Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl.

It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.

Complicated plasmodium falciparum malaria initially presenting as myocardites.

Despite recent advancements in diagnostic and treatment modalities, malaria is still one of the most prevalent human diseases with high mortality and morbidity. We described a case of 45 years old man with Plasmodium falciparum malaria primarily presenting with myocarditis. The possibility of malaria was Subsequently considered when he developed fever followed by signs of cerebral involvement. This happens to be a distinctly unusual presentation and we highlighted various features of this case. Thus in hyperendemic areas complicated Plasomdium falciparum malaria may present initially With atypical features and high index of suspicion may lead to prompt early aggressive antimalarial therapy and reduce the complications.

Clinico-radiological aspects of neurocysticercosis in pediatric population in a tertiary hospital.

INTRODUCTION: Neurocysticercosisis common in developing countries including Nepal. Clinicalpresentations vary depending on the CT scan findings of head. Adequate information of neurocysticercosis in children from Western Nepal is lacking. This study was conducted with an objective of evaluating the most common clinical and radiological picture in children suffering from NCC at a tertiary care teaching hospital in Western Nepal. METHODS: Hospital records of all pediatric inpatients, admitted from 16th June 2010 to 15th December 2012, consistent with the diagnosis of Neurocysticercosis were reviewed. RESULTS: Forty nine cases of neurocysticercosis were enrolled. Their age varied 2.6 years to 14 years with the mean age of 10.6 years and the peak age was at 12 years with slight male predominance, ratio being male:female 1.2:1. The commonest presentation was seizures (n=38; 77.5 %); partial seizures being most common. Most of the lesions were single (n=44; 89.8%), predominantly in the parietal region (n=20; 40.8%) and most were in transitional stage (61.22%) in Computed tomography (CT).However, number of lesions from CT scan of head showed no significance in association with seizure types (p=0.84). In addition, perilesional edema and scolex within the lesion were noted in 67.34% and 18.36% of the cases respectively. CONCLUSIONS: Any child presenting with acute onset of afebrile seizure should be screened for neurocysticercosis provided other common infective and metabolic causes are ruled out. CT scan is the valuable diagnostic tool to support our diagnosis.

Onchocerciasis in Malawi. 2. Subjective complaints and decreased weight in persons infected with Onchocerca volvulus in the Thyolo highlands.

In the course of an onchocerciasis survey in southern Malawi, body weight was recorded for 10,335 persons aged 20 years and older, and the body mass index was calculated for 5572. A history of symptomatic complaints was elicited from 5653 persons 20 years of age and older. Persons with microfilariae in the skin snips weighed significantly less than persons with negative skin snips. Symptomatic complaints of musculoskeletal pains, itching, dizziness and poor vision were reported more commonly in the group with microfilariae. These findings suggest that onchocerciasis should no longer be considered a disease affecting the eye and skin only but an infection which produces systemic effects as well. Systemic effects of onchocerciasis may lessen productivity of an endemic region by a process distinct from the effects of visual impairment.