19 research outputs found
Typhus Fever: An Overlooked Diagnosis
A case of typhus fever is presented. On admission, the clinical diagnosis was typhoid fever. Forty-eight hours after admission, the presence of subconjunctival haemorrhage, malena, and jaundice raised the possibility of a different aetiology, the two most likely differentials being dengue and typhus. Finally, a co-infection of typhoid and typhus was discovered. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission being treated as a case of typhoid fever
Occult Pneumonia: An Unusual but Perilous Entity Presenting with Severe Malnutrition and Dehydrating Diarrhoea
A three-month old boy was admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh, with the problems of acute watery diarrhoea with some dehydration and suspected dyseletrolytaemia, severe malnutrition, and reduced activity. Occult pneumonia was added to the problem list after demonstration of radiologic consolidation in right upper lung, despite the lack of clinical signs, both on admission and after correction of dehydration. The problem list was further expanded to include bacteraemia due to Staphylococcus aureus when the blood culture report was available. Severely-malnourished children may not exhibit typical clinical signs of pneumonia, and the possibility of existence of such problems should be remembered in the assessment and provision of care to hospitalized young children with severe malnutrition
Extending Prayer Marks as a Sign of Worsening Chronic Disease
A 60-year old Muslim man was admitted to the Dhaka Hospital of ICDDR,B with an exacerbation of his chronic obstructive pulmonary disease. Incidental hyperpigmented skin lesions were noticed overlying the dorsum of his ankles, knees, and elbows. Such asymptomatic areas of thickened, lichenified and hyperpigmented skin are called ‘prayer marks’ and are well-imprinted on the knees, ankles, and forehead. These are secondary to prolonged periods of pressure over bony prominences during prayer. The patient's wife stated that the appearance of the elbow marks had coincided with an increase in his breathlessness and subsequent use of his elbows to rise from daily prayers. Prayer marks extending to the elbows could be a sign of worsening chronic disease
Recurrent Sclerema in a Young Infant Presenting with Severe Sepsis and Severe Pneumonia: An Uncommon but Extremely Life-threatening Condition
A one month and twenty-five days old baby girl with problems of acute
watery diarrhoea, severe dehydration, severe malnutrition, and reduced
activity was admitted to the gastrointestinal unit of Dhaka Hospital of
icddr,b. The differentials included dehydration, dyselectrolytaemia and
severe sepsis. She was treated following the protocolized management
guidelines of the hospital. However, within the next 24 hours, the
patient deteriorated with additional problems of severe sepsis, severe
pneumonia, hypoxaemia, ileus, and sclerema. She was transferred to the
Intensive Care Unit (ICU). In the ICU, she was managed with oxygen
supplementation, intravenous antibiotics, intravenous fluid, including
a number of blood transfusions, vitamins, minerals, and diet. One month
prior to this admission, she had been admitted to the ICU also with
sclerema, septic shock, and urinary tract infection due to Escherichia
coli and was discharged after full recovery. On both the occasions,
she required repeated blood transfusions and aggressive antibiotic
therapy in addition to appropriate fluid therapy and oxygen
supplementation. She fully recovered from severe sepsis, severe
malnutrition, ileus, sclerema, and pneumonia, both clinically and
radiologically and was discharged two weeks after admission.
Consecutive episodes of sclerema, resulting in two successive
hospitalizations in a severely-malnourished young septic infant, have
never been reported. However, this was managed successfully with blood
transfusion, broad-spectrum antibiotics, and correction of electrolyte
imbalance
Salmonella Typhi and Plasmodium falciparum Co-infection in a 12-year Old Girl with Haemoglobin E Trait from a Non-malarious Area in Bangladesh
A 12-year old girl from Uttar Badda, Dhaka, Bangladesh, was admitted to the Dhaka Hospital of ICDDR,B, with a 23-day history of fever and diarrhoea. After admission, she was treated for culture-proven Salmonella Typhi-associated infection and was discovered to be heterozygous for haemoglobin E. Despite treatment with appropriate antibiotics, the patient's condition did not improve, prompting further investigation, which revealed malaria due to Plasmodium falciparum. Dhaka is considered a malaria-free zone, and the patient denied recent travel outside Dhaka. Subsequently, the patient recovered fully on antimalarial therapy
Typhus Fever: An Overlooked Diagnosis
A case of typhus fever is presented. On admission, the clinical
diagnosis was typhoid fever. Forty-eight hours after admission, the
presence of subconjunctival haemorrhage, malena, and jaundice raised
the possibility of a different aetiology, the two most likely
differentials being dengue and typhus. Finally, a co-infection of
typhoid and typhus was discovered. This uncommon clinical scenario
should be taken into account in the management of patients with high
fever on admission being treated as a case of typhoid fever
Hereditary Spherocytosis
A 12-year old girl was brought to the Dhaka Hospital of ICDDR,B with
diarrhoea. Incidentally, the parents provided a history of repeated
episodes of pallor and jaundice since she was two and half years old.
Three of her family members had similar problems. History, clinical
examination, and laboratory findings of the girl and her family members
suggested a case of hereditary spherocytosis. To our knowledge, this is
the first report of such a case in Bangladesh
Ampicillin and Gentamicin Are a Useful First-line Combination for the Management of Sepsis in Under-five Children at an Urban Hospital in Bangladesh
The study evaluated the commonly-used drugs for the management of
sepsis and their outcome among under-five children. We evaluated the
hospital-records of all paediatric sepsis patients (n= 183) in the
intensive care unit (ICU) and longer-stay unit (LSU) of the Dhaka
Hospital of icddr,b. These records were collected from the hospital
management system (SHEBA) during November 2009 to October 2010. A total
of 183 under-five children with clinical sepsis were found during the
study period, and 14 (8%) of them were neonates. One hundred and
eighty-one patients had received a combination of injection ampicilin
and injection gentamicin, and two patients had received the combination
of injection ceftriaxone and injection gentamicin. Only 46 (25%)
patients required a change of antibiotics to the combination of
intravenous ceftriaxone plus gentamicin after non-response of injection
ampicilin and injection gentamicin combination; 7/181 (4%) patients
died who received injection ampicilin and injection gentamicin whereas
none died among the other two patients who received injection
ceftriaxone and injection gentamicin (p=1.00). The combination of
injection ampicilin and injection gentamicin as the first-line
antibiotics for the management of sepsis in children even beyond the
neonatal age is very effective, resulting in lower mortality
Extending Prayer Marks as a Sign of Worsening Chronic Disease
A 60-year old Muslim man was admitted to the Dhaka Hospital of ICDDR,B
with an exacerbation of his chronic obstructive pulmonary disease.
Incidental hyperpigmented skin lesions were noticed overlying the
dorsum of his ankles, knees, and elbows. Such asymptomatic areas of
thickened, lichenified and hyperpigmented skin are called 'prayer
marks' and are well-imprinted on the knees, ankles, and forehead. These
are secondary to prolonged periods of pressure over bony prominences
during prayer. The patient\u2019s wife stated that the appearance of
the elbow marks had coincided with an increase in his breathlessness
and subsequent use of his elbows to rise from daily prayers. Prayer
marks extending to the elbows could be a sign of worsening chronic
disease
Use of Only Oral Rehydration Salt Solution for Successful Management of a Young Infant with Serum Sodium of 201 mmol/L in an Urban Diarrhoeal Diseases Hospital, Bangladesh
A boy aged 4 months 7 days was admitted to the Intensive Care Unit
(ICU) of the Dhaka Hospital of icddr,b, Dhaka, Bangladesh, with the
problems of acute watery diarrhoea with some dehydration, pneumonia,
lethargy, and hypernatraemia (serum sodium of 201 mmol/L). Correction
for hypernatraemia was tried by using only oral rehydration salt (ORS)
solution. Seizures occurred during correction of the hypernatraemia.
These were difficult to control and required three doses of injection
lorazepam, a loading dose of injection phenobarbitone, followed by
injection phenytoin and finally two doses of injection mannitol (even
though there was no clinical or imaging evidence by ultrasonography or
computed tomography of cerebral oedema). The correction was continued
with ORS, and all the anticonvulsants were successfully weaned without
any further seizures, and the patient recovered without any overt
neurological sequelae. We present a case report of extreme
hypernatraemia, which was successfully managed using only ORS