Test concordance and diagnostic accuracy of three serological assays for detection of anti-SARS-CoV-2 antibody: result from a population-based sero-epidemiological study in Delhi.

BACKGROUND: Several methodological tests are available to detect SARS-CoV-2 antibody. Tests are mostly used in the aid of diagnosis or for serological assessment. No tests are fully confirmatory and have variable level of diagnostic ability. We aimed at assessing agreement with three serological tests: quantitative anti receptor binding domain ELISA (Q-RBD), qualitative ELISA (WANTAI SARS-CoV-2 Ab) and qualitative chemiluminescence assay (CLIA). METHODS: This study was a part of a large population based sero-epidemiological cohort study. Participants aged 1 year or older were included from 25 randomly selected clusters each in Delhi urban (urban resettlement colony of South Delhi district) and Delhi rural (villages in Faridabad district, Haryana). Three type of tests were applied to all the baseline blood samples. Result of the three tests were evaluated by estimating the total agreement and kappa value. RESULTS: Total 3491 blood samples collected from March to September, 2021, out of which 1700 (48.7%) from urban and 1791 (51.3%) from rural. Overall 44.1% of participants were male. The proportion of sero-positivity were 78.1%, 75.2% and 31.8% by Wantai, QRBD and CLIA tests respectively. The total agreement between Wantai and QRBD was 94.5%, 53.1% between Wantai and CLIA, and 56.8% between QRBD and CLIA. The kappa value between these three tests were 0.84 (95% CI 0.80-0.87), 0.22 (95% CI 0.19-0.24) and 0.26 (95% CI 0.23-0.28). CONCLUSIONS: There was strong concordance between Wantai and QRBD test. Agreement between CLIA with other two tests was low. Wantai and QRBD tests measuring the antibody to same S protein can be used with high agreement based on the relevant scenario.

Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study.

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.

Rapid chromatographic immunoassay-based evaluation of COVID-19: A cross-sectional, diagnostic test accuracy study & its implications for COVID-19 management in India.

Background & objectives: Coronavirus disease 2019 (COVID-19) has so far affected over 41 million people globally. The limited supply of real-time reverse transcription-polymerase chain reaction (rRT-PCR) kits and reagents has made meeting the rising demand for increased testing incompetent, worldwide. A highly sensitive and specific antigen-based rapid diagnostic test (RDT) is the need of the hour. The objective of this study was to evaluate the performance of a rapid chromatographic immunoassay-based test (index test) compared with a clinical reference standard (rRT-PCR). Methods: A cross-sectional, single-blinded study was conducted at a tertiary care teaching hospital in north India. Paired samples were taken for RDT and rRT-PCR (reference standard) from consecutive participants screened for COVID-19 to calculate the sensitivity and specificity of the RDT. Further subgroup analysis was done based on the duration of illness and cycle threshold values. Cohen's kappa coefficient was used to measure the level of agreement between the two tests. Results: Of the 330 participants, 77 were rRT-PCR positive for SARS-CoV-2. Sixty four of these patients also tested positive for SARS-CoV-2 by RDT. The overall sensitivity and specificity were 81.8 and 99.6 per cent, respectively. The sensitivity of RDT was higher (85.9%) in participants with a duration of illness ≤5 days. Interpretation & conclusions: With an excellent specificity and moderate sensitivity, this RDT may be used to rule in COVID-19 in patients with a duration of illness ≤5 days. Large-scale testing based on this RDT across the country would result in quick detection, isolation and treatment of COVID-19 patients.

Emergence of Burkholderia cepacia in ICU Setting.

BACKGROUND: B. cepacia is metabolically versatile organism which is not only resistant to many antibiotics but also disinfectants. This makes their survival easy even in restricted areas like intensive care unit (ICU) and management difficult. AIMS AND OBJECTIVES: To describe sudden emergence of Burkholderia at a tertiary care centre ICU setting in milieu of colistin usage. MATERIALS AND METHODS: Cases were patients with culture proven B.cepacia. They were picked up as non-lactose fermenting, oxidase positive, motile, gram-negative bacilli which was resistant to colistin and aminoglycosides and sensitive to cotrimoxazole. These isolates were further confirmed by both VITEK-2 compact system (Biomerieux, France) and standard bacterial techniques.Colistin consumption data were retrospectively collected from medical store records of hospitals and individual ICU pharmacy records from January 2016 to June 2016, and were expressed as total dialy doses in a month per 1000 patient days (DDD/1000PD). RESULTS: An increase was observed in B. cepacia infection linked to increased consumption of colistin in ICU. CONCLUSION: Based on these results an increase was observed in B.cepacia infection which correlated with increased consumption of colistin in ICU. We speculate that extensive use of colistin may lead to selection of intrinsically resistant B. cepacia and may facilitate their spread as nosocomial pathogens. HOW TO CITE THIS ARTICLE: Meena S, Bir R, Sood S, Das BK, Kapil A. Emergence of Burkholderia cepacia in ICU Setting. Indian J Crit Care Med 2019;23(9):423-426.

Atypical acquired toxoplasmosis.

A 33-year-old male presented with unilateral painless vision loss with a history of sub-tenon steroid for the same. The fundus showed an elevated focus of retinochoroiditis with vitritis. On investigating for the cause, polymerase chain reaction test on the anterior chamber tap was found to be positive for Toxoplasma. Such confusing and atypical cases usually produce a clinical dilemma and should be managed in a stepwise manner. Ancillary investigations usually provide a clue to the clinician and should be performed without any hesitation.

The Factors Associated With COVID-19 Infection Among Healthcare Workers at a Tertiary Care Institution in North India: A Case-Control Study.

Background and objective Healthcare workers (HCWs) are at a higher risk of contracting coronavirus disease 2019 (COVID-19) since they regularly come into direct contact with infected patients and their surroundings. In light of this, it is critical to study the potential risk factors for SARS-CoV-2 infection among HCWs to help determine its transmission patterns and prevent infections among HCWs, as well as healthcare-associated COVID-19. Methods We conducted a case-control study at a tertiary healthcare center from December 2020 to August 2021. HCWs who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, by RT-PCR were included as cases and those who tested negative for RT-PCR and SARS-CoV-2 antibodies were recruited as controls. We interviewed 316 HCWs (187 cases and 129 controls) by using the WHO questionnaire titled "Protocol for assessment of potential risk factors for coronavirus disease 2019 among health workers in a health care setting" to assess infection prevention and control (IPC) knowledge and practices, including the use of personal protective equipment (PPE). The odds ratio (OR) for factors associated with infection was determined by multivariable logistic regression. Results The majority (87.2%) of the cases were symptomatic. Adherence to IPC measures was higher among controls as compared to cases. A significantly higher number of controls used PPE compared to cases. The proportions of HCWs involved in cleaning, patient transport, reception, and catering were higher among cases (37.9%) compared to controls (19.1%). In multivariable analysis, undergoing training on care for COVID-19 patients was associated with a lower risk of infection (OR: 0.40, 95% CI: 0.24-0.69). Conclusions Adherence to IPC and use of PPE were significantly higher among controls as compared to cases. Receiving training in COVID-19 patient care and compliance with IPC measures were associated with a lower risk of COVID-19 infection among HCWs in this study.

Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms.

Objectives: Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. Methods: These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Results: Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum ß-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi.

BACKGROUND: This study was conducted to understand the effect of the COVID-19 pandemic on urine culture and sensitivity results in an outpatient setting. There are plenty of data from inpatient and ICU settings but there is a paucity of data in outpatient or community settings. Thus, this study primarily targeted change in antibiotic resistance of urinary tract infection (UTI) agents in the pre- and post-COVID-19 period. METHODS: In the study, urine samples received in the Department of Laboratory Medicine (microbiology laboratory) with a preliminary diagnosis of UTI between April 2019 and March 2021 were analyzed. Urine cultures and antibiotic susceptibility tests of the patients included in the study were examined in two periods (pre-pandemic and post-pandemic). RESULTS: A total of 22,372 urine samples were received in the pre-pandemic period (April 2019 to March 2020) and 4885 samples in the post-pandemic period (April 2020 to March 2021). The positivity rate obtained from urine cultures sent post-COVID-19 pandemic (16%) was significantly higher than those sent before the COVID-19 pandemic (8%). According to cultures and antibiogram results, resistance to ampicillin, amikacin, ceftazidime (p < 0.05), co-trimoxazole, levofloxacin, gentamicin (p < 0.05), nitrofurantoin, fosfomycin, and tetracycline decreased compared with the pre-COVID-19 period. CONCLUSIONS: In this study, we found that the frequency of significant bacteriuria increased significantly in the post-pandemic period. However, resistance to antibiotics decreased significantly in the post-COVID-19 period compared to the pre-COVID-19 period. There was no significant change in the etiology of UTI during the two time periods.

Spectrum and Trends of Intestinal Parasitic Infections at a Tertiary Care Hospital during Pandemic Times: A Laboratory-Based Retrospective Study.

Introduction Intestinal parasitic infections continue to loom in developing countries with low sanitation and socioeconomic conditions. Pandemic times are especially important to study the prevalence of these pathogens since the focus of all healthcare services was coronavirus disease 2019 (COVID-19). This study aimed to evaluate the prevalence and time-trend of intestinal parasitic infections in the capital region of India during the pandemic times. Methods In this cross-sectional study, a retrospective review based on data from the past 2 years in the post-COVID-19 pandemic was used. Descriptive and time-trend analyses were applied to the data. Time series analysis was analyzed using the best fit autoregressive integrated moving average (ARIMA) model to look for seasonality in trends and forecasting. Results A total of 7267 patients' stool samples over a 2-year pandemic period were included in the study. Intestinal parasites were detected in 11.18% (813/7276) patients. Giardia lamblia (2.28%) and Blastocystis hominis (3.78%) were the predominant ones. Time-trend analysis from 2020 to 2021 using ARIMA model predicted an increasing trend with waning of pandemic. The most prevalent infection was found in the monsoon and autumn months. Conclusion Rates of infection with Giardia lamblia and Blastocystis hominis have increased in comparison to other protozoan infections like Entamoeba histolytica when compared with prepandemic hospital-based studies. With fading of the pandemic, further increasing trends are predicted.

Microsporidia in HIV-Positive and HIV-Negative Pediatric Patients with Diarrhea at a Tertiary Care Hospital.

Background Human microsporidiosis presents as an important and rapidly emerging opportunistic infection. However, the exact burden of this infection especially in the pediatric population of Northern India remains unknown. In this study, we investigated the prevalence of microsporidia among human immunodeficiency virus (HIV)-positive and HIV-negative pediatric patients who presented with diarrhea. Methods A total of 263 children were recruited consisting of 98 HIV seropositive with diarrhea and 165 HIV seronegative but with diarrhea. Morning stool samples were collected and both direct and formol ether concentrated samples were examined for the presence of intestinal parasites. The modified acid-fast staining was done for coccidian parasites and trichrome stain for microsporidia detection. Further, the species were detected using a real-time polymerase chain reaction (PCR) targeting a conserved region of the small ribosomal subunit rRNA gene of Enterocytozoon bieneusi , Encephalitozoon hellem , Encephalitozoon intestinalis , and Encephalitozoon cuniculi . Results Overall, one or more parasites were detected in 52.04% (51/98) of HIV seropositive and 53.33% (88/165) of seronegative children ( p = 0.8391). However, coccidian parasites were detected in a significantly huge number of HIV seropositive children (21.43% [21/98]) as compared with HIV seronegative children (4.24% [7/165]). Microsporidial DNA could be detected in HIV seropositive with diarrhea children (17.35% [17/98]) by PCR. A significant correlation between low CD4 count (≤ 200/µL) and intestinal parasite positivity could be established. Conclusion Microsporidia is a significant cause of diarrhea in HIV seropositive pediatric patients and should be kept in mind as one of the differential diagnoses in such patients.

Household transmission investigation for Corona Virus Disease 2019 (COVID-19) in a rural and urban population of north India.

BACKGROUND: Transmissibility within closed settings, such as households, can provide a strategic way to characterize the virus transmission patterns because the denominator can be well defined. We aimed to characterize the household transmission of Severe Acute Respiratory Syndrome Coronavirus (SARS CoV-2) and its associated risk factors. METHODS: This prospective case-ascertained study was conducted among the household contacts of laboratory-confirmed SARS CoV-2 cases residing in Ballabgarh, Haryana. We enrolled 148 index cases and their 645 household contacts between December 16, 2020 and June 24, 2021. We defined household contact as any person who had resided in the same household as a confirmed COVID-19 case. Baseline data collection and sample collection for real time- reverse transcriptase polymerase chain reaction (RT-PCR) and IgM/IgG against SARS CoV-2 were done on day 1 visit, and followed for a period of 28 days. RT-PCR was repeated on day 14 or whenever the contact is symptomatic and blood sample for serology was repeated on day 28. We estimated household secondary infection rate (SIR) and other epidemiological indicators-median incubation period and serial interval. We employed binomial logistic regression to quantify risk factors associated with infection. RESULTS: The household SIR was 30.5% (95% CI: 27.1-34.1%). The secondary clinical attack rate was 9.3% (95% CI: 7.2-11.8). The risk factors that showed higher susceptibility to infection were household contacts who were the primary care giver of the case, whose index cases were symptomatic, those with underlying medical conditions, those living in overcrowded households, who were sharing toilet with the index cases and also who were not wearing a mask when coming in contact with the case. The median (IQR) incubation period was 4 days (4, 5), mean (SD) serial interval 6.4 (±2.2) days, and median (IQR) serial interval 5 days (5, 7). CONCLUSION: Households favour secondary transmission of SARS CoV- 2, hence, index cases are recommended to self-isolate and wear masks; and household contacts to follow strict COVID infection control measures within households when a family member is infected.

A Combination of Inflammatory and Hematological Markers is Strongly Associated with the Risk of Death in Both Mild and Severe Initial Disease in Unvaccinated Individuals with COVID-19 Infection.

Background: Inflammatory and hematological markers are used extensively for early prognostication and monitoring in COVID-19.We aimed to determine whether routinely prescribed laboratory markers can predict adverse outcome at presentation in COVID-19. Methods: This retrospective observational study was performed on 401 samples collected between July to December 2020 from COVID-19 positive subjects, admitted at All India Institute of Medical Sciences, Delhi, India. Clinical details and laboratory investigations within 3 days of COVID-19 positivity were obtained. Clinical outcomes were noted from patient medical records, till discharge or death. Laboratory parameters, with individually defined cut-offs, were used, either singly or in combination to distinguish survival and death for those having severe and non-severe disease at initial presentation. Findings: Total Leukocyte count, Absolute neutrophil count, Neutrophil to Lymphocyte ratio, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Lactate Dehydrogenase, Ferritin and Lymphocyte to CRP ratio (LCR) were significantly altered at presentation in severe COVID-19 as compared to non-severe cases; and, also in those who died due to COVID-19 compared to those who survived. A combination of four markers, CRP (≥3.9mg/dL); IL-6 (≥45.37pg/ml); Ferritin (≥373ng/mL); 1/LCR ≥0.405 was found to strongly predict mortality in cases with non-severe presentation as also in severe cases. Conclusion and Interpretation: The combination of routinely used markers, CRP, IL-6, Ferritin and 1/LCR can be used to predict adverse outcomes, even in those presenting with mild to moderate disease. This would identify subset of patients who would benefit from closer monitoring than usual for non-severe disease.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India.

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Medical postgraduate (MD) program in Laboratory Medicine in India: The Past, Present and Future.

A medical postgraduate course in the field of Laboratory Medicine for the Bachelor of Medicine and Bachelor of Surgery (MBBS) degree holders has existed for more than two decades in India, initiated and offered by the All India Institute of Medical Sciences, New Delhi, which was created under the special Act of Parliament of India 1956. This course has recently been included in the draft of National Medical Commission's Post Graduate Regulation 2021 list of medical courses, and the foundation guidelines have been laid for other medical colleges and teaching hospitals across the country to start this course. This article, written purely in academic interest, describes the past, present and future of this postgraduate training program in India with an aim to answer several doubts regarding this unique and holistic course with a view to providing a direction to those who are willing to become a laboratory physician through this post-graduation.

Comparative Assessment of Matrix-assisted Laser Desorption Ionization-time of Flight Mass Spectrometry (MALDI-TOF-MS) and Conventional Methods in the Identification of Clinically Relevant Yeasts.

BACKGROUND: Candida species are generally identified by conventional methods such as germ tube or morphological appearance on cornmeal agar (CMA), biochemical methods using API kits, and molecular biological techniques. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) has revolutionized the identification of fungi reducing the turnaround time of days to minutes. PURPOSE: To compare the performance of MALDI-TOF MS and conventional methods in the identification of clinically relevant yeasts. MATERIALS AND METHODS: In this study, Candida identifications on CMA are compared with the results obtained on MALDI-TOF MS (Bruker Daltonics, Bremen, Germany). Discrepant results were confirmed by sequencing internal transcribed spacer (ITS) regions of rDNA. RESULTS: A total of 114 clinical Candida species isolated from blood cultures were isolated and identified with conventional methods as well as with the MALDI-TOF-MS system. The agreement between the two test results were analyzed using Inter-rater reliability analysis (Cohen's Kappa) in SPSS Software Version 24 (IBM Corp., Armonk, NY). Overall, there was substantial agreement (Cohen's kappa=0.763) between the two methods. A value between 0.61 and 0.80 is classified under substantial. The most frequently isolated bloodstream Candida species included Candida albicans, C. tropicalis, C. parapsilosis, C.lusitaniae, C. glabrata which were accurately identified by MALDI-TOF-MS. When compared with conventional identification methods, MALDI-TOF-MS results are more reliable and rapid for Candida identification.

Detection of three pandemic causing coronaviruses from non-respiratory samples: systematic review and meta-analysis.

SARS-CoV-2 has posed an unprecedented challenge to the world. Pandemics have been caused previously by viruses of this family like Middle East Respiratory Corona Virus (MERS CoV), Severe Acute Respiratory Syndrome Corona Virus (SARS CoV). Although these viruses are primarily respiratory viruses, but they have been isolated from non-respiratory samples as well. Presently, the detection rate of SARS-CoV-2 RNA from different clinical specimens using Real Time Reverse Transcriptase Polymerized Chain Reaction (qRT-PCR) after onset of symptoms is not yet well established. Therefore, the aim of this systematic review was to establish the profile of detecting SARS-CoV-2, MERS CoV, SARS CoV from different types of clinical specimens other than the respiratory using a standard diagnostic test (qRT-PCR). A total of 3429 non-respiratory specimens were recorded: SARS CoV (total sample-802), MERS CoV (total sample-155), SARS CoV-2 (total sample-2347). Out of all the samples studied high positive rate was seen for saliva with 96.7% (14/14; 95% CI 87.6-100.0%) for SARS CoV and 57.5% (58/250; 95% CI - 1.2 to 116.2%) for SARS CoV-2, while low detection rate in urine samples for SARS CoV-2 with 2.2% (8/318; 95% CI 0.6-3.7%) and 9.6% (12/61; 95% CI - 0.9 to 20.1%) for SARS CoV but there was relatively higher positivity in urine samples for MERS CoV with detection rate of 32.4% (2/38; 95% CI - 37.3 to 102.1%). In Stool sample positivity was 54.9% (396/779; 95% CI 41.0-68.8%), 45.2% (180/430; 95% CI 28.1-62.3%) and 34.7% (4/38; 95% CI - 29.5 to 98.9%) for SARS CoV-2, MERS CoV, and SARS CoV, respectively. In blood sample the positivity was 33.3% (7/21; 95% CI 13.2-53.5%), 23.7% (42/277; 95% CI 10.5-36.9%) and 2.5% (2/81; 95% CI 0.00-5.8%) for MERS CoV, SARS CoV-2 and SARS CoV respectively. SARS-CoV-2 along with previous two pandemic causing viruses from this family, were highly detected stool and saliva. A low positive rate was recorded in blood samples. Viruses were also detected in fluids along with unusual samples like semen and vaginal secretions thus highlighting unique pathogenic potential of SARS-CoV-2.

Evaluation of Direct Examination, Culture, and Histopathology in the Diagnosis of Mucormycosis: Reiterating the Role of KOH Mount for Early Diagnosis.

Introduction Invasive fungal infections have always been a major cause of mortality and morbidity and are especially prevalent in the immunosuppressed groups of patients. Members of the Mucoracea family have an increasing incidence and prevalence. It has always been difficult to diagnose this condition due to various reasons. Materials and Methods This was an observational study carried out jointly by the Department of Microbiology and the Department of Pathology for a duration of one year. All patients who presented in various clinical departments with a high index of clinical suspicion for mucormycosis were included in this study. A total of 186 samples were received from suspected cases of mucormycosis and were all subjected to direct microscopy by potassium hydroxide (KOH), fungal culture, and histopathological examination. Results Mucormycosis was documented in 33 out of 186 cases on direct microscopy, whereas 21 were positive on fungal culture. Histopathological positivity was reduced with only 11 cases showing aseptate hyphae suggestive of mucormycosis. Conclusion As these organisms generally do not grow well on routine culture media and with the histopathological results also being not suggestive clearly of mucormycosis, direct microscopy thus becomes more important and essential in the rapid diagnosis of this deadly condition.

A rare case of fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent individual in India.

BACKGROUND AND PURPOSE: Herein, we describe a rare case of fatal cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent individual without any underlying risk factors. CASE REPORT: A 55-year-old female presented with a short history of fever for 1 month, as well as headache, sudden onset of right-sided upper and lower limb weakness, and loss of speech for 10 days. Contrast-enhanced magnetic resonance imaging scan revealed large, peripherally enhancing, well-defined, cystic, space- occupying, axial lesion in the left parietal lobe with a mass effect. The patient was subjected to craniotomy, and the drained pus revealed pigmented septate hyphae in potassium hydroxide mount examination, which was identified as Cladophialophora bantiana. The patient was started on amphotericin B and voriconazole. However, she developed acute respiratory infection leading to multi-organ failure and death on day 27 post-operation. CONCLUSION: In the absence of comparative trials owing to the rarity of the disease, the radical resection of lesion, drainage of pus, and prolonged targeted antifungal therapy with close postoperative radiological surveillance are the therapeutic measures of choice for patients with brain abscess caused by phaeoid fungi.

Microfilaria in achylous hematuria: Can it imitate urolithiasis?

Wuchereria bancrofti is the major species resulting in filarial cases in India. Filariasis may present with various clinical presentations: asymptomatic, microfilaremia, lymphedema, acute adenolymphangitis and chronic lymphatic disease. Microfilariae of W. bancrofti have been detected in various clinical samples, but incidental detection of microfilaria in achylous urine is a rare finding with unexplained pathology. We report a case of microfilaria in achylous urine of a 30-year-old female who presented with pain abdomen and ureteric calculus on ultrasonography.

Candida auris emergence in the Himalayan foothills: First case report from Uttarakhand, India.

BACKGROUND AND PURPOSE: Candida auris is a rapidly emerging fungus, which is considered globally a cause of concern for public health. This report describes the first case of C. auris fungemia from a tertiary care hospital in the hilly state of Uttarakhand in India. CASE REPORT: The patient was a 37-year-old female who underwent a Whipple procedure for the carcinoma of the head of the pancreas. She developed fever 12 days after the operation while recovering from surgery in the hospital. Blood culture yielded C. auris which was identified by the matrix-assisted laser desorption/ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient was successfully treated with caspofungin. CONCLUSION: In conclusion, C. auris is potentially multidrug resistant, resulting in nosocomial outbreaks and sporadic infections which can be potentially prevented when identified early by implementing contact precautions.