Prevalence of SARS-CoV-2 virus in saliva, stool, and urine samples of COVID-19 patients in Bihar, India.

Introduction. The coronavirus illness caused by SARS-CoV-2 can cause multiple organ involvement, with varying degrees of severity. Besides inhalation as a route for transmission, feco-oral has also been proposed. Its transmission to sewage systems is a growing public health issue. Objective. To detect SARS-CoV-2 RNA in non-respiratory samples (saliva, urine, and stool) collected from COVID-19 cases, in Bihar. Methods. This cross-sectional observational study was conducted from January 2021 to March 2022 on human non-respiratory samples. A total of 345 samples including saliva (116), stool (97), and urine (132) were collected from 143 COVID-19 cases. Samples were analysed for SARS-CoV-2 by multiplex RT-PCR targeted against E, ORF 1ab, and RdRp genes. Results. In this study, out of 143 cases, a total of 107 (74.8 %) were positive for SARS-CoV-2 RNA in at least one of the non-respiratory samples. Conclusion. There is a high prevalence of SARS-CoV-2 virus in non-respiratory samples.

Demographic and microbiological profile of corneal ulcer patients presenting at a tertiary healthcare center of Eastern India during the COVID era: A hospital-based cross-sectional study.

Purpose: To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Method: Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. Results: In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Conclusion: Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.

Fungal Keratitis Due to Fusarium lichenicola: A Case Report and Global Review of Fusarium lichenicola Keratitis.

Fusarium species are among the most commonly isolated causes of fungal keratitis. Most species of the genus Fusarium belong to Fusarium solani species complex (FSSC). Fusarium lichenicola, a member of the FSSC complex, is a well-established plant and human pathogen. However, reports of fungal keratitis due to Fusarium lichenicola have not been frequently reported. To the best of our knowledge, only twelve cases of Fusarium lichenicola keratitis have been reported in the past fifty years. Clinical cases of Fusarium lichenicola may have most likely been misidentified because of the lack of clinical and microbiological suspicion, as well as inadequate diagnostic facilities in many tropical countries where the burden of the disease may be the highest. We report a case of fungal keratitis caused by Fusarium lichenicola and present a global review of the literature of all cases of fungal keratitis caused by this potentially blinding fungus.

Effectiveness of COVID-19 vaccine in preventing infection and disease severity: a case-control study from an Eastern State of India.

Effectiveness of corona virus disease-19 (COVID-19) vaccines used in India is unexplored and need to be substantiated. The present case-control study was planned to elicit the effectiveness of COVID-19 vaccines in preventing infection and disease severity in the general population of Bihar, India. This case-control study was conducted among people aged ≥45 years during April to June 2021. The cases were the COVID-19 patients admitted or visited All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India, and were contacted directly. The controls were the individuals tested negative for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) at the Virology laboratory, AIIMS-Patna and contacted telephonically for collection of relevant information. The vaccine effectiveness (VE) was calculated by using the formula (VE = 1 - odds ratio). The adjusted VE for partial and full vaccination were estimated to be 52.0% (95% confidence interval (CI) 39.0-63.0%) and 83.0% (95% CI 73.0-89.0%) respectively for preventing SARS CoV-2 infection. The sub-group analyses of the cases have shown that the length of hospital stays (LOS) (partially vaccinated: 9 days vs. unvaccinated: 12 days; P = 0.028) and the severity of the disease (fully vaccinated: 30.3% vs. partially vaccinated: 51.3% and unvaccinated: 54.1%; P = 0.035) were significantly low among vaccinated compared to unvaccinated individuals. To conclude, four out of every five fully vaccinated individuals are estimated to be protected from contracting SARS CoV-2 infection. Vaccination lowered LOS and chances of development of severe disease.

Melioidosis in Bihar, India: unearthing the first of many?

Melioidosis, a disease with protean clinical manifestations, is prevalent in many parts of India, with established endemic hotspots on the southern coast of the country. However, it is still underdiagnosed in many resource-poor regions of the country. We report what is, to the best of our knowledge, the first case of melioidosis diagnosed and treated in Bihar, an economically underdeveloped state in East India. The patient, a 52-year-old diabetic male, presented to the outpatient department with a fever of insidious onset along with pain and restriction of movement in the right shoulder joint and right knee joint, and swelling and tenderness of bilateral ankle joints. Radiological features were suggestive of multiple joint and organ abscesses. A diagnosis of disseminated septicaemic melioidosis was confirmed microbiologically. The patient improved clinically following aggressive treatment with meropenem and cotrimoxazole. The case highlights the need for increased clinical suspicion of melioidosis and adequate diagnostic facilities, as well as the need for early institution of appropriate empirical antibiotics in suspected cases of melioidosis in this region of the world.

Bilateral endogenous endophthalmitis complicated by scleral perforation: an unusual presentation.

Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study.

Background: Breast feeding by SARS-CoV-2-infected mothers has been a concern because of the possibility of excretion of virus in breast milk. Objective: To detect SARS-CoV-2 in expressed breast milk (EBM) of mothers infected with SARS-CoV-2 and clinical outcome of neonates delivered and breast fed by them. Design: A single-centre, prospective observational study involving 50 SARS-CoV-2-infected mothers and their 51 neonates. Setting: A tertiary care hospital in Eastern India. Participants: SARS-CoV-2-infected mothers and neonates delivered by them. Main outcome measures: We investigated the presence of SARS-CoV-2 in the breast milk of mothers, who tested positive for this virus in their nasopharyngeal swab (NPS). Clinical outcome was assessed in neonates breast fed by these mothers after 1 month of the postnatal period. Results: 50 SARS-CoV-2-positive expectant mothers were enrolled for the study. One out of 51 neonates, who delivered through lower segment caesarean section at term gestation and tested SARS-CoV-2 negative, died due to severe birth asphyxia. One sample of EBM was collected from each of the 49 mothers within 4 days of delivery. All EBM samples tested negative for SARS-CoV-2 through real-time reverse transcriptase-PCR (RT-PCR). All the newborns were screened twice for presence of SARS-CoV-2 RNA in their NPS, by RT-PCR. 2 of 51 neonates had COVID-19 infection after 24 hours of life. Caregivers of 37 of 50 alive neonates responded to follow-up via telephone. Except for minor feed intolerance in one (1 of 37) neonate, all neonates were reported well after 1 month of their age. Conclusion: All the samples of breast milk were negative for SARS-CoV-2. Most of the neonates remained asymptomatic on breast feeding, whose mothers had SARS-CoV-2 infection before delivery.

Detection of severe acute respiratory syndrome corona virus 2 in cervico-vaginal secretion of COVID-19-affected female: A prospective observational study from India.

BACKGROUND: The novel severe acute respiratory syndrome corona virus 2 (also known as 2019-nCoV) is a highly infectious agent and is declared as a global public health emergency by the World Health Organisation. The main known transmission route of severe acute respiratory syndrome corona virus 2 is through respiratory air droplets. Although recent studies have revealed that the virus is detectable in the throat, blood, urine, anal swabs, tears and even faeces; however, modes of transmission other than respiratory droplets has not been studied much. Knowledge on the presence of the virus in the female genital tract may help determine the risk of sexual transmission as well as the risk of mother-to-child transmission. However, not much data are available yet regarding the presence of the virus in the female genital system. Hence, to explore the presence of the virus in the female genital system and possibility of sexual transmission, a study was conducted where in we tried to detect severe acute respiratory syndrome corona virus 2 in cervico-vaginal secretions. METHODS: From July 2020 to September 2020, 35 COVID-19-positive female patients admitted to tertiary care teaching institute of Eastern India, which is now declared dedicated Corona Hospital and Centre of Excellence for COVID-19 care, who consented for the research were enrolled in this prospective observational study. Proper gynaecological history, clinical records along with laboratory findings of the patient was recorded. The possibility of the sexual transmission of the virus from female to her male partner was to be ascertained by testing the presence of severe acute respiratory syndrome corona virus 2 in the vaginal, cervical secretions by reverse transcriptase polymerase chain reaction. RESULTS: All 35 COVID-19-positive female patients were tested for severe acute respiratory syndrome corona virus 2 in their vaginal and cervical secretions by reverse transcriptase polymerase chain reaction. All the samples were tested negative for the virus. CONCLUSION: Findings from this study reveals that severe acute respiratory syndrome corona virus 2 is not present in the cervical and vaginal secretions, and the possibility of transmission from female to her male partner by vaginal sexual intercourse is unlikely.

RmtC and RmtF 16S rRNA Methyltransferase in NDM-1-Producing Pseudomonas aeruginosa.

We investigated 16S rRNA methyltransferases in 38 blaNDM-1-positive Pseudomonas aeruginosa isolates and found RmtC in 3 isolates, 1 of which also harbored RmtF. The isolates were clonally unrelated; rmtC and rmtF genes were located on a chromosome with the blaNDM-1 gene. Strategies are needed to limit the spread of such isolates.

Prevalence and molecular characterisation of New Delhi metallo-ß-lactamases NDM-1, NDM-5, NDM-6 and NDM-7 in multidrug-resistant Enterobacteriaceae from India.

The growing prevalence of carbapenem resistance in Enterobacteriaceae worldwide is a major concern. New Delhi metallo-ß-lactamase (NDM)-mediated carbapenem resistance has been identified in Enterobacteriaceae from numerous countries including those of the Indian subcontinent. Currently, seven NDM ß-lactamase variants (NDM-1 to -7) have been identified. This study evaluated the detection and molecular characterisation of NDM variants in Enterobacteriaceae at a tertiary care hospital in India. A total of 464 isolates were tested; 57 (12.3%) were resistant or showed reduced susceptibility to imipenem and meropenem. All carbapenem-resistant isolates were blaNDM-positive by PCR, but 13 isolates bore variants that differed in sequence from blaNDM-1. NDM-5, NDM-6 and NDM-7 were identified in two, eight and three isolates, respectively. blaNDM variants were located on plasmids of >100kb with IncF, IncA/C and untypeable replicon types. Genes encoding the 16S rRNA methyltransferases RmtB, RmtC and ArmA as well as those for AmpC ß-lactamases were also located on the same plasmids as blaNDM in different combinations. The prevalence of NDM-5 to -7 variants was significantly higher in Escherichia coli (P=0.015) and they were more frequently isolated from the urology ward (P=0.037) than NDM-1. The mortality rate was comparable between patients infected with isolates positive for blaNDM-1 and blaNDM variants [25% (11/44) vs. 23% (3/13)]. Expression of blaNDM variants in E. coli using the same promoter showed that NDM-7 conferred higher resistance to imipenem. The diverse genotypic features of blaNDM indicate rapid evolution of NDM resulting from their wide spread in the Indian subcontinent.

Immune-inflammatory markers in massively disseminated cysticercosis.

Disseminated cysticercosis is a common endemic tropical infection. We report a 24-year-old man who presented with a single episode of focal seizure and transient depression. Imaging studies revealed disseminated vesicular cysticercosis involving almost all the body parts. In spite of severe dissemination and significantly raised immunological inflammatory markers, the patient had negligible symptoms. He was subsequently followed up with oral corticosteroid and antiepileptic drug without further complication. The extensive dissemination, relatively benign nature of the disease and clinicoradiological discordance are interesting to describe. This neglected tropical infection can sometimes be alarming and needs public health awareness.