Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: Case report and review of literature

Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a two-day history of altered conscious state. A diagnosis of severe falciparum malaria was made based on the clinical presentation and a positive blood smear with parasitaemia of 45%. Despite adequate anti-malarial therapy with artesunate, the patient had persistent and worsening abdominal pain. Investigations suggested a diagnosis of acute pancreatitis, a rare association with falciparum malaria. However, in spite of supportive therapy for acute pancreatitis and a 10-day course of intravenous artesunate and oral doxycycline at recommended doses, he continued to be febrile with peripheral blood smear showing persistence of ring forms. Antimalarial therapy was, therefore, changed to quinine on the suspicion of possible artesunate resistance. On the 17th day of stay in hospital, the patient developed generalized tonic-clonic seizures. Computerized tomography of the brain showed bilateral fronto-parietal subdural haematomas that were surgically drained. His fever persisted beyond 30-days despite broad-spectrum antibiotics, quinine therapy and negative malarial smears. A possibility of drug fever was considered and all drugs were ceased. He subsequently became afebrile and was discharged on the 38th hospital admission day. Recognition of complications and appropriate management at each stage facilitated successful outcome. This report has been presented to highlight the occurrence of several rare complications of falciparum malaria in the same patient

Predictors of outcome in older adults admitted with sepsis in a tertiary care center

Background: Although there is increasing interest in exploring outcomes and predictors of outcomes of older adults who present with sepsis in developing countries, there is limited information from the low- and middle-income countries. Objective: This study was done to determine inhospital mortality and ascertain the factors predicting mortality among older inpatients with sepsis. Materials and Methods: This was a prospective observational study, from March 2018 to September 2019 in a tertiary care center in India. Baseline clinical, demographic, laboratory parameters and mortality were recorded from patients above the age of 60 years with a diagnosis of sepsis who were admitted to either the ward or intensive care unit (ICU). Logistic regression analysis was performed to determine predictors of inhospital mortality. Results: We found that 201 patients, predominantly male (64.6%) with a mean (standard deviation) age of 70.3 (7.8) years and a median (interquartile range) admission Sequential Organ Failure Assessment score of 5 (3–7), were admitted with sepsis. Lung infection was the most common source of sepsis (47.2%). Seventy-three patients (36.3%) required ICU admission, and inhospital mortality was 40.2%. Predictors of mortality included high Charlson Comorbidity Index (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1–1.6, P = 0.08), serum albumin (OR: 0.41, 95% CI: 0.20–0.80, P = 0.009), invasive mechanical ventilation (OR: 3.24, 95% CI: 1.2–8.9, P = 0.022), and the use of vasoactive agents (OR: 7.44, 95% CI: 2.8–19.9, P < 0.001). Blood culture positivity was found to have a survival benefit on Kaplan–Meier estimates. Conclusion: The mortality rate in older inpatients with sepsis was 40.2%. A high comorbidity burden, low serum albumin, and the need for invasive mechanical ventilation and vasoactive agents were independent predictors of mortality

Ornidazole-induced ataxia in an Indian woman: A case report

The nitroimidazole group of antibiotics like metronidazole have been reported to cause cerebellar ataxia as a rare side effect. Ornidazole, the newest derivative of this class, has a long half life and is very rarely known to cause cerebellar ataxia. Here, we report a 61-year-old patient who developed ataxia due to ornidazole to highlight an unusual adverse event that improved rapidly after discontinuation of the offending drug