Asian Pacific Journal of Tropical Biomedicine

Issue 7,2012 Table of Contents

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  • 1  Evaluation of berries of Phytolacca dodecandra for growth inhibition of Histoplasma capsulatum var. farciminosum and treatment of cases of epizootic lymphangitis in Ethiopia
    Negesse Mekonnen Eyasu Makonnen Nigatu Aklilu Gobena Ameni
    [Abstract](8) [HTML](0) [PDF 358.38 K](70)
    Objective: To evaluate the berries of Phytolacca dodecandra (P. dodecandra) for its effect on Histoplasma capsulatum var. farciminosum (HCF) and for the treatment of cases of epizootic lymphangitis (EL). Methods: Samples were collected from un-ruptured nodules of cases of EL at Debre Zeit and Akaki (central Ethiopia). Mycological culture and isolation of HCF were performed at the Aklilu Lemma Institute of Pathobiology. Phytochemical screening was done for n-butanol extract of P. dodecandra to detect alkaloids, saponins, phenolic compounds and flavonoids. The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of aqueous and n-butanol extracts of P. dodecandra against HCF were determined by agar dilution assay. For the in vivo trial, 5% simple ointment was prepared from n-butanol extract and applied topically to 24 (twelve early and twelve moderate) cases of EL. Results: Phytochemical screening showed that n-butanol extract of P. dodecandra was positive for alkaloids, saponins and phenolic compounds but negative for flavonoids. The MICs of n-butanol and aqueous extracts of P. dodecandra were (0.039%-0.078%) and (0.625%-1.250%), respectively. The MFCs of n-butanol and aqueous extracts of P. dodecandra were (0.078%-0.156%) and (1.250%-2.500%), respectively. The MIC and MFC of ketoconazole (positive control) was (1.200×10-5%-2.500×10-5%) and (5.000×10-5%-1.000×10-4%), respectively while growth was observed on free medium (negative control). From the total of 24 treated cases of EL, 14 (58.3%) responded to treatment; however, 10 (41.7%) did not respond to treatment. There was no significant difference in the degree of response to treatment between early and moderate cases (χ2=0.686; P=0.408). Conclusions: It can be concluded that n-butanol extract of P. dodecandra demonstrates antifungal effects while the aqueous extract shows no antifungal activity.
    2  Protective effect of Pisonia aculeata on thioacetamide induced hepatotoxicity in rats
    Anbarasu C Rajkapoor B Bhat KS John Giridharan A Arul Amuthan Satish K
    [Abstract](17) [HTML](0) [PDF 265.45 K](80)
    Objective: To evaluate the protective effect of Pisonia aculeata (P. aculeata) on thioacetamide induced hepatotoxicity in rats. Methods: Male Wistar rats were administered 250 or 500 mg/kg p.o. of P. aculeata extract for 21 days and simultaneously administered thioacetamide (TAA) 50 mg/ kg bw s.c. 1 h after the respective assigned treatments every 72 h. At the end of all experimental methods, all the animals were sacrificed by cervical decapitation. Blood samples were collected. Serum was separated and analyzed for various biochemical parameters. Results: TAA induced a significant rise in aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP), total bilirubin, gamma glutamate transpeptidase (GGTP), lipid peroxidase (LPO) with a reduction of total protein, superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx) and glutathione S-transferase (GST). Treatment of rats with different doses of plant extract (250 and 500 mg/kg) significantly (P<0.001) altered serum marker enzymes and antioxidant levels to near normal against TAA treated rats. The activity of the extract at a dose of 300 mg/kg was comparable to the standard drug, silymarin (50 mg/kg, p.o.). Conclusions: It can be concluded that P. aculeata extract possesses a remarkable hepatoprotective and antioxidant activity against TAA induced hepatotoxicity. More research is required to derive an optimal therapeutic dose.
    3  In-vitro antimicrobial activity screening of some ethnoveterinary medicinal plants traditionally used against mastitis, wound and gastrointestinal tract complication in Tigray Region, Ethiopia
    Shewit Kalayou Mekonnen Haileselassie Gebremedhin Gebre-egziabher Tsegay Tiku’e Samson Sahle Habtamu Taddele Mussie Ghezu
    [Abstract](25) [HTML](0) [PDF 293.57 K](77)
    Objective: To screen the antibacterial activity of nine ethnoveterinary plants traditionally used for the treatment of mastitis, wound and gastrointestinal complications. Methods: Hydroalcoholic exctracts of medicinal plants namely, Achyranthes aspera (A. aspera) L. (Family Asparagaceae), Ficus caria (F. caria) (Family Moraceae), Malvi parviflora (M. parviflora) (Family Malvaceae), Vernonia species (V. species) (local name Alakit, Family Asteraceae), Solanum hastifolium (S. hastifolium) (Family Solanaceae), Calpurinia aurea (C. aurea) (Ait) Benth (Family Fabaceae), Nicotiana tabacum (N. tabacum) L. (Family Solanaceae), Ziziphus spina-christi (Z. spina-christi) (Family Rhamnaceae), Croton macrostachys (C. macrostachys) (Family Euphorbiaceae), were screened against clinical bacterial isolates of veterinary importance from October 2007 to April 2009. The antibacterial activity was tested using disc diffusion at two concentrations (200 mg/mL and 100 mg/mL) and broth dilution methods using 70% methanol macerated leaf extracts. Results: With the exception of S. hastifolium all plant extracts exhibited antibacterial activity. Among the medicinal plants tested C. aurea, C. macrostachyus, A. aspera, N. tabacum and vernonia species (Alakit) showed the most promising antimicrobial properties. Conclusions: It can be concluded that many of the tested plants have antibacterial activity and supports the traditional usage of the plants for mastitis, wound and gastrointestinal complications treatment. Further studies into their toxicity and phytochemistry is advocated.
    4  Antidiabetic and hypolipidemic activities of ethanolic leaf extract and fractions of Melanthera scandens
    Enomfon J Akpan Jude E Okokon Emem Offong
    [Abstract](16) [HTML](0) [PDF 293.28 K](71)
    Objective: To evaluate the antidiabetic and hypolipidemic activities of ethanolic leaf extract and fraction of Melanthera scandens (M. scandens) in alloxan-induced diabetic rats. Methods: M. scandens leaf extract/fractions (37-111 mg/kg) were administered to alloxan-induced diabetic rats for 14 days and blood glucose levels (BGL) of the diabetic rats were monitored at intervals of 7 hours for acute study and 14 days for prolonged study. Lipid profiles of the treated diabetic rats were determined after the period of treatment. Results: Treatment of alloxan-induced diabetic rats with the extract/fractions caused a significant (P<0.001) reduction in fasting bloodglucose levels (BGL) of the diabetic rats both in acute study and prolonged treatment (2 weeks). The activities of the extract and fractions were more than that of the reference drug, glibenclamide. The extract/fractions exerted a significant reduction in the levels of serum total cholesterol, triglycerides, LDL and VLDL of extract with increases in HDL levels of the diabetic rats. Conclusions: These results suggest that the leaf extract/fractions of M. scandens possesses antidiabetic effect on alloxan induced diabetic rats and this justifies its use in ethno medicine and can be exploited in the management of diabetes.
    5  Anti-oxidative role of quercetin derived from Allium cepa on aldehyde oxidase (OX-LDL) and hepatocytes apoptosis in streptozotocin-induced diabetic rat
    Mina Bakhshaeshi Arash Khaki Fatemeh Fathiazad Amir Afshin Khaki Elham Ghadamkheir
    [Abstract](32) [HTML](0) [PDF 288.65 K](74)
    Objective: To study the role of Quercetin in streptozotocin-induced diabetes in rats. Methods: Wistar male rat (n=40) were allocated into three groups, control group (n=10) and Quercetin (QR) group received 15 mg/kg (IP) QR, (n=10), and diabetic group that received 55 mg/kg (IP) streptozotocin (STZ) (n=20) which was subdivided to two groups of 10; STZ group and treatment group. Treatment group received 55 mg/kg (IP) STZ plus 15 mg/kg QR, daily for 4 weeks, respectively; however, the control group just received an equal volume of distilled water daily (IP). Diabetes was induced by a single (IP) injection of streptozotocin (55 mg/kg). Animals were kept in standard condition. Twenty-eight days after inducing diabetic, 5 mL blood were collected for TAC, MDA and Ox-LDL levels and liver tissues of rat in whole groups were removed then prepared for apoptosis analysis by Tunel method. Results: Apoptotic cells significantly decreased in group that has received 15 mg/kg (IP) Quercetin (P<0.05) in comparison to experimental groups (P<0.05). Conclusions: Since in our study 15 mg/kg (IP) Quercetin have significantly Preventive effect on liver cells damages by reducing number of apoptotic cells in Liver, so it seems that using it can be effective for treatment in diabetic rat.
    6  Molecular study of HCV detection, genotypes and their routes of transmission in North West Frontier Province, Pakistan
    Asher Zaman Safi Yasir Waheed Joharia Sadat Solat-Ul-Islam Sadia Salahuddin Umar Saeed Muhammad Ashraf
    [Abstract](17) [HTML](0) [PDF 305.47 K](74)
    Objective: To determine hepatitis C virus (HCV) genotypes and explore the associated risk factors in chronic HCV patients. Methods: A total of 116 patients with chronic hepatitis C were subjected to polymerase chain reaction (PCR) based detection out of which 112 chronic HCV patients [53 male (47.32%), 59 female (52.68%); mean age (43.76±16.40) years; mean BMI (23.8±3.9) kg] were enrolled in this study. The frequency of 6 HCV genotypes and associated risk factors were evaluated from five districts of North West Frontier Province (NWFP). Results: Genotype 3 was the most prevalent in 73 samples (65.17%) followed by genotype 1 in 24 (21.42%) and genotype 2 in 13 (11.60%) samples. Genotype 3 had significantly high prevalence (P=0.0002). The results showed that 48 (42.85%) samples were infected with HCV 3a; 25 (22.32%) with 3b; 14 (12.50%) with 1a; 10 (8.92%) with 1b; 11 (9.82%) with 2a; 2 (1.78%) with 2b; and 2 were untypable. The distribution of HCV genotypes in Mardan, Charsadda, Peshawar, Sawabi and Nowshehra districts was different. Use of unsterile equipment for medication, barbers and previous history of hospitalization were the main risk factors for HCV transmission. Conclusions: Genotype 3a and 3b, 1a, 1b and 2a are the common genotypes in NWFP. Genotype 4, 5, and 6 can not be found in a single sample. The level of awareness about various modes of transmission of HCV among the population is found to be very low.
    7  Antiepileptic activity of lobeline isolated from the leaf of Lobelia nicotianaefolia and its effect on brain GABA level in mice
    Abrar M Tamboli Rukhsana A Rub Pinaki Ghosh SL Bodhankar
    [Abstract](17) [HTML](0) [PDF 333.06 K](75)
    Objective: To investigate the anticonvulsant activity of the lobeline isolated from the Lobelia nicotianaefolia in chemoconvulsant-induced seizures and its biochemical mechanism by investigating relationship between seizure activities and altered gamma amino butyric acid (GABA) in brain of mice in Pentylenetetrazol (PTZ) seizure models. Methods: The anticonvulsant activity of the isolated lobeline (5, 10, 20 and 30 mg/kg, i.p.) was investigated in PTZ and strychnine induced seizures in mice and the effect of isolated lobeline on brain GABA level in seizures induced by PTZ. Diazepam was used as reference anticonvulsant drugs for comparison. Results: Isolated lobeline (10, 20 and 30 mg/kg, i.p.) significantly delayed and antagonized (P < 0.050–0.001) the onset of PTZ-induced seizures. It also antagonized strychnine induced seizures. The mortality was also prevented in the test group of animals. In biochemical evaluation, isolated lobeline (5, 10 and 20 mg/kg, i.p.) significantly increased the brain GABA level. And at dose of 30 mg/kg GABA level showed slight decrease in PTZ model. Conclusions: In our findings, isolated lobeline (20mg/ kg) exhibited potent anticonvulsant activity against PTZ induced seizures. Also a biochemical evaluation suggested significant increase in barain GABA level at 20 mg/kg i.p. of isolated lobeline. Hence, we may propose that lobeline reduces epileptic seizures by enhancing the GABA release supporting the GABAergic mechanism.
    8  Antidiabetic and hypolipidemic activities of Kigelia pinnata flowers extract in streptozotocin induced diabetic rats
    Kumar S Kumar V Prakash OM
    [Abstract](6) [HTML](0) [PDF 240.18 K](81)
    Objective: To evaluate antidiabetic and hypolipidemic activities of Kigelia pinnata methanolic flowers extract in streptozotocin (STZ) induced diabetic wistar rat. Methods: Rats were made diabetic by a single dose of STZ at 60 mg/kg body weight i.p. The blood glucose level was checked before and 72 h after STZ injection to confirm the development of diabetes. The flower extract and glibenclamide were administered orally at the doses of 250 and 500 mg/kg body weight for 21 days. Results: Daily oral treatment with the extract and standard drug for 21 days significantly reduced blood glucose, serum cholesterol and triglycerides levels. High density lipoprotein-cholesterol level was found to be improved (P<0.01) as compared to diabetic control group. Conclusions: It is concluded that Kigellia pinnata flowers extract have significant antidiabetic and hypolipidemic effect.
    9  Antioxidant potential of phenolic extracts of Mimusops elengi
    Durre Shahwar Muhammad Asam Raza
    [Abstract](17) [HTML](0) [PDF 307.02 K](72)
    Objective: To evaluate the antioxidant potential of the phenolic extracts of Mimusops elengi (M. elengi) L. (Sapotaceae). Methods: The extract of stem bark and seeds of M. elengi were prepared in methanol and acetone:water (7:3). The acetone: water was further partitioned with ethyl acetate and n-butanol. Antioxidant activity of the extracts and partitioned fractions of M. elengi was evaluated in terms of radical scavenging potential (DPPH), inhibition of lipid peroxidation [ferric thiocyanate (FTC)], and total antioxidant activity (phosphomolybdate method). Total phenolics content were calculated using Folin-Ciocalteu reagent. Results: The stem bark extract partitioned with ethyl acetate exhibited highest amount of total phenols (98.0 mg GAE/g dry weight), among all other extracts, with 92.0% DPPH radical scavenging activity at concentration of 0.5 mg/mL, while methanol extract (stem bark) had maximum inhibition of lipid peroxidation (62.0%) and total antioxidant activity (771.0 mg/g GAE/g). A positive correlation occurred between total phenols and radical scavenging activity (R2 = 0.922 9) and total antioxidant activity (R2 = 0.945 1). Conclusions: Our study suggested that antioxidant activity of stembark extract of M. elengi is due the presence of phenolic compounds. Furthermore, the bark extract is a valuable source of natural antioxidants.
    10  Resolution pattern of jaundice among children presenting with severe malaria in rural South-West Nigeria
    Osonuga OA Osonuga A Osonuga AA Osonuga IO
    [Abstract](20) [HTML](0) [PDF 245.78 K](81)
    Objective: To compare the pattern of jaundice resolution among children with severe malaria treated with quinine and artemether. Methods: Thirty two children who fulfilled the inclusion criteria were recruited for the study from two hospitals with intensive care facilities. They were divided into two groups; ‘Q’ and ‘A’, receiving quinine and artemether, respectively. Jaundice was assessed by clinical examination. Results: Sixteen out of 32 children recruited (representing 50%) presented with jaundice on the day of recruitment. The mean age was (7.00±2.56) years. On day 3, four patients in ‘A’ and six patients in ‘Q’ had jaundice. By day 7, no child had jaundice. Conclusion: The study has shown that both drugs resolve jaundice although artemether relatively resolves it faster by the third day.
    11  Antifungal activity of four honeys of different types from Algeria against pathogenic yeast: Candida albicans and Rhodotorula sp.
    Ahmed Moussa Djebli Noureddine Aissat Saad Meslem Abdelmelek Benhalima Abdelkader
    [Abstract](18) [HTML](0) [PDF 280.62 K](72)
    Objective: To evaluate the antifungal activity of four honeys of different types from Algeria against pathogenic yeast i.e. Candida albicans (C. albicans) and Rhodotorula sp. Methods: Four Algeria honeys of different botanical origin were analyzed to test antifungal effect against C. albicans, and Rhodotorula sp. Different concentrations (undiluted, 10%, 30%, 50% and 70% w/v) of honey were studied in vitro for their antifugal activity using C. albicans and Rhodotorula sp. as fungal strains. Results: The range of the diameter of zone of inhibition of various concentrations of tested honeys was (7-23 mm) for Rhodotorula sp., while C. albicans showed clearly resistance towards all concentrations used. The MICs of tested honey concentrations against C. albicans and Rhodotorula sp. were (70.09-93.48)% and (4.90-99.70)% v/v, respectively. Conclusions: This study demonstrates that, in vitro, these natural products have clearly an antifungal activity against Rhodotorula sp. and C. albicans.
    12  Toxicological studies for some agricultural waste extracts on mosquito larvae and experimental animals
    Somia El-Maghraby Galal A Nawwar Reda FA Bakr Nadia Helmy Omnia MHM Kamel
    [Abstract](24) [HTML](0) [PDF 299.24 K](71)
    Objective: To evaluate some agricultural waste extracts as insecticide and their effects on enzyme activities in liver and kidney of male mice. Methods: The insecticidal activity of five tested compounds (one crude extract and 4 waste compounds) was bioassay against the 3rd instars of the Culex pipiens (Cx. pipiens) larvae in the laboratory. The LC50 values of eucalyptol, apricot kernel, Rice bran, corn, black liquor and white liquor are 91.45, 1 166.1, 1 203.3, 21 449.65, 4 025.78 and 6 343.18 ppm, respectively. Selection of the compounds for the subsequent studies was not only dependent on LC50 values but also on the persistence of these wastes products on large scale. Results: White and black liquor did not produce any gross effect at 200 mg/Kg body weight. No apparent toxic symptoms were observed in tested animals during the whole period of the experiment which run out for 14 days. No statistically significance was observed in the enzyme cholinesterase activity, the activities of liver enzymes and kidney function in treated mice with black and white liquors. While, no and slight inhibition was observed after the 2 weeks of treatment period with deltamethrin and fenitrothion reached to about 24% in plasma cholinesterase enzyme activity. Significantly increase in the activities of liver enzymes and kidney function in treated mice with deltamethrin and fenitrothion. Conclusions: Black liquor can be used efficiently to control Cx. pipiens larvae under laboratory condition. Environmental problem caused by rice straw can be solved by converting the waste material to beneficial natural selective insecticide.
    13  Organophosphorous residue in Liza aurata and Cyprinus carpio
    Mansoreh Shayeghi Mehdi Khoobdel Fatemeh Bagheri Mohammad Abtahi Hojjatollah Zeraati
    [Abstract](6) [HTML](0) [PDF 319.68 K](72)
    Objective: To determine the amount of azinphos methyl and diazinon residues in two river fishes, Liza aurata and Cyprinus carpio, in the north of Iran. Methods: This study was done during 2006-2007. In this survey, 152 water and fish samples from Gorgan and Qarasu rivers, north of Iran, were investigated. Sampling was done in three predetermined stations along each river. Organophosphorus compounds (OPs) were extracted from the fishes and the water of rivers. After extraction, purification and concentration processes, the amount and type of insecticides in water and fish samples were determined by high performance thin layer chromatography (HPTLC). Results: There was a significant difference in the residue of the insecticides in the water and fish samples between summer and other seasons in the two rivers. The highest amount of insecticides residue was seen during summer. In both rivers, the amount of diazinon and azinphos methyl residues in the two fishes was more than 2 000 mg/L in summer. There was no significant difference in insecticides residue between the fishes in two rivers. The diazinon residue was higher than the standard limits in both rivers during the spring and the summer, but the residual amount of azinphos methyl was higher than the standard limits only during the summer and only in Qarasu River. Conclusions: It can be concluded that the amount of OPs in the water and the two fishes, Liza aurata and Cyprinus carpio, is higher than the permitted levels.
    14  Bioactivity of seagrass against the dengue fever mosquito Aedes aegypti larvae
    M Syed Ali S Ravikumar J Margaret Beula
    [Abstract](8) [HTML](0) [PDF 270.08 K](71)
    Objective: To identify the larvicidal activity of the seagrass extracts. Methods: Seagrass extracts, Syringodium isoetifolium (S. isoetifolium), Cymodocea serrulata and Halophila beccarii, were dissolved in DMSO to prepare a graded series of concentration. Batches of 25 early 4th instars larvae of Aedes aegypti (Ae. aegypti) were transferred to 250 mL enamel bowl containing 199 mL of distilled water and 1 mL of plant extracts (0.01 mg – 0.1 mg). After 24 h the mortality rate was identified with the formulae [(% of test mortality - % of control mortality)/(100 - % of control mortality)] × 100. Each experiment was conducted with three replicates and a concurrent control group. A control group consisted of 1 mL of DMSO and 199 mL of distilled water only. Results: The root extract of S. isoetifolium showed maximum larvicidal activity with minimum concentration of extract of LC50= 0.0 604 ± 0.0 040)μg/mL with lower confidence limit (LCL) - upper confidence limit (UCL) = (0.051-0.071) and LC90=0.0 972μg/mL followed by leaf extract of S. isoetifolium showed LC50= (0.062 × 0.005)μg/mL. The regression equation of root and leaf extract of S. isoetifolium for 4th instar larvae were Y= 4.909 + 1.32x (R2 = 0.909) and Y= 2.066 + 1.21x (R2 =0.897) respectively. The results of the preliminary phytochemical constituents shows the presence of saponin, steroids, terpenoid, phenols, protein and sugars. Conclusions: From the present study the ethanolic extracts of seagrass of S. isoetifolium possesses lead compound for development of larvicidal activity.
    15  Synthesis of silver nanoparticles using leaves of Catharanthus roseus Linn. G. Don and their antiplasmodial activities
    Ponarulselvam S Panneerselvam C Murugan K Aarthi N Kalimuthu K Thangamani S
    [Abstract](35) [HTML](0) [PDF 352.93 K](85)
    Objective: To develop a novel approach for the green synthesis of silver nanoparticles using aqueous leaves extracts of Catharanthus roseus (C. roseus) Linn. G. Don which has been proven active against malaria parasite Plasmodium falciparum (P. falciparum). Methods: Characterizations were determined by using ultraviolet-visible (UV-Vis) spectrophotometry, scanning electron microscopy (SEM), energy dispersive X-ray and X-ray diffraction. Results: SEM showed the formation of silver nanoparticles with an average size of 35-55 nm. X-ray diffraction analysis showed that the particles were crystalline in nature with face centred cubic structure of the bulk silver with the broad peaks at 32.4, 46.4 and 28.0. Conclusions: It can be concluded that the leaves of C. roseus can be good source for synthesis of silver nanoparticle which shows antiplasmodial activity against P. falciparum. The important outcome of the study will be the development of value added products from medicinal plants C. roseus for biomedical and nanotechnology based industries.
    16  Biological activities and medicinal properties of Gokhru (Pedalium murex L.)
    V Rajashekar E Upender Rao Srinivas P
    [Abstract](19) [HTML](0) [PDF 272.85 K](77)
    Bada Gokhru (Pedalium murex L.) is perhaps the most useful traditional medicinal plant in India. Each part of the neem tree has some medicinal property and is thus commercially exploitable. During the last five decades, apart from the chemistry of the Pedalium murex compounds, considerable progress has been achieved regarding the biological activity and medicinal applications of this plant. It is now considered as a valuable source of unique natural products for development of medicines against various diseases and also for the development of industrial products. This review gives a bird’s eye view mainly on the biological activities of some of this compounds isolated, pharmacological actions of the extracts, clinical studies and plausible medicinal applications of gokharu along with their safety evaluation.
    17  Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient
    Juanarita Jaafar Wan Hazabbah Wan Hitam Raja Azmi Mohd Noor
    [Abstract](17) [HTML](0) [PDF 245.56 K](79)
    A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

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