Kikuchi-Fujimoto disease.

A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.

Comparative studies on IFAT, ELISA & DAT for serodiagnosis of visceral leishmaniasis in Bangladesh.

The purpose of the study was to estimate the specificity and sensitivity of different serological methods for the diagnosis of visceral leishmaniasis in Bangladesh. Blood samples from 155 suspected kala-azar patients together with 80 sick subjects and 50 healthy subjects from the endemic areas were collected. Out of the 155 suspected kala-azar patients, bone marrow were collected from 126 patients. All bone marrow samples were examined by direct microscopy. 92 bone marrow samples were also examined by culture method. Blood samples were examined by various serological tests. Out of 126 marrow samples, LD bodies were present by microscopy in 77 (61.1%) cases and out of 92 marrow samples, cultures for LD bodies were positive in 33 (35.9%) cases. All the three serological tests (IFAT, ELISA & DAT) were positive in all parasitologically positive kala-azar patients. They were also positive in seven (15.5%) out of 45 parasitologically negative cases and 10 (34.4%) out of remaining 29 cases in whom bone marrow samples were not available. Thus the serological tests proved to be simple, non-invasive, highly sensitive and specific methods for the diagnosis of visceral leishmaniasis. DAT is the simplest of these serological tests, although these tests did not differ in sensitivity and specificity.

Study on Mycobacterium tuberculosis: the primary drug resistance pattern.

The study was carried out to investigate the primary drug resistance pattern of tubercle bacilli isolated from the pulmonary tuberculosis patient attended in Shyamoli TB clinic, Dhaka. Sputum from 961 suspected tuberculous patients were randomly collected and stained by Ziehl-Neelsen (Z.N) stain. 135 were microscopically positive for Acid Fast Bacilli (AFB). Among them 30 patients were excluded from the study as they received antitubercular treatment before. So only 105 microscopically positive cases were cultured on Lowenstein-Jensen (L-J) media and 100 showed pure growth and rest 5 were contaminated with fungus. These 100 cases were studied on 4 antitubercular drugs. Out of these 100 isolates, 91 were M. tuberculosis and rest 9 in the nonchromogen group of mycobacteria other than tuberculosis (MOTT) species. Among 91 M. tuberculosis species, 89 (97.80%) to Isoniazid (INH), 73 (80.21%) to Rifampicin (RMP) and 91 (100%) to Streptomycin (SM) and Ethambutol (ETHM) were sensitive. Of the 9 MOTT species, 4 (44.44%) to SM, 7 (77.78%) to ETHM were sensitive and all (100%) were resistant to INH and RMP. Among the 100 isolates, 27 (18 M. tuberculosis and 9 MOTT) were resistant to 4 drugs either single or in combination. Of the 18 (66.67%) M. tuberculosis species, 16 (59.26%) to RMP, and 2 (7.41%) to RMP and INH were resistant. Of the 9 (33.33%) MOTT species, 4 (14.81%) to RMP and INH, 3 (11.11%) to RMP, INH and SM and 2 (7.41%) to RMP, INH, SM and ETHM were resistant.

Indirect fluorescent antibody test in the serodiagnosis of visceral leishmaniasis in Bangladesh.

Indirect fluorescent antibody test (IFAT) was found to be 100% sensitive and 100% specific when tested with sera from 125 parasitologically proven kala-azar patients, 100 healthy controls and 50 sick control cases. Promastigotes of both L. enriettii and L. donovani as well as amastigotes of L. enriettii were found equally satisfactory as antigen for IFAT. From the results of the present study, it is concluded that IFAT is a highly sensitive as well as specific serological test for the diagnosis of kala-azar.