Tinea nigra is a rare superficial fungal infection characterized by asymptomatic, unilateral, well-defined brown to black macules predominantly affecting the palms and soles. Diagnosis is often challenging due to its rarity and resemblance to other pigmented lesions. This report presents a clinical case, a diagnostic algorithm, and treatment recommendations, emphasizing the role of thorough examination and questioning. We describe the case of a 64-year-old woman of Amerindian (Maya) heritage from Yucatan, Mexico, who presented with a three-month history of a slowly growing dark spot on her left palm. The lesion was asymptomatic, non-scaling, and non-palpable. Palmar skin scrapings, prepared with KOH, revealed pigmented yeast and hyphae, leading to a diagnosis of tinea nigra. Following treatment with topical ketoconazole, the patient\'s lesions completely resolved at the one-month follow-up. The cultivation of scales confirmed the presence of Hortaea werneckii. Our findings highlight the importance of considering tinea nigra in the differential diagnosis of pigmented lesions on acral surfaces. We propose a diagnostic algorithm to aid healthcare professionals in recognizing this uncommon condition and recommend treatment protocols that effectively resolve the infection within two weeks. This case underscores the necessity for increased awareness and accurate diagnosis of tinea nigra, particularly in non-endemic regions.

In this image, the autors reinterprate \"The Thinker\" from Auguste Rodin to transfer knowledge about dengue fever, which can range from flu-like illness to severe hemorrhagic fever. By fostering awareness and understanding of dengue fever, we strive to empower individuals and communities in the ongoing fight against dengue and other infectious threats.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a serious hyperinflammatory condition associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Usually, the diagnosis of MIS-C is made by criteria defined by international organizations, which include specific clinical features, laboratory findings, and evidence of SARS-CoV-2 infection. We hereby present a case series of three children. The objective of this case series, involving chart review of medical records of children admitted with MIS-C, is to emphasize that the features of MIS-C may overlap with other conditions.
METHODS: Three children were presented with MIS-C based on World Health Organization (WHO) criteria and given treatment for the same. However, due to persistent symptoms, they were further worked up and diagnosed to have underlying bacterial infections which included liver abscess, enteric fever, or urinary tract infection.
CONCLUSIONS: The criteria for MIS-C may overlap with other conditions, particularly bacterial infection that may lead to overdiagnosis of MIS-C. Therefore, one should be very careful in making an MIS-C diagnosis and other differential diagnoses should be considered when the symptoms persist or worsen.

UNASSIGNED: Newer coexisting conditions should be identified in order to modify newer risk factors. Aim was to identify patients with non-classical or less common coexisting conditions in patients infected of COVID 19.
UNASSIGNED: Single centred study from June 2020 to May 2021 at a tertiary centre in North India. A preformed questionnaire was used to record clinical and laboratory parameters and to identify cases which are in addition to CDC list and Indian data.
UNASSIGNED: 0.67% (46) cases out of 6832 patients were identified to have non-classical coexisting illness. It was divided into 2 groups-infections A (60.1%) and non-infections B (39.9%). Group A included-tuberculosis- pulmonary (14.3%) & extra pulmonary (32.9%), bacterial (25.0%) viral infections [dengue, hepatitis B & C] (14.3%), HIV disease (10.7%) and malaria (3.6%). Group B included- organ transplant (27.8%), autoimmune [myasthenia gravis, polymyositis, psoriasis] (22.6%), haematologic [Haemophilia, ITP, Aplastic anaemia, APML, CML] (27.8%), uncommon malignancies [disseminated sacral chordoma and GTN] (11.1%) and snakebite (11.1%). Serum Procalcitonin was not helpful for diagnosis of bacterial infection in COVID-19 disease. Group A had significantly longer duration of illness, hepatitis and elevated CRP. The mortality in group A & B were 32.1% and 43.8% respectively. Death in non-severe COVID cases was in tetanus and snakebite. 30.7% death among tuberculosis patients. More than 70% of deaths were attributable to COVID 19 in both the groups.
UNASSIGNED: In Indian settings, comorbidities like tuberculosis and bacterial infections can precipitate severe COVID 19 unlike other parts of the world where tuberculosis is relatively uncommon.

UNASSIGNED: Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH.
UNASSIGNED: We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared.
UNASSIGNED: Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections.
UNASSIGNED: High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.

Neglected tropical diseases (NTDs) encompass a group of diseases predominantly found in tropical regions, with origins dating back to their inclusion in the United Nations Millennium Development Goals in 2000. This initiative aimed to raise awareness and global funding to combat these diseases, which thrive in areas with limited sanitation, healthcare, and education. NTDs are caused by various pathogens such as bacteria, fungi, parasites, and viruses and affect over two billion individuals in resource-poor communities, leading to preventable deaths and devastating consequences. While the musculoskeletal system is only occasionally affected, the resulting chronic disabilities prevent individuals from working, posing a significant socioeconomic burden in this region of the world. Some NTDs exhibit distinct imaging features, and radiologists need to be aware of these characteristics to facilitate early treatment. In this review, we delve into musculoskeletal NTDs, focusing on clinical features and imaging findings, differential diagnosis, and clinical management.

The coronavirus disease 2019 (COVID-19) pandemic has changed the way we manage patients, especially those with respiratory illnesses. Clinical manifestations, chest imaging, and reverse-transcription polymerase chain reaction (RT-PCR) play major roles in diagnosing respiratory infections during a pandemic. However, several infections can mimic COVID-19 regarding its clinical signs, symptoms, and imaging appearance. Diagnosing pneumonia other than COVID-19 is a big challenge in developing countries, given the limited resources available. We presented a case of a 25-year-old female with clinical symptoms and radiological characteristics typical of COVID-19 but a repeated negative RT-PCR test. Further workups found lung tuberculosis as her primary diagnosis. Our patient continued treatment with an antituberculosis agent and a short course of steroids, with a remission of symptoms.

Tropical diseases prevalent in leprosy-endemic areas may alter the immunological patient response and also complicate the presentation of leprosy reactional episodes. The introduction of anti-malarial drugs in our case produced a subsidence of reaction. With dwindling manpower skilled in leprosy, the reactional episodes are very often treated with non-steroidal anti-inflammatory drugs, steroids and thalidomide, neglecting the possibility of other co-existing infections, tropical or other. Our case emphasises the importance of history, examination and balanced investigation in the context of tropical diseases in endemic areas before injudicious intervention.

Dirofilariasis is a zoonotic infection transmitted by several species of mosquitoes. A 16-year-old boy presented with forearm swelling of two months duration. Imaging studies revealed a parasitic cyst. Surgical excision of the lesion was performed, and pharmacotherapy with diethylcarbamazine was given. A histopathological examination confirmed a diagnosis of human subcutaneous dirofilariasis caused by Dirofilaria repens. Clinicians should consider similar infections, especially in light of current climate changes and the emergence of various zoonoses. The epidemiological impact of diagnosing and preventing similar zoonotic infections is invaluable.

Extrapulmonary tuberculosis (ETB) involving skin with multiple lesions is an uncommon presentation of mycobacterial infection. Cutaneous tuberculosis (TB) having multiple lesions with Poncet\'s disease (tuberculous Rheumatism) is rarely reported. We hereby report a multifocal cutaneous tuberculosis with Poncet\'s disease in a 19-year-old immunocompetent female.