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Abstract:Malaria caused by vivax is more common than those caused by falciparum. We report here a patient of vivax malaria presented with tender hepatomegaly. A 30 year old male from a rural area was admitted with high grade irregular fever for 5 days with severe right hypochondriac pain for 2 days. Patient was toxic and agonizing with pain. He had tender hepatomegaly. His cardiovascular and respiratory examination findings were normal. ICT for malaria and blood film revealed presence of P. vivax. His hepatic enzymes and viral markers were negative and ultrasonogram of hepatobiliary system excluded features of hepatitis or any abscess cavity. Echocardiogram showed no cardiac abnormality. Presence of tender hepatomegaly in the absence of other co-morbidity is rare in vivax malaria and not well documented in adults, which makes this presentation.

Kala-Azar is a devastating parasitic disease caused by Leishmania donovani, increasing in our country and turning into serious public health problem in Bangladesh due to multiple problems. The standard drug for treatment of Kala-Azar is still Sodium Stibogluconate (SAG) in our country due to high cost of liposomal Amphotericin B. The aim of this study is to see the cardiac complication and electrographic alterations during SAG therapy in standard dose. One hundred and twenty five patients (62.4% male and 37.6% female) were included in this study. All had normal ECG prior to therapy. Various electrographic alterations were noted in 31 (24.8%) of the cases after starting antimony therapy. Most common changes seen in our study were T wave inversion (24.4%), reduced amplitude of T wave (7.3%) and ventricular ectopic (8%). These changes were observed during 2 nd to 3 rd weeks of therapy and disappeared within two weeks of stoppage of further antimony therapy. Alteration in ECG might be the prior evidence of cardiotoxicity and might explain sudden deaths encountered during antimony in Kala-Azar. Close clinical observations and ECG monitoring of the patients receiving antimony therapy for Kala-Azar is essential for early detection of cardiotoxicity and thereby to prevent further complications including sudden death.

Abstract:Annually about two million deaths occur globally due to tuberculosis (TB). Bangladesh ranks the sixth position among 22 highest burden TB countries in the world and also one of the 27 high multidrug resistant tuberculosis (MDR-TB) burden countries where about 70,000 people die every year due to TB. Among six key components of Stop TB Strategy (STS) Plan, the first one includes increase case notification of all forms of TB and improve diagnosis of new smear negative, extrapulmonary cases and TB in children by 2016. As TB can affect any organ in human body, the TB cases are managed by any discipline in medical community. Unfortunately diagnostic accuracy is not satisfactory and is not only due to uniform unavailability of the latest diagnostic facilities but also due to inadequate knowledge of the professionals about currently available modern laboratory techniques to diagnose TB. Light-emitting diode (LED) microscopy with fluorescence (auramine-rhodamine staining) should be preferred than conventional microscopy with Zeihl-neelsen (acid fast) staining to identify TB bacilli. Mantoux test (MT) indicates only infection by TB bacilli, does not necessarily the active disease. It may be positive in latent TB and in BCG (Bacillus Calmette-Guerin) vaccinated cases. Antibodies from Lymphocyte Secretion or Antibodies in Lymphocyte Supernatant (ALS) assay can detect active TB cases within three days of sample collection. The test is very useful to diagnose TB in children where sputum collection is difficult. Interferon gamma release assay (IGRA) tests are not advocated in low and middle-income countries, typically those with a high TB and/or HIV burden. Anti TB IgG/IgM/IgA tests should be avoided because these are being misinterpreted by someone as active TB cases. Adenosine Deaminase Assay (ADA) is a reliable test to diagnose tuberculous pleural effusion together with other evidences. ADA in pleural fluid <40 IU/L is considered negative for TB. The more the ADA level, the more possibility to be tuberculous effusion. Level >100 IU/L is highly specific for TB origin. Gene Xpert MTB/RIF, an Xpert test for mycobacterium tuberculosis (MTB) and Rifampicin (RIF) resistance, is used for rapid identification for TB bacilli, specially when MDR-TB is suspected, in human immunodeficiency virus ( HIV) infected cases and highly suspected sputum negative cases ( as a follow on test ) where microscopy frequently failed due to low bacterial load. The test exhibits high sensitivity and specificity for detecting pulmonary TB.

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