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Infective endocarditis, a great masquerader, is a clinical entity which may present with a myriad of manifestations. Its changing epidemiological profile has been studied in the previous decades in both the developed and the developing nations. In this study, we strived to uphold the evolving clinical profile and its outcome from a government tertiary care hospital in Northern India. It was a descriptive, cross-sectional, observational study conducted over two years' period involving 44 patients diagnosed with definite infective endocarditis, according to modified Dukes' criteria. Demographic, clinical, microbiological, and echocardiographic data were analysed. Mean age of patients was 31 years. Rheumatic heart disease with regurgitant lesions was the commonest risk factor. Dyspnea and fever were the predominant symptom, and pallor and heart failure the commonest sign. Cultures were positive in 52% with Staphylococcus, the major isolate. Transesophageal echocardiography fared better than transthoracic one to define the vegetations. Mortality is reported in 4.5%. Prolonged duration of fever, pallor, hematuria, proteinuria, rheumatoid factor positivity, and large vegetations proved to be poor prognostic variables. Culture positive endocarditis, with persistent bacteremia, had higher incidence of acute renal failure. Right sided endocarditis was frequent in congenital lesions or IV drug user, whereas left sided endocarditis mostly presented with atrial fibrillation.

examination were normal, hemoglobin (Hb) was 6.2 gm% and TLC was normal. The thyroid proÞ le and reproductive hormonal proÞ le, including prolactin levels, were normal, with a normal chest X-ray. Mantoux test was positive at 25×25 cm and ESR was raised-48 mm in Þ rst hour. IgG ELISA for TB (Tuberculosis) was high positive, i.e., greater than 400 U/ml (Immuno Vision's M. tuberculosis IgG Avidity ELISA test kit [USA], supplied by Amar Diagnostics, Mumbai, India). Sputum and urine examination did not reveal any AAFB. She was vaccinated with BCG at birth.Since invasive procedures could not be undertaken in this particular patient, her menstrual blood was sent for AFB examination. Mycobacterial culture facilities were not available and hence, not done. The sample was homogenized, centrifuged at 3000 rpm for 15 minutes and smears were made from the deposit. After dehemoglobinizing the smear, it was stained by Zeihl Neelsen (ZN) stain, using 3% acid alcohol as a decolorizer. On examination under oil immersion, straight to slightly curved, beaded, acid and alcohol fast bacilli (AAFB), with morphology suggestive of Mycobacterium tuberculosis were seen (Fig. 1). Two consecutive samples in the same menstrual cycle were also positive for AAFB.The patient was diagnosed as a case of genital tuberculosis and anti-tubercular therapy (ATT-category I) was started, according to RNTCP guidelines.[1] After one month of treatment, when patient came for follow-up, she HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeÞ ciency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

BackgroundDuring the second wave of the COVID-19 pandemic, outbreaks of Zika were reported from Kerala, Uttar Pradesh, and Maharashtra, India in 2021. The Dengue and Chikungunya negative samples were retrospectively screened to determine the presence of the Zika virus from different geographical regions of India.MethodsDuring May to October 2021, the clinical samples of 1475 patients, across 13 states and a union territory of India were screened and re-tested for Dengue, Chikungunya and Zika by CDC Trioplex Real time RT-PCR. The Zika rRTPCR positive samples were further screened with anti-Zika IgM and Plaque Reduction Neutralization Test. Next generation sequencing was used for further molecular characterization.ResultsThe positivity was observed for Zika (67), Dengue (121), and Chikungunya (10) amongst screened cases. The co-infections of Dengue/Chikungunya, Dengue/Zika, and Dengue/Chikungunya/Zika were also observed. All Zika cases were symptomatic with fever (84%) and rash (78%) as major presenting symptoms. Of them, four patients had respiratory distress, one presented with seizures, and one with suspected microcephaly at birth. The Asian Lineage of Zika and all four serotypes of Dengue were found in circulation.ConclusionOur study indicates the spread of the Zika virus to several states of India and an urgent need to strengthen its surveillance.

Background Burn is a leading cause of fatality in a developing country. C-reactive protein levels (CRP) and procalcitonin (PCT) can be prognostic indicators for the burn patients' mortality. Aim To assess serial levels of serum PCT and serum CRP as prognostic indicators in burns. Patient and Methods In patients admitted with burns, alternate-day serum PCT and CRP were measured from the time of admission until the time of discharge or until survival. The change in trends of CRP and PCT serum levels were studied, and it was then correlated with mortality among these burn patients. Results The first-day value of serum PCT > 1772 pg/mL and serum CRP > 71 mg/mL or any value of serum PCT > 2163 pg/mL and of serum CRP > 90 mg/L indicate a poor prognosis in burns. Conclusions The day-1 values of PCT and CRP were significantly higher in nonsurvivors than survivors in burns. The increasing trends of serum PCT and CRP levels are independent predictors of mortality in burns requiring prompt intervention. Rising PCT and CRP level denote poor prognosis in burns with an increased likelihood of death by 4.5 and 23.6 times, respectively.

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A pair of live Fasciolopsis buski wriggled their way out through the ileostomy opening in a young adult male who had recently migrated to Delhi and had met with a road traffic accident. Finding this parasite in the national capital, a non endemic area for Fasciolopsiasis, prompted us to emphasize the importance of changes in the ecology, human demography, and human behaviour that may provide an environment conducive to their adaptability to the new geographical requirements. Awareness of Fasciolopsiasis, which is endemic in some regions of India, especially in rural settings, is an important issue because early diagnosis is essential. Hence, a surveillance mechanism among the migratory population to institute preventive interventions is necessary.