Enteric Fever as an Antecedent to Development of Miller-Fisher Syndrome and Possible Role of COVID-19 Vaccination

Summary: Guillain-Barre Syndrome is an immune-mediated demyelinating disorder. Miller-Fisher Syndrome is an uncommon subtype of GBS. It is characterized by findings of ophthalmoplegia, ataxia, and areflexia. Here we present the case of Miller-Fisher Syndrome following an episode of typhoidal diarrhea. The presentation was of rapidly progressing weakness beginning in the lower extremity with diplopia. Examination revealed diminished reflexes. CSF testing revealed albuminocytologic dissociation which was later supported by neurophysiological testing. The patient was treated with intravenous immunoglobulins (IVIG). We conclude that Miller-Fisher syndrome should be considered in the diagnostic workup of patients presenting with new sensorimotor deficits following diarrheal illnesses and/or COVID-19 mRNA vaccination. Early recognition is essential given the propensity of GBS to cause life-threatening respiratory failure and prompt IVIG administration is associated with a better prognosis. Keywords: Enteric Fever, Miller-Fisher Syndrome, COVID-19, Vaccinatio

Risk Factors and Secondary Infections in Dengue Hemorrhagic Fever Patients

Background: Dengue hemorrhagic fever (DHF) is a fatal manifestation of dengue disease. DHF’s risk factors profile holds significance importance in the clinical practice and efficient care plan are required during dengue disease flare-up. The aim of this study was to investigate the risk factors for pathogenesis of dengue disease and dengue hemorrhagic fever. Methods: In this descriptive cross-sectional study, data was obtained from 256 patients with diagnoses of Dengue hemorrhagic fever (DHF). Comprehensive history, physical assessment and biochemical estimations were recorded. Patients were followed to identify and assess the risk factors for DHF. The Statistical Package of Social Sciences for analysis of data. Stratification of residence and socioeconomic status to see effect of these on result variable by applying chi square test. p value of <0.05 was taken as significant. Results: Among the 256 patients, the mean age of the age (Mean±SD) of study population was 28.4±12.1 years, 162 (63.28%) were less than 40 years of age and 94 (36.72%) were ≥40 years. The males were 181 (70.70%) and females were 75 (29.30%). The frequency of risk factors was observed to be 26 (10.8%) patients had Diabetes Mellitus, 55(21.5%) hypertension, 25(9.8%) hyperlipidemia. Secondary infection occurred in 192 (75%) but results were insignificant (p>0.05). All diseases were common in participants who belonged to the urban area. Conclusion: Secondary infection was most common risk factor in patients with DHF and found mostly in less than 40 age than older patients. Whereas, males were predominately affected more than the females (p<0.05). Keywords: Severe Dengue, Dengue Hemorrhagic Fever, Risk Factor