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Hepatitis E virus (HEV) usually causes self-limiting acute hepatitis, but the disease can become chronic in immunocompromised individuals. HEV infection in pregnant women is reported to cause up to 30% mortality, especially in the third trimester. Additionally, extrahepatic manifestations like neuronal and renal diseases and pancreatitis are also reported during the course of HEV infection. The mechanism of HEV pathogenesis remains poorly understood. Innate immunity is the first line of defense triggered within minutes to hours after the first pathogenic insult. Growing evidence based on reverse genetics systems, in vitro cell culture models, and representative studies in animal models including non-human primates, has implicated the role of the host’s innate immune response during HEV infection. HEV persists in presence of interferons (IFNs) plausibly by evading cellular antiviral defense. This review summarizes our current understanding of recognizing HEV-associated molecular patterns by host cell Pattern Recognition Receptors (PRRs) in eliciting innate immune response during HEV infection as well as mechanisms of virus-mediated immune evasion.

Necrotising fasciitis is one of the fatal skin and soft tissue infections. Vibrio vulnificus is a rare cause of necrotising fasciitis; however, the disease is one of the major manifestations of the bacteria. Here, we report one such case in a middle-aged male patient. He presented with the signs of bilateral lower limb cellulitis and altered sensorium. V. vulnificus was isolated from blood culture and also from debrided tissue. Though the organism is well characterised, it is a rare causative agent of necrotising fasciitis. This case is a re-emphasis on active look out for this bacterium in patients presenting with necrotizsing fasciitis.

Salmonella Typhi cause a broad spectrum of human illnesses like gastroenteritis, typhoid fever, and bacteremia. It has also been recognized as a causative organism of osteomyelitis for more than a century but the incidence appears to be uncommon. Microbiological workup plays important role in the diagnosis of Typhoid spondylodiscitis as most of the time it mimics tuberculosis and misguide the clinician, especially in the developing world. Here, we reported an uncommon case of lumbar spondylodiscitis by Salmonella Typhi in an immunocompetent teenager, with the help of clinical, microbiological and radiological evidence. The case was managed conservatively after posterior spinal stabilization.

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Hydatid disease is an important emerging neglected disease worldwide, with significant geographic variation in seroprevalance. The disease is commonly diagnosed on basis of clinical suspicion, imaging and serology. This study was conducted to evaluate our experience with serology in diagnosing hydatid disease in terms of identifying the numbers of patients testing positive for antibodies against Echinococcus, and to study their clinical profile. This retrospective study included all patients who tested for anti-Echinococcus IgG antibodies by ELISA in the years 2014-2015. The clinical characteristics of seropositive patients were contrasted with seronegative patients, and the test results were correlated with radiological findings and, where performed, with histopathological studies. Analysis was performed on SPSS (IBM, Inc). Chi-square test was used to statistically compare between patient groups. Out of 54 patients evaluated by serology for Echinococcosis during the study period, Fourteen (26%) were seropositive. The two groups were comparable with respect to age, gender and most hematological parameters, excepting eosinophilia, which was more frequent among seropositive patients (28.6% vs. 2.5%; p=0.01). Alkaline phosphatase also tended to be higher among seropositives (42.9% vs 20%; p=0.09). Liver was the most frequent site involved (12 patients; 86%). Of the 29 patients who also underwent biopsy, all the seven patients with positive biopsy were seropositive, suggesting 100% sensitivity. The specificity was 81.8%, but this might be a lower estimate due to potentially high rate of false-negative biopsies, as all the seropositive patients also had imaging features suggestive of disease. The positive and negative predictive values were 63.6% and 100%, respectively. ELISA for detection of anti-Echinococcus antibodies is a simple serological test that helps in correlation with imaging finding in the diagnosis and subsequent management of hydatid disease.

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