High-grade Fever Research Articles

Demographic and clinical variables in the dengue epidemic in Punjab, Pakistan

Objectives: To identify the latest trends in the clinical picture and severity of the disease, which will help better understand and manage dengue.
 Methodology: It was a cross-sectional, hospital-based study performed in the tertiary care hospitals of Punjab from August 21 to December 2022, in which serologically and polymerase chain reaction (PCR) confirmed patients with dengue infection, were enrolled. Demographic and clinical variables were recorded on a pre-tested Performa, processed and presented in frequency and percentages, and graphs were generated. Mean and standard deviation was used to present continuous variables.
 Results: Out of a total of 580 patients, 472 were diagnosed with Dengue Fever (DF) and 108 with Dengue Hemorrhagic Fever (DHF). About 79.31% of the patients were male and 20.69% were females. The mean age of patients was 32.5±9 years. Among the clinical features the percentage of high-grade fever, body aches, and vomiting were the highest. The liver function profile showed that serum bilirubin, Serum aspartate transaminase (AST), serum alanine transaminase (ALT,) and alkaline phosphatase (ALP) levels were markedly raised.
 Conclusion: This study showed that with time the trends in the presentation of dengue are slowly shifting, which will help us better manage the disease burden in the future.
 doi: https://doi.org/10.12669/pjms.39.6.7383
 How to cite this: Mushtaq S, Khan MIU, Khan MT, Husain A. Demographic and clinical variables in the dengue epidemic in Punjab, Pakistan. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7383
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The possibilities of using oseltamivir in children in modern conditions: clinical practice

According to statistics, the acute respiratory diseases incidence in the paediatric population is much higher than in the adult population, due to immature immune system, beginning of active contacts in organized groups, and often the lack of habits and skills in sanitary hygiene. Given the anatomical and physiological features, children often have more pronounced symptoms, which causes not only a faster visit to a doctor, but also more reports of polypharmacy in paediatric practice. The article presents a detailed differential diagnosis of acute respiratory viral infections, including influenza and COVID-19, according to the leading clinical symptoms and syndromes. The possibilities and features of the action of the main drugs used for the treatment of influenza and ARVI in children’s practice – oseltamivir, umifenovir and interferon alpha-2b are described. Using clinical examples, the tactics of choosing a treatment regimen in the routine work of a pediatrician, taking into account the impact of the ongoing COVID-19 pandemic in modern conditions, are considered. The advantages of using oseltamivir for influenza in children are shown. The first clinical case report: a 6-year-old child diagnosed with an acute upper respiratory infection: acute nasopharyngitis, clinical and epidemiological diagnosis – moderate to severe influenza. Severe fever and leukopenia syndrome on the third day of illness pointed to the possibility of disease progression and the development of complications, which justified selection of oseltamivir as the most effective and well-established anti-influenza drug. The second clinical case report: a 3-yearold child diagnosed with acute upper respiratory infection: acute nasopharyngitis, clinical and epidemiological diagnosis – influenza. High-grade fever, severe neutrophilia in the absence of elevated levels of leukocytes, a high level of C-reactive protein in the absence of signs of bacterial infection, determined the choice of oseltamivir. The practical administration of oseltamivir demonstrates reduction in the risk of developing severe influenza, reversing the intoxication syndrome and other manifestations of influenza, as well as prevention of the development of complications, if used in a timely manner.

Mucormycosis as a Rare Infection in Lower Limb Necrotizing Fasciitis: A Case Report

Introduction: Necrotizing fasciitis is a severe, life-threatening infection that can be fatal and rapidly progressive. It is usually caused by polymicrobial infection, monomicrobial infection by group-B streptococci (GBS) or staphylococci, or by anaerobes like Clostridium difficile that presents as a gas gangrene or rarely by fungi. Fungal infections, though found in diabetic foot ulcers, remain extremely rare agents in necrotizing fasciitis, often causing severe morbidity and higher mortality than regular bacterial infections. Though severe, these infections are not often late to diagnose and very few reports exist citing their presence. With our case report, we present another rare manifestation of Mucormycosis in a foot wound. Case Report: We present a 57-year-old diabetic male patient who presented with a rapidly progressing very painful right foot ulcer, with high-grade fever and fatigue that did not respond to surgical intervention and treatment with broad-spectrum antibiotics. Mucormycosis species were identified in wound cultures. The patient then underwent an amputation and was treated with liposomal Amphotericin B. Conclusion: This report aims to further highlight that virulent fungal infections, especially mucormycosis, should be considered when suspecting or diagnosing necrotizing fasciitis. An extensive review of the literature with our newly added case would serve as an eye-opener on this pathogen in the setting of difficult-to-treat necrotizing fasciitis.

Clinical presentations and microbiological analysis of cerebrospinal fluid samples in cases of suspected bacterial meningitis patients attending a 1600 bedded teaching hospital from 2019 to 2022: A retrospective study.

Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0-20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners.

A case of hereditary hemorrhagic telangiectasia presenting with brain abscess

BackgroundHereditary hemorrhagic telangiectasia (HHT), characterized by telangiectases and arteriovenous malformations that can occur in any organ but primarily the lungs, liver, and brain, is an autosomal dominant disorder. Brain abscess, though a rare and potentially fatal complication, can be an initial presentation of this condition. Case summaryA 60-year-old man presented with anemia and black tarry stools, then developed right-sided weakness initially misdiagnosed as an ischemic stroke. Subsequent onset of headaches and high-grade fever led to the diagnosis of brain abscess, and HHT was subsequently identified. ConclusionThis case underscores that brain abscess can be an initial symptom of HHT. Prompt diagnosis and treatment are vital, which requires physicians to maintain a high index of suspicion and conduct appropriate investigations promptly.

Multisystemic Inflammatory Syndrome Post COVID-19 Infection in an Arab Female: A Case Report of a Rare Manifestation

Background: Multisystemic inflammatory syndrome is a rare but severe complication in children and adolescents infected with SARS-CoV-2. Case report: This report describes a four-year-old Arab descent female presenting with a history of high-grade fever of 7 days duration with erythematous rash and family history of COVID infection suggestive of atypical Kawasaki disease, which turned out to be multisystemic inflammatory syndrome (MIS-C) post COVID infection. Based on the available published evidence, the World Health Organization has provided a preliminary definition of MIS-C as “children and adolescents 0–19 years of age with fever > 3 days presenting with two of five clinical criteria, such as 1. skin rash or mucocutaneous inflammation or non-purulent conjunctivitis, 2. hypotensive shock, 3. signs of myocardial dysfunction, 4. coagulopathy, and 5. the acute gastrointestinal problem, elevated inflammatory markers, no evidence of other microbial infections, and evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19”. Case Report: Some criteria are similar, and others are different from Kawasaki disease and toxic shock syndrome, such as the presence of rash, conjunctivitis, mucocutaneous inflammation, and coronaries involvement are shared criteria between Kawasaki and MIS-C, whereas hypotensive shock and coagulopathy are shared criteria between MIS-C and toxic shock syndrome. The positive testing for COVID-19 in the absence of microbiological isolation confirms MIS-C. Conclusion: Among the complications of COVID-19 infection, MIS-C is rare. Owing to the management differences among Kawasaki, toxic shock syndrome, and MIS-C, timely diagnosis of MIS-C saves the children from a poor outcome.

COVID-19 in congenital heart disease patients: what did we learn?!

COVID-19 pandemic has spread widely at unpreceded pace. Cardiovascular comorbidities are significantly correlated with severe and critical illness. Nevertheless, studies examining the impact of congenital heart disease on COVID-19 severity are scarce and restricted to hospitalized patients. This study aims to explore the course of COVID-19 illness, severity and complications in patients with concomitant congenital heart disease. This study is a cross sectional survey that includes patients with congenital heart disease who are registered at the Children Heart Center at the American University of Beirut Medical Center. The survey was conducted in the pediatric cardiology outpatient clinics or remotely via phone calls. A total of 238 patients participated in the study, of which 47.9% had suspected or confirmed diagnosis of SARS-CoV-2 infection. The majority of patients had mild illness. The symptoms ranged between rhinorrhea (15.6%), cough (15.6%), low-grade fever (11.2%), anosmia (2.7%), ageusia (2.5%), headache (9.8%), high-grade fever (8.5%), gastrointestinal symptoms (7.6%), lethargy (6.3%), muscle aches (5.6%), difficulty breathing (5.4%), joint pain (4.7%), and chills (4.7%). 20% of the surveyed patients required treatment at home. Hospitalization and oxygen therapy was required in 3.5% of cases, while only 1.5% demanded intensive care admission. Only one fatality was encountered. COVID-19 infection in pateints with congenital heart disease exhibits a mild to moderate course, and doesn't necessarily increase risk of complicated disease. No correlation could be found between specific congenital heart lesion and disease severity.

A fatal misidentification: Burkholderia pseudomallei misidentified as Acinetobacter spp

A middle-aged uncontrolled diabetic with chronic kidney disease presented with high-grade fever, skin abscesses and cough for two weeks. His blood cultures grew Burkholderia pseudomallei. A few weeks prior, blood cultures drawn for PUO workup elsewhere grew an organism identified as Acinetobacter sp with an unusual susceptibility pattern. His fever responded to a short course of meropenem. In retrospect, the earlier blood culture had likely misidentified B.pseudomallei as Acinetobacter sp given the background history, risk factors and the peculiar susceptibility report. Through this case, we discuss important aspects of melioid diagnostics which may be clinically relevant to establish this diagnosis.

Clinical Profile and Outcome of Children with Empyema Thoracis in Tertiary Hospital

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. It is a common condition in childhood having significant morbidity and mortality. The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. The present study analyses the epidemiological aspects of the disease, etiological agents, clinical features and associated lesions in diagnosis of empyema and the outcome of early Video-assisted thoracoscopic surgery (VATS) on morbidity of disease in children.
 Objectives: To study various demographic characteristic and to evaluate various management strategies and outcome in children with empyema thoracis.
 Methodology: This is a prospective hospital based observational study, conducted at Nobel Medical College Teaching Hospital Biratnagar, from December 2021 to November 2022. All children in the age group of 1month to 16 years diagnosed pyogenic empyema by lights criteria during the study are included in the study. Children below 1 month of age and pleural effusion not meeting the criteria for exudative pleural effusion by Light's criteria are excluded from the study.
 Results: Majority of the study population are in the age group of >5 years. Males are more common than females. Most common clinical feature was fever followed by cough, chest pain and shortness of breath. Culture is positive in 68% out of which 32% is staphylococcus aureus, 20% is mycobacterium tuberculosis ,16% is streptococcus pneumonia. Duration of illness is <1week in 48% of the children, 1-2weeks in 40% and >3weeks in 12% of the children. In 80% of the children there is unilateral involvement in the x- ray chest. In the children who are uncomplicated all of them had intercoastal chest tube drain (ICD) usage,76.4% had urokinase therapy and 5.8% had undergone thoracotomy and none of them had need for surgery. In the children with complication 87.5% had ICD usage and urokinase therapy,25% of them had undergone thoracotomy and 12.5% had need for surgery.
 Conclusion: Empyema thoracis is more commonly seen in the males of the group>5 years with duration of illness <1 week maned mostly by ICD usage, where there was mostly unilateral involvement in x ray chest.

Severe Acute Bronchial Asthma with Sepsis: Determining the Status of Biomarkers in the Diagnosis of the Disease.

Bronchial asthma is a widely prevalent illness that substantially impacts an individual's health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition are linked to viral respiratory tract infections (RTI), and bacterial infection appears to have an insignificant impact. However, antibiotics are recommended when there is a high-grade fever, a consolidation on the chest radiograph, and purulent sputum that contains polymorphs rather than eosinophils. Managing acute bronchial asthma with sepsis, specifically the choice of whether or not to initiate antimicrobial treatment, remains difficult since there are currently no practical clinical or radiological markers that allow for a simple distinction between viral and bacterial infections. Researchers found that serum procalcitonin (PCT) values can efficiently and safely minimize antibiotic usage in individuals with severe acute asthma. Again, the clinical manifestations of acute asthma and bacterial RTI are similar, as are frequently used test values, like C-reactive protein (CRP) and white blood cell (WBC) count, making it harder for doctors to differentiate between viral and bacterial infections in asthma patients. The role and scope of each biomarker have not been precisely defined yet, although they have all been established to aid healthcare professionals in their diagnostics and treatment strategies.

Safety and Efficacy of Paracetamol + Lignocaine Injection in Patients with High-grade Fever: A Prospective Analysis

High-grade fever is a common presenting symptom in various infectious and inflammatory conditions, requiring prompt and effective management. Paracetamol (acetaminophen) is a widely used antipyretic agent, while lignocaine possesses analgesic and anti-inflammatory properties. This prospective study evaluated and established the safety and efficacy of paracetamol + lignocaine injection in patients with high-grade fever. The study outcomes revealed that after administering paracetamol and lignocaine injections, 89% of patients experienced a reduction in high fever, while 68.6% of patients reported no or mild pain at the injection site. Based on these findings, the authors recommend that health care professionals consider the potential benefits of using paracetamol and lignocaine injections for patients suffering from severe fever accompanied by pain and discomfort.

Systemic-onset Juvenile Idiopathic Arthritis in a young child

We present a 31-month-old female child who was referred by the pediatricians with 1-year history of recurrent high-grade fever associated with polyarthritis and recurrent skin rash, which disappears within 24 hours of resolution of fever. She had lost the ability to walk unsupported because of persistent arthritis. Her Full Blood Count (FBC) was remarkable for marked leucocytosis, thrombocytosis, and a mild normocytic normochromic anemia; Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) were both elevated at 110mm/hour and 200mg/L (<7) respectively while serial blood cultures were negative for septicemia and blood films were negative for acute leukemia; HIV, hepatitis B and C virus, tuberculosis, rheumatic fever, rheumatoid arthritis, and connective tissue disease screenings were all negative. Her hemoglobin genotype is AA. She had repeatedly received treatments for malaria and ‘sepsis’ with parenteral and oral antimalarials and antibiotics with no permanent relief, hence the reason for referral to the rheumatologist. An assessment of Systemic-onset Juvenile Idiopathic Arthritis (SoJIA) was made when her serum ferritin came back elevated at 670ng/mL (4.63 – 204) and she was commenced on oral ibuprofen with remarkable improvement evidenced by resolution of fever, joint pain and rash and normalization of ESR, CRP and serum ferritin within 8 weeks of treatment. Although SoJIA is rare, it would be worthwhile to include this disease in the differential diagnoses and subsequent evaluation in any child presenting with unexplained recurrent fever associated with body rash and polyarthritis.

Digestive hemorrhage and fever as a result of a double secondary aortoenteric fistula following the repair of a juxtarenal abdominal aortic aneurysm and an infection of the aortobifemoral bypass graft: a case report.

During aortoc reconstructive surgery, the patient may present with a variety of unusual complaints, including fever and GI bleeding. These symptoms are indicative of problems, including the development of an aortoentric fistula, particularly when there is a double secondary fistula. The patient was admitted to the hospital due to hematemesis, melena, and high-grade fever after undergoing synthetic grafting aortobifemoral bypass (anatomical reconstruction) and partial resection of the juxtarenal abdominal aortic aneurysm. Pus discharge and a double aortoenteric fistula in unusual sites such as the second-third portion of the duodenum and caecum are visible in upper GI endoscopy and computed tomography angiography. The patient underwent a two-stage open surgery, the first stage involving aortic limb graft exclusion and extra anatomical reconstruction, and the second stage involving graft removal, fistula management, and bowel repair. Then the patient spent a few days in the surgical intensive care unit before being discharged. Primary and secondary AEF are the two categories of AEF. In patients who underwent aortic reconstruction surgery, the frequency of secondary AEF ranges from 0.36 to 1.6%. Due to the 8:1 injury ratio in the secondery AEF, men suffer more injuries than women.There are two types of fistula depending on whether or not the suture line is involved. The first form is graft enteric erosion, which excludes the suture line, while the second type is entric graft fistula, where the suture line is included. Most common site fistula is third and fourth part of duodenum and least common site is fistula formation in large bowel. An uncommon complication is double secondary AEF following aortic reconstruction surgery. Since one of the most significant presentations an AEF patient can present with is major GI bleeding and sepsis, A delay in seeking immediate medical treatment could result in the patient's death. It should be emphasized that one of the mechanisms for AEF formation and a frequent cause of sepsis in patients is recurrent aortic graft infection following aortic reconstruction surgery.

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Objective: To assess the spectrum of measles during COVID-19 era among children. Study Design: Cohort study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari Karachi. Period: February 2019 to February 2021. Material & Methods: Clinically diagnosed measles children of either gender aged between 3 months to 5 years admitted to our tertiary care center in the 2 years marked period of the study were analyzed. Measles was labeled as the presence of high grade fever (>104 0F) and maculopapular rash. Medical history was noted and clinical examination was performed in all children. Necessary laboratory investigations like complete blood count and chest X-rays (CXR) were evaluated. All patients were treated as per standard institutional protocols. Outcomes were noted in terms of successful discharge or expiry. Results: In a total of 88 children, 55 (62.5%) were male. The mean age was 1.61±1.12 years while 49 (55.7%) children were aged ≤ 1 year. Twenty four (27.3%) children were fully vaccinated appropriate to their age. Fever and rash were found among all children (100%) while respiratory distress and coryza were reported by 82 (93.2%) and 51 (58.0%) children respectively. Overall duration of hospitalization was 7.02±2.32 days. Mortality was reported in 11 (12.5%) children while 76 (86.4%) children were successfully discharged. Development of acute respiratory distress (p=0.0011) and shock (p<0.0001) proved to have significant association with mortality. Conclusion: Mortality was relatively high among children with measles during the COVID-19 pandemic era. During hospitalization, most frequent complications were pneumonia, and eye and/or mouth related complications. Development of acute respiratory distress and shock proved to have significant association with mortality.

Acute Focal Bacterial Nephritis in a Patient with Solitary Kidney: Case Report.

Acute focal bacterial nephritis is an underdiagnosed condition. It clinically resembles acute pyelonephritis. If unrecognized and undertreated, it may progress into complications (kidney abscess and scars). Contrast-enhanced computed tomography (CT) reveals specific images of the disease and is considered the gold standard to make the diagnosis. A 63-year-old male patient with solitary kidney presented with symptoms compatible with acute pyelonephritis. Kidney ultrasound was not conclusive. Because of persisting high-grade fever not resolving after 48 hours of antibiotics, a contrast-enhanced CT was then performed, and the diagnosis of acute focal bacterial nephritis was made. A repeat CT after three weeks of intravenous (IV) antibiotics showed marked improvement of the intrarenal lesions, and a fourth week of IV antibiotics was dispensed. Diagnosing acute focal bacterial nephritis is important (particularly in a patient with solitary kidney). This will dictate the therapy duration. Unlike acute pyelonephritis, acute focal bacterial nephritis requires at least three weeks duration of antibiotics to avoid progress into further complications.

Unforeseen complications: a case of dengue shock syndrome presenting with multi-organ dysfunction in a subtropical region

OverviewDengue fever, a viral illness transmitted by the Aedes mosquito, is capable of causing a range of serious complications, including fulminant hepatic failure, renal dysfunction, encephalitis, encephalopathy, neuromuscular and ophthalmic disorders, seizures, and cardiomyopathy.Case descriptionThis report details the case of a 30-year-old lactating woman with no notable medical history who presented to the emergency department with symptoms of high-grade fever, altered mental status, and seizures. Upon imaging, bilateral infarcts in the thalami and cerebellar hemispheres were observed, consistent with cerebellitis and dengue encephalitis.Patient treatment and outcomeThe patient was admitted to the intensive care unit and received appropriate treatment. Following a critical phase and successful patient stabilization, she was transferred to a high dependency unit for a week before being discharged with recommendations for follow-up care.ConclusionThis case illustrates the broad spectrum of complications that can arise as a result of dengue infection and the importance of timely diagnosis and management in improving patient outcomes. Further investigation is required to better understand the mechanisms underlying these complications and to formulate specific guidelines for the prevention and treatment of dengue shock syndrome.

Patterns of ECG Manifestations in Dengue Infection

Background: Dengue fever has emerged as one of the most common viral diseases in the world. The clinical manifestation ranges from mild febrile illness to severe disease such as dengue hemorrhagic fever and dengue shock syndrome. Dengue is known to affect various systems. So, different aspects of disease need to be explored. Cardiac involvement in dengue fever is not uncommon and has been reported in literature. ECG is widely used as a screening tool not only because it is easily available but also due to its ability to indicate cardiac involvement. Objective: The aim of the study was to determine the patterns of ECG changes and their frequency in a cohort of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) along with the association of ECG changes with severity of dengue infection and clinical manifestation of cardiac involvement. Method: We conducted a cross-sectional observational study involving 50 patients with dengue fever and dengue hemorrhagic fever, admitted in Medicine department of Dhaka Medical College Hospital, Dhaka from 1st October, 2017 to 31st March, 2018. Admitted patients with high grade fever and positive Dengue IgM, NS1 AG or RT-PCR were included. Patients with electrolyte abnormalities, preexisting heart disease, drugs interfering with heart rhythm were excluded from study. The Standard 12 lead ECG was carried out in study patients on 3rd day of disease onset and on the day of discharge after disease recovery. Frequency & pattern of ECG changes like heart rate, rhythm, P wave, T wave, ST segments and QRS complex were analyzed and recorded. Statistical analysis was done using SPSS 25 on windows 10. Categorical and numerical data’s were expressed as frequencies and percentage. Cross tabulation was done between DF and DHF with different ECG findings. To establish the significance of various findings and association in between variables chi-square analysis, Pearson correlations were done in all cases. P value < 0.05 considered significant Result: Total 50 patients with dengue fever were enrolled, 39 patients (78%) were diagnosed as dengue fever and 11 patients (22%) were diagnosed as dengue hemorrhagic fever (DHF). Mean age of the patient was 33.08 ± 9.79 years. Male – female ratio of 1.5:1 fever was noted in all 50 patients (100%), myalgia (94%), headache (84%), skin rash (82%), & retro-orbital pain(54%), vomiting (26%), only 3 patients (6%) complained about abdominal pain. Only 4 patients had cardiac symptoms. 3 patients complained about palpitation and only 1 patient had symptom of chest pain and dyspnea. In most of the patients, (34 in number, 68%) ECG was normal. Only 16 patients (32%) had abnormal findings in ECG. 9 patients (18%) had bradycardia, 3 patients (6%) had tachycardia, 2 Patient (4%) had T Inversion and 1 patient (2%) had ST elevation and 1 patient (2%) had ST depression. Among total 16 abnormal ECG, predominant finding was bradycardia (>50% of abnormal ECG). P value is <0.01. Correlation of ECGs with clinical severity (Dengue fever and Dengue Hemorrhagic fever) found no statistically significant association (P value is 0.725). J MEDICINE 2023; 24(2): 119-124

A Rare Case of Cladophialophora Isolated in a Renal Transplant Patient after Rejection Therapy

Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis. A case of live-related renal allograft recipient complained of high-grade continuous fever on the 5th postoperative day (POD). No organism was isolated on cultures and no foci were found on chest X-ray. He was started on broad-spectrum antibiotics. The patient thereafter developed acute antibody-mediated plus acute cellular rejection on the 7th POD. He received a high dose methylprednisolone with plasmapheresis. On the 18th POD, the patient was diagnosed with right frontotemporal and basal ganglionic region abscess on magnetic resonance imaging of the brain. Urgent neurosurgical intervention was done and the sample was sent for investigation. Initially, there was suspicion of Aspergillus on culture. Injection of liposomal amphotericin B was given for 14 days, after which oral voriconazole was started. The patient improved initially but multiple abscesses recurred on the 46th POD. Abscess was drained. On the final culture report, C. bantiana was isolated. 5-flucytosine was added to voriconazole as dual antifungal therapy.

An Ayurvedic management for repeated pregnancy loss (Putraghni Yonivyapada): A case report

The loss of a pregnancy is a loss that affect the couple both mentally and emotionally. In Ayurveda, this condition is coined as Putraghni (habitual abortion), Vamini (profluvium seminis), Asrija (gestational bleeding), and Yonivypada (vaginal diseases). These conditions usually result in pregnancy loss. A 29-year-old female with her husband aged 31 years residing at Jamnagar reported to the outpatient department of Prasuti Tantra evam Striroga, Institute of Teaching and Research in Ayurveda, Jamnagar with complaints of loss of pregnancy twice in the past 12 months. She had associated complaints of Yoni Daha (burning at vagina), Yoni Vrana (cervical erosion), Yoni Pidaka (eruptions in vagina), Maithuna Asahishnutva (dyspareunia), burning during sexual intercourse, and weakness. Her menstrual history revealed excess menstrual flow for 5–7 days with an interval of 25 days. The patient had a past history of high-grade fever, followed by mild fever for 20 days, 4 years ago, followed by which she had multiple episodes of fever and heavy menstrual flow. Her reports showed TORCH infection positive. Semen analysis report of her husband was within normal limits. According to Ayurveda, the patient was diagnosed with a case of Putraghni Yonivypad and was treated with Virechana (therapeutic purgation), followed by oral medication, Pitta Shamaka (Pitta alleviating drugs), Jwaraghna Chikitsa (principle of fever management), Brimhana (nourishment), and Garbha Sthapaka Yoga (preventive measures for abortion and promotive measures for fetal health and quality). The patient conceived in the 3rd menstrual cycle. She was advised to follow Garbhini Paricharya (pregnancy regime). The patient had a full-term normal delivery and was blessed with a female child weighing 2600 g, with no obvious abnormalities detected at the time of birth.

SPECTRUM OF FEBRILE THROMBOCYTOPENIA AMONG CHILDREN IN A TROPICAL COUNTRY: A HOSPITAL BASED OBSERVATIONAL STUDY IN DHAULADHAR REGION

Background: Pediatric admissions often involve febrile thrombocytopenia. Infections are the main cause however noninfectious reasons occur. This study estimated the prevalence of thrombocytopenia in pediatric fever patients, its etiologies, presentations, and the association between platelet count and disease severity and prognosis. Methods: Retrospective observational study done by collecting data fromhospital records of children admitted inRPGMC Tanda from January 2021 to December 2022. Children in the age group of 6 months to15 years with fever and thrombocytopenia at admission were included in the study. Children on treatment with antiplatelet drugs, other chronic diseases and infants less than 6 months were excluded. Results: 48% had high-grade fever at presentation. Fever averaged 4–6 days and peaked at 14 days. Constitutional symptoms (vomiting, abdominal pain) followed. Respiratory and diarrheal manifestations were rare. Seizures and altered sensorium were present in 4%. The next most common clinical finding was hepatomegaly with right hypochondrial tenderness (44%), followed by fluid leak (ascites, pleural effusion) (40%), periorbital puffiness (30%), subcutaneous bleeds (20%), conjunctival congestion (14%) and splenomegaly (14%). Conclusions: Dengue-endemic children have febrile thrombocytopenia. Thrombocytopenia with abdominal pain, vomiting, or oliguria suggests dengue. Enteric fever, scrub typhus, and chikungunya induce similar symptoms. Leukemia, idiopathic thrombocytopenic purpura, hemolytic uremic syndrome, and sepsis can induce febrile thrombocytopenia. Blood and antibiotics are unusual.