ObjectivesWe aim to define the burden of rifampicin monoresistant tuberculosis (TB) at a tertiary care centre in northern India as well as determine the second-line drug susceptibilities (SL-DST) in a subset of patients.MethodsA total of 3045 pulmonary (n=1883) and extrapulmonary (n=1162) samples from likely patients with TB were subjected to microscopy, culture and the Xpert MTB/RIF assay from March 2017 to June 2019. SL-DST testing by line probe assay version 2 for fluoroquinolones (FQs) and second-line injectable drugs were performed on 62 samples.ResultsOut of 3045 samples processed in our laboratory during the study period, 36.1% (1101/3045) were positive for Mycobacterium tuberculosis complex (MTBC) and 21.6% were rifampicin monoresistant (223/1032). The rate of rifampicin resistance in pulmonary samples was 23.5% (166/706) and in extrapulmonary cases, it was 17.4% (57/326). Out of 62 cases included for second-line testing, 48 were resistant to FQs (77.4%) while 11 were extensively drug resistant.ConclusionsIndia urgently needs to arrest an emerging multidrug-resistant TB epidemic with associated resistance to FQs. A robust surveillance system is needed to execute the National Strategic Plan for 2017–2025.
Patients with cancer are known to be at an increased risk for community-acquired respiratory viruses, because of their frequently observed systemic immunosuppressive state caused by the malignancy and anticancer treatments, such as chemotherapy, targeted therapy and immunotherapy. In this study different challenges of radiation oncology department and their infection control practices are given such as Pt screening, temperature monitoring and pt staff education, hygiene and departmental cleaning, zoning,work load management etc.There must be national and departmental measures to be taken in response to covid 19 pandemic.Some of risk adapted triage strategies for radiotherapy patients during covid 19 is discussed further. Comparison between covishield, covaxin and sputnik V covid 19 vaccines and lack of vaccine prioritisation for cancer patients in India have been elaborated.
Rhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25–60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases.
Background: To detect Mycobacterium tuberculosis on stool specimens by polymerase chain reaction (PCR) among patients with pulmonary tuberculosis. Detection of M. tuberculosis complex in sputum forms the basis of diagnosis of pulmonary tuberculosis. However, some patients tend to swallow sputum and some are unable to produce sputum. Based on the survival of M. tuberculosis in the gastric fluid, swallowed organisms may be detectable in stool samples. Methods: The study was carried out on 30 cases each in four groups: sputum smear-positive and sputum smear-negative adults, pediatric patients suspected of pulmonary tuberculosis along with healthy controls. The samples were processed for direct microscopy for acid-fast bacilli (AFB) and M. tuberculosis culture. Stool PCR was done on all 120 samples. Results: AFB was demonstrated in 42 and cultured in 39 out of 240 samples. PCR-targeting IS6110 gene showed positive results in 24 (20%) out of 120 stool samples. PCR in stool showed the highest positivity in sputum smear-positive samples followed by gastric aspirates and sputum smear-negative samples. Conclusion: Stool PCR is a potentially useful diagnostic method for pulmonary tuberculosis.
Microbacterium arborescens, among coryneform bacteria are gram positive rods with orange pigmented colonies. Usually these are environmental contaminant but has shown invasive potential in immunocompromised individuals.A 56 yrs old lady presented with uncontrolled hyperglycaemia and hypertension. M. arborescens was isolated on blood culture. Identication was done based on biochemical characterictics and conrmed by Matrix assisted light desorption ionisation Time of Flight Mass Spectrometry( MALDI TOFF MS). Further amplication and sequencing was done and phylogenetic tree was contructed. Tree clearly shows clinical strain PGI 2 is different from environmental strain
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