Leptospirosis with Indian Tick-borne Typhus Coinfection: A Rare Presentation of Tropical Febrile Illness.

INTRODUCTION: Leptospirosis and tick-borne typhus are zoonotic diseases, rarely reported as coinfection. More specific molecular tests are not easily accessible for diagnosis of these diseases, thus resulting in delayed diagnosis and eventually considerable morbidity and mortality. CASE DESCRIPTION: We report a case of leptospirosis with tick-borne typhus coinfection in an abattoir worker who presented with a short history of fever, myalgia, jaundice, nonoliguric renal failure, diffuse petechial rash, and altered sensorium. His lab investigations showed leukocytosis, raised C-reactive protein (CRP), elevated transaminases and creatinine, mild pleocytosis, and mildly raised proteins in cerebrospinal fluid (CSF). Serology for Leptospira IgM was positive by enzyme-linked immunosorbent assay (ELISA). A paired Weil-Felix test (WFT) showed a fourfold increase in OX19 and OX2 titers. The patient responded well to IV antibiotic therapy and was discharged. This is the first time that leptospirosis and Indian tick-borne typhus coinfection has been reported from western India. CONCLUSION: Leptospirosis and Indian tick-borne typhus coinfection is a rare but important cause of tropical fever. Arduous efforts to establish a definitive diagnosis help not only in surveillance for epidemiological data of the disease entities but also in avoiding severe complications resulting from considerable delay in appropriate therapy.

Characteristics and Outcomes of COVID-19 during the Third Wave of COVID Pandemic: A Single-center Descriptive Study.

AIM: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been causing a global pandemic of Coronavirus (COVID-19) disease in recurring waves. On November 24, 2021, a new SARS-CoV-2 variant (B.1.1.529) was identified in South Africa. We aimed to study the clinical profile, laboratory parameters, complications, and outcomes in patients hospitalized with COVID-19 infection during the third wave in India. MATERIALS AND METHODS: This was a single-center cross-sectional study conducted from 10th January 2022 to 10th Feuary 2022. Data on demographic profile, clinical symptoms, laboratory findings, complications, and clinical outcome was collected and compared between nonsevere and severe cases. RESULTS: A total of 74 patients were included. Four (5.4%) had a severe disease while 70 (94.6%) had a nonsevere disease. The most common symptoms were fever (60.8%), cough (52.7%), and sore throat (45.9%). There was a significant difference between severe and nonsevere groups in terms of vaccination history (p = 0.0412), and time elapsed from symptom onset to hospitalization (p ≤0.001). The severe disease group also had significantly higher levels of leukocyte count, C-reactive protein (CRP), D-dimer, ARDS, sepsis, and a higher need for respiratory support (p < 0.001). A total of 70 (94.6%) patients were discharged while four (5.4%) patients succumbed to complications of COVID-19 infection. Complete vaccination against COVID was associated with significantly lower chances of severe disease [odds ratio (OR) 0.083, 95% confidence interval (CI) 0.0080-0.8632]. CONCLUSION: As compared to the previous two waves, the current wave of the pandemic had milder symptoms, less severe disease, and fewer ICU admissions and deaths. Successful completion of vaccination against COVID was associated with significantly lower morbidity and mortality.

Neurological Manifestations and Their Effect on Outcome in Second Wave of COVID-19 Pandemic: A Retrospective Cohort Study.

AIM: There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. MATERIALS AND METHODS: This was a retrospective study. All patients ≥18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. RESULTS: A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23-19.43; p = 0.0006) in patients with neurological manifestations. CONCLUSION: The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients.