration and biopsy should be performed simultaneously in pancytopenic patients when the diagnosis is elusive. Megaloblastic anaemia is a major cause of pancytopenia, and may present acutely in the critically ill. It is a rapidly correctable disorder and should not be missed.

Cryptococcal meningitis in acquired immunodeficiency syndrome.

OBJECTIVE: To study the clinical course and outcome of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Patients infected with human immunodeficiency virus (HIV) and symptoms suggestive of meningitis were evaluated with detailed history, clinical examination and investigations. Diagnosis of CM was based on positive India ink preparation or positive fungal culture of CSF. All patients were treated with amphotericin those showing response were put on oral fluconazole. RESULT: A total of 431 patients with HIV infection were admitted to this centre during the study period, of these 15 were diagnosed to have CM. Majority of the patients had a subacute presentation with signs of meningeal irritation seen in only seven patients. India ink preparation and positive fungal culture on cerebrospinal fluid (CSF) established diagnosis in all cases. All patients were treated with amphotericin B and fluconazole. Complete response was noticed in seven patients, two patients were lost to follow-up and six patients died during the course of therapy. Raised intracranial tension (ICT) and disseminated disease were associated with poor prognosis. CONCLUSION: CM is a common opportunistic fungal infection in patients with AIDS. A high index of clinical suspicion and routine mycological surveillance is required to diagnose this infection. Majority of patients respond to therapy except those who have disseminated infection, altered sensorium and features of raised ICT at presentation.

Toxoplasmic encephalitis in acquired immunodeficiency syndrome.

OBJECTIVES: To study the clinical course and outcome of toxoplasmic encephalitis (TE) in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Patients infected with human immunodeficiency virus (HIV) and neurological abnormality compatible with diagnosis of TE were enrolled in the study. These patients were treated with combination of trimethoprim/sulfamethoxazole and pyrimethamine. Response to therapy was assessed by clinical examination and repeat CT/MRI scan done after three weeks of starting treatment. Those showing response were put on prophylactic therapy. RESULTS: A total of 451 patients of HIV infections were admitted to this centre during the study period, of these 11 patients were diagnosed to have TE. The common presenting symptoms were fever (80%), seizures (45%), headache (45%) and altered sensorium (25%). Focal neurological deficit was present in 80% of cases. Nine cases had ring-enhancing lesions on CT scan while in the remaining two patient's ring lesions were seen on MRI. These were either multiple (55%) or solitary (45%). Antitoxoplasma antibody was detected in 10 patients. It was absent in one patient. Ten patients had clinical and radiological improvement with trimethoprim/sulfamethoxazole and pyrimethamine within 10 +/- 3 days of starting therapy. One patient died within 10 days of starting therapy. CONCLUSION: Toxoplasmosis is a common opportunistic infection of the central nervous system in patients with AIDS. Majority of patients with cerebral toxoplasmosis present with focal neurological abnormality in presence of characteristic neuroradiological abnormality and positive antitoxoplasma antibody titer. Response to empirical therapy helps to confirm the diagnosis, lifelong prophylaxis there after prevents relapse of potentially fatal and easily treatable condition.