Identification of coxsackievirus A-24 GIV C5 strain as the cause of acute hemorrhagic conjunctivitis outbreak in Hyderabad, India in 2022.

Viral infection is frequently the cause for acute hemorrhagic conjunctivitis (AHC) epidemics. AHC can result from adenoviruses, with enterovirus 70 and coxsackievirus A24 being the primary agents. AHC was initially identified in Ghana in 1969, caused by enterovirus 70 and leading to a global pandemic. Since 2000, outbreaks of AHC linked to coxsackievirus A24 variant have been documented in Spain, Pakistan, Singapore, India, Korea, and China. A sudden surge of conjunctivitis cases reported in October 2022 in and out of the Hyderabad region. This infection presented with usual symptoms of redness of the eyes, discharge, pain in the eyes and crusting. Occular swab samples from 110 patients were collected in order to identify and characterize the virus that was causing the epidemic. We examined adenovirus, enterovirus, COVID-19 and Herpes Simplex Virus by using commercially kits available at the hospital. Conserved regions in the enteroviral 5'-UTR and VP2 gene were analyzed further for characterization of serotype at the National apex laboratory. None of them was found positive except Enterovirus in 16.36 % (18/110) of the patients. From enterovirus-positive samples, the coxsackievirus A24 was observed in all 18 positive samples. These clinical isolates constitute a new lineage cluster associated with genotype IV-C5, according to additional sequencing of the full-length VP2 genes and subsequent phylogenetic analysis. In conclusion, the current outbreak of acute haemorrhagic conjunctivitis in Hyderabad, India was traced to the coxsackievirus A24 strain GIV C5.

Clinical and microbiological spectrum of external ventricular drain related infections (EVDRIs) from a tertiary care center.

Background and Objectives: Insertion of an External Ventricular Drain (EVD) is a common and important lifesaving procedure that can lead to morbidity and mortality. This study was conducted to assess the infection rate, risk factors, causative organisms, and outcome of EVDs. Materials and Methods: A prospective study was undertaken in a tertiary care centre from August 1st to October 30th, 2020. Over 192 patients had undergone insertion of EVDs in the neurosurgical intensive care unit. CSF samples were collected in sterile containers and transported to the laboratory. Results: A total of 214 EVDs were inserted in 192 patients for 691 days. The median duration for EVD in situ and the mean time between catheter insertion and onset of infection were 14.5 days and 8 days. EVD related infection rate was 19.4 for 1000 EVD days. The most common risk factor for EVD insertion were tumors (55%) followed by hydrocephalus (40%).We identified 25 patients out of 192 (12%) who had clinical signs and symptoms with deranged CSF counts. A total of 13/25 (52%) specimens were culture positives out of which 10 (76.9%) were Gram negative pathogens and 3 (23%) were Gram positive pathogens and 3/10 (30%) Gram negative pathogens were Multidrug resistant organisms (MDROs). Conclusion: It was observed that longer duration of catheter in situ was an important risk factor for EVD-related infections (ERIs) and also higher frequency of CSF sampling. A proper EVD infection prevention and control protocol must be followed in the form of a checklist at the time of EVD insertion.