studyingwithsky

[studyingwithsky]

[studyingwithsky]

Jan 21, 2025 - Tuesday

Trying a new setup! Actually I’ve been trying to build a setup that I liked for the past few months and I think I’m finally getting somewhere! I brought my hourglass from home and it’s already making it feel a bit more like ‘me’

[studyingwithsky]

“There is only one thing more painful than learning from experience, and that is not learning from experience.”

— Archibald Macleish (b. 7 May 1892)

[studyingwithsky]

The paradox of being a student: a full notebook, an empty head.

[studyingwithsky]

lately it's been me and my brown pen + highlighter combo 🍂🤎📔

[studyingwithsky]

life lately... thanks for 1000 followers, definitely a shock to me... i'll try to post more often...

[studyingwithsky]

1 5 • 0 3 • 2 0 2 1

“No one sees what you see, even if they see it too”

I’ve been really busy lately... and assignments never seem to end.

I need holidays now!

I have an exposition tomorrow and an oral exam too... oh, and classes from 7 to 5 (kill me now, please)

ZOOMESTER STUDYBLR CHALLENGE

I’m really late with this... but I know I can catch up.

Day 4• For my researching fellows, what are you researching on? If you’re not currently researching, what is the topic within your field that you’re most passionate about?

I’m just in my first year... but I would love to investigate something about embryology or biochemistry.

Perhaps something about mental illnesses too?

Day 5• Tag 3 studyblrs that you like seeing on your dashboard.

@marie-curie Her posts are stunning! I love the descriptions in white letters and the words written on the window.

@study-van She always inspires me to study!

@coralstudiies Her notes are really beautiful!!

[studyingwithsky]

[studyingwithsky]

November 17th, 2024

it’s slowly approaching my favorite time of the year <3

things on the agenda today:

• preparing for tomorrow’s exam

• internship tasks

• meetings with supervisor

• journaling

[studyingwithsky]

[studyingwithsky]

“All serious daring starts from within.”

[studyingwithsky]

that’s how you write a headline

[studyingwithsky]

Leishmaniasis

Case Reports, like we're on a episode of house

23M in Kenya, presenting with months of LOW, persistent fevers, and abdo fullness, found to have massive splenomegaly.

examination: massive splenomegaly (10 cm below costophrenic margin, and will definitely cross midline) and hepatomegaly

pancytopaenic on bloods, plt's down to 40s

diagnosis confirmed on BMAT (parasite seen)

normal HIV, liver and kidney function

Bodies seen on the BMAT below are part of the lifecycle of the parasite that is intracellular, hence you can see the macrophages/neutrophils loaded with them, even bursting

What is it:

think of it when you get a patient with pancytopaenia and hepatosplenomegaly, who either traveled to or is in/from a tropical/subtropic region (where sand flies are)

cause - protozoa parasite Leishmania, transmitted by infected sandflies

Epidemio (when to consider it)

tropics, subtropics (South America, Asia, AFrica), Southern Europe

Microbiology/Transmission

parasite, replicates intracellularly (Leishmania donovani)

transmitted in sand flies (can be unnoticeable and usually bite in dawn or dusk - evenings or night), can also be transmitted via needles/blood

more common in rural areas

I've simplified this, but is more extensively covered in StatPearls and Wiki (there's different species of Leish and sandflies that transmit it)

once bitten, the protozoa are phagocystosed by skin macrophages, which then becomes full of the "bodies" (part of the lifecycle). Eventually these burst to release more of the bodies that infect more macrophages

they eventually are spread via blood to liver/spleen/BM and LNs

Random history:

ancient, records of disease date back to Egyptian mummies from 3000 BC --> positive DNA amplication for Leishmania and on papyrus from 1500 BC

multiple physicians from different times have described the disease, but it's named for 2 who described the parasite's intracellular ovoid body stage in smears from infected patients in India: Lt General William Boog Leishman and Captain Charles Donovan (Ronald Ross named the bodies after the 2 --> "Leishman Donovan bodies"

significant disease in Allied troops in Sicily in WWII, called "jericho buttons" (image on wiki from a WWI trooper serving in the middle east)

Leishman: Scottish pathologist and British Army medical officer, later it's director general in the 20s, did extensive research into the parasite named for him by Sir Ronald Ross. He mistook the parasite he observed for trypanosomes (cause of Chagas in South America and African sleeping sickness in Africa)

Donovan: Irish parasitologist, medical officer in India, observed an epidemic across India just after the rebellion of 1857, discovered the "bodies" in spleen tissue as the causative agent for what the locals called "kala azar" (severe visceral leishmaniasis - see below)

Donovan also discovered the "bodies" of Klebsiella granulomatis, hence these too are named after him (cause of ulcerative granulomas)

It became scandalous as both wanted credit for the "discovery" of this newly identified organism. So Sir Ronald Ross named it for both of them.

Sir Ron, by the way, won a Nobel in Medicine for discovering that malaria is transmitted via mossies (this was also a source of scandal, he was meant to share it with another physician who he accused of fraud - and they never received the award)

finally, it was actually a Russian physician who identified it first, but well, he published in a little known Russian journal which was promptly forgotten.

Clinical features

cutaneous type vs visceral organ type (spleen, liver, bones)

From wiki

can be asymptomatic

cutnaeous: can be there for years and resemble leprosy, causes an open chronic wound (most common), incubation 2-4 weeks on average (nodules at site of inoculation that eventually form ulcers), can heal spontaneously in 2-5 yrs

in diffuse cutaneous cases, can affect face, ears, extensor surfaces

can be muscosal = eg nasal symptoms/epistaxis, severe: perforated septum, this occurs in 1/3 after resolution of cutaenous symptoms (can be severe/lifte threatning, as it can affect vocal cords and cartilage, but oddly not bone)

visceral (incubation periods of up to years until immuncompromise): fever, weight loss, hepatosplenomegaly (spleen more than liver), pancytoaepnia, high total protein and low albumin with hypergammaglobulinaemia

this has seasonal peaks related to sandfly habits and humidity

interestingly it is an infective cause of massive splenomegaly, such that it crosses the midline

Extreme - but noticeable hepatosplenomgealy/abdo fullness, from medscape

can be atypical in HIV co infected patients, LAD in seom regions like Africa

Kala azar = black fever in some severe cases (fatal due to secondary mycobacterial infection or bleeding), refers to damage fto spleen, liver and anaemia

invstigations:

serology not great (minimal humoral response to the parasite), so often requires histopath (tissue sample) for which BMAT is safest in visceral organ involvement

visualisation of amastigotes (or Leishman-Donovan bodies), as intracellular --> can be seen in macrophages (small round bodies) post Giemsa staining

PCR of DNA also possible (as done in the Egyptian mummies)

Image source:

Treatment

liposomal amphotericin B (holy shit strong stuff) in visceral, PO: miltefosine (caution in pregnancy), all have significant ADRs, or paromycin. however, mortality of 10% if visceral left untreated

mixed results with azoles

in HIV co infection - start the HAARTs! can improve survival, mortality is 30% in HIV patients

cutaneous: stibolgluconate (have never heard of these drugs) and megluaine antimoniate, but limited disease often spotnaeously gets cleared by the innate system

prevention:

use DEET insect repellant at dawn and dusk

loose fitting clothing that covers all skin

no vaccine (were attempts at vaccinating dogs, which decreased rates)

sandflies are smaller than mossies, so requires small netting

Differentials for hepatosplenomegaly

Sources:

WHO guidelines

CDC guidlelines

Wiki - Haven't covered pathophysio, but wiki does extensively

StatPearls

DermNet - great resource for all things derm, that my derm colleagues pointed out to me

[studyingwithsky]

missed two classes because i was sick = 20 pages of makeup work

[studyingwithsky]

making my silly little moodboards in the hopes of them motivating me to study𐙚*‧₊˚

[studyingwithsky]

It's so cool that potions are real and we can just buy them at actual stores. It's also really cool that we figured out how to dehydrate and shape them so that they be measured in perfectly even doses. Like wow I got a migraine about to knock me out? Eat Potion of Migraine Pain Relief (acetaminophen)!

[studyingwithsky]

sleepily taking some addiction and compulsive disorder notes 😴