India (again), and SouthEast Asia

Tapeworms: Today we discussed tapeworms, fish tape worm D. latum, pork Tape worm (T. Solium), beef tape worm (T. saginata). Of all of them, probably the most significant is the pork tape worm, not so much because infection with it causes disease, but ingestion of its eggs causes neurocysticercosis.   http://www.nejm.org/doi/full/10.1056/NEJM199209033271004 The article often quoted to demonstrate this point with orthodox Jews in New York who acquired it because their South American workers who were preparing the food had the tape worm themselves. Having tapeworms can be difficult to diagnose, we were told of one patient who was actually given anti-pscyh medications, the take home point being to document (picture and or bring in the worm or proglottids), to help identify it. Thereis a stool antigen (ELISA) for T. solium. Hymenolepsis nana (not to be confused with E. nana) is a dwarf tapeworm causing abdo pain and possibly pruritis, the one reason to check stool O&P in...

The day started off with a talk on Leprosy, the WHO has given cardinal features to consider leprosy in endemic areas; the idea being easy for health care providers to recognize. 1.      Anaesthetic skin lesion 2.      Enlargement of peripheral nerves with evidence of nerve damage (loss of sensation, weakness, paralysis) 3.      Positive skin smears The above sounds simple enough but it can be difficult to diagnosis, patient can have neuropathy only, papules, plaques, ulcers, loss of hair (eye brows or eye lashes), and ichthyosis. The talk further highlighted the spectrum of leprosy from tuberculoid to lepromatous and the in between. The disease further is classified based on paucibacillary or multi-bacillary leprosy which will alter the drug regimen, and the duration. India has around 60% of the worlds leprosy (together with Indonesia and Brazil make up 80% of the worlds leprosy cases) and it is still very m...