Study on 40 cases of rickettsia.

Rickettsia is emerging in the subcontinent and clinically presents as non-specific febrile illness. At present there is no cheap & easily available diagnostic tool in our hand. Beside this, Weil-Felix test is becoming abandoned. So, high index of clinical suspicions is essential to diagnose rickettsia at early stage and to prevent mortality & morbidity. 40 cases were recorded among the admitted febrile patients in MMCH since 2003 to 2005. Cases were selected by clinical suspicions; exclusions of other common febrile illness & thereafter supported by lab. Investigations, specially by positive Weil-felix test. Cases were distributed through out the year but 19 (47.5%) cases were detected in March to May. 12 (30%) cases were found in August to October. The remaining 9 cases were detected in the rest 6 months. All (40) cases were presented with fever (100%), headache was present in 33 (82.5%) cases, rashes were present in 15 (37.5%) cases, isolated splenomegaly was found in 15 (37.5%) cases & hepatosplenomegaly in 12 (30%) cases, arthralgia in 13 (32.5%) cases, lymphadenopathy in 5 (12.5%) cases; 2 (5%) cases attended with unconsciousness & epistaxis in 1 (2.25%) case. Scrub typhus were 19 (47.5%), Indian tick typhus 16 (40%), 5 (12.5%) cases were with dual pathology and were associated with enteric fever. 15 (37.5%) cases were treated with tetracycline only. 20 (50%) cases with only doxyclycline & 5 (12.5%) cases with tetracycline and ceftriaxone as these cases were associated with enteric fever. All patients (100%) cured with treatment.

Protective efficacy of maternal antibodies induced by Salmonella toxoid (vaccine).

An attempt was made to evaluate the protective efficacy of maternal antibodies in chicks against salmonellosis. Layer chicks ageing 21 days were individually vaccinated with 100 microg of Salmonella enterica subspecies enterica serovar Weltevreden (BM 1643) toxoid adjuvanted with vitamin E subcutaneously. After 90 days of the primary vaccination the birds were given booster dose of the vaccine. The saline extract of the yolk of eggs laid by the vaccinated birds yielded agglutination and ELISA titres ranging from 43.2 +/- 5.33 to 75.2 +/- 6.26 and 4.987 x 10(3) +/- 0.54 to 5.89x103 +/- 0.56, respectively. Sera of chicks hatched from eggs laid by the vaccinated layers were also subjected to agglutination and ELISA. Agglutination and ELISA titres on the 5th day--post hatching (dph) were 21.6 +/- 1.75 and 4.025 x 10(2) +/- 0.59, while on the 10th dph titers were 13.6 +/- 1.65 and 1.21 x 10(2) +/- 0.60, respectively. It was also observed that only one out of 6 chicks died when challenged with 2 x 10(9) CFU of S. serovar Gallirarum at the age of 7 days showing 83.33% protection. Thus it can be concluded that passive immunity confided by Salmonella enterica subspecies enterica serovar Weltevreden (BM 1643) toxoid can protect chicks against salmonellosis during their early days of life.

Budd-Chiari syndrome.

A 30 years old, non-alcoholic farmer from Trishal, Mymensingh was admitted in Mymensingh Medical College Hospital on 7 February, 2004 with the complaints of gradual swelling of abdomen, both legs and upper abdominal pain for 3 months. For the last 6 years, he was treated as a case of chronic liver disease (CLD) with spironolactone and frusemide. He was non-icteric, mildly anaemic with mild oedema, clubbing, gynaecomastia and engorged vein over anterior abdominal wall, flanks and back. Direction of venous flow was from below upward. There were mild hepatosplenomegaly, ascites and bilateral testicular atrophy. He was diagnosed as a case of Budd-Chiari Syndrome (BCS) on the basis of physical examination and it was confirmed by the findings of ultrasonography, liver scan and doppler study. The patient was managed by medical therapy alone.