RESUMO
Here in we report a diagnostically challenging case of adult hemophagocytic lymphohistiocytosis (HLH) triggered by disseminated tuberculosis and Klebsiella pneumoniaeco-infection in an immunocompetent Individual. She was a young female presented with complaints of fever, abdominal pain and jaundice. Her evaluation showed cytopenias, hyperbilirubinemia, transaminitis, and hepatosplenomegaly. She progressed to have multi-organ involvement in the form of myocarditis, pleural effusion. Provisional diagnosis of fever with unknown origin and sepsis with multiple-organ dysfunction was made and evaluated for the same. Rapid clinical deterioration with evaluation for sepsis being normal prompted for considering HLH in the differential diagnoses, bone marrow and other criteria have been met resulting in confirmation of the same. Without prior past or family history of HLH, secondary HLH was suspected and substantial evaluation for possible triggers was made, and concomitantly immune suppression was started with corticosteroids. Disseminated tuberculosis was diagnosed and concomitantly Klebsiella pneumoniaewas isolated from the bronchioalveolar lavage cultures. As there was no significant immune response culmination, intravenous immunoglobulins were added along with the treatment for possible triggers-tuberculosis and Klebsiellasimultaneously. Patient showed significant improvement with this approach. In conclusion management of HLH is different from conventional sepsis and the treatment for each cause of HLH also varies. Furthermore, this case report stresses on the importance for initiating treatment rapidly and tailored approach of management therapy for each case.
RESUMO
Background: Snake bite is a common medical emergency and an occupational hazard, more so in tropical India, where farming is a major source of employment. In India alone, it has been estimated that as many as 2.8 million people are bitten by snakes, and 46 900 people die from snakebite every year. The objective of the present study is to study the awareness about hazards of snake bite and to educate about preventive and first aid measures for snake bite.Methods: This study was a community based longitudinal study conducted in 7 villages near Kurnool town. The sample size was 230. From each agriculture workers after obtaining consent pre-test was done to know their awareness regarding hazards of snake bites in agriculture fields and preventive and first aid measures in each village followed by post-test after health education.Results: In this study 230 agriculture workers were participated. Among them 108 (46.95%) were males and 122 (53.1%) were females. Most of the study population were in the age group of 31-40 years (36.9%). Using torch during nights was 68.7% it was increased significantly to 83% after health education, using foot wear was only in 30.4% and increased significantly to 100%, using stick was in 76% and increased to 100% significantly.Conclusions: The practice of using torch, wearing footwear, using stick while on field, avoid sleeping on ground in the field were significantly improved after health education. The first aid measure measures after snake bite like immobilization of bitten limb, reassure the person bitten by snake, avoid suctioning, avoiding tourniquet were also improved significantly after health education.