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 Table of Contents    
LETTER TO THE EDITOR
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 121  

Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication23-Jun-2016

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.184536

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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 Jun 26];9:121. Available from: http://www.ojoonline.org/text.asp?2016/9/2/121/184536

Sir,

With reference to the interesting case report by Arora et al., [1] 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%). [2] 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). [3] 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. [4] 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. [5] 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.

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   References Top

1.
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.  Back to cited text no. 1
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2.
Laishram S, Kang G, Ajjampur SS. Giardiasis: A review on assemblage distribution and epidemiology in India. Indian J Gastroenterol 2012;31:3-12.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
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].  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    




 

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