Case Reports, Infectious Diseases and the Developing WorldGeoffrey Pasvol

Professor of Infection & Tropical MedicineConsultant in Infection & Tropical Medicine

Associate Editor, Transactions of the Royal Society of Tropical Medicine & HygieneDirector, Imperial Wellcome Centre for Clinical Tropical Medicine

Imperial College London

Celebrating Case Reports, Friday May 15, 2009

Out of the Tropics/Developing World …………

‘ex Africa semper aliquid novi’Pliny the Elder

Infectious Diseases, Tropical Medicine a truly fertile ground- rich in variety, complexity and intrigue

The Triad in Case Reports

The Reader

The Author

The Editor

So why NOT Case Reports?

• The Reader

»Anecdotal

»Unsubstantiated

»Unedifying

»Unscientific

• The Author

»Lengthy review process

»Pot luck!

• The Editor

»Impact factor

»Who will review

»Titles/keywords to confuse or reveal?

• “CR remain CR”

So why Case Reports?

• The Reader

»Aids clinical practice

»Stimulating

»Interesting

»Challenging

• The Author

»A step on the publication ladder

»Source of research ideas

»Important eg ADR

• The Editor

»Readable

»Space-filler

Transactions of the Royal Society of Tropical Medicine & Hygiene

•One of the top ranked Journals in Tropical Medicine

•Impact Factor 2-3

•Published since 1907

•Online submission free of page charges

•Manuscripts - peer-reviewed online

•Accepted papers - published electronically on ScienceDirect® and immediately indexed by PubMed

•8 Case reports Jan 2008- May 2009

From Bhubaneswar, India

A successful outcome of gross haematuria (due to lymphatic filariasis) treated with diethylcarbamazine and ivermectin.

Kerketta et al, 2008

From New Delhi, India

Cutaneous leishmaniasis in Nepal:

Leishmania major as a cause.

Kumar et al, 2008

From New Delhi, India

Immune response following miltefosine therapy in a patient with post-kala-azar dermal leishmaniasis.

Ansari et al, 2008

From Alexandroupolis, Greece

Maggot infestation (myiasis) of external fixation pinsites in diabetic patients.

Verettasa et al, 2008

From Piaui, Brazil

Myiasis in the uterine cavity of an elderly woman with a complete uterine prolapse.

Lopes-Costa et al, 2008

From Lima, Peru

Cervical tumor caused by the sexually mature stage of Fasciola hepatica.

Luis et al, 2009

From Cape Town, South Africa

First case report of pharyngeal cysticercosis.

Sobnach et al, 2009

From Khon Kaen, Thailand

Sequential imaging studies of cerebral gnathostomiasis with subdural hemorrhage as its complication.

Sawanyawisutha et al, 2009Gnathostoma spinigerum

Case Reports and the Developing World• The Reader

»Access: Internet, CD, DVD, paper, laminated cards»A repository of knowledge»‘Small Is Beautiful’

• The Author»Disadvantaged: Lacks diagnostic tools (esp dev countries) »Language»Open access?»Encouraging»Inclusive

• The Editor»Colour; powerful image»Reviewing- what allowances»Copyediting

Confessions…………

1. 1984 Pneumonia due to Legionella bozemanii first report of a case in Europe. Journal of Infection 8: 251-255.

2. 1996 Leptospirosis in pregnancy: an unusual and relatively unrecognised cause of death in man. Journal of Obstetrics and Gynaecology 16: 163-165

3. *1996 Fatal quinine cardiotoxicity in the treatment of falciparum malaria. Transactions Royal Society of Tropical Medicine 90: 305-307.

4. 2000 Acute adrenal insufficiency precipitated by isolated involvement of the adrenal gland by tuberculosis. Journal of Infection. 39: 244-245.

5. *2002 Malarone ® treatment failure and in vitro confirmation of resistance of P falciparum isolate from Lagos, Nigeria. Malaria Journal 1(1) 1-4

6. 2002 Severe acute symptomatic hyponatraemia in falciparum malaria. Transactions of the Royal Society of Tropical Medicine 96: 647-648

7. 2003 Amoebic abscess in the left lobe of the liver masquerading as pyelonephritis. Journal of Infection 46: 249-250

8. *2005 Kikuchi's disease: a rare cause of meningitis? Clinical Infectious Diseases. 41:e80-2.

9. *2005 Pneumococcal meningitis and etanercept--chance or association? Journal of Infection. 51:E49-51.

10. (2005) Images in clinical medicine Chromoblastomycosis. New England Journal of Medicine. 352: e19.

11. (2005) Successful treatment of severe Kikuchi’s disease with intravenous immunoglobulin. Rheumatology. 235-236

“From Case Report to Clinic……”

“From Case Report to Clinic……”

“From Case Report to Clinic……”

So for all……….

• Raises questions

• Ambivalence

• The best- the worst

• Just because they are fun, harmless but possess potential

• Teach, research and practice

• So why not celebrate?

Lest anyone doubt ………………….

‘I come to celebrate case reports, not to bury them!’

Plenty the Wiser

Acknowledgements

Bo Drasar (Editor) and The Transactions of the Royal Society of Tropical Medicine and Hygiene

www.rstmh.org/transactions.asp

Healthcare Information for all by 2015

www.hifa2015.org

The Organisers