Annals of Tropical Medicine and Public Health
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   2010| July-December  | Volume 3 | Issue 2  
    Online since March 1, 2011

 
 
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ORIGINAL ARTICLES
Prevalence of cutaneous fungal infections among sports-active individuals
Shahindokht Bassiri-Jahromi, Ali Asghar Khaksar
July-December 2010, 3(2):53-57
DOI:10.4103/1755-6783.77182  
Background: This study was conducted to evaluate the occurrence of cutaneous fungal infections affecting athletes. Methods: A respectively study of superficial fungal infections in athletes was carried out during the period March 2002 to December 2006 on 656 mycologically proven cases of dermatophytosis found in athletes in Tehran. Mycological examination consisted of culturing of pathologic material followed by direct microscopic observation. Mycological cultures were carried out on Sabouraud Chloramphenicol Agar, Sabouraud Chloramphenicol and Cyclohexamide Agar, and Dermatophyte Agar incubated at 25° C for at least 28 days. Diagnosis was based on macroscopic and microscopic characteristics of the colonies. Results: We surveyed 1075 athletes suspected of having cutaneous fungal infections from 201 institutions and found that 656 (61%) were positive for fungal infections. The fungal isolates comprised Trichophyton tonsurans (56%), Epidermophyton floccosum (11.8%), Trichophyton mentagrophytes (8.9%), Trichophyton rubrum(8.3%), Trichophyton verrucosum (3.9%), Trichophyton violaceum (3.3%), Microsporum canis (2.5%), Malassezia fur fur (3.3%), and Pityrosporum oval (2%). The distribution of the lesions on the body was: trunk> groin> hair and scalp> sole and toe webs> finger nails> toe nails. Fungal infections were more commonly seen in wrestlers and aerobics. Conclusion: The results suggest that athletic activity seems to be a predisposing factor, especially for fungal infections.
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Clinico-radiological profile and treatment outcomes in neurocysticercosis: A study of 40 patients
Tushar B Patil, Madhuri M Paithankar
July-December 2010, 3(2):58-63
DOI:10.4103/1755-6783.77186  
Aims: This study was aimed to study the clinical and radiological profile of neurocysticercosis and outcomes of treatment in neurocysticercosis. Settings and Design: A prospective observational study conducted in a tertiary care hospital. Subjects and Methods: Forty patients coming under Definitive or Probable Diagnosis of neurocysticercosis as per the revised diagnostic criteria for neurocysticercosis were included in this study. Cinical history, physical examination and neuroimaging [computed tomography (CT) or magnetic resonance imaging (MRI)] studies were done at the beginning. Patients were treated with albendazole, corticosteroids and antiepileptic drugs. They were followed up clinically for 3 months and neuroimaging study was repeated 3 months after albendazole therapy. Results: Definitive cases were 28 (70%) and probable cases were 12 (30%). Male:female ratio was 2.07. Mean age of 29.62 ± 9.08 years. The commonest presentation was seizures in 38 (95%); 29 (72.5%) patients had a single lesion and 11 (27.5%) had multiple lesions in initial imaging study. Commonest site of lesion was parietal lobe (45%). Most common stage of presentation was colloidal (55%). Thirty-seven (92.5%) patients were free of seizures at the end of 3 months. At the end of 3 months, 23 (57.5%) patients had radiological resolution (complete resolution + partial resolution + calcification). Conclusions: Neurocysticercosis usually affects young persons, mostly in the third decade, being equally common among vegetarians. Most common clinical manifestation is seizures. Single lesion is more common than multiple lesions, commonly presenting in colloidal stage. Clinical and radiological response to 4 weeks therapy with albendazole is quite satisfactory. All cases of young and adult onset epilepsy in tropical countries should be investigated for neurocysticercosis.
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A study of opportunistic parasitic infections and CD4 counts in HIV-seropositive individuals in Narketpally, South India
KV Ramana, Kranthi Prakash, SK Mohanty
July-December 2010, 3(2):49-52
DOI:10.4103/1755-6783.77180  
Context: Human immunodeficiency virus (HIV), causative agent in AIDS, is fast becoming a major threat in the Indian subcontinent with an estimated 3.7 million persons being infected with HIV. The progressive decline in immunological and mucosal defensive mechanisms predisposes HIV-positive individuals to gastrointestinal infections, thus increasing susceptibility to a number of opportunistic intestinal pathogens, among which protozoan and coccidian parasites like Cryptosporidium Sp., Isospora Sp., Cyclospora Sp. are being frequently detected. Objectives: To determine the opportunistic parasitic infections of the gastrointestinal tract in HIV-seropositive individuals and simultaneously their TCD4+ counts in South India. Settings and Design: Individuals seropositive for HIV infection were selected, and a Performa including age, sex, marital status, history of exposure, present clinical condition along with socioeconomic status, hygiene, etc was collected. Statistical Analysis Used: Percentages, Mean, Standard deviation. Results: Cryptosporidium Sp and Isospora Sp were found in 17.8% and 17.1% of all samples, respectively. Entamoeba histolytica, Giardia lamblia, Entamoeba coli and Blastocystis hominis were seen in 15.6%, 12.6%, 10.4% and 4% of all examined feces, respectively. Among helminths, Hymenolepis nana, Ascaris lumbricoides, Ancylostoma duodenale, and Strongyloides stercoralis were found in 0.5%, 0.4%, 0.1%, and 0.03% of all patients, respectively. The TCD4+ counts in case of coccidian infections were 365 cells/mm 3 ± 86.43 whereas in case of other protozoan, helminthic and mixed parasitic infections they were: 468±40.50 cells/mm 3 , 429±190 cells/mm 3 and 312±65.74 cells/mm 3 respectively. Our data showed that among HIV-seropositive stool samples screened routinely, 44.6% were found positive for at least one parasitic agent. Concentration technique improved the findings to 59.5%. Among the intestinal parasites 88.4% infections were by protozoan parasites compared to 11% by helminthes. Of the protozoan parasitic infections Cryptosporidium Sp., Isospora Sp., Entamoeba histolytica, Giardia lamblia were most frequently detected. Conclusions: Among intestinal parasites 88.4% infections were by protozoan parasites compared to 11% by helminthes. Of the protozoan parasitic infections Cryptosporidium Sp., Isospora Sp., Entamoeba histolytica, Giardia lamblia were detected in the majority of cases. Our findings also suggest that the intestinal parasitic infections vary with the geographical areas and studies must be carried out in respective regions to evaluate the frequent causes of intestinal parasitic infections in HIV-seropositive individuals. Early diagnosis of opportunistic infections and prompt treatment definitely contribute to increased life expectancy of infected individuals by delaying the progression to AIDS.
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CASE REPORTS
Pulmonary aspergilloma
A Malini, S Sageerabanoo, S Vithiavathi
July-December 2010, 3(2):72-74
DOI:10.4103/1755-6783.77192  
We report here a case of pulmonary aspergilloma that was diagnosed by sputum culture. The diagnosis of aspergilloma is most commonly based on the chest X-ray showing a cavity with an air-crescent sign and by histopathological examination of the resected tissue. However, in our case, the typical radiological sign was absent. A 36-year-old female patient presented with history of cough, breathlessness and hemoptysis. Sputum examination was negative for acid fast bacilli and culture yielded Aspergillus fumigatus from three sputum samples. With a diagnosis of pulmonary aspergilloma, the patient was referred to a higher center for further management.
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Hyperreactive malarial syndrome with noncirrhotic portal hypertension
Sourya Acharya, Samarth Shukla, SN Mahajan, SK Diwan, Karan Chaudhary
July-December 2010, 3(2):75-77
DOI:10.4103/1755-6783.77194  
Patients from tropical areas where malaria is endemic sometimes present with massive splenomagaly, that is usually known as tropical splenomegaly syndrome after ruling out other possible causes of splenomegaly. At present this condition is defined as hyperreactive malarial syndrome (HMS). One of the rarest and unique complication of HMS is prehepatic type of portal hypertension/ noncirrhotic portal hypertension. We report a case of HMS with prehepatic portal hypertension.
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An unusual presentation of brucellosis
H Singh, P Talapatra, V Gupta, S Ray
July-December 2010, 3(2):78-79
DOI:10.4103/1755-6783.77196  
Brucellosis is a multisystem disease with protean manifestations. In spite of its prevalence worldwide and endemicity in certain areas, pleural involvement is still a rare presentation of brucellosis and there are only a very few case reports in literature. A case report of pleural brucellosis along with review of literature is being reported.
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Corneal blindness following traditional medicinal practices after snakebite
Asim Kr Kandar, Bhavna Chawla, Prakash Agarwal, Radhika Tandon
July-December 2010, 3(2):80-82
DOI:10.4103/1755-6783.77197  
We report two cases of bilateral corneal blindness. The first case was a 38-year-old male who presented with bilateral corneal abscesses after a whitish powder was instilled into his eyes by a snake charmer following a snakebite on his right foot. The left eye responded to medical management with intensive topical antibiotics and in the right eye, a penetrating keratoplasty was performed to salvage vision. Another 19-year-old male sustained a similar injury. The right eye responded to medical management and a large-diameter lamellar keratoplasty with symblepharon release was performed for limbal stem cell deficiency in the left eye. Use of traditional eye medicines by snake charmers is still rampant in rural areas of developing countries. Awareness among medical practitioners and the general population is important to avoid the serious blinding consequences of this menace.
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Unusual case of subacute intestinal obstruction due to eosinophilic enteritis with enteroliths
C D'souza, KR Bhagavan, H Sunil, R Mohan
July-December 2010, 3(2):83-85
DOI:10.4103/1755-6783.77198  
Eosinophilic enteritis is an uncommon disease characterized by eosinophilic infiltration involving any layer of the bowel wall. It can affect any area of gastrointestinal tract although stomach and small intestine are sites most frequently involved. It is important to recognize this disease and institute the necessary treatment at the earliest in order to avoid its complications. We present a case where the patient presented with features of subacute intestinal obstruction due to distal ileal strictures and enteroliths. Histopathologic examination of the resected specimen revealed characteristic features of eosinophilic enteritis.
  - 5,523 11
ORIGINAL ARTICLES
HIV-infected patients and dermatological manifestations in a tertiary care hospital in the tribal (Bastar) region of Chhattisgarh, India between January 2006 and June 2008
Harminder Singh, Prabhakar Singh, Pavan Tiwari, Vivek Dey, Navin Dulhani, Amita Singh
July-December 2010, 3(2):64-67
DOI:10.4103/1755-6783.77188  
Objective: The aim of this study is to estimate the status of cutaneous manifestations in HIV-infected patients and its co-relationship with the CD4 cell count at a tertiary care centre at Bastar, Jagdalpur. Material and Methods: In this study, 137 HIV-positive subjects were enrolled. Information on demographics i.e. weight, height, socioeconomic status, age, educational status, sex, laboratory parameters (CD4 counts) and treatment regimens were noted, and patients were examined for skin disorders by a dermatologist. Data were analyzed using Chi-square test for categorical variables. Results: Majority of the patients resided in a rural area (65.69%), and belonged to low socioeconomic and educational status; 30.65% were housewives, 23.35% drivers and 16.78% laborers respectively. The predominant mode of transmission was heterosexual contact (94.16%). The most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%), xerosis (52.5%), generalized skin hyperpigmentation 56 (46.67%), onychomycosis 53 (44.16%), pruritic papular eruption 27 (22.5%), oral candidiasis 21 (17.5%), photo dermatitis 21 (17.5%) and scabies 4 (3.33%). Significant correlation with low CD4+ cell counts was found for oral candidiasis (P<0.0001) and Kaposi's sarcoma (P 0.03), while other disorders like seborrheic dermatitis (P 0.22), xerosis (P 0.25) and onychomycosis (P 0.08) were not statistically significant. Conclusion: This study showed a high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. So, early diagnosis and management of skin disorders can improve the quality of life of HIV-infected subjects.
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The presenting complaints of children with severe malaria
Kobina Imananagha
July-December 2010, 3(2):68-71
Background: Severe malaria (SM) remains a major health problem confronting the people of Sub-Sahara Africa, where children under five years of age are at great risk. Aims: To document the presenting complaints of children with this life-threatening disease, with the ultimate aim of identifying non-laboratory criteria for the grading of case severity of SM. Material and Methods: The study documented the presenting complaints of 155 Niger Delta children whose disease conditions fulfilled the 2000 World Health Organization (WHO) criteria for severe malaria. The required data were extracted from the hospital records of the patients of two Nigerian tertiary hospitals. Results: A total of eight most common presenting complaints were identified, namely fever (100%), anemia (86%), vomiting (54%), convulsion (43%), impaired consciousness/coma (43%), cough (36%), respiratory distress (28%) and prostration (19%). In addition, the presenting complaint-related fatality rates were calculated. Overall severe malaria mortality was 10.3%. Conclusion: The data obtained from this study will be used, in the next stage of our study, in formulating a non-laboratory method of grading SM in children.
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Status of zinc in pulmonary tuberculosis
Waseem Qureshi, G Hassan, SM Kadri, MS Aatif, GQ Khan, Manzoor Ahmad, Manish Kak
July-December 2010, 3(2):45-48
DOI:10.4103/1755-6783.77179  
This prospective study including 50 patients of pulmonary tuberculosis (TB) and 30 subjects as the control group was conducted to study the status of zinc as a micronutrient in pulmonary TB. There was a statistically significant fall in serum zinc levels with advanced age and disease and the levels improved after institution of antitubercular therapy. We conclude that estimation of serum zinc levels is an important tool in the diagnosis, monitoring of response to treatment in pulmonary TB, and booster of the immunological mechanisms if instituted in the therapy.
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