Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario.
These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers’ diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation.
Aims: To study the epidemiology and clinical presentation of Scrub typhus in Southern India. Study design: Observational study Place and Duration of Study: Apollo Hospital, Chennai, India, between January 2010 and December 2011. Methodology: This is an observational study of 182 patients from a tertiary care center between January 2010 and December 2011. Cases of scrub typhus were defined by a positive IgM scrub typhus ELISA, compatible clinical features and negative workup for other pathogens. Epidemiological data and clinical data were collected from the records for the study purpose. Results: Fever (100%), headache (69.7%) and cough (47.8%) were the predominant presenting symptoms. The majority (85.7%) of cases were during the period from July to December in both the years, corresponding to the monsoon in South India. 62% of cases were from urban areas and 47.3 % of cases required admission to the critical care unit. An eschar was present in 46.7% of cases and 97.3% of the cases improved with therapy. All patients received either doxycycline or azithromycin or a combination of both as therapy. Defervescence was seen within 72 hours in 98.5% of patients. Conclusion: Scrub typhus is a re-emerging disease in South India. It should be considered in the differential diagnosis of acute undifferentiated febrile illness even in urban areas in all age groups, especially during the monsoon season. Careful search for an eschar is important. Treatment with doxycycline or azithromycin is effective. The mortality rate is expected to be high if untreated, so we suggest that these antibiotics be part of initial empiric therapy whenever the disease is in the differential diagnosis in all severely ill patients awaiting diagnostic results.
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