objective The diagnosis of acute viral respiratory tract infections (RTI) is a challenge due to overlapping clinical presentations and lack of availability of robust diagnostic methods. This in turn leads to lack of data regarding incidence and seasonality of viral RTIs which could potentially help to implement efficient strategies of antimicrobial stewardship as well as vaccine administration. Here we utilise a commercial Multiplex PCR assay for the early diagnosis of acute respiratory tract infections and discuss their epidemiology. methods A prospective, observational study was conducted over a period of 3 years (2017-2019). Respiratory samples received from outpatients and inpatients with suspected acute RTIs from three multispeciality hospitals located in the twin cities of Hyderabad-Secunderabad were subjected to FilmArray Respiratory Panel (RP) (BioFire Diagnostics, Salt Lake City, Utah, USA). Results were tabulated and statistically analysed. results Of 513 samples, 261 (50.9%) were positive for one or more pathogens. The viruses detected included influenza A H1 2009 (26.0%), human rhinovirus/enterovirus (21.5%), influenza A H3N2 (17.0%), human metapneumovirus (9.4%), influenza B (6.6%), coronavirus (4.9%), parainfluenza virus (4.5%), respiratory syncytial virus (3.1%) and adenovirus (2.1%). The largest number of samples was positive during the monsoon season (43.8%). Influenza A H1 2009 peaked in the monsoon season with another, smaller peak in February. conclusions There is a bimodal peak of respiratory infections relative to the seasons, and vaccine administration should take place in April-May before the advent of the monsoons in this part of the country. Multiplexed PCR may be used as first line for diagnosis of viral infections so that infection control measures can be prioritised and antibiotic administration can be avoided in those who do not require it. keywords multiplex PCR, respiratory tract infections, viral infections, influenza Sustainable Development Goals (SDGs): SDG 3 (good health and well-being)
Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.
Purpose The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). Methods A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. Results Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary ( n = 25, 12%), gastrointestinal ( n = 6, 3%), isolated cerebral ( n = 2) and disseminated mucormycosis ( n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. Conclusion Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
The more common manifestations of cryptococcal infections are restricted to the central nervous system and lungs. We report an unusual case of fungal osteomyelitis due to Cryptococcus. The patient was a young man who had been adequately treated for pulmonary tuberculosis three years prior. Three months before, he sustained a minor road-traffic accident with only minor abrasions. He presented with subacute chest pain of 15 days’ duration and was found to have radiological evidence of a lytic lesion of the fifth rib. Given prior tuberculosis, he was thought to have a relapse of disease with tuberculous osteomyelitis. Surprisingly, a biopsy revealed evidence of fungal osteomyelitis with Cryptococcus. An evaluation for primary immunodeficiency revealed low CD4 cell counts with undetectable serum IgA and IgM levels. Genetic sequencing proved a genetic mutation consistent with primary T-cell immunodeficiency. The patient responded well to treatment and is asymptomatic on follow-up.
Background: Leprosy (also known as Hansen's disease) is a chronic granulomatous infection caused by Mycobacterium Leprae(M.leprae). Incubation period varies from few months to several years (3 months to 10 years). Mode of transmission is via droplets. The disease mainly affects the skin, peripheral nerves, mucosa of upper respiratory tract. Aims and Objectives: To study clinical and epidemiological characteristics of the leprosy patients attending Government General Hospital, Kadapa, Andhra Pradesh, India. Materials andMethods:Thisis a hospital based prospective study carried out over a period of 1 year,fromMay 2018 toApril 2019. consecutive 167 leprosy patients attended the outpatient department of DVL, Government General Hospital, Kadapa, Andhra Pradesh, India were enrolled in this study.The study populationwas divided into 7 groups.Thisinclude age group oflessthan 10 years:11 to 20 years;21 to 30 years:31 to 40 years:41 to 50 years;51to60years;more than60years.Datawas analyzedtostudyclinical andepidemiological characteristics ofleprosydisease. Results: There were 106 males and 61 females in a total of 167 study population. Atotal of 46(27.55%) were aged between 31 to 40 years. Among 167 patients ,145(86.82%) patients has multibacillary form of leprosy. Pure neuritic leprosy was seen 7(4.19%) patients; histoid leprosy seen in 4(2.39%) patients. Conclusion:Leprosy may be down but is not yet out. Continuous efforts are required to prevent this disease from making a resurgence
Septicemia is one of the important causes of morbidity and mortality. Emergence of multidrug resistant bacteria is a major problem in the management of septicemia. Present study was undertaken to isolate the common bacterial pathogens associated with septicemia and determine their antibiotic resistance. Blood cultures from 100 suspected cases of septicemia were examined. The growths from the subcultures were identified by conventional biochemical tests. Antibiotic susceptibility testing done by Kirby-Bauer disk diffusion method and antibiotic resistant strains in the primary screening were further processed for MRSA, ESBL and MBL production. Out of 100 suspected cases, 28 (28%) were cultures positive. Of which 15 (53.57%) were Gram positive cocci and 13 (46.42%) were Gram negative bacilli. The prevalence of MR CONS was found to be high 78% when compared to MRSA 67%. The overall prevalence of ESBL producers among Gram negative bacilli was found to be 46% and MBL among Pseudomonas aeruginosa was 33%.Thus, the study highlights the rising level of antibiotic resistance amongst the bacterial isolates from blood and, hence, the need to continuously monitor the locally emerging antibiotic resistance patterns, and updates the existing antibiotic policies.
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