Molecular detection of Trypanosoma species and haematological alterations in four trypanosome-infected Nigerian horses

Trypanosomes cause anaemia and are responsible for widespread morbidity and mortality particularly in imported breeds of animals found in sub-tropical and tropical parts of the world. Light microscopy and polymerase chain reaction (PCR) were used to detect trypanosomes in naturally infected Nigerian crossbred horses at Obollo-Afor abattoir, Udenu Local Government Area, Enugu State Nigeria. Blood was collected via the jugular outflow from a total of 200 horses of varying ages and either sex. Conventional procedures were followed during the PCR assay, parasite identification in wet mount, Leishman-stained thin blood and buffy coat smears on glass slides. Light microscopy revealed Trypanosoma species with an elongated, streamlined and tapered body, highly suggestive of T. brucei brucei or its subspecies T. evansi or T. equiperdum. PCR assay produced the expected fragment size of 700 bp specific for ITS-1 region of the 18SrRNA gene of Trypanosoma species in 4 (2%) of 200 blood samples against the routine blood and buffy coat smear examination, which revealed trypanosomes in 3 (1.5%) out of 200 blood samples. Sex and age were not significantly (p>0.05) associated with the trypanosome infection. One of the Trypanosoma infected anaemic horses had microcytic normochromic anaemia, high erythrocyte sedimentation rate and normal leukocyte count, while one of the Trypanosoma species infected non-anaemic horses had erythrocytic parameters and ESR values that are within the reference range, with leukocytosis. It was concluded that the prevalence of equine trypanosomosis was very low, and it’s characterized by mild to moderate anaemia in clinical cases.

Case Report: Gastrointestinal Basidiobolomycosis with Multi-Organ Involvement Presented with Intussusception

Gastrointestinal basidiobolomycosis (GIB) is a rare, life-threatening fungal infection affecting immunocompetent individuals in tropical and subtropical regions. A diverse presentation of GIB has been reported, but no report has yet been published on intussusception. We describe a 23-month-old immunocompetent boy from a subtropical area in Iran who presented with intussusception. Prolonged fever, an abdominal mass, hepatomegaly, high erythrocyte sedimentation rate, and peripheral eosinophilia strongly suggested GIB. Accordingly, GIB was diagnosed based on the characteristic histopathology (the Splendore-Hoeppli phenomenon) detected in a liver sample taken via biopsy. Exploratory laparotomy showed several organs, including the colon, gall bladder, liver, and abdominal wall, were involved. Antifungal therapy with trimethoprim/sulfamethoxazole, liposomal amphotericin B, a saturated solution of potassium iodide, and surgical resection of involved tissues were used with improved outcome. The presence of non-septate fungal hyphal elements in the colonic mucosa led to the thickening of the bowel wall, leading to secondary intussusception.

The diagnostic challenge of acute Q fever endocarditis

A 79-year-old man was admitted to our ward with symptomatic heart failure 2 months after aortic valve replacement due to severe aortic stenosis. On the third day following admission, he became febrile (>38°C) while manifesting an increase in inflammatory markers. Endocarditis was suspected despite negative blood cultures. Echocardiogram (transthoracic and transesophageal) did not describe any vegetations. No hypermetabolic lesions were described on the Positron emission tomography scan. Empirical antibiotics were started but the fever persisted. Serologies revealed a Coxiella burnetii IgG phase II titre of 1:800, high erythrocyte sedimentation rate. Positive antinuclear antibodies, antibeta2 IgM and anticardiolipin supported a diagnosis of acute Q fever endocarditis. Doxycycline and hydroxychloroquine were started with total resolution of symptoms. This case illustrates the difficulty of diagnosing Q fever endocarditis during its acute phase, not only because vegetations can be minimal or absent, a challenge that is further compounded by a complex presentation of immunological markers.

Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction

Infectious mononucleosis (IM) due to Epstein–Barr virus (EBV) infection is usually self-limited. It presents with fever, pharyngitis, fatigue, and cervical lymph node enlargement. It is common among adolescents and young adults. Although most patients recovered without any sequelae, rare complications have been reported. We described a 28-year-old man with fever, sore throat, dysphagia, and a positive IgM viral capsid Ag (VCA Ag) for EBV infection. He was admitted and received dexamethasone. He developed bilateral peritonsillar abscess (PTA) and splenic infarction, rare complications of acute EBV infection, two days after discharge. Although early reports noted PTA might occur following dexamethasone administration, recently, no obvious evidence supports it. However, high erythrocyte sedimentation rate level in our patient might indicate bacterial superinfection, which could exacerbate with dexamethasone administration. Several mechanisms such as transient hypercoagulable state and insufficient blood supply due to splenomegaly were proposed for splenic infarction due to EBV infection. Since our patient remained asymptomatic during the disease, IM-associated splenic complications, including splenic infarction, should be kept in mind. Our patient underwent bilateral tonsillectomy and received conservative management for the splenic infarction. These two rare complications of acute EBV infection have not been reported simultaneously yet.

Bone Marrow Granuloma with Miliary Mottling presenting as Pancytopenia- A rare finding in Tuberculosis - A Case report

Bone marrow granuloma and miliary mottling presenting as pancytopenia together is a rare finding in disseminated form of tuberculosis. Here we report a case of a 52-year, old male patient presented with generalized weakness, loss of appetite, decreased physical activity for one month. Initial lab hematological investigations revealed pancytopenia and high Erythrocyte sedimentation rate. Bone marrow biopsy was performed to determine the cause of pancytopenia which showed caseating granulomas with positive acid fast bacilli on Ziehl-Neelsen staining (Z-N). In chest X-ray miliary mottling and bone marrow biopsy findings together confirmed the case of disseminated tuberculosis. This unusual presentation highlights the considerable diagnostic challenge and importance of bone marrow biopsy for early diagnosis and initiation of treatment. Mediscope Vol. 8, No. 1: January 2021, Page 63-66

Etiological and Clinical Profile of Acute Nonbacterial Encephalitis in Children: A Single-Center Prospective Study

Encephalitis is a serious neurological syndrome caused by inflammation of the brain. The diagnosis can be challenging and etiology remains unidentified in about half of the pediatric cases. We aimed to investigate demographic, clinical, laboratory, electroencephalographic and neuroimaging findings, and outcome of acute encephalitis of nonbacterial etiology. This prospective study included children hospitalized with the diagnosis of acute encephalitis between 2017 and 2019. Microbiological investigations of the cerebrospinal fluid (CSF) were recorded. All CSF specimens were tested for anti-N methyl D-aspartate receptor (NMDAR) antibodies. In total, 31 children aged 10 months to 17 years (median = 6 years) were included. Pathogens were confirmed in CSF in three patients (9.7%): varicella zoster virus, herpes simplex virus type 1 (HSV-1), and both HSV-1 and NMDAR antibodies. Presenting features included encephalopathy (100%), fever (80.6%), seizure (45.2%), focal neurological signs (29%), and ataxia (19.4%). On clinical follow-up of median 9 (6–24) months, six patients showed neurological deficits: together with two patients who died in hospital, total eight (25.8%) patients were considered to have unfavorable outcome. Need for intubation, receiving immunomodulatory treatment, prolonged hospitalization, and high erythrocyte sedimentation rate at admission were associated with unfavorable outcome. The etiology of encephalitis remains unexplained in the majority of children. HSV-1 is the most frequently detected virus, consistent with the literature. The fact that anti-NMDAR encephalitis was detected in one child suggests autoimmune encephalitis not being rare in our center. The outcome is favorable in the majority while about one-fifth of cases suffer from sequelae.

Predictors of COVID-19 severity: a systematic review and meta-analysis

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched as of April 5, 2020. The quality of the included papers was appraised using the Newcastle-Ottawa scale (NOS). Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

Predictors of COVID-19 severity: a systematic review and meta-analysis

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

Dilated Cardiomyopathy Concomitant with Acute Rheumatic Fever and Sporadic Hereditary Spherocytosis

Dilated cardiomyopathy (DCM) is a heart muscle disorder defined by the presence of a dilated and poorly functioning left ventricle in the absence of abnormal loading conditions (hypertension, valve disease) or ischaemic heart disease sufficient to cause global systolic impairment. A 5 years old and 6 months old girl with unremarkable cardiac history hospitalized for congestive heart failure due to dilated cardiomyopathy concomitant with acute rheumatic feverandsporadic hereditary spherocytosis.Acute rheumatic fever diagnosed based on the presentation of carditis, fever, high erythrocyte sedimentation rate, C-Reactive Protein (+), and antistreptolysin titer O (+).DCM was diagnosed after echocardiography. Sporadic hereditary spherocytosis was diagnosed based on anamnesis of pale and jaundice, splenomegaly on physical examination, hemolytic anemia, reticulocytosis, spherosit (+). Both parents reveals normal hematologic finding and the osmotic resistance test showed increasing of osmotic fragility. Prognosis of this patient remains worse because of inadequateleft ventricle-right ventricle (LV-RV) function and highly increasing The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level.