This document discusses several common tropical diseases seen in surgery, including filariasis, leprosy, tropical chronic pancreatitis, and poliomyelitis. Filariasis is caused by a parasitic worm and can lead to lymphedema and elephantiasis. Leprosy is caused by Mycobacterium leprae and can result in skin lesions and nerve damage leading to claw hand deformities. Tropical chronic pancreatitis has unknown causes but is linked to poor nutrition and affects young people in developing countries. Poliomyelitis is caused by an enterovirus and while most cases are mild, it can also lead to paralysis requiring rehabilitation and surgical intervention.

1. Disease Burden And Distribution

2. “In surgery physiology is the king, anatomy the
queen: you can be the prince, but only
provided you have the judgement”
(Mosche Schein, Professor of Surgery, Cornell
University).

3. Learning Objectives
1. To be aware of common surgical problems in
tropics.
2. To appreciate patients do not seek medical
help until late in disease.
3. Emergency presentations of various common
conditions.

4. Common conditions
1. Typhoid.
2. Tuberculosis of Small Intestine.
3. Amoebiasis.
4. Ascaris Lumbricoides.
5. Hydatid Disease.
6. Filariasis.
7. Poliomyelitis.
8. Leprosy.
9. Asiatic Cholangiohepatitis.
10.Tropical Chronic Pancreatitis.

5. FILARIASIS
 Filariasis caused mainly by Wucheria bancrofti
in 90% of patients.
 In 10% it is caused by Brugia malayi and
timori.
 It is carried by mosquito and transmitted by its
bite.
 Two third of whole patients live in India.
 It is the second most common cause of long
term disability acc to WHO.

6. Diagnosis
 Males are affected more than females.
 Acute presentation: Episodic attacks of fever
lymphangitis and lymphadenitis.
 Chronic presentation: Appear after repeated
attacks over many years.
Adult worms cause lymphatic Obstruction.
Sup Lym Obstn: Peau d’ Orange
Elephantiasis Of lower limb,scrotum and penis.
Secondary streptococcal infection.

7. Elephantiasis Of Leg

8. Elephantiasis Of Leg

9. Elephantiasis Of Penis

10. Elephantiasis Of Scrotum

11. Cont…….
 Chyluria and chylous ascitis.
 A mild form of disease may affect resp system
causing dry cough and is known as Tropical
Pulmonary eosinophilia.
 Investigations: Eosinophilia
Microfilaria in nocturnal peripheral blood
Parasite in urine , ascitis and chylous fluid

12. Treatment
 Medical Treatment: Effective in early cases.
DOC is DEC
 In early stages of limb swelling: Intermittent
Pneumatic compression helps.
 Surgery: For hydrocele
Limb reduction surgeries are doubtful.

13. LEPROSY
 Also known as Hansen’s Disease.
 Caused by acid fast bacilli My.Leprae.
 Globally India, Bazil,Nepal……………accounts
for 91% of cases.
 Associated with social stigma.

14. Pathology
 The disease transmitted by nasal secretions.
Disease contracted in childhood after
incubation period of many years the disease
presents as skin, upper resp and neurological
menifestations.
 Can be of two types: Lepromatous and
Tuberculoid type.

15. Clinical Features And Diagnosis
 In Tuberculoid leprosy tissue damage occurs
early and is limited.
 Neural involvement characterised by
thickening of nerves which are tender.
 Assymetric, welldefined , hypopigmented or
erythrematous anaesthetic macules called
Leprids.
 Nodular lesions in face give rise to leonine
facies.

16.  Destruction of nasal bridge, loss of eyebrows etc.
 Claw hand because of ulnar and median nerve.
 Anaesthesia of hands and feet makes suceptible
to burns and injuries…….chronic infection,
contraction and autoamputation.
 Involvement of testis leads to atrophy.
 Confirmation of involvement by skin smear and
biopsy.

17. Social Outcast

18. Hypopigmented Patches

19. Autoamputation Of Fingers

20. Leonine Facies

21. Leonine Facies

22. Treatment
 Multidrug therapy advocated by WHO.
 Team approach.
 Surgical reconstruction.
 Education of patient and the public

23. TROPICAL CHRONIC PANCREATITIS
 Mysteious disease affecting young individuals
of lower socioeconomic strata in devloping
countries exclusively. Mostly seen in South
India.
 Unknown etiology. May be malnutrition,
dietary, familial and genetic influences play a
role.
 Alcohol ingestion doesn’t play a part in
etiology.

24. Aetiology
 Cassava(Tapioca): root vegetable consumed as
staple by poor. It contains derivatives of
cyanide which is detoxified by sulphur
containing amino acids in liver.
 Poor nutritional status leads to scarcity ofsuch
amino acids leading to cyanogen toxicity
causing disease.
 Proof of several members of family being
affected strengthens the theory.

25. Pathology
 Macroscopically: Pancreas is firm nodular with
extensive periductal fibrosis with intraductal
calcium carbonate stones.
 Microscopically: Fibrosis is predominant
feature.
 High incidence of Pancreatic cancer seen.

26. X-Ray

27. Pancreatic Calculi

28. Diagnosis
 Male, below 40 yrs from poor background.
 Severe abdominal pain, thirst with polyuria ith
features of pancreatic insufficiency.
 Blood and urine test reveal patient is Type 1
Diabetic.
 Increase amylase and lipase.
 Xray: Staghorn stones.
 USG, CT
 ERCP Done as therapeutic measure

29. Treatment
 Mainly Medical- pain relief with exocrine
support using pancreatic enzymes, treatment
of diabetes and improvement of nutritional
status.
 Surgery for intractable pain.
 Procedures are side to side
pancreatojejunostomy. Sometimes resection
needed in extreme cases.

30. POLIOMYELITIS
 It is a preventable enterovirus infection
affecting children.
 Virus enters the body by inhalation or
ingestion.
 Clinical Features: Mild form of fever and
headache lasting weeks to extreme variety of
paralysis of bulbar form.

31. Diagnosis
 Disease affects anterior horn cells causing
lower motor neuron paralysis.
 Muscles of lower limb affected twice more
than upper limbs.
 1 to 2% only paralytic symptom.
 Has to be diffrentiated from Guillian Barre
Syndrome

32. Management
I. Rehabilitation of patients with residual
paralysis.
II. Operation tailored to individual disabilities.
III. Improvement seen in muscle funtion for
upto 2 yrs after onset of illness.
IV. Core team comprises of Orthopaedic
surgeon and physiotherapist.

33. Goals of surgery
I. To correct muscular imbalances and
deformities of bone and soft tissues.
II. Tendon transfers for dynamic muscle
imbalance.
III. Arthrodesis for stabilization of flail joints and
orthoses for static joint instabilities.