Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

A Study of Erectile Dysfunction in Male Diabetes Patients and its Correlation with Platelet-Lymphocyte Ratio

Introduction: Erectile dysfunction (ED) constitutes a large burden on society given its high prevalence and impact on quality of life. Diabetes is a common cause of organic ED. Prevalence of ED in diabetes ranges from 35% to 85% depending on the study, versus 26% in general population. Platelet-lymphocyte ratio (PLR) has been detected as an important marker for inflammation. Some studies have identified its role in ED but more research is needed. Material and methods: It was a hospital-based prospective observational study. According to International Index of Erectile Function (IIEF)-5 questionnaire, patients were divided into 4 categories: mild ED with score 17 to 21, mild-to-moderate ED with score 12 to 16, moderate ED with score 8 to 11 and severe ED with score 1 to 7. Presence of ED and its severity was correlated with age, residence, duration of diabetes, glycemic status, lipid profile, PLR, complications, body mass index (BMI), etc. Results: Prevalence of ED in male diabetes patients was found to be 72.4%. Among 110 cases with ED, 8 had mild ED (7.2%), 27 had mild-to-moderate (24.5%), 27 had moderate ED (24.5%) and 48 had severe ED (43.6%). Prevalence of ED was found to be proportional to age. Majority of cases in ED group were those with long-standing diabetes. Correlation of ED with complication of diabetes, like nephropathy and retinopathy, was significant, whereas it was not significant with neuropathy. Significant correlation of ED was found with BMI and PLR. Conclusion: ED prevalence was high among the diabetes patients and it increased with age and duration of the disease. Presence of diabetic complications was significantly associated with ED. BMI was significantly associated with development of ED. PLR was significantly higher in ED group and closely related to severity of ED.

Scrub Typhus and Myocarditis: A Rare Complication

Scrub typhus, also called bush typhus, is a zoonotic disease a Gram-negative bacterium. Its presentation may range from nonspecific febrile illness to severe disease, with cardiovascular, renal, hepatic and neurological involvement. Myocarditis is one of the rare complications of scrub typhus. Hence, we are reporting a case of a 50-year-old male, farmer by occupation, presenting to us in multiorgan dysfunction syndrome who developed myocarditis during second week of his illness.