Dengue fever is an acute mosquito-borne infection caused by dengue viruses belonging to the family Flaviviridae. It is an important public health problem in tropical and subtropical climates. Acute motor quadriparesis during the course of dengue infection is quite unusual and uncommonly reported. We hereby report two cases of acute motor quadriparesis during the course of dengue infection due to hypokalemia.
We describe an unusual clinical presentation of autoimmune Bartter syndrome in a patient with primary hypothyroidism. A 65-year-old female patient was admitted with neuromuscular weakness associated with hypokalemia and metabolic alkalosis. She had a suboptimal response to potassium supplementation and potassium-sparing diuretic resulting in re-hospitalization with the same symptoms. A detailed serum and urinary biochemistry analysis in the absence of other causes of potassium wasting helped diagnose Bartter syndrome, a rare entity in adults. An autoimmune profile showed anti-Scl-70 antibody to be positive, although she did not develop other systemic features of the disease. Our patient responded to a steroid-based regimen potassium supplement, Indomethacin, and aldosterone antagonist with remarkable resolution of symptoms and correction of electrolyte derangement. We reviewed the literature to search for similar cases and included twenty-seven fulllength publications on acquired and autoimmune causes of Bartter syndrome. Our case highlights the fact that hypokalemia with metabolic alkalosis in an adult patient should prompt clinicians to evaluate for common and uncommon conditions. While assessing for abnormal conditions, acquired Bartter syndrome should be considered if a patient has an underlying autoimmune, endocrine, or connective tissue disease.
The clinical spectrum of amoebiasis is broad ranging from asymptomatic passage of cysts through fulminant colitis to localized abscesses of the liver, lung, brain, and other tissues. Amoebic liver abscess (ALA) is a serious, but readily treatable form of hepatic infection. It usually presents with high-grade fever, associated with right upper abdominal pain, constitutional symptoms, and pleuropulmonary complications mainly in the form of pleural effusion and leucocytosis. However, pneumonitis, leukemoid reaction, and jaundice are an uncommon association. We hereby report a young nonalcoholic immunocompetent female, diagnosed to have ALA associated with multiple unusual complications,who showed excellent response to intravenous metronidazole.
Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.
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