Relevance of Weil-Felix test in diagnosis of scrub typhus in India.

OBJECTIVE: To study the relationship of Weil-Felix test and microimmunofluorescence test. METHODS: Sera of 21 patients with clinical diagnosis of scrub typhus were subjected to Weil-Felix and Microimmunofluorescence tests. RESULTS: On Weil-Felix test, 13 (62%) sera showed titers 1: > or = 40-320. 7 patients showed titers 1: > or = 320, 3 showed titers 1 : 160, 2 showed titers 1 : 80 and 1 patients showed titers 1 : 40, to Proteus OXK antigen. All 21 sera showed significant titers to O. tsutsugamushi on microimmunofluorescence. CONCLUSION: Weil-Felix test is not a very sensitive test in diagnosis of scrub typhus but due to of lack of availability of definitive tests in India it canbe a useful tool when used and interpreted in the correct clinical context.

Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh.

BACKGROUND: Community acquired pneumonia (CAP) is a common clinical problem. The present study was designed to evaluate the clinical and bacteriological profile of CAP in Shimla. METHODS: Seventy patients with community acquired pneumonia were enrolled in this study. In all the patients blood culture, sputum culture, pleural fluid culture (if available) and serological studies for the detection of Mycoplasma pneumoniae specific IgM antibodies by enzyme linked immunosorbent assay (ELISA) were done. RESULTS: Of the 70 patients, 53 (75.6%) had an identifiable atiology with 12 patients having evidence of mixed infection. No organisms could be isolated in 17 patients inspite of using serological methods for Mycoplasma pneumoniae, invasive procedures like bronchoscopic aspirations in addition to the conventional methods like sputum culture, blood culture and pleural fluid culture. The most frequent pathogen was Streptococcus pneumoniae (n = 19; 35.8%) followed by Klebsiella pneumoniae (n = 12; 22%), Staphylococcus aureus in (n=9; 17%), Mycoplasma pneumoniae (n = 8; 15%), Escherichia Coli (n = 6; 11%), beta-haemolytic streptococci (n = 4; 7.5%) and other Gram-negative bacilli (n = 5, 9%). CONCLUSION: Age smoking and under lying co-morbid conditions specially chronic obstructive pulmonary disease (COPD) were significantly associated with the development of CAP (p < 0.01).

Aetiology and dynamics of dyspepsia in Shimla: a study of 500 patients.

Dyspepsia is a frequent presenting symptom amongst patients attending medical clinics worldwide. However their aetiologies differ geographically. The present study was conducted to identify the aetiologies of dyspepsia of our centre and to determine their clinical characteristics. Five hundred consecutive patients presenting with dyspepsia were studied at our Institute. All patients underwent detailed structured questionnaire, stool examination, upper gastrointestinal endoscopy, ultrasound scan of upper abdomen and sigmoidoscopy when necessary. Among 500 patients, 34% suffered from essential dyspepsia, 28% had peptic ulcer, 19.2% had cholelithiasis, 10.8% had irritable bowel syndrome and 6% had gastro-oesophageal reflux. Significantly more patients with peptic ulcer experienced night paints, pain relief with food, milk, antacids or H2 receptor antagonists and periodic pain. In patients with essential dyspepsia, pain was continuous, mild to moderate in intensity, aggravated by food or alcohol, without relief with milk, antacids or H2 receptor antagonists and night pains were absent in them.

Electrocardiographic changes during upper gastrointestinal endoscopy in ambient hypoxia.

Electrocardiographic (ECG) changes were studied in 120 consecutive subjects during and after upper GI endoscopy done in ambient hypoxia (PO2-120 mmHg) at Shimla (2200 m). No premedication was given to any of the subjects. There were 75 men and 44 women. Fifty three subjects were aged 40 years or below (Group I) and 67 subjects were above 40 (Group II). There were 29 subjects with and 91 subjects without cardiac diseases. Increase in heart rate was seen in 96.6% of subjects. Maximum rise in heart rate was found in cardiac patients. ST depression was seen in 14.2%, T wave inversion in 13.3%, supraventricular tachycardia in 5.8% and ventricular ectopics in 1.6%. ST depression was more frequent in cardiac than in non cardiac patients (P less than 0.001) and T wave inversion was more frequent in women than in men (P less than 0.001). All the changes reverted to normal within 10 minutes. ECG changes notwithstanding, upper GI endoscopy without premedication in the presence of ambient hypoxia is a safe procedure.

Electrocardiographic manifestations following household electric current injury.

Electrocardiographic monitoring of a 24 year old male, who sustained household electric current injury, showed low voltage ECG complexes, varying degrees of atrioventricular (AV) blocks, and ventricular fibrillation. The low voltage ECG complexes and varying AV blocks disappeared spontaneously and ventricular fibrillation reverted to normal after cardioversion.

Neurocysticercosis presenting with psychosis.

Cysticercosis consists of infection with the small bladder-like larvae of the pork tapeworm Taenia solium. The life cycle of parasite is maintained between man and pig infected with cysticerci. Epilepsy is the most common presentation of neurocysticercosis; focal signs, headache, involuntary movements and global mental deterioration are other symptoms. Psychosis is a rare presentation and may be seen in up to 5% of patients. We present a 25 years old male, who had been under treatment from psychiatry OPD for psychosis for one year, developed generalized tonic-clonic seizures. CT scan of brain revealed multiple calcified and hypodense lesions with surrounding oedema. Histopathological examination of subcutaneous nodule confirmed the diagnosis of neurocysticercosis.

Hemiplegia as a manifestation of acute mountain sickness.

A young mountaineer who developed right sided hemiplegia with aphasia at high altitude is reported. This is an uncommon nervous system manifestation in acute mountain sickness.