Visceral Leishmaniasis: An Overview and Integrated Analysis of the Current Status, Geographical Distribution and Its Transmission

Visceral leishmaniasis (VL) is a vector–borne disease transmitted by Phlebotomine sandflies, with up to 350 million people are at risk of developing infection globally. VL has a severe influence on the impoverished and undeveloped populations among several subcontinents. Early and accurate diagnosis and treatment remain crucial to the management of VL, which still depends on vector control. The present chapter objectives are to provide an overview of visceral leishmaniasis and to raise knowledge of the most recent progress in this condition’s management, treatment, and prevention. Additionally, this chapter could be helpful for comprehending the difficulties and knowledge gaps in eliminating this protozoan disease as well as for learning the planning lessons from the global management of diseases like malaria and tuberculosis

Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

BACKGROUND Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). METHODS We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. RESULTS Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. CONCLUSION After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully

ICAR: endoscopic skull‐base surgery

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HIV negative aids-idiopathic CD4 lyphocytopenia

Idiopathic CD4+ T-cell lymphocytopenia (ICL) is a rare disorder of immune system with heterogeneous clinical manifestations and immunologic profile. This is a rare condition, which was first defined in 1992 by the Centers for Disease Control and Prevention. It is marked by a CD4 count that is <300 cells/mm3 without human immunodeficiency virus (HIV) infection. Its course differs from that of acquired immunodeficiency syndrome (AIDS), although patients with this disorder may develop opportunistic infections. Hence, the clinicians should be aware of this rare immunologic disorder and that a decrease in the CD4 count is not a hallmark for HIV infection, but could be due to other idiopathic causes as well

Idiopathic Pulmonary Hemosiderosis in a Young Adult Patient: A Rare Case

Idiopathic pulmonary hemosiderosis (IPH) is often an ignored and rare cause of diffuse alveolar hemorrhage (DAH). It is characterized by triad of hemoptysis, anemia, and alveolar opacity on radiology. It is a diagnosis of exclusion, established after ruling out other causes of DAH such as Goodpasture’s syndrome, large vessel vasculitis, small vessel vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA) (Wegener’s granulomatosis, Churg–Strauss syndrome, microscopic polyangiitis), immune complex-related vasculitis (collagen vascular diseases, Henoch–Schönlein purpura, mixed cryoglobulinemia) drug reactions, anticoagulation and thrombocytopenia. Though it is a disease primarily affecting children, we hereby report a case of IPH in an adult patient who responded dramatically to oral corticosteroid