Abstract:Introduction: Males and females respond differently to infection, which again is modified by the 'stage of life cycle' they belong to. This knowledge however is often neglected during surveys/ studies or while deliberating protocols for disease control. Materials and methods: Data collected without segregation of sexes in separate age groups may thus be biased, confounding conclusions and disease control strategies formulated based on them. We analyzed results of IgM ELISA tests for chikungunya virus (CHIKV) released by Kerala State Institute for Virology and Infectious Diseases (KSIVID) done in 2007 during last epidemic caused by the virus in Kerala, and found two interesting epidemiological trends relating to sex based dimorphism in host response to CHIKV. Results: The 'proportion' of seropositive females over males increased steadily from near puberty, to become one of clear female predominance in reproductory age group, and then waning through middle age, reverting to original proportions, by menopause. From a situation where IgM positive males and females about equally represented, during the early epidemic, the proportion of positive females increased through mid-epidemic period, almost 'eclipsing' the male segment and then waned during post-epidemic period, the ratio tending to revert to original proportions. Conclusions: We seek to emphasize the importance of collecting and analyzing data separately for males and females categorized in different stages of life cycle (as per guidelines of W.H.O.) in studies/ epidemiological surveys.
Introduction: Sexes respond differently to infection, which further is modified by the 'stage of life cycle' they belong to. Materials and methods: We studied a cohort of patients admitted in our hospital diagnosed with dengue during the year 2014-2015 and found significant dimorphism in response of males and females in different age categories to infection; this appeared to modify the disease process from infection to progression/outcome. Results: Females in reproductive age category were found to be more inclined to developing uncomplicated dengue (DF). Severe dengue was found to occur in males and females past middle age-males appearing to be more prone to developing complications. Possible reasons based on available knowledge are discussed. Conclusions: Dimorphism in response to infection in the sexes in different stages of their lifecycle was found to modify disease process from infection to progression and outcome of dengue.
The pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a global health problem. COVID-19 has given rise to a number of secondary bacterial or fungal infections. During the second wave of COVID-19, India experienced an epidemic of mucormycosis in COVID-19 patients. In this paper, we discuss the clinical features, investigations and management of four patients having COVID-19-associated mucormycosis (CAM), especially rhino-orbital mucormycosis (ROM) caused by Rhizopus arrhizus and Mucor species. We also compare the cases and their risk factors with previously reported CAM cases in India. Three patients had mucormycosis after recovering from COVID-19. They were successfully treated with surgical debridement and early initiation of anti-fungal therapy with systemic amphotericin B and other supportive measures such as broad-spectrum antibiotics, insulin infusion, antihypertensives and analgesics. The remaining patient had mucormycosis during COVID-19. He was admitted in the intensive care unit due to COVID-pneumonia and was on mechanical ventilation. In spite of all supportive measures, the patient succumbed to death due to cardiogenic shock. Three out of our four patients had diabetes mellitus. All patients were treated with systemic steroid during COVID-19 treatment. Diabetes mellitus and steroid treatment are the major risk factors for CAM. Early diagnosis of this life-threatening infection along with strict control of hyperglycemia is necessary for optimal treatment and better outcomes.
The SARS-CoV-2 Variant of Concern, Delta (B.1.617.2) was first reported in December 2020 in India and has spread colossally throughout the globe. Owing to factors like increased transmissibility, immune escape, and virulence, the delta variant has been considered as a potential public health threat apart from other variants of concern like alpha, beta and gamma. Kerala was one of the first states in India to enroll in the systematic genomic surveillance. In the present report, vaccine breakthrough infections were followed up in 147 patients including 55 healthcare workers who had been vaccinated with ChAdOx1 nCoV- 19/BBV152 across eleven districts from the state of Kerala. The timeline of samples analysed were from April 2021 till June 2021. Severity of the infections reported in the enrolled patients found to be mildly symptomatic, majorly with only 0.7% (n=1) of the cohort to be asymptomatic. Genomic analysis of the samples revealed the Delta variant (B.1.617.2) to constitute about 81.6% (n=120) in the studied cohort. This was followed by the Kappa variant B.1.617.1 (8.35%, n=9), AY.1 (0.6%, n= 1), AY.12 (0.6%, n= 1), AY.4 (1.2%, n= 2), AY.9 (1.2%, n= 2) and Eta variant, B.1.525 (0.6%, n= 1). 11 samples were not assigned any lineage. Evidence from this study suggests the preponderance of the Delta variant in the samples analysed.
A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.
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