Insect Bites Research Articles

A Review on Formulation and Evaluation of Herbal Face Serum

Facial wrinkles and skin aging are often caused by sun damage and UV rays, and there are currently no effective methods to slow down the aging process. Aloe Vera, glycerin, and honeybee venom are key ingredients in a concentrated face serum that helps improve skin health. Aloe Vera provides quick cosmetic benefits and also has psychological effects. The serum is easily absorbed and can penetrate deeper layers of the skin. Aloe Vera is known for treating skin issues like sunburns, minor cuts, and insect bites, and it has healing, anti-inflammatory, antibacterial, and antifungal properties. Bee venom, a toxin produced by bees, is believed to help improve blood flow and increase collagen production. The face serum was tested for its quality, including pH, consistency, and size of the droplets. Stability tests showed that the serum maintained its appearance, texture, and consistency without any changesg

Hand infections : when to consult a hand surgeon ?

The hand is an anatomical site frequently affected by infection due to its central role in all daily activities. It is therefore regularly the site of wounds (contused, penetrating, insect stings, bites, etc.), all of which are potential entry points for infections. Recognition by the general practitioner of the red flags requiring an urgent specialist consultation is therefore essential in order to improve the patient's functional prognosis, determined by the initial management. In this article, we focus on the most frequent situations encountered in primary care.

Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study.

As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear. This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints. We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites). Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=-0.25, 95% CI -0.49 to -0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=-0.39, 95% CI -0.54 to -0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden. Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously. ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163.

Pediatric Allergy Management at ULSNE: Insights into Public Health Implications

Abstract Introduction Pediatric allergies present a complex challenge to public health systems, affecting both policy-making and clinical management. This study explores the management trends and challenges of pediatric allergies at the Unidade Local de Saúde do Nordeste (ULSNE) in Portugal, emphasizing its implications for refining healthcare practices over a seven-year period. Methods A retrospective review of medical records was performed, from children aged 0 to 18 who presented with allergic reactions at ULSNE’s emergency services between 2017 and 2023. The analysis concentrated on demographics, allergen types, reaction severity, and the management strategies deployed. Results The analysis revealed a wide range of allergens, from food to insect stings, with medication being the most prevalent triggers. Significant findings include observing severe allergic reactions across all age groups, highlighting the need for acute emergency interventions. The data underscores a critical demand for early diagnosis and tailored-made management plans to efficiently handle the diverse severity of allergic reactions observed. Conclusions This study demonstrates the complexity of managing pediatric allergies within ULSNE’s public health framework. Standardized, evidence-based management methods should be adopted to strengthen emergency response capabilities, as shown by the frequency of severe responses and the prevalence of various allergens. As an outcome, our results support a comprehensive, interdisciplinary strategy that includes medical personnel, educational institutions, and family involvement to create a supportive community that is supportive of both immediate care and long-term preventive measures. Subsequent efforts should give precedence to educational programs designed to increase consciousness and encourage preventive measures in community environments. Key messages • A rapid response is essential for healthcare systems to have fast, effective strategies ready for children’s severe allergic reactions. • Emphasizes a collective approach involving healthcare workers, schools, and families to prevent and manage children’s allergies, enhancing safety and awareness.

Clinical Profile And Aetiology of Acute Kidney Injury Developing In Patients Hospitalized Due To Non-Renal Cause With Pre-Existing Normal Renal Function

Background: Acute kidney injury (AKI) is a common complication in patients hospitalized for non-kidney disease and having normal renal function. Early detection of development of deteriorating renal function and assessment of its cause can help to manage the cases effectively and can prevent further kidney damage or progression to end stage renal failure. Methods: This observational study was done on 50 patients selected from the departments of Medicine and Nephrology of Dhaka Medical College (DMCH) and BSMMU, from June 2012 to November 2012. Patients were included in the study who developed clinical features and biochemical findings of acute kidney injury, while being admitted with various non-renal diseases and had previous normal renal function. Results: In this study the cause of deterioration of renal function was Sepsis in 44.0% of the patients, 42.0% had fluid loss, 6.0% had used nephrotoxic drugs, 4.0% had hepatitis, 2.0% patients each had pancreatitis and insect bite respectively. 40% of the patients were above 40 years of age, 54% were male. Vomiting was present in 42% of the patients and diarrhoea in 20% of the patients. 26% patients had DM and 22% had hypertension. Conclusion: Sepsis and hypovolemia were the common causes of developing acute kidney injury in the hospital. In-hospital mortality was 18.0% and 22.0% patients developed CKD after three months follow-up. J Dhaka Med Coll. 2023; 32(1) : 85-91

Specific anti-toxic immunotherapy: use in medical practice and perspectives

The results of use of approaches and means of antitoxic immunotherapy in medical practice are summarized: passive transfer of various variants of antibodies specific to toxic compounds, vaccination – specific active immunization with vaccines carrying determinants of the immunochemical specificity of target toxic compounds. The practical effectiveness of the known approaches of passive transfer and vaccination is associated with the ability of specific antibodies, by binding target bioactive compounds with pronounced toxicity, to change the availability of corresponding structures in the body-targets and, in the presence of a sufficient number of specific antibodies with high binding ability to the target compounds, neutralize their toxicity. In medical practice, polyspecific heterologous antisera or the gamma globulin fraction of antisera (extremely rare monoclonal antibodies of narrow specificity) are widely used for passive transfer as antidotes in the treatment of victims in order to prevent deaths and extensive necrosis of soft tissues at the site of the bite of poisonous snakes and insects. Active immunization – vaccination with appropriate antigenic drugs should create in immunized individuals a state of humoral immunity with the corresponding characteristics of antibody formation specific to the target compound. When a target toxic compound enters an immunized organism, it is also possible to neutralize its toxicity. The most successful experience in using the principles of active immunization as a technology for specific antitoxic therapy is associated with the practice of using toxoids for toxinemic infections. Specific practical techniques used to achieve the effectiveness of possible approaches to specific antitoxic immunotherapy in the form of passive transfer of specific antibodies or their fragments are considered: to combat lethal infections in the pathogenesis of which the toxic effects of bacterial exotoxins are significant; when treating victims of snake and insect bites, exposure to poisons of marine organisms, algae and plant toxins; in the treatment of severe intoxication with certain low molecular weight toxic substances: digoxin, colchicine, tricyclic antidepressants. The most successful experiences of using the principles of active immunization as a technology for specific antitoxic therapy, based on the use of toxoids with specificity for diphtheria, tetanus, botulism, cholera, typhoid fever, dysentery, gas gangrene and other toxinemic infections, are also considered. The fairly high immunogenicity of toxoids with the possibility of activating both constitutional and adaptive immunity has become the basis for their use as macromolecular carriers of hapten analogues of narcotic substances – a promising direction in drug addiction, in the implementation of which a number of experimental molecular and combined vaccines of opiates, methamphetamine, cocaine, and nicotine. This variant of practical efforts in medicine can be regarded as a new direction of specific antitoxic immunotherapy – an option to combat drug addiction by vaccinating drug addicts.

Eosinophilic Dermatosis of Haematological Malignancy.

This report is regarding a 71-year-old female with a background of CLL diagnosed in 2017, managed conservatively with active surveillance under haematology. Presented to dermatology 5 years ago with a non-resolving insect bite-like rash on her chest. Multiple biopsies were taken over the years due to the diagnostic challenge. The biopsies usually demonstrated peri-vascular inflammation, heavy eosinophilic infiltrate along with lymphocytes and histiocytes without evidence of a frank vasculitis. Following multi-disciplinary team (MDT) discussion with clinical and pathological correlation, a diagnosis of eosinophilic dermatosis of haematological malignancy mimicking insect bites was made.

Cutaneous mastocytosis: diagnostic challenges and dietary influences in a prolonged case report

Cutaneous mastocytosis is a rare condition characterized by abnormal mast cell proliferation in the skin. We present the case of a 65-year-old man with recurrent urticaria-like rashes persisting for more than eight years. Despite multiple misdiagnoses as insect bites, examination and biopsy revealed mast cell infiltration. The patient's unique lifestyle, particularly his frequent seafood consumption, adds an intriguing dimension to the case. Treatment with systemic antihistamines and corticosteroids provided symptomatic relief, but long-term follow-up showed the persistence of clinical lesions, indicating that the treatment did not adequately address the underlying cause of the disease. A notable improvement in disease control was observed when the patient's diet was adjusted, suggesting a potential link between food and cutaneous mastocytosis. To our knowledge, this is the first documented case of maculopapular cutaneous mastocytosis in Syria.

Intensive Care for Anaphylaxis in Children: Current Trends

Anaphylaxis is an acute allergic reaction with rapid clinical development and risk of death. This article provides an analysis of literary sources devoted to intensive care of anaphylaxis in childhood. It was revealed that the prevalence of anaphylaxis is increasing, in children and adolescents as well. The main triggers of anaphylaxis in pediatric practice include food products, insect bites and drugs. Anaphylaxis is an IgE-mediated hypersensitivity reaction of type 1, characterized by the release of chemical mediators that lead to smooth muscle contraction, increased permeability and vasodilation and vagal activation. Clinically, anaphylaxis is manifested by allergic skin rash, angioedema, obstruction of the upper respiratory tract (URT), broncho-obstructive syndrome (BOS), arterial hypotension, tachycardia. Intensive care for anaphylaxis in children begins with stabilization of the condition: stopping the entry of a possible allergen into the body, hospitalization in the anesthesiology and intensive care unit, restoring patency of the URT, conducting oxygen therapy, monitoring vital functions. The first-line drug for the treatment of anaphylaxis in children is adrenaline at a dose of 0.01 mg/kg, which stops all the main pathophysiological links of anaphylaxis. Adrenaline autoinjectors are not used in the Russian Federation. Second-line drugs for intensive care for anaphylaxis in children include glucocorticosteroids (GCS), antihistamines, bronchodilators and infusion therapy. The effectiveness of GCS in anaphylaxis in children has not been proven, antihistamines can relieve skin manifestations of an allergic reaction, but do not affect vital disorders. Bronchodilators reduce BOS and are an additional treatment, while infusion therapy eliminates hypovolemia. Knowledge and timely implementation of modern care algorithms for anaphylaxis in children and adolescents will improve the quality of emergency care and reduce the risk of fatal outcomes in this pathology.

Effect of Bilvapatra Lepa (Aegle Marmelos) over unknown insect bite Poisoning - A Single Case Study

Ayurveda is the ancient science of life, has eight branches. According to Ayurved there are two main types of poison – Natural and Artificial. Natural poison is of two types – Sthavar and Jangam. (1) Danstrachikita is a Ayurveda toxicology branch. Insect bite is comes under Jangam Visha. A 9 year boy, while playing cricket affect with unknown insect bite complying of itching, swelling, redness and burning pain over upper back region. He was treated by local application of Bilvapatra Lepa (Aegle marmelos). Aegle marmelos is one of the important plants which have medicinal as well as other properties. This study shows that external application of Bilvapatra Lepa is effective in the treatment of unknown insect bite (Kitakadansha)

Interleukin 31 mediates pruritus in horses.

This study investigated the effects of recombinant equine IL-31 (eIL-31) in vivo and in vitro. Equine IL-31 mRNA sequences were verified by sequencing. Recombinant eIL-31 was produced using mammalian and bacterial expression systems. From November 2019 through February 2021, 12 normal horses, 6 to 10 years old with no history or clinical signs consistent with allergic skin disease, were injected ID with eIL-31 and saline in 2 challenge studies. Pruritus-associated behaviors were recorded for a minimum of 15 minutes preinjection and 4 hours postinjection. Adherent monocytes from 3 pruritic horses, exhibiting insect bite hypersensitivity and/or atopic dermatitis, were stimulated with bacterial eIL-31, and subsequent phosphorylation of signal transducer and activator of transcription 3 (STAT3) was measured by western blot and AlphaLISA. The bacterial eIL-31 was produced with greater purity than the mammalian eIL-31 (> 95% vs 70%). Pruritus was elicited by both recombinant proteins. The mammalian eIL-31 induced mild pruritus (cumulative seconds spent itching postinjection ranged from 6 to 313). The bacterial eIL-31 induced marked pruritus in some horses (a cumulative maximum of 5,529 seconds spent itching in 1 horse) and a milder response in others (range of cumulative seconds spent itching, 17 to 2,313). Most pruritus occurred after 2 hours and subsided by 4 hours postinjection. Bacterial eIL-31 induced STAT3 phosphorylation in adherent monocytes from allergic horses. In this proof-of-concept study, IL-31 was found to mediate pruritus and was associated with STAT3 phosphorylation in horses as in other species. Interleukin 31 is a promising therapeutic target for equine allergic pruritus.

Knowledge and Experiences of Diseases with Associated Factors among Agricultural Workers in Manikganj District

Background: Farmers are generally the people of poor segment of the society and agricultural workers are prone to develop different types of health problems. Objectives: The study was conducted with a view to finding out the pattern of health problems of the agricultural workers in a rural area of Manikganj district. Methodology: This was a descriptive type of cross-sectional study carried out in Koshunda village of Manikganj district during the period of November, 2021 to April, 2022 in the Department of Community Medicine, Monno Medical College, Manikganj. For finding out pattern of diseases, knowledge and practice of the study subjects were determined by using pretested questionnaire. Results: Among the 300 cases, majority (124, 41.33%) of the respondents belonged to the age group 36-50 years. Most of the respondents (239, 79.67%) were male, being literate (195, 65.00%) had monthly family income of 10,001 or more BDT (139, 46.33%). Regarding cultivators’ knowledge of health problems during cultivation, majority (230, 76.67%) expressed occurring cut injury, followed by 206(68.67%) temperature injury, 85(24.08%) insect bite and others. Responding to question regarding injuries caused by tools and machineries of or animals involved in cultivation, majority (134, 44.67%) told that they are injured by handtools, followed by 51(17.00%) due to cattle’s kick, 46(15.33%) due to tractors and other machineries, and otherswhereas, majority of them (199, 66.33%) also reported that the injuries occur in hands, followed by 192(64.00%) in legs and others. Diseases experienced by the respondents during agricultural works included temperature-related injury (165, 55.00%), cut injury (96, 32.00%), skin problems (34, 11.33%) and others. Regarding the knowledge of the respondents’ choice of physician, majority (125, 41.67%) preferred MBBS Doctors, followed by rural medical practitioners (121, 40.33%), homeopathic doctors (67, 22.33%) and others. Conclusion: Most of the farmers shared their knowledge of suffering from different types of diseases with choice of treatment by MBBS doctors. Journal of Monno Medical College December, 2023; 9 (2):73-77

A NOVEL TREATMENT FOR PTOSIS COMPLICATION AFTER PRESEPTAL CELLULITIS IN DIABETIC PATIENT (CASE REPORT

Background: Preseptal cellulitis (PC) is an inflammation of the eyelid and surrounding soft tissues covering the anterior portion of the orbital septum (palpebral fascia) characterized by eyelids unilateral swelling, can develop to orbital cellulitis and be fatal for diabetics after complication. Two main mechanisms of the PC development are distinguished. One of them is based on a spread of local infection on the eyelid. The second group of PC causes include eye surgery, trauma or insect bites. In most cases, serious complications are rare, but sometimes sight-threatening infections behind the orbital septum may develop. It is important to be able to distinguish periorbital cellulitis from orbital cellulitis, and treat according to the diagnosis. In this paper, we discuss a case of PC and successful recovery after medical intervention even though due to late presentation to the Clinic, patient developed ptosis. A clinical case of PC developed to complete ptosis, treatment and successful elimination of all residual symptoms in diabetic patient with is described. We used a novel approach to PC treatment and ptosis after PC. Results: We achieved complete recovery from ptosis after PS in a diabetic patient thanks to novel approach to treatment Findings: 1. The use of nepafenac instead of diclofenac helps to enhance the effectiveness of treatment and prevent the spread of infection to nearby tissues during PС. 2. For the treatment PC complication, ptosis, we suggest the simultaneous, not separated in time use of proserin in combination with glycine.

8179 Complicated Pancreatitis Unveiled: A Case Of Untreated Primary Hyperparathyroidism

Abstract Disclosure: A. Rehan: None. H. Al Jumaili: None. J. Lim: None. Introduction: Acute pancreatitis (AP) triggered by hypercalcemia stemming from primary hyperparathyroidism (PHPT) is an infrequent occurrence, with a prevalence of about 1.5-7%. The proposed mechanism involves deposition of calcium in the pancreatic ducts and activation of pancreatic enzymes. While a causal connection between AP and PHPT has been described, it remains controversial. Calcium levels are thought to play a major role in determining the severity of the pancreatitis. Additionally, it is thought that genetic mutations may contribute to the development of AP in PHPT. Here, we report a case of necrotizing pancreatitis in a patient with untreated PHPT. Clinical Case: Patient is a 59-year-old male with a medical history of hypertension, nephrolithiasis and PHPT secondary to parathyroid hyperplasia (scheduled for parathyroidectomy) who presented with abdominal pain, nausea, vomiting and was found to have AP. He reported no history of alcohol use, trauma or insect bites. His workup was unrevealing for cholecystitis, choledocholithiasis or hypertriglyceridemia. He represented with calcium level of 16 mg/dL (NR 8.7-10.1) due to PHPT. PHPT was deemed the likely cause of AP. Course was further complicated by necrotizing pancreatitis and pseudocyst. A few months later, patient started having coffee ground emesis, worsening epigastric pain and weight loss of 60 lbs due to poor oral intake. CT abdomen/pelvis showed walled off pancreatic necrosis with peripancreatic stranding and concern for gastric outlet obstruction. EGD with PEG-J placement was done with plans for future endoscopic drainage. Few weeks after, he had another bout of worsening abdominal pain. Labs at the time showed corrected calcium between 11-13 mg/dL, PTH 147 pg/ml (NR 5-44), phosphorus 1.6 mg/dL (NR 2.5-4.5), vitamin D 25 hydroxy 19.5 ng/ml (NR 22-110). His condition became more complex with a hemorrhagic walled off pancreatic necrosis and splenic artery pseudoaneurysm requiring ICU care. The repeated escalation of symptoms resulted in multiple delays for the scheduled parathyroidectomy. Patient was started on treatment with Cinacalcet and vitamin D while in the hospital. Due to constraints in resources, he was unable to continue Cinacalcet outpatient. He subsequently was able to undergo parathyroidectomy with pathology showing benign adenoma. Conclusion: Hypercalcemic hyperparathyroidism causing AP, although rare, is often severe and poses a greater risk of complications making it important to be aware of this association, especially when more common causes have been excluded. Imaging techniques like cervical ultrasound, CT, and scintigraphy using 99mTc-Sestambi should be utilized to confirm suspicion. Surgical resection is the mainstay treatment, and having a multidisciplinary team with gastroenterologists, endocrinologists, and surgeons helps improve outcomes. Presentation: 6/2/2024

Phenotypic Shift of an Inflammatory Eosinophil Subset into a Steady-State Resident Phenotype after 2 Years of Vaccination against IL-5 in Equine Insect Bite Hypersensitivity

Eosinophils play a key role in allergic diseases such as insect bite hypersensitivity (IBH). Together with Th2 cells, they shape the course of inflammation in associated type I/IVb allergies. Therefore, a virus-like particle (VLP)-based vaccine targeting equine interleukin-5 (eIL-5), eIL-5-CuMV-TT, was developed to interfere with the IL-5 dependency of eosinophils by inducing the production of anti-self-IL-5 antibodies and alleviating clinical signs in IBH-affected horses. A previous study highlighted the presence of two eosinophil subsets, steady-state resident eosinophils (rEos) and inflammatory eosinophils (iEos), circulating in the blood of healthy and IBH-affected horses, distinguishable by the expression of integrin CD49f. Furthermore, eIL-5-CuMV-TT 1st year vaccination showed a significant decrease of total eosinophils and, in particular, iEos. Nevertheless, the very few remaining eosinophils still shared an iEos phenotype, reflected by bigger size and higher granularity. The aim of this study was to follow up on the phenotype of eosinophils in the 2nd year of vaccination of IBH-affected horses with eIL-5-CuMV-TT. Using flow cytometry analysis of the blood of healthy, IBH, IBH-placebo, and IBH-vaccinated horses, the percentage and count of cells were compared between groups with a focus on pair analysis of eosinophils in 1st and 2nd year vaccinated horses. Our data showed comparably low levels of iEos and a significant increase of rEos in 2nd year compared to 1st year vaccinated horses, suggesting a phenotypic shift toward a resident-like eosinophil population, primarily associated with the phenotype of healthy horses. The reduction of size, granularity, and expression of integrin CD49f in the 2nd year suggests a benefit of long-term treatment with the eIL-5-CuMV-TT vaccine.

Allergen immunotherapy using recombinant Culicoides allergens improves clinical signs of equine insect bite hypersensitivity.

Insect bite hypersensitivity (IBH) is an IgE-mediated allergic dermatitis of horses caused by bites of Culicoides spp., sharing some common features with human atopic dermatitis. Allergen immunotherapy (AIT) using Culicoides whole-body extracts has limited efficacy. This study aimed to evaluate AIT with a pool of major Culicoides recombinant allergens in a prospective, double-blinded, placebo-controlled study. The IBH lesion score was assessed during a pre-treatment year and first treatment year (May-October) in 17 horses and in May and July of a second treatment year. Nine horses were immunized subcutaneously 3× with a combination of nine r-allergens (20 μg each/injection) in alum and monophosphoryl lipid A (MPLA). Eight horses received a placebo. The immunization was repeated twice the following year. The specific antibody response to one of the AIT Culicoides r-allergens was assessed. In the first treatment year, the decrease in average IBH lesion score was significantly larger in the AIT compared to the placebo group, with 67% of the AIT group and 25% of the placebo horses reaching >50% improvement of the average IBH lesion score. The response to the AIT was enhanced in the 2nd treatment year when 89% of the AIT vs. 14% of the placebo horses showed an improvement (p ≤ 0.01). IgG antibodies of all subclasses were induced, with IgG4/7 showing the most significant differences between groups. The post-AIT sera showed IgE blocking activity. AIT using only a few injections of small amounts of r-allergens in alum and MPLA as immunomodulators seems a promising approach for the treatment of insect bite allergy.

First reported cases of Borrelia and dengue co-infection: A case series.

Dengue fever is one of the most common diagnoses in patients presenting with acute febrile illness in tropical countries. Borrelia, on the other hand, is the cause of vector-borne infections of relapsing fever and Lyme disease. While co-infections of dengue with chikungunya, Zika, malaria, influenza and typhoid have been reported, clinical cases of Borrelia infections have never been reported in Malaysia. Based on available evidence, this is the first case series to report dengue fever and Borrelia spp. co-infection. All three patients in this report were admitted to medical wards on day 3 to day 8 of illness for dengue fever as evidenced by a positive dengue NS1 antigen test. The clinical manifestations were typical of dengue fever, with all patients having high grade fever, myalgia, and arthralgia. All patients also had thrombocytopenia. Features of severe dengue, such as shock, hemorrhage and impaired consciousness were absent. Borrelia DNA were detected in the blood samples of the patients. However, all the patients denied having skin lesions and a history of insect bites. All the patients were given intravenous fluid therapy and were discharged after 3 to 5 days of hospitalization.

Unusual Unsatisfactory Treatment in Two Patients with Imported Cutaneous Leishmaniasis.

Cutaneous leishmaniasis is one of the most commonly diagnosed dermatological condition in travel medicine after diarrhoeal diseases and febrile status. The disease is transmitted by Phlebotomus and Lutzomyia sandflies. It appears in various clinical forms, the most common of which is a painless ulcer with raised edges, usually present on exposed parts of the body on the side where the insect bite occurred. Annually, over a million new cutaneous leishmaniasis (CL) cases are reported globally. We present two cases of affliction, the first occurring in Patient 1, who attempted treatment through the Kambo cleanse in South America, which is considered a toxic, even life-threatening, procedure. It involves the subcutaneous application of a substance dangerous to humans derived from the surface mucus of a frog. Patient 2 applied caustic ointments, a fruitarian diet, and hyperbaric oxygen therapy in a private setting. After initial therapeutic failures caused by the patients' unconventional treatment ideas, the causal treatment effect was satisfactory, demonstrating the efficacy of these treatments in resolving the infection when applied appropriately. Despite the typical CL presentation in both patients, their self-treatment course was unusual. It is worth noting that alternative, sometimes harmful, self-treatment initiatives by patients may be surprising and ineffective. Promoting knowledge about tropical diseases among travellers and medical staff is crucial to improving treatment outcomes.

Linear manifestation of bed bug bites in an adult

Linear manifestation of bed bug bites in an adult

Wells Syndrome Associated with Fungal Infection

Introduction: Eosinophilic skin diseases encompass a broad spectrum, including Wells syndrome, which is characterized by histological findings of eosinophilic infiltration in the dermis. The etiology and pathogenesis of Wells syndrome are still unknown, but it has been reported that insect bites, infections, and medications can act as triggers. Fungal infections are common in clinical practice; however, when they are recurrent, have atypical characteristics, or are resistant to treatments, they must be recognized as potential triggers for hypersensitivity reactions such as Wells syndrome. Case Presentation: We present the clinical and histopathological characteristics of a case in which Wells syndrome was associated with a fungal infection. Conclusions: Wells syndrome is a rare skin disorder with polymorphic manifestations, making diagnosis challenging in clinical practice. Therefore, a high index of suspicion is required, and blood tests and skin biopsy are necessary to confirm the diagnosis.