|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 2 | Page : 121
Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq
|Date of Web Publication||23-Jun-2016|
Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Mendalawi MD. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child. Oman J Ophthalmol 2016;9:121
|How to cite this URL:|
Al-Mendalawi MD. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child. Oman J Ophthalmol [serial online] 2016 [cited 2019 Aug 22];9:121. Available from: http://www.ojoonline.org/text.asp?2016/9/2/121/184536
With reference to the interesting case report by Arora et al.,  there are three prevailing health threats in India. Giardiasis is a significant cause of diarrheal disease, and it is associated with a significant morbidity in children and adults. The available data pointed out to a substantial prevalence rate of giardia infection in patients with diarrhea in India (0.4-70%).  Tuberculosis (TB) is another public health problem of great significance in India. The recently published data indicated an alarming increase in the prevalence of multidrug-resistant TB (P < 0.001) by 12% (4.7% in 2000-19.8% in 2012).  Human immunodeficiency virus (HIV) infection is still imposing a great health burden in India. The recently published data showed that the estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it leveled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively.  It is obvious that there are numerous ophthalmic manifestations in patients with HIV infection in the era of highly active antiretroviral therapy, where 7% of the patients in India were found to present with ophthalmological features as the initial manifestation of HIV infection. Moreover, most (70%) of the ophthalmic manifestations of HIV infection were presented when CD4 count was <200 cells/μL.  I presume that the constellation of peripheral ulcerative keratitis (PUK), chronic malabsorption syndrome due to giardiasis, and miliary TB in the case in question should alert the authors to the underlying immune deficiency status, particularly HIV infection. Hence, the diagnostic algorithm of CD4 count and viral overload measurements was solicited to be contemplated by the authors. If that diagnostic algorithm was done and it disclosed a concomitant HIV infection, the case in question could be regarded as a novel case report, as concurrent occurrence of the three infections in a patient with PUK has never been reported in the literature.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arora T, Sharma N, Shashni A, Titiyal JS. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child. Oman J Ophthalmol 2015;8:205-7.
Laishram S, Kang G, Ajjampur SS. Giardiasis: A review on assemblage distribution and epidemiology in India. Indian J Gastroenterol 2012;31:3-12.
Raveendran R, Oberoi JK, Wattal C. Multidrug-resistant pulmonary & extrapulmonary tuberculosis: A 13 years retrospective hospital-based analysis. Indian J Med Res 2015;142:575-82.
Raj Y, Sahu D, Pandey A, Venkatesh S, Reddy D, Bakkali T, et al.
Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011. Int J STD AIDS 2015. pii: 0956462415612650. [Epub ahead of print].
Gharai S, Venkatesh P, Garg S, Sharma SK, Vohra R. Ophthalmic manifestations of HIV infections in India in the era of HAART: Analysis of 100 consecutive patients evaluated at a tertiary eye care center in India. Ophthalmic Epidemiol 2008;15:264-71.