Browsing by Author "Kailash Kumar"

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Acid exposure induces multiplication of salmonella enterica serovar typhi
(American Society for Microbiology, 2014) Suneel Kumar Ahirwar; Chandra Bhan Pratap; Saurabh Kumar Patel; Vijay K. Shukla; Indarjeet Gambhir Singh; Om Prakash Mishra; Kailash Kumar; Tej Bali Singh; Gopal Nath
Salmonella enterica serovar Typhi faces several environmental stresses while going through the stomach (acidic pH) to the small intestine (basic pH) and intracellularly in macrophages (acidic pH) in humans. The acidic pH followed by alkaline pH in the small intestine might be responsible for expression of certain stress-induced genes, resulting in not only better survival but also induction of multiplication and invasion of the bacterium in the small intestine. Based on this hypothesis, we developed a process wherein we exposed the blood, urine, and stool specimens from 90 acute typhoid fever patients and 36 chronic typhoid carriers to acidic pH to see the effect on isolation rate of S. Typhi. About 5 g of freshly passed unpreserved stool, a centrifuged deposit of 15 ml of urine, and 5 ml of blood clot were subjected to 5 ml of Luria-Bertani (LB) broth (pH 3.5) for 20 min, followed by enrichment in bile broth-selenite F broth. When the combined isolation from all 3 specimens, i.e., blood, urine, and stool, after acid exposure was considered, a total of 77.7% of the acute typhoid patients were observed to be positive for the isolation of the S. Typhi serotype, compared to 8.8% by the conventional method. Similarly, 42% (15/36) of chronic carriers yielded positive for S. Typhi growth after acid exposure, compared to 5.5% (2/36) by the conventional method. It therefore can be concluded that acid shock triggers the multiplication of the bacteria, resulting in better isolation rates from blood clot, stool, and urine specimens. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Adenovirus Meningoencephalitis and Neurocysticercosis Co-infection: First Case from India
(Bentham Science Publishers, 2023) Anju Dinkar; Jitendra Singh; J. Bhavya; Swati Singh; Nilesh Kumar; Kailash Kumar
Background: Adenovirus generally causes upper and lower respiratory tract infections. It is common in children and occasionally in adults. Neurological involvement is rare, which may be mild aseptic meningitis to potentially fatal acute necrotizing encephalopathy. Recently, viruses have been reported increasingly to cause CNS infections. Viral aetiology typically varies with age. Case Presentation: Here, we report an unusual adenovirus meningoencephalitis with a co-infection of neurocysticercosis in an immunocompetent adult patient. An 18-year-old healthy female student was admitted with fever and headache for 11 days and progressive altered behaviour for 5 days, followed by altered sensorium for 3 days. This variable and unusual presentation of adenoviral infection involv-ing CNS provoked diagnostic difficulties, but with the help of advanced diagnostics, especially molec-ular, exact aetiology was detected. Even with the neurocysticercosis infection in this patient, the outcome was not adversely affected. Conclusion: This unusual co-infection with a successful outcome is the first case of this type in litera-ture. © 2023 Bentham Science Publishers.
Anti-apoptotic role of sonic hedgehog on blood platelets
(Elsevier Ltd, 2014) Sharda Kumari; Susheel N. Chaurasia; Kailash Kumar; Debabrata Dash
Sonic hedgehog (Shh) is an essential morphogen involved in vertebrate organogenesis. Perturbation of Hh signaling is associated with pathological consequences like tumor formation and chronic lung fibrosis. Platelets are highly sensitive circulating blood cells responsible for hemostasis, while hyperactivity of these cells lead to morbidities like ischemic heart diseases and stroke. Despite being terminally differentiated cells with life span of 10-12 days, platelets have recently been shown to respond to Wnt ligand, another developmental signal similar to Shh. In this study, we demonstrate that components of Shh signaling, Patched and Gli3, are expressed in human platelets consistent with existence of functional Hedgehog signaling in these cells. Shh had potent inhibitory effect on platelet apoptosis induced by ABT-737 or thrombin through attenuation of caspase-3 activity. The Shh-mediated pathway may thus represent a novel endogenous mechanism for regulating platelet activity and life span. © 2014 Elsevier Ltd. All rights reserved.
Association of carcinoma of the gallbladder with typhoid carriage in a typhoid endemic area using nested PCR.
(2008) Gopal Nath; Yogesh Kumar Singh; Kailash Kumar; Anil Kumar Gulati; Vijay Kumar Shukla; Ajay Kumar Khanna; Sunil Kumar Tripathi; Ashok Kumar Jain; Mohan Kumar; Tej Bali Singh
Although well studied the association between chronic typhoid carrier state and carcinoma of the gallbladder (CaGB) remains unproven. The study was performed at a tertiary care medical center in North India and involved 52 patients with CaGB, 223 patients with benign gallbladder diseases, 508 healthy individuals and, 424 corpses. For the detection of Salmonella enterica serovar Typhi, hepatobiliary specimens were subjected to DNA extraction for specific nested- PCR amplification of the S. Typhi flagellin gene. Anti-Vi S. Typhi antibodies were detected in serum samples from patients by indirect haemagglutination. Thirty five of the 52 (67.3%) CaGB patients were PCR-positive for the S. Typhi flagellin gene; significantly higher than for patients with benign gallbladder diseases (95/223, 42.6%; p<0.01) and corpses (35/424, 8.2%; p<0.001). The numbers of individuals that had significant anti-Vi antibody titres (> or = 160) in their serum were 20/52 (38.5%) for CaGB patients, 31/223 (13.9%) for patients with benign gallbladder diseases, and 47/508 (9.2%) for healthy individuals. Specific nested-PCR amplification of the S. Typhi flagellin gene in hepato-biliary specimens was more sensitive for detection of S. Typhi carriage than anti-Vi antibody titres in serum. The results demonstrate an association between typhoid carriage and gallbladder diseases, both CaGB and benign. S. Typhi specific immunosuppression is also suggested in patients with gallbladder diseases.
Bilateral Periorbital Erythema and Swelling as an Initial Presentation of Systemic Lupus Erythematosus: A Rare Case
(Bentham Science Publishers, 2025) Jitendra P. Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Isha Atam
Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement due to autoantibody production and immune complex deposition. While classical cutaneous manifestations, such as malar rash, are common, atypical presentations, like periorbital erythema and swelling, are rare and pose diagnostic challenges. Early recognition is crucial to prevent disease progression and complications. Case Presentation: A 16-year-old girl presented with a three-month history of intermittent bilateral periorbital swelling. Clinical examination revealed pallor and localized alopecia with no significant systemic abnormalities. Laboratory investigations showed pancytopenia with normal renal, hepatic, and thyroid functions and unremarkable urinalysis, chest X-ray, and ECG. Autoimmune markers were positive, with a strongly positive ANA titer of 1:1000 and significantly elevated anti-dsDNA antibodies of 380 IU/mL (reference range: 0-200 IU/mL). According to the 2019 EULAR/ACR classification criteria, a diagnosis of SLE was established. The patient was treated with pulse intravenous methylprednisolone (1g daily for three days), followed by oral prednisolone (1 mg/kg/day), in a tapering regimen and hydroxychloroquine at standard doses. She showed marked improvement, with resolution of periorbital swelling, recovery of pancytopenia, and hair regrowth. At two-month follow-up, she remained asymptomatic and continued hydroxychloroquine for maintenance therapy. Conclusion: This case underscores the importance of considering SLE in patients with atypical presentations, like periorbital erythema and pancytopenia. Early diagnosis based on clinical and serological findings, followed by appropriate therapy, can achieve remission and prevent complications. The case highlights the need for heightened clinical suspicion and multidisciplinary management in young patients. © 2025 Bentham Science Publishers.
Bullous hemorrhagic dermatosis following unfractionated heparin therapy
(Wolters Kluwer Medknow Publications, 2025) Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Heparin, a commonly used anticoagulant, has been associated with several cutaneous adverse effects, including skin necrosis, bruising/ecchymosis, urticaria, angioedema, red plaques, nodular lesions, and allergic contact dermatitis. Bullous hemorrhagic dermatosis (BHD) caused by heparin is a rare skin-related side effect. A 34-year-old woman diagnosed with anti-phospholipid syndrome was recently observed to develop hemorrhagic bullous dermatosis distant from the site of intravenous unfractionated heparin. Heparin therapy was continued for 5 days, followed by daily oral warfarin 2 mg, along with aspirin 75 mg, with monitoring of lesions. Two weeks later, skin lesions resolved spontaneously. BHD is nonthreatening and typically resolves on its own without the need for extensive treatment. Clinicians should be aware of the presentations of this self-limiting illness to avoid unnecessary workups. © 2025 Indian Journal of Pharmacology.
C1 Esterase Inhibitor Deficiency in an Indian Female: A Rare Case Report and a Review of Literature with Treatment Update
(Bentham Science Publishers, 2025) Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar; Rajendra Prakash Maurya
Introduction: Hereditary Angioedema (HAE) is a rare, autosomal dominant disorder characterized by episodic, non-pruritic, non-pitting swelling of the skin, respiratory tract, and gastrointestinal system resulting from C1 esterase inhibitor (C1-INH) deficiency or dysfunction. It is frequently underdiagnosed, particularly in developing countries like India, due to its nonspecific presentation and overlap with allergic angioedema. Case Presentation: We report a case of a 28-year-old Indian woman who presented with a five- month history of progressive facial and periorbital swelling. She had no urticaria, known allergies, or systemic symptoms and did not respond to antihistamines or corticosteroids. The initial workup revealed normocytic anemia and elevated inflammatory markers, with normal renal, hepatic, thyroid, and autoimmune profiles. Radiological evaluation showed bilateral pre-septal edema. Complement C4 was normal; however, serum C1-INH level was markedly reduced, confirming type I HAE. She responded well to intravenous plasma-derived C1-INH concentrate (Cinryze). Unfortunately, she succumbed to a later episode of upper airway edema, highlighting the life-threatening potential of untreated or delayed HAE. Conclusion: This case emphasizes the need for high clinical suspicion of HAE in patients with unexplained, non-histaminergic angioedema, especially when conventional therapies fail. Early biochemical confirmation and targeted therapy are essential for effectively managing and preventing fatal complications. © 2025 Bentham Science Publishers
Case Report and Review of the Literature: Ischemic Stroke in Dengue Virus Infection
(American Society of Tropical Medicine and Hygiene, 2024) Jitendra Singh; Anshika Sinha; Anju Dinkar; Nilesh Kumar; Kailash Kumar
Dengue continues to pose a global health challenge, particularly in tropical and subtropical areas. Dengue can impact various organs, including the central nervous system, and can cause various neurological symptoms, although stroke is an uncommon complication. Among strokes, ischemic stroke is very uncommon in dengue. A 27- year-old unmarried female was referred to our institution with 8 days of fever and myalgia, 5 days of vomiting, and 3 days of altered sensorium. Small-sized bilateral pupils reacted slowly to light. Chest auscultation revealed diffuse coarse crepitation. Poor general condition and labored breathing led to intensive care unit transfer and intubation. Her contrastenhanced brain magnetic resonance image showed chronic pontine infarction. She was diagnosed with dengue fever (NS1Ag positive) complicated by bilateral pontine infarction. After a long course of illness, she was finally discharged to home in good recovery status. Clinicians need to be aware of the uncommon dengue presentation of stroke. Treatment is supportive with variable outcomes. © 2024 American Society of Tropical Medicine and Hygiene.
Clinical Dilemma, Bernard Soulier Syndrome versus Immune Thrombocy-topenic Purpura: A Case Report
(Bentham Science Publishers, 2023) J. Bhavya; Nitish Kumar Patel; Nilesh Kumar; Jitendra Singh; Kailash Kumar
Background: Bernard Soulier Syndrome (BSS) is a rare autosomal recessive disorder due to deficiency or dysfunction of the glycoprotein GPIb-V-IX complex on the platelet surface. It is also known as hemorrhagiparous thrombocytic dystrophy or congenital hemorrhagiparous thrombo-cytic dystrophy. The patient usually presents with severe and prolonged bleeding along with charac-teristics of giant blood platelets and low platelet counts. Manifestations of BSS include epistaxis, gum bleeding, purpuric rashes, menorrhagia, rarely melena, and hematemesis. On the other hand, immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder in which there is ac-celerated platelet destruction and reduced platelet production. Isolated thrombocytopenia without fever, lymphadenopathy, and organomegaly usually lead to the diagnosis of immune thrombocyto-penia. Case Presentation: A 20 years old female presented with complaints of recurrent episodes of epi-staxis since childhood and menorrhagia during menarche. She was misdiagnosed as ITP elsewhere. Later, based on thorough clinical examination and investigation, the diagnosis was confirmed as BSS. Conclusion: BSS should always be taken in the differential diagnosis of ITP, especially when per-sistent, refractory, and treated unsuccessfully with steroids or splenectomy. © 2023 Bentham Science Publishers.
Clinical Profile and Severity Correlation of Acute Leptospirosis in Northern India, 2019-2023: A Tertiary Care Center-based study
(Bentham Science Publishers, 2025) Anju Dinkar; Jitendra P. Singh; Nilesh Kumar; Kailash Kumar; Ramanand Yadav
Background: Leptospirosis is a globally important zoonotic disease with substantial morbidity and mortality, yet it remains underreported in Northern India. This study aimed to evaluate the seroprevalence, clinical characteristics, and severity determinants of acute leptospirosis in a tertiary care setting. Methods: We conducted a retrospective cross-sectional analysis of 174 hospitalized leptospirosis patients from 20,162 admissions between 2019 and 2023. The diagnosis was established using Leptospira IgM ELISA testing. Clinical, haematological, and imaging parameters were systematically evaluated. Results: The incidence of leptospirosis was 0.9%, peaking at 38.5% post-monsoon. Rural residents (64.9%), males (59.2%), and individuals involved in agricultural work (62.6%) were predominantly affected. Common presentations were fever (100%), headache (70.7%), myalgia (62%), and calf pain (50%), followed by jaundice (39.7%), and reduced urine output (33.3%).. The mortality rate was 20.1%. Severity correlated significantly with nausea/vomiting, abdominal pain, cough, and complications, including diffuse alveolar haemorrhage (DAH), disseminated intravascular coagulation (DIC), multiorgan dysfunction syndrome (MODS), hepatic dysfunction, acute renal injury, and leukocytosis. Discussion: The findings emphasize the critical need for early risk stratification and timely intervention to improve clinical outcomes. Identifying clinical and laboratory predictors of severity can significantly guide early management strategies in endemic areas. Conclusion: Several clinical and laboratory parameters are significant predictors of leptospirosis severity. Early recognition and risk stratification based on these indicators are crucial to improving patient outcomes. Enhanced surveillance, preventive measures, and clinician awareness are urgently needed to address this neglected tropical disease. 2025, Bentham Science Publishers
Comparison of Vi serology and nested PCR in diagnosis of chronic typhoid carriers in two different study populations in typhoid endemic area of India
(SEAMEO TROPMED Network, 2010) Gopal Nath; Pushpa Maurya; Anil Kumar Gulati; Tej Bali Singh; Ramit Srivastava; Kailash Kumar; Sunil Kumar Tripathi
For detection of chronic typhoid carriers, nested PCR targeting flagellin the gene of Salmonella enterica subspecies enterica serotype Typhi was carried out on DNA extracted from hepatobiliary specimens from 424 autopsies which were apparently free from gallbladder pathology on postmortem examination. The second study population was 508 healthy volunteers, who did not suffer from typhoid fever during the preceding year and whose sera were subjected to detection of carriage by estimation of Vi antibody levels using an indirect hemagglutination assay. Males of both study populations had comparable rates of detection by the two methods, 6.3% by PCR and 4.1% by Vi serology. Similarly, females in both study groups had comparable frequency of detection of chronic typhoid carriage using the two methods, ie 13.1% by PCR and 15.1% by Vi serology. S. Typhi specific immunosuppression could be speculated in females of 51-60 years as only 40% were positive by Vi serology against 100% by nested PCR. Vi serology may be recommended for community based detection of chronic typhoid carriers.
Correlation of the Disease Activity and Pro-inflammatory Cytokine Expression Between Young and Elderly Onset Rheumatoid Arthritis
(SAGE Publications Ltd, 2025) Shivam Sharma; Sourabh Pathania; Diparani Takhelmayum; Kailash Kumar; Anup P. Singh
Background and Aims: Rheumatoid arthritis (RA) is a complex autoimmune inflammatory disease-causing disability. The immunopathogenic difference between elderly onset RA (EORA) and younger-onset RA (YORA) and the factors responsible for their clinical characteristics are yet to be explored completely. The study was done to correlate inflammatory biomarkers in EORA patients and compare with YORA patients. Methods: A cross-sectional study comprising 30 patients each for YORA and EORA was done. Serum levels of interleukin IL-1β, IL-6, IL-8, tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and anticyclic citrullinated peptide were determined by Enzyme-Linked Immunosorbent Assay (ELISA). These were correlated with disease activity using the DAS28, and the modified Larson score was used to assess bone erosion. Results: Significantly higher levels of serum IL-6 (25.1 vs. 12.8 pg/mL) and IL-8 (83.5 vs. 65.15 pg/mL) were found in EORA patients, while significantly higher levels of serum TNF-α (360.8 vs. 86.3 pg/mL) were found in patients with YORA. IL-1β, IL-8 and TNF-α have a significantly positive correlation with DAS28 in YORA, while IL-1β, TNF-α and IFN-γ are significantly associated with disease activity in EORA. Increased bone erosion was linked to EORA. Conclusion: Apart from clinical symptoms, serological profile, EORA, and YORA have a distinct cytokines profile. This provides a valuable insight for selecting targeted therapies, especially in managing naive and refractory RA cases of EORA. Given the higher risk of joint damage in EORA, early and aggressive management may result in early remission and improve patient’s quality of life. © 2025 The Author(s). This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
COVID-19 Associated Acute Pancreatitis: A Case Series from India
(Bentham Science Publishers, 2022) Jitendra Singh; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Introduction: Initially, COVID-19 was typically concerned with respiratory symptoms and had a mild and asymptomatic to critical clinical course. Over time, many atypical presentations related to cardiac, hepatic, gastrointestinal, renal, musculoskeletal, and neurological features have been reported in COVID-19. Case Presentation: We present three confirmed cases of COVID-19, who developed acute pancreatitis without any other obvious discernible cause. One middle-aged 48-years old male was presented with severe abdominal pain with mild symptoms of COVID-19, who was later diagnosed with acute pancre-atitis with a positive outcome. Another 40-year-old male, hospitalized due to moderate COVID-19, developed acute pancreatitis and was managed successfully. The third 58-year-old patient with control diabetes and severe COVID-19 developed acute necrotizing pancreatitis. Unfortunately, he succumbed due to multiorgan failure while on the mechanical ventilator. Conclusion: Acute pancreatitis is uncommon in COVID-19. Although, it should be kept as a high-index clinical suspicion if abdominal pain is reported. Early diagnosis and prompt management can significantly impact the patient's outcome. © 2022 Bentham Science Publishers.
COVID-19 Associated Pancytopenia (CAP): A Clinical Impact
(Bentham Science Publishers, 2023) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar
Background: SARS-CoV-2 infection has mild and asymptomatic to critical clinical course affecting mainly the lungs. Few case reports of COVID-19-associated pancytopenia are reported, but a series of 18 cases is not described in the literature to date. Aims and Objectives: This study aimed to investigate pancytopenia in COVID-19 and its correlation with severity and to explore the detailed clinical and biochemical information in COVID-19-associated pancytopenia. This study also highlights pancytopenia's rarity and prognostic value among COVID-19 patients. Materials and Methods: This was a retrospective observational study conducted in a tertiary care centre at a level 3 COVID care facility that included adults of either sex having positive RT PCR for COVID-19 from October 2020 to May 2021. Data were collected from the online outpatient department and hospitalized patients. Results: A total of 18 cases were included in the study; 13 were males (72.2%). The mean age was calculated as 48.56 years. Cases were categorized as severe 13 (72.2%) and non-severe 5 (27.8%) disease on the first day of pancytopenia. The most common presentations were fever 18 (100%) and cough 18 (100%), followed by generalized weakness 16 (88.9%), breathlessness 15 (83.3%), and diarrhoea 10 (55.6%). One case died in the severe disease group. The mean of haemoglobin, leukocyte count, and platelets in severe vs non-severe disease were calculated as 8.59 vs 8.74, 2339 vs 2578, and 77769 vs 88600, respectively. Conclusion: Pancytopenia was more prevalent in severe disease and age group 40-60 years. CAP was most likely due to secondary bone marrow suppression. It has no prognostic value for disease outcomes. © 2023 Bentham Science Publishers.
Cure of antimony-unresponsive Indian post-kala-azar dermal leishmaniasis with oral miltefosine
(2006) Shyam Sundar; Kailash Kumar; Jaya Chakravarty; Dipti Agrawal; Shrinkhla Agrawal; Amit Chhabra; Vikram Singh
We report the case of a patient with Indian post-kala-azar dermal leishmaniasis (PKDL) who failed to show any response to 2 months' treatment with sodium stibogluconate. Six months later he was treated with oral miltefosine on a compassionate basis as an off-label indication. Miltefosine was given 100 mg daily in divided doses for an initial 8 weeks. Due to insufficient response, the treatment was extended up to a total of 12 weeks. The patient showed an excellent response to treatment, and after 12 months of follow-up there was complete healing of all cutaneous lesions. Oral miltefosine appears to be an important alternative for the treatment of PKDL in India and confirmatory studies in controlled clinical trials are needed. © 2005.
Dengue Fever Related Reactive Thrombocytosis in Young Male: A Case Report and Review Literature
(Bentham Science Publishers, 2024) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Vikrant
Introduction: Dengue fever is prevalent in tropical nations, especially India. Leucopenia and thrombocytopenia are distinctive features of acute dengue fever that revert to normal levels after the patient's recovery. Dengue fever is associated with numerous unusual clinical manifestations of different body systems. Additionally, the emergence of severe thrombocytosis following thrombocytopenia is extremely rare. Based on our extensive knowledge, only three cases similar to this have been documented in the literature. Case Report: Here, we present a case of a 36-year-old healthy man who had acute dengue and subsequently developed severe reactive thrombocytosis. The patient was treated conservatively and discharged. Subsequently, he developed thrombocytosis. Aspirin was given for a short period to alleviate any potential repercussions. Conclusion: Thrombocytosis, a rare consequence of dengue infection, is usually asymptomatic. Nevertheless, ongoing monitoring of dengue patients is required to avoid complications. © 2024 Bentham Science Publishers.
Diagnostic Challenges of Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes (POEMS) Syndrome: A Rare Case Report and Review of the Literature
(Bentham Science Publishers, 2025) Kailash Kumar; Rohit Ghanshyamdas Daga; Jitendra P. Singh; Nilesh Kumar; Anju Dinkar
Introduction: POEMS syndrome is a rare multisystem disorder associated with plasma cell dyscrasia and abnormal cytokine production, including vascular endothelial growth factor (VEGF). The mandatory criterion for its diagnosis includes polyneuropathy and monoclonal plasma cell disorder, along with other major and minor criteria. This case highlights the diagnostic and therapeutic challenges of POEMS syndrome by depicting the case of a 61-year-old male with progressive sensory-motor polyneuropathy, lymphadenopathy, and splenomegaly. Case Presentation: The patient presented with a year-long history of bilateral limb weakness and sensory disturbances, accompanied by abdominal distention, weight loss, and other systemic symptoms. Clinical examination revealed skin hyperpigmentation, splenomegaly, and a right axillary lymph node enlargement. Neurological evaluation showed distal limb hypotonia, absent reflexes, and sensory deficits. Diagnostic investigations, including nerve conduction studies, imaging, and bone marrow biopsy, confirmed POEMS syndrome based on polyneuropathy, monoclonal IgG lambda plasma cells, Castleman disease, sclerotic bone lesions, elevated VEGF, and minor criteria, such as endocrinopathy and skin changes. The treatment comprised lenalidomide and dexamethasone, resulting in significant improvement at the three-month follow-up, including normalized VEGF levels and resolution of ascites. Conclusion: This case highlights the necessity of identifying the many presentations of POEMS syndrome for prompt diagnosis and treatment. Despite its rarity and diagnostic complexity, prompt treatment can significantly improve clinical outcomes. POEMS syndrome should be considered in patients with unexplained neuropathy and systemic features, enabling better outcomes through targeted therapies. Bentham Science Publishers
Digital Gangrene Associated with Scrub Typhus: A Case Series
(American Society of Tropical Medicine and Hygiene, 2024) Jitendra Singh; Anju Dinkar; Nilesh Kumar; Kailash Kumar; Nidhi Tejan
Rickettsial diseases cover a broad spectrum of illnesses. Scrub typhus is present worldwide, and Orientia tsutsugamushi is the causative agent of this chigger mite–borne infectious illness. Infections exhibit a range of severity, from mild illness to the more severe manifestation of multiorgan failure. We report three cases of scrub fever (55-year-old female, 63-year-old female, and 29-year-old male), all cases developed focal or pan-digital gangrene. All cases were successfully treated by administering doxycycline and additional supportive measures. Digital gangrene is uncommon in scrub typhus. Clinical suspension for early diagnosis and appropriate treatment may avoid further complications. Copyright © 2024 American Society of Tropical Medicine and Hygiene.
Disseminated Cryptococcosis in Idiopathic CD4+ Lymphocytopenia
(Bentham Science Publishers, 2023) Ankita Dewangan; Jitendra Singh; Dinesh Kumar; Nilesh Kumar; Kailash Kumar; Anju Dinkar
Introduction: Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non– HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobac-terial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients. Case Presentation: Here, a 55-year-old lady was referred with a history of diffuse headache and in-termittent fever for two months, projectile vomiting, and altered mental status for five days. Non-pruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died. Conclusion: It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states. © 2023 Bentham Science Publishers.
Distribution of Hepatitis B virus genotypes among healthy blood donors in eastern part of North India
(2011) Kailash Kumar; Manoj Kumar; Sk.H. Rahaman; T.B. Singh; Saurabh Kumar Patel; Gopal Nath
Aim: We evaluated the distribution HBV genotypes among non-remunerated healthy blood donors in eastern North India. Materials and Methods: During screening of donated blood, 176 consecutive HBsAg positive, samples comprised the study. HBV-DNA was quantitative detected in 150 samples by PCR. HBV genotype was determined by identifying genotype-specific DNA band using nested PCR. Results: Majorities were of age group 31-40 yrs (65.3%). Males (92.7%) outnumbered females (7.3%) and were HbeAg-negative HBsAg carriers. Over all, genotype-A was the most prevalent (54%) followed by D (21.3%). We did not find genotype-G and H. Districts under study, divided into four zones: Zone-I genotype-A was most common (62.3%) followed by D (18.8%); Zone-II genotype-C (41.2%) was more frequent followed by D (20.6% and A (17.7%). Zone-III in adjoining Bihar state close to Zone-I, A was more prevalent (81.8%) followed by B and C (9.1%). In Zone-IV adjoining Zone- II had genotype-A (100%) only. Genotype-D had more sporadic distribution. Genotype-E and F were prevalent in Zone I and II (3/150, 2%). Conclusions: Among blood donors HBV genotype-A followed by D was the most prevalent in eastern North India. Genotype-A had pattern of distribution signifying common focus, while D was more sporadic and C had single large pocket (Zone-II) probably common focus but restricting to particular area. Evidences are suggestive of association of HBV genotype in liver dysfunction. An effective treatment and preventive strategies based of genotypes will reduce the disease burden and increase the blood safety.