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Histopathological diagnosis Deep biopsy is obtained under general or regional anaesthesia, although the chance of local spread is high. The biopsy should be adequate, contain grains and should be fixed immediately in 10% formal saline. Three types of host tis...

Imaging techniques On ultrasonography , an abscess cavity in the liver is seen as a - hypoechoic or anechoic lesion with ill-defined borders; internal echoes suggest necrotic material or debris ( Figure 6.1 ). The - investigation is very accurate and is used fo...

Introduction and pathology Hydatid disease is caused by Echinococcus granulosus, commonly called the dog tapeworm. The disease is globally distributed and, while it is common in the tropics, it is much less common in other countries; for example, in the UK t...

INTRODUCTION Most surgical conditions in the tropics (regions of the Earth surrounding the equator) are associated with parasitic infesta tions and infections related to poor hygienic conditions. With the ease of international travel, diseases that are commo...

Investigations The haematological and biochemical investigations reflect the presence of a chronic infective process: anaemia, leukocytosis, raised inflammatory markers – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – hypoalbuminaemia and d...

LEPROSY Introduction Leprosy , also called Hansen’s disease, is a chronic infectious disease caused by an acid-fast bacillus, Mycobacterium leprae, that is widely prevalent in the tropics. Globally , India, Brazil, Nepal, Mozambique, Angola and Myanmar account...

Learning objectives To be able to list: The common surgical infections and infestations that • occur in the tropics To appreciate: That many patients do not seek medical help until late • in the course of the disease because of socioeconomic reasons To be able...

MYCETOMA Introduction Mycetoma is a chronic, specific, granulomatous, progressive, destructive inflammatory disease that involves the skin, subcu taneous tissues and deeper structures. The causative organism may be true fungi, when the condition is called eumyce...

Management Surgical management is directed mainly towards the rehabili - tation of the patient who has residual paralysis, the operations being tailored to the particular individual’s disability . Children especially may show improvement in their muscle functi...

POLIOMYELITIS Introduction Poliomyelitis is an enteroviral infection that sadly still a ff ects children in certain parts of the world – this is in spite of e ff ec - tive vaccination having been universally available for several decades. The virus enters the ...

Pathogenesis y are The organism enters the gut through food or water contam - inated with the cyst. In the small bowel, the cysts hatch and a large number of trophozoites are released and carried to the colon, where flask-shaped ulcers form in the submucosa. f...

Pathology and life cycle The fertilised eggs can survive in a hostile environment for a long time. The hot and humid conditions in the tropics are ideally suited for the eggs to turn into embryos. The fertilised eggs are present in soil contaminated with infec...

Pathology In humans, the parasite matures into the adult worm in the intrahepatic biliary radicles, where it may reside for many years. The intrahepatic bile ducts are dilated, with epithelial hyperplasia and periductal fibrosis. These changes may lead to dyspl...

Pulmonary hydatid disease The lung is the second commonest organ a ff ected after the liver. The size of the cyst can vary from very small to a considerable size. The right lung and lower lobes are slightly more often involved. The cyst is usually single, alth...

ROUNDWORM ( ASCARIS LUMBRICOIDES ) Introduction Ascaris lumbricoides, commonly called the roundworm, is the commonest intestinal nematode to infect humans and a ff ects a quarter of the world’s population. The parasite causes pulmonary symptoms as a larva and ...

Spread Local spread occurs predominantly along tissue planes. The organism multiplies to form colonies that spread along the fascial planes to skin and underlying structures. Lymphatic spread, more common in actinomycetoma, occurs to the regional lymph nodes, ...

Surgical treatment Surgery is indicated for small, localised lesions, resistance to medical treatment or for a better response after medical treatment in patients with massive disease. Excision may need to be much more extensive than suggested at first on clini...

TROPICAL CHRONIC PANCREATITIS Introduction Tropical chronic pancreatitis is a disease a ff ecting the younger generation from poor socioeconomic strata in resource-poor countries, seen mostly in southern India. The aetiology remains obscure, with malnutrition, ...