Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole resistant Candida spp. isolates in low-and-middle-income -countries (LMICs) compared to high-income-countries (HIC). We describe the epidemiology, Candida spp. distribution, treatment and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalised infants < 60 days postnatal age with sepsis (August 2018-February 2021). 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34) and median birth weight was 1270 g (IQR: 990–1692). Only a minority had high risk criteria, such as being born < 28 weeks, 19% (24/127), or birth weight < 1000 g, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%) and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrolment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines.
Objective: Dengue has emerged as a major public health concern across the globe in terms of mortality and morbidity. The clinical and epidemiological profile of dengue infection changes from time to time. The study was conducted to determine the prevalence of dengue infection, to study the seasonal variation and the clinical profile in these cases. Methods: A prospective, observational study conducted over a period from April 2015 to March 2016. Patients with acute febrile illness with clinical suspicion of dengue fever admitted in the hospital were included in the study. Serological tests like Dengue IgM and NS1 antigen ELISA were performed to confirm the diagnosis. Serologically confirmed patients of dengue fever were studied for their clinical presentation and lab parameters. Results: From a total 4732 patients tested for dengue viral infection, 1165 (24.6%) tested positive for dengue. The most affected age group was 26-35 years (25.7%) with male predominance. Most dengue cases were seen in the months of August to December 2015. Commonly clinical symptoms and signs were myalgia (72.4%), arthralgia (34.4%), vomiting (50%), abdominal pain (38.6%), hepatomegaly (27.4%) and ascites (10.8%). Lab parameters revealed leukopenia (43%) and thrombocytopenia (93.1%) in most cases. Transaminitis was seen in 84.1% cases. Common complications were shock (4.8%) and encephalopathy (4.8%). Hepatic failure was seen in 3.7% of patients and renal failure in 1.8% of patients. Conclusion: Dengue fever has a very non-specific and variable presentation. Knowledge of local prevalence and recent outbreaks can be very helpful in recognizing the clinical entity.
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