Analysis of Two Outbreaks of Scrub Typhus in Rajasthan: A Clinico-epidemiological Study.

AIMS AND OBJECTIVES: To describe the diversity of clinical manifestations, laboratory findings and outcome of scrub typhus in hospitalised patients of SMS Hospital, Jaipur during 2012 and 2013. MATERIAL AND METHODS: All the cases of febrile illness with thrombocytopenia diagnosed as scrub typhus were analysed. Diagnosis was made by ELISA based IgM serology. OBSERVATIONS AND RESULTS: A total of 125 patients were studied. All of them presented with fever; the other major symptoms were headache, cough, dyspnoea and myalgias. On examination, patients had hepatosplenomegaly, lymphadenopathy and eschar. On investigation elevated SGOT, SGPT with normal or elevated bilirubin levels were the most common findings. Other laboratory findings were thrombocytopenia and deranged renal function tests. Most common X-ray finding observed in these patients was bilateral lung infiltrates. Other complications were MODS, ARDS, hypotension and meningoencephalitis. Majority responded to doxycycline. CONCLUSION: Scrub typhus though prevalent is under-reported in our country. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, and B/L chest opacities. Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.

Utility of neutrophil CD64 in distinguishing bacterial infection from inflammation in severe alcoholic hepatitis fulfilling SIRS criteria.

To assess utility of neutrophilCD64 (nCD64) expression in differentiating bacterial infection from inflammation in patients with severe alcoholic hepatitis (SAH) fulfilling systemic inflammatory response syndrome criteria. Patients with SAH and infection (n = 58), SAH without infection (n = 70), and healthy controls (n = 20) were included. Neutrophil CD64 expression by flowcytometry, serum Procalcitonin (ELISA) and C-reactive protein (Nephelometry) and neutrophil-lymphocyte ratio (NLR) were studied. Percentage of neutrophils with CD64 expression (nCD64%) was significantly higher in patients with SAH and infection than in those without infection and controls [76.2% (56.9-86.5) vs. 16% (12.6-23.1) vs. 7.05% (1.4-9.5), p < 0.05], as was their mean fluorescence intensity [MFI; 1431 (229-1828) vs. 853 (20-968) vs. 99.5 (54.7-140.7), p < 0.05]. Using a cut-off of 27%, the sensitivity and specificity of nCD64% to diagnose bacterial infection was 94% and 81%, respectively, with area under curve (AUC) of 0.95. At a cut-off value of 0.261 ng/ml, the sensitivity and specificity of serum procalcitonin was 83% and 72%, respectively, with AUC of 0.86. Serum CRP, total leukocyte count, NLR had AUCs of 0.78, 0.63 and 0.64, respectively. Quantitative measurement of nCD64 can better distinguish systemic bacterial infection and inflammation in SAH as compared to traditional biomarkers.

Serum Metabolic Disturbances Associated with Acute-on-chronic Liver Failure in Patients with Underlying Alcoholic Liver Diseases: An Elaborative NMR-based Metabolomics Study.

OBJECTIVES: Acute-on-chronic liver failure (ACLF), which develops in patients with underlying alcoholic liver disease (ALD), is characterized by acute deterioration of liver function and organ failures are secondary to that. The clear understanding of metabolic pathways perturbed in ALD-ACLF patients can greatly decrease the mortality and morbidity of patients through predicting outcome, guiding treatment, and monitoring response to treatment. The purpose of this study was to investigate the metabolic disturbances associated with ACLF using nuclear magnetic resonance (NMR)-based serum metabolomics approach and further to assess if the serum metabolic alterations are affected by the severity of hepatic impairment. MATERIALS AND METHODS: The serum-metabolic profiles of 40 ALD-ACLF patients were compared to those of 49 age and sex-matched normal-control (NC) subjects making composite use of both multivariate and univariate statistical tests. RESULTS: Compared to NC, the sera of ACLF patients were characterized by significantly decreased serum levels of several amino acids (except methionine and tyrosine), lipid, and membrane metabolites suggesting a kind of nutritional deficiency and disturbed metabolic homeostasis in ACLF. Twelve serum metabolic entities (including BCAA, histidine, alanine, threonine, and glutamine) were found with AUROC (i.e., area under ROC curve) value >0.9 suggesting their potential in clinical diagnosis and surveillance. CONCLUSION: Overall, the study revealed important metabolic changes underlying the pathophysiology of ACLF and those related to disease progression would add value to standard clinical scores of severity to predict outcome and may serve as surrogate endpoints for evaluating treatment response.

Intra-articular Fibroma of Tendon Sheath in Knee Joint Associated with Iliotibial Band Friction Syndrome: Rare Occurrence in a Teenage Girl.

INTRODUCTION: Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion with friction syndrome has rarely been reported. Among such nodular lesions around knee, fibroma of tendon sheath (FTS) is a rare occurrence. All the more intra-articular occurrence is extremely rare. CASE REPORT: A 16-year-old female presented with recurrent pain and movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as rare intra-articular FTS on the basis of histopathology findings. CONCLUSION: When nodular lesions around knee are detected on magnetic resonance imaging, a FTS could be included in the differential diagnosis. Etiology and pathogenesis of ITB friction syndrome should be revised in view of such rare presentations.