Pathology of Opportunistic Infections in Tropics RK Gupta
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1Pathology of Opportunistic Infections in Tropics2
3Pathology of Opportunistic Infections in Tropics
RK Gupta MD FAMS Formerly Director, Dean, Professor and Head Department of Pathology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow (UP) India
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Pathology of Opportunistic Infections in Tropics
© 2007, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2007
9788184480689
Typeset at JPBMP typesetting unit
Printed at Rajkamal
5In Memorium
My Parents
Brij and Gopal
Dedicated
to
My wife Sushma and sons Pankul and Pallav
My Colleagues and Students and My Patients
6
7Preface
Over past few decades, certain therapeutic advances such as organ transplantation, prolonged use of steroids and other immunosuppressants for various diseases, chemo-radiotherapy for the treatment of malignancy, etc. while prolonging patient survival, have also contributed to the causation of significant aberrations in host defenses in the affected population. Due to compromised host resistance these patients are potentially vulnerable to a variety of opportunistic infections. Other clinical conditions such as HIV/AIDS, diabetes mellitus, major organ compromises like chronic renal failure and chronic liver diseases, etc. also predispose to opportunistic infections. In majority of these patients signs and symptoms of infection are often not well identified until the disease is far advanced. Therefore due to unusual presentation and lack of early detection often the infection and not the primary illness significantly contributes to the morbidity and mortality in such patients.
The challenges posed by these opportunistic agents are numerous. Early clinical suspicion, prompt investigations, pathological identification and timely management of these infections is essential so as to prevent the high morbidity and mortality associated with them. These agents are often not identified because of the ignorance about their morphological appearance on histopathology and/or cytological evaluation. Although sufficient text is available on microbiological, serological and molecular diagnosis of these infections, however, an updated comprehensive text with representative illustrations on the tissue identification of such infections is the need of the day and the present book fills the lacuna well.
The author during past 15 years of working at a tertiary care medical center performing large number of organ transplants in India, encountered a score of opportunistic infections during histopathological and cytological evaluation of various specimen obtained from immunocompromised patients, which form the basis of this book. The book is devoted entirely to the identification of opportunistic infections in pathological specimens in an appropriate clinical setting. It is written in simple language, the text is well compiled and the layout is clearly organized. The book has separate chapters dealing with opportunistic bacterial, viral, fungal and parasitic infections. A chapter on commonly encountered opportunistic infections as diagnosed on histopathology and/ or cytological evaluation at a tertiary care hospital by the author has also been included. Each chapter is well referenced. The book includes more than 80 high quality color microphotographs along with short clinical history of each case. An appendix on the techniques and interpretation of commonly performed histochemical stains useful in the identification of these infections for the practicing pathologists has also been incorporated.8
I hope that this illustrative and informative book shall be useful to a diverse group of medical fraternity including pathologists, microbiologists, general physicians, nephrologists, immunologists, oncologists, transplant surgeons and others as well.
Your suggestions and comments are welcomed.
March 2007
Lucknow
RK Gupta
9Acknowledgements
About a year and a half ago my son Dr Pallav Gupta, while preparing for his postgraduate medical entrance examination felt the need of having a comprehensive book on the pathological diagnosis of opportunistic infections. His suggestion coupled with my interest in the field attracted me to the possibility of writing such a book. I discussed the proposal with my friends and colleagues in various institutes interested in this field and sought their help and support in this endeavor.
Majority of the cases included in this book have been drawn from author's own material; while few others have been contributed by collaborators from other institutes.
I gratefully acknowledge the contribution of some of the interesting cases made by Prof Kusum Joshi, Head of Department Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Prof SK Shankar, Head of Department Neuropathology, NIMHANS, Bangalore, Prof Arun Chitale, Chief Consultant Pathologist, Jaslok Hospital, Mumbai and Prof KN Prasad, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. I am also grateful to my colleagues Dr Manoj Jain, Additional Professor and Dr Vinita Agrawal, Assistant Professor, Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow for extending all possible support in compilation of this book.
I also thank the publisher M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi not only for publishing but also making the book presentable.