Demographic and clinical profiles of Plasmodium falciparum and Plasmodium vivax patients at a tertiary care centre in southwestern India.

BACKGROUND: Malaria remains an important cause of morbidity and mortality in India. Though many comprehensive studies have been carried out in Africa and Southeast Asia to characterize and examine determinants of Plasmodium falciparum and Plasmodium vivax malaria pathogenesis, fewer have been conducted in India. METHODS: A prospective study of malaria-positive individuals was conducted at Goa Medical College and Hospital (GMC) from 2012 to 2015 to identify demographic, diagnostic and clinical indicators associated with P. falciparum and P. vivax infection on univariate analysis. RESULTS: Between 2012 and 2015, 74,571 febrile individuals, 6287 (8.4%) of whom were malaria positive, presented to GMC. The total number of malaria cases at GMC increased more than two-fold over four years, with both P. vivax and P. falciparum cases present year-round. Some 1116 malaria-positive individuals (mean age = 27, 91% male), 88.2% of whom were born outside of Goa and 51% of whom were construction workers, were enroled in the study. Of 1088 confirmed malaria-positive patients, 77.0% had P. vivax, 21.0% had P. falciparum and 2.0% had mixed malaria. Patients over 40 years of age and with P. falciparum infection were significantly (p < 0.001) more likely to be hospitalised than younger and P. vivax patients, respectively. While approximately equal percentages of hospitalised P. falciparum (76.6%) and P. vivax (78.9%) cases presented with at least one WHO severity indicator, a greater percentage of P. falciparum inpatients presented with at least two (43.9%, p < 0.05) and at least three (29.9%, p < 0.01) severity features. There were six deaths among the 182 hospitalised malaria positive patients, all of whom had P. falciparum. CONCLUSION: During the four year study period at GMC, the number of malaria cases increased substantially and the greatest burden of severe disease was contributed by P. falciparum.

Filarial granuloma of the testicular tunic mimicking a testicular neoplasm: a case report.

INTRODUCTION: Any firm or solid intratesticular mass on examination and/or any hypoechoic area within the tunica albuginea on imaging is markedly suspicious for testicular cancer. Filarial involvement of the testicular tunic has not been reported previously. CASE PRESENTATION: A 32-year-old man presented with a history of noticing a swelling in his right testicle for a period of 1 month which had become painful over the 10 days before presentation. Pre-operative imaging failed to shed light on the nature of the lesions (malignant or benign). The diagnostic dilemma was explained to the patient and informed consent was obtained for an orchiectomy. The patient underwent a high inguinal orchiectomy. The histopathology revealed a filarial granuloma of the testicular tunic. CONCLUSION: While it is generally regarded that any testicular swelling, especially in a young person, should be treated as a malignancy unless proven otherwise, it is important to remember that infectious diseases such as filariasis and tuberculosis may mimic neoplasms. Careful consideration of these diagnoses must be given when dealing with testicular swellings especially in areas where the prevalence of these diseases is high.