Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study.

BACKGROUND: Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS: Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS: A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION: A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.

Histoplasmosis of Adrenal Gland: A 5 Years' Review from a Multispecialty Diagnostic Centre.

Objective Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum . Histoplasmosis is considered to be endemic to India, especially the Gangetic belt. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients, whereas isolated adrenal involvement as the presenting manifestation in immunocompetent is uncommon. We aimed to determine the clinicopathological and radiological findings of adrenal histoplasmosis in immunocompetent patients attending a multispecialty diagnostic center referred from different clinics and hospitals. Materials and Methods All tissue samples were initially examined microscopically by performing potassium hydroxide (KOH) wet mounts, followed by culture on two tubes of Sabouraud dextrose agar and phase conversion. Histopathological correlation was done using tissue stains, hematoxylin and eosin, periodic acid-Schiff, and Gomori methenamine silver. Results We evaluated 84 clinically suspected cases radiologically for adrenal mass. The pathological and microbiological work-up was done from these suspected cases. A total of 19 cases were evident from the tissue stain and fungal culture methods. The affected population were mostly above 45 years and male. Seven patients had bilateral adrenal involvement. All these patients received amphotericin B and/or itraconazole treatment, which led to symptomatic improvement in most cases. Conclusion Diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients presenting with nonspecific symptoms, clinical signs, and laboratory and radiological features that often resemble adrenal neoplasms. Clinical specimens, together with fungal culture, must be sent for cytopathology/histopathology for a definite diagnosis and appropriate management.

Non-healing perianal ulcer: A rare presentation of cutaneous tuberculosis.

Perianal tuberculosis is an extremely rare form of tubercular disease. We report here a case of chronic non-healing perianal tubercular ulcer associated with, asymptomatic pulmonary tuberculosis in a 16-year-old boy for its rarity and to emphasize the importance of considering tubercular etiology in the work up of persistent perianal ulcer.

Evaluation of virulent multidrug resistant Klebsiella infection status in a tertiary care hospital in Eastern India.

Klebsiella especially Klebsiella pneumoniae is gaining renewed interest because of emergence of multidrug resistance among klebsiellae associated with infections.These are now being recognised as one of the major threats to effective management of patients in hospital, especially in developing country like India. Pathogenic mechanism of klebsiella Infections are associated with virulence factors such as capsule and mucoid phenotype, etc. The present study was designed to determine the virulence factors and antibiogram of klebsiellae, isolated from various clinical specimen in a tertiary care hospital of West Bengal, India. A total of 2370 clinical specimens which include blood, urine, wound swab, sputum were processed for isolation and identification of klebsiella to the species level. For each klebsiella isolate demonstration of capsule was done by capsule relief stain and detection of mucoid phenotype was done by string test. Antibiogram was studied by Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The results showed that klebsiella species were isolated and identified from 139 clinical samples (5.9% prevalence rate) among which 4 (2.9%) were Klebsiella oxytoca and the remaining 135 Isolates (97.1%) were Klebsiella pneumoniae. Out of 139 klebsiella isolates, capsule was demonstrated in 118 (84.9%) and 116 (83.4%) were positive for string test. Antibiogram revealed that most of isolates of Klebsiella pneumoniae were multidrug resistant.

A study on blood culture positivity and C-reactive protein variability in neonatal septicaemia at neonatal intensive care unit of a tertiary care hospital.

Neonatal septicaemia is an important cause of neonatal morbidity and mortality. Blood culture is the gold standard for diagnosis of neonatal septicaemia. Several laboratory investigations are available to detect neonatal sepsis, one important is 'sepsis screen' which includes C-reactive protein (CRP), micro -ESR, total WBC count including immature to mature (VT) ratio and absolute neutrophil count. Blood culture was done among 210 samples from neonatal intensive care unit (NICU), RG Kar Medical College with suspected septicaemia along with CRP estimation. Among all the parameters, clinical correlation of CRP is significant; 65.2% of patients has blood culture positive. CRP positivity varied in different organisms. CRP is a non-specific acute phase reactant and rises significantly after 12 hours onwards. It can be used as an important parameter in infant at risk of septicaemia (significant > 6 mg/dl) and early institution of antimicrobials therapy. It has got prognostic value.

A Rare Case of Pancreatic Abscess due to Candida Tropicalis.

Candida albicans is found frequently as a commensal organism in the gastrointestinal tract. Despite this, it is rarely found in pancreatic abscesses, there being only a few cases in the literature and in most of these cases the significance of Candida spp. as a pathogen was not initially recognized at the time of diagnosis. In most of the earlier reported pancreatitis associated with candida, C. albicans was the commonest isolate. We report the case of a patient in whom computed tomography was used initially to diagnose a pancreatic abscess, aspiration of which showed growth of Candida tropicalis and Escherichia coli on culture. The patient was started on amphotericin B and imipenem, but the condition of the patient deteriorated, for which the patient underwent surgical necrosectomy and continued treatment with imipenem and amphotericin B led to the satisfactory recovery of the patient.