[Atypical ocular toxocariasis in a child: A case report]

INTRODUCTION

Ocular toxocariasis is a rare disease, predominantly affecting children and young adolescents, and usually presenting as unilateral posterior uveitis. We report the case of a child with toxocariasis associated with serous retinal detachment.

OBSERVATION

A 8-year-old child with no previous history of toxocariasis was referred for a 1-year decline in visual acuity, unimproved by optical correction, with vitreous condensation on examination, without central or peripheral granulomas, and serous retinal detachment on OCT. The diagnosis was made after extensive questioning, with evidence of contact with dogs and positive serology. Medical treatment combining corticosteroid therapy and antiparasitic therapy was initiated, and the clinical picture improved.

DISCUSSION

Ocular toxocariasis is a rare infection, unilateral in 90% of cases. Its clinical manifestation in children is pars planitis, posterior uveitis with a posterior pole chorioretinal focus associated with vitreoretinal traction and/or peripheral granuloma. In our case, the patient presented with vitreous condensation only, with OCT serous retinal detachment and no peripheral or central granulomas. Positive plasma serology or ocular samples confirmed the diagnosis.

CONCLUSION

Ocular toxocariasis should not be ruled out in the absence of a typical clinical picture, and seropositivity enables confirmation of the diagnosis when clinical suspicion arises.

[Ethambutol-induced toxic optic neuropathy during treatment of tuberculosis meningitis in a child]

INTRODUCTION

Toxic optic neuropathy is a severe optic nerve injury that can compromise the prognosis for vision, justifying early clinical and ancillary diagnosis.

CASE DESCRIPTION

We report the case of an 11-year-old child being treated for tuberculous meningitis with a combination of ethambutol and three other anti-bacillary drugs, referred for a rapidly progressive bilateral decline in visual acuity. On ophthalmologic examination, the visual acuity was counting fingers within 1ft in both eyes, and bilateral optic disc pallor was noted, without other associated abnormalities. Neurological imaging was unremarkable, with red-green dyschromatopsia and a bilateral cecocentral scotoma. Faced with this clinical and paraclinical picture, we arrived at the diagnosis of ethambutol toxic optic neuropathy, with a multidisciplinary decision leading to a change in the antibacillary treatment protocol. No clinical improvement was noted after 3 months of follow-up.

DISCUSSION

Optic nerve toxicity is rare in children and is classically described as dose- and time-dependent.

CONCLUSION

Ethambutol ocular toxicity is extremely rare in children, and the required action when detected is to discontinue the drug. Reversibility is not always assured, which requires early detection of toxic optic neuropathy by close clinical and ancillary monitoring and, above all, sensitization of the treating physicians (pediatricians, pulmonologists and neurologists).

Enteropathogenic Escherichia coli (EPEC): Does it have a role in colorectal tumourigenesis? A Prospective Cohort Study

BACKGROUND

Despite the characterization of many aetiologic genetic changes. The specific causative factors in the development of sporadic colorectal cancer remain unclear. This study was performed to detect the possible role of Enteropathogenic Escherichia coli (EPEC) in developing colorectal carcinoma.

PATIENTS AND METHOD

Fresh biopsy specimens have been obtained from the colonic mucosa overlying the colorectal cancer as well as from the colon of the healthy controls. Culture, genotyping and virulence of EPEC were done using (nutrient broth culture, and PCR). Strains biochemically identified as Escherichia coli were selected from the surface of a MacConkey's plate and were serogrouped by slide agglutination tests.

RESULTS

From January 2011 to June 2014, 213 colorectal cancer patients (Group 1) and 248 healthy controls (Group 2) were prospectively enrolled in this study. EPEC was positive in 108 (50.7%) in group 1 and 51 (20.6%) in group 2 (P = 0.0001). A significant difference between both groups was observed regarding serotyping, genotyping (eae gene) and virulence category (P = 0.0001). A significant difference between the 2 subgroups of colorectal cancer cases was observed regarding genotyping (eae, bfb genes) and virulence category.

CONCLUSION

The incidence EPEC was higher significantly in patients with colorectal cancer. E. coli in patients with colorectal cancer significantly differed serotypically and genotypically from the E. coli in normal population. E. coli colonization of the colonic mucosa may be a cause colorectal cancer.

Laparoscopic repair of perforated peptic ulcer: patch versus simple closure

BACKGROUND

Laparoscopic correction of perforated peptic ulcer (PPU) has become an accepted way of management. Patch omentoplasty stayed for decades the main method of repair. The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as patch omentoplasty.

METHODS

Since June 2005, 179 consecutive patients of PPU were treated by laparoscopic repair at our centers. We conducted a retrospective chart review in December 2012. Group I (patch group) included patients who were treated with standard patch omentoplasty. Group II (non-patch group) included patients who received simple repair without patch.

RESULTS

From June 2007 to Dec. 2012, 179 consecutive patients of PPU who were treated by laparoscopic repair at our centers were enrolled in this multi-center retrospective study. 108 patients belong to patch group. While 71 patients were treated with laparoscopic simple repair. Operative time was significantly shorter in group II (non patch) (p = 0.01). No patient was converted to laparotomy. There was no difference in age, gender, ASA score, surgical risk (Boey's) score, and incidence of co-morbidities. Both groups were comparable in terms of hospital stay, time to resume oral intake, postoperative complications and surgical outcomes.

CONCLUSION

Laparoscopic simple repair of PPU is a safe procedure compared with the traditional patch omentoplasty in presence of certain selection criteria.

Antagonistic potentiality of Trichoderma harzianum towards seed-borne fungal pathogens of winter wheat cv. Protiva in vitro and in vivo

The antagonistic effect of Trichoderma harzianum on a range of seed-borne fungal pathogens of wheat (viz. Fusarium graminearum, Bipolaris sorokiniana, Aspergillus spp., and Penicillium spp.) was assessed. The potential of T. harzianum as a biocontrol agent was tested in vitro and under field conditions. Coculture of the pathogens and Trichoderma under laboratory conditions clearly showed dominance of T. harzianum. Under natural conditions, biocontrol effects were also obtained against the test fungi. One month after sowing, field emergence (plant stand) was increased by 15.93% over that obtained with the control treatment, and seedling infection was reduced significantly. Leaf blight severity was decreased from 22 to 11 at the heading stage, 35 to 31 at the flowering stage, and 86 to 74 at the grain filling stage. At harvest, the number of tillers per plant was increased by 50%, the yield was increased by 31.58%, and the 1,000-seed weight was increased by 21%.

[Macular serous detachment revealing acute lymphoblastic leukemia]

BACKGROUND

Leukemias are a group of malignant diseases caused by immature hematopoietic cells proliferating in the blood marrow. Some manifestations result from ocular-orbital involvement, which usually occurs through the central nervous system. Other manifestations stem from vasculopathy and/or hemorheologic disorders (anemia, thrombocytopenia, hyperviscosity).

OBSERVATION

We report a case of a 42-year-old women presenting with loss of vision caused by serous macular detachment. The investigations showed the diagnosis of acute lymphoblastic leukemia. Steroids and chemotherapy led to complete remission with normal visual acuity during a follow-up of 29 months.

DISCUSSION

Ocular involvement is seen in 28%-80% of leukemia cases. The most obvious findings are the presence of retinal hemorrhages, which are most commonly located in the posterior pole. The intraretinal hemorrhage may contain a white component that usually is a white dot in the center of the hemorrhage, but other clinical features are described. Serous detachment of the neuroepithelium is seldom reported, and can be the first symptom of the disease. Other ocular findings include infiltrative involvement of the chorioretina, anterior segment involvement, and orbital location. Ocular location is estimated to be an equivalent of central nervous system involvement, and subsequently requires adequate treatment (steroids, chemotherapy and radiotherapy of the central nervous system).

CONCLUSION

Ocular manifestations of leukemia are frequent but rarely reveal the disease. Serous detachment is rarer. However, the diagnosis of leukemia should be considered in case of pigmentary epithelium involvement.