Strongyloides stercoralis (SS) is one of the most overlooked helminthic infections despite being highly endemic in tropical and subtropical areas. In immunocompromised patients, especially those on long-term steroids, infection can often escalate to fatal dissemination into major organs. We present a compendium of two immunocompromised patients, who were on high-dose steroids and presented with worsening neurological status. Cerebrospinal fluid analysis was notable for larvae of SS as diagnosed by direct visualization. A syndrome of SS hyperinfection with dissemination was made after stool, and sputum samples also revealed SS larvae. SS is an elusive disease and should be considered early on, especially in endemic regions like India. Early diagnosis and prompt initiation of antihelminthic therapy is indispensable for favorable outcomes.

BACKGROUND Strongyloidiasis is an infectious parasitic disease caused by Strongyloides stercoralis-the soil transmitted intestinal nematode pathogenic to humans. The infection is prevalent throughout, infecting more than 100 million people worldwide with predominance in the warm and humid climates of tropical and sub-tropical regions of the world including India. Strongyloides stercoralis assumes a special status due to its versatile life cycle (Autoinfection) and its potential to cause long-lasting infections, particularly in immunosuppressed individuals with a defective cell-mediated immunity, in whom it may lead to hyperinfection syndrome and disseminated strongyloidiasis involving several organs. Aims and Objectives-The aim of this study is to look for the prevalence of Strongyloidiasis in various clinical samples (stool, sputum, BAL, CSF and pleural fluid, etc.) and to determine the predisposing conditions for it. MATERIALS AND METHODSThis is a hospital-based observational study from September 2016 to August 2017. The various samples were received to look for opportunistic parasitic infections. They were processed by macroscopic examination, microscopic wet mount examination (Saline and Iodine Preparations) and modified Ziehl-Neelsen staining as per the standard techniques. RESULTSA total of 318 samples were screened for opportunistic parasitic infections. 16 cases (5.03%) were found to be positive for Strongyloides stercoralis larvae. 11 were males and 5 were females (Male: Female ratio= 2.2: 1). Of the 16 cases, 5 cases were found to have Strongyloides hyperinfection diagnosed by the simultaneous presence of multiple larvae in their stool and sputum samples. Similarly, 2 cases were suggestive of Strongyloides disseminated disease as diagnosed by the presence of larvae in their cerebrospinal fluid samples. Out of 16 cases 13 cases had immunosuppression history, most commonly prolonged steroid therapy and diabetes. CONCLUSIONActive surveillance of S. stercoralis should be emphasised as Strongyloidiasis is frequently underdiagnosed and remains a neglected parasitic disease. A high index of suspicion, keen observation and an attentive mind is the key to make prompt and accurate diagnosis of Strongyloidiasis.

Objectives: Few of the common symptoms for which cirrhotic patient seeks medical care are gastrointestinal bleed, abdominal distension (ascites), altered sensorium (hepatic encephalopathy [HE]), etc. This study was done to look at the spectrum of HE among cirrhotic patients admitted in a tertiary care center. Material and Methods: This hospital-based study was carried on 36 HE patients (with liver cirrhosis and age >18 years) admitted in the department of gastroenterology of a tertiary care center, between April 2019 and November 2019. Results: Constipation and infections were the two most frequent precipitating factors identified. Majority patients (77.8%) belonged to CTP Class C. In-hospital mortality was observed in seven patients. The OR was significant for infections and in-hospital mortality (OR – 28.80 and P < 0.05). A moderate positive correlation (Pearson’s correlation, r = 0.335) was seen between MELD score and in-hospital mortality among HE patients. Conclusion: A larger mass of HE patients belongs to CTP Class C. Constipation and infections are the two most common precipitating factors for HE. All HE patients who have concomitant infection and/or high MELD score should be managed on priority basis.

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Objective: The objective of the study was to know the isolation rate and antibiotic susceptibility pattern of pathogens causing urinary tract infection (UTI). Methods: A total of 500 urine samples of clinically suspected UTI were collected from January 2019 to June 2019. The samples were inoculated on Cystine Lactose Electrolyte-Deficient agar and incubated at 37°C for 24 h. Results: In our study, 303 (60.6%) samples showed growth of isolates. Among 303 isolates, 31 were Candida spp. which was not included in the study. Out of 272 isolates, Escherichia coli was 31.68%, followed by Klebsiella spp. (27.72%), Enterococcus faecalis (22.44%), Citrobacter spp. (3.96%), Staphylococcus aureus (2.64%), and Pseudomonas spp. (1.32%). For Gram-negative and Gram-positive isolates, the most effective antibiotic was nitrofurantoin. Conclusion: The study shows E. coli as the predominant pathogen that causes UTI. Nitrofurantoin and fosfomycin showed very high susceptibility to uropathogens and can be used to treat primary or uncomplicated UTI.

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Within a couple of months since the first case diagnosis, coronavirus disease 2019 (COVID-19) briskly swamped the world and was affirmed as the pandemic by the World Health Organization. [1] The primary source of contagion remains the respiratory droplets and infected fomites. With more than 200 countries (including areas/territories) afflicted, 7.5 million confirmed cases and 400 thousand deaths, the rising figures are disquieting. [2] India is currently combating this pandemic with full vigor. A nationwide lockdown was implemented in India from March 25, 2020, when there were nearly 600 cases diagnosed with COVID-19 in the country. There was no community transmission of COVID-19 in India and it was struggling hard to contain the disease, with 46,000 confirmed cases till the 1 st week of May. [2] However, by the mid of June 2020, the total cases in India have crossed 3 lakhs and total deaths are nearing 10000. [3] This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.