Comparison of rapid tests (antigen vs. antibody) for the diagnosis of typhoid in the first and second weeks of fever.

Objectives: We conducted this study with an objective to compare the diagnostic accuracy of rapid antigen and antibody kits for early detection (<5 days of fever) and late detection (>5 days of fever) of S.Typhi and S.Paratyphi in relation to the Widal test. Methods: A cross-sectional observational study was conducted over 15 months, during which 180 cases of documented fever were enrolled. Paired samples (at <5 and >5 days of fever) were processed for rapid antigen test (RAg), rapid antibody test (RAb) and Widal test. Blood culture (BacT/Alert system) was considered as the gold standard for confirmation. Results: The mean (SD) age of patients with enteric fever was 16.42 (12.53) years, with a slight male preponderance (58.33% males vs. 41.67% females). Positive blood culture was reported in 58 (32.22%) cases. For RAg, RAb and Widal tests, the diagnostic accuracy was 45.56%, 42.22% and 41.11%, respectively, which was comparable for diagnosing enteric fever in cases with <5 days of fever (P = 0.675). For fever >5 days, RAg showed a significantly lower diagnostic accuracy (15%) as compared to RAb (61.11%) and Widal test (66.11%) (P < 0.0001). Conclusion: The study concludes that RAg marks a high sensitivity of accurate diagnosis in the initial five days of typhoid fever while RAb (with or without Widal tests), hold a superior sensitivity for diagnosis after five days of onset of enteric fever.

Zika a Vector Borne Disease Detected in Newer States of India Amidst the COVID-19 Pandemic.

Background: During the second wave of the COVID-19 pandemic, outbreaks of Zika were reported from Kerala, Uttar Pradesh, and Maharashtra, India in 2021. The Dengue and Chikungunya negative samples were retrospectively screened to determine the presence of the Zika virus from different geographical regions of India. Methods: During May to October 2021, the clinical samples of 1475 patients, across 13 states and a union territory of India were screened and re-tested for Dengue, Chikungunya and Zika by CDC Trioplex Real time RT-PCR. The Zika rRTPCR positive samples were further screened with anti-Zika IgM and Plaque Reduction Neutralization Test. Next generation sequencing was used for further molecular characterization. Results: The positivity was observed for Zika (67), Dengue (121), and Chikungunya (10) amongst screened cases. The co-infections of Dengue/Chikungunya, Dengue/Zika, and Dengue/Chikungunya/Zika were also observed. All Zika cases were symptomatic with fever (84%) and rash (78%) as major presenting symptoms. Of them, four patients had respiratory distress, one presented with seizures, and one with suspected microcephaly at birth. The Asian Lineage of Zika and all four serotypes of Dengue were found in circulation. Conclusion: Our study indicates the spread of the Zika virus to several states of India and an urgent need to strengthen its surveillance.

An observational study to compare the diagnostic accuracy of rapid antigen test and rapid antibody tests in various periods of enteric fever.

A cross-sectional observational study was done on 180 fever patients to assess the diagnostic accuracy of rapid serological tests in early detection (<5 days of fever) of S. typhi and S. paratyphi in comparison to blood culture and Widal test Blood culture was positive in 58 (32.22%) cases. The diagnostic accuracy (<5 days of fever) of rapid antigen test, rapid antibody test, and Widal test was 45.56%, 42.22%, and 41.11% (p = 0.675) while sensitivity was 68.97%, 48.28%, and 46.55%, respectively. In conclusion, rapid antigen test holds moderately higher sensitivity in the first five days of fever as compared to rapid antibody and Widal tests. It is recommended that the antigen detection tests should be used for screening enteric fever in the first week of presentation.

Evaluation of Serum Levels of Procalcitonin and C-Reactive Protein as Prognostic Indicators in Burns.

Background Burn is a leading cause of fatality in a developing country. C-reactive protein levels (CRP) and procalcitonin (PCT) can be prognostic indicators for the burn patients' mortality. Aim To assess serial levels of serum PCT and serum CRP as prognostic indicators in burns. Patient and Methods In patients admitted with burns, alternate-day serum PCT and CRP were measured from the time of admission until the time of discharge or until survival. The change in trends of CRP and PCT serum levels were studied, and it was then correlated with mortality among these burn patients. Results The first-day value of serum PCT > 1772 pg/mL and serum CRP > 71 mg/mL or any value of serum PCT > 2163 pg/mL and of serum CRP > 90 mg/L indicate a poor prognosis in burns. Conclusions The day-1 values of PCT and CRP were significantly higher in nonsurvivors than survivors in burns. The increasing trends of serum PCT and CRP levels are independent predictors of mortality in burns requiring prompt intervention. Rising PCT and CRP level denote poor prognosis in burns with an increased likelihood of death by 4.5 and 23.6 times, respectively.

Diagnostic value of galactomannan antigen test in serum and bronchoalveolar lavage fluid sample from suspected patients of invasive pulmonary aspergillosis.

Invasive pulmonary aspergillosis (IPA) is mainly caused by Aspergillus fumigatus and other Aspergillus species. Galactomannan (GM) is a polysaccharide antigen that exists primarily in the cell walls of Aspergillus species. GM may be released into the blood and other body fluids even in the early stages of Aspergillus invasion; therefore, detection of the GM antigen level can be useful in making an early diagnosis of IPA.

Evaluation and comparison of molecular and conventional diagnostic modalities for detecting pulmonary tuberculosis in bronchoalveolar lavage fluid.

CONTEXT: In cases of sputum smear-negative and sputum-scarce (SSN/SC) pulmonary tuberculosis (PTB), bronchoalveolar lavage (BAL) fluid may be helpful in establishing diagnosis. No specific recommendations for BAL samples have yet been formulated due to limited literature. AIMS: 1. To find a sensitive and specific protocol for same-day diagnosis of PTB using BAL in SSN/SC clinically suspected patients. 2. To evaluate the need to routinely perform MGIT for all BAL samples. SETTINGS AND DESIGN: Prospective observational study design in a tertiary care hospital in New Delhi. METHODS AND MATERIAL: Fibreoptic bronchoscopy was performed and BAL collected from 175 clinically suspected SSN/SC PTB patients. BAL samples were subjected to: ZN Stain, Xpert MTB/RIF CBNAAT, BACTEC MGIT 960 liquid culture and M. tuberculosis complex DNA Real time PCR. The results of the various diagnostic tests were analysed using a) MGIT as gold standard and b) a composite reference standard (CRS) for a final diagnosis of PTB. STATISTICAL ANALYSIS USED: Microsoft Excel 2016 and SPSS version 21.0 were used. Sensitivity, specificity and predictive values were calculated and compared using McNemar test. A p value of <0.05 was considered statistically significant. RESULTS: 34 Cases had a final diagnosis of TB as per the CRS. Using CRS, MGIT had a sensitivity of 50.0% (32.4%-67.6%). There was no statistically significant difference between sensitivities of CBNAAT and PCR; both were more sensitive than ZN stain. Sensitivity and specificity of CBNAAT was 79.4% (62.1%-91.3%) and 100.0% (97.4%-100.0%) respectively. The preferred protocol for the hospital is CBNAAT and ZN stain. There was no statistically significant difference in sensitivity by adding PCR or MGIT to this protocol. CONCLUSIONS: We found it a good strategy to perform CBNAAT and ZN stain on BAL fluid for accurate and same-day PTB diagnosis. CBNAAT is useful for ruling PTB in even when BAL cultures are negative. It is prudent to continue to routinely perform MGIT for all BAL samples.

A treated case of rhinocerebral zygomycosis with aspergillosis: a case report from India.

Zygomycosis and aspergillosis are two serious fungal infections that are commonly seen in immunocompromised patients. Since both of these infections involve fungi that invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can clinch the diagnosis. Here, we present a case of a 60-year-old diabetic patient who presented with swelling and pain over the nose and left eye for 7 days with loss of vision in the left eye. After investigation, the patient was diagnosed as having rhinocerebral mucormycosis and aspergillosis, and was initially treated with amphotericin B (1 mg kg-1 day-1 intravenously), followed by endoscopic debridement under general anaesthesia. The patient gradually improved after surgery, and treatment with intravenous amphotericin B was continued along with the addition of 200 mg oral voriconazole twice daily (for the aspergillosis). With prompt diagnosis and treatment, the patient survived these fatal fungal co-infections and finally was discharged.

Diagnosis of pulmonary tuberculosis from gastric aspirate samples in nonexpectorating pediatric patients in a tertiary care hospital.

OBJECTIVES: The aim of this study was to assess the utility of Xpert assay, Ziehl-Neelsen (ZN) staining, and Mycobacteria Growth Indicator Tube (MGIT™) culture for diagnosis of pediatric pulmonary tuberculosis from gastric aspirate (GA) samples and to compare Xpert assay and ZN staining with MGIT rapid liquid culture. MATERIALS AND METHODS: GA samples from 210 nonexpectorating children, aged between 6 months to 12 years, presenting to the pediatric out-patient department (OPD) with clinical suspicion of tuberculosis (TB) were collected. The samples were tested by GeneXpert, ZN staining, and MGIT liquid culture. RESULTS: GeneXpert is a more sensitive method for rapid and early diagnosis of pediatric TB when compared with microscopy.

Role of procalcitonin, Il-6 and C- reactive protein in suspected cases of sepsis.

OBJECTIVES: To study the role of serum procalcitonin as a diagnostic biomarker in sepsis and to compare it with other sepsis markers (IL-6, CRP) in patients of suspected sepsis. MATERIALS AND METHODS: A total of 80 patients were included in this study from ICU and each patient was investigated for serum Procalcitonin, Interleukin-6 and C-reactive protein levels by ELISA along with blood cultures by BacT/Alert system. RESULT: Procalcitonin along with CRP is a better diagnostic tool for sepsis.

An unusual case of reversible mild cognitive impairment.

Mild cognitive impairment (MCI) is cognitive dysfunction greater than expected for age and education in either a single cognitive domain or in multiple domains without impairment of activities of daily living. The present case report describes the case of an elderly male patient of 71 years who presented with MCI and was Venereal Disease Research Laboratory test reactive in serum. This was confirmed by Treponema pallidum Hemagglutination Assay. After a complete course of antibiotic therapy, his memory complaints disappeared completely. Though syphilis is termed as reversible dementia; to the best of our knowledge, this is the first case of MCI with reactive syphilis serology who responded to antimicrobial therapy.

Treatment paradox in musculo-skeletal tuberculosis in an immunocompetent adult male; a case report from a tertiary care hospital.

Paradoxical reactions like immune reconstitution inflammatory syndrome (IRIS) as seen with patients on retroviral treatment in HIV infection, have also been identified in HIV sero-negative patients with extra pulmonary tuberculosis especially lymph-node tuberculosis. Musculo-skeletal tuberculosis presenting as a cold abscess of the anterior chest wall is a rare entity which poses diagnostic and therapeutic challenge. A 35-year-old immunocompetent male came with complains of painless lump on right side of his chest over 9th and 10th intercostal space which gradually increased and extended upto 11th rib area. Clinically, diagnosis of cold abscess was made and anti-tubercular therapy (ATT) was started. Despite of being on ATT for 3 weeks, patient developed pain and signs of inflammation. Fluid was aspirated and sent for biochemical and microbiological investigations. The aspirated fluid was positive for acid fast bacilli by ZN stain and grew Mycobacterium tuberculosis in culture, sensitive to first line ATT. Pyogenic and fungal culture was negative. This case presented as an anterior chest wall cold abscess which deteriorated on initiation of first line ATT, thus creating a suspicion of resistance to ATT which was cleared on ATT susceptibility testing. Hence, this case underlines the possibility of treatment paradoxes seen in immunocompetent musculo-skeletal tuberculosis.

Primary tubercular chest wall abscess in a young immunocompetent male.

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

Pyogenic liver abscess caused by Salmonella Enteritidis: a rare case report.

Salmonella Enteritidis is one of the most important serovars transmitted from animals to humans and a serovar most commonly reported worldwide. Infection with Enteritidis is mainly limited to the intestinal tract, but under certain circumstances may cross the mucosal barrier to disseminate and get established as some localized infectious focus. Although cited as one of the very uncommon causes, Enteritidis may involve the liver and evolve into an overt abscess. Pyogenic liver abscess by a gas forming organism like Enteritidis usually follow a serious fulminant course and associated morbidity and mortality is unacceptably high unless immediate therapeutic interventions are initiated.

A Study of Clinical, Microbiological, and Echocardiographic Profile of Patients of Infective Endocarditis.

Infective endocarditis, a great masquerader, is a clinical entity which may present with a myriad of manifestations. Its changing epidemiological profile has been studied in the previous decades in both the developed and the developing nations. In this study, we strived to uphold the evolving clinical profile and its outcome from a government tertiary care hospital in Northern India. It was a descriptive, cross-sectional, observational study conducted over two years' period involving 44 patients diagnosed with definite infective endocarditis, according to modified Dukes' criteria. Demographic, clinical, microbiological, and echocardiographic data were analysed. Mean age of patients was 31 years. Rheumatic heart disease with regurgitant lesions was the commonest risk factor. Dyspnea and fever were the predominant symptom, and pallor and heart failure the commonest sign. Cultures were positive in 52% with Staphylococcus, the major isolate. Transesophageal echocardiography fared better than transthoracic one to define the vegetations. Mortality is reported in 4.5%. Prolonged duration of fever, pallor, hematuria, proteinuria, rheumatoid factor positivity, and large vegetations proved to be poor prognostic variables. Culture positive endocarditis, with persistent bacteremia, had higher incidence of acute renal failure. Right sided endocarditis was frequent in congenital lesions or IV drug user, whereas left sided endocarditis mostly presented with atrial fibrillation.

A finding of live Fasciolopsis buski in an ileostomy opening.

A pair of live Fasciolopsis buski wriggled their way out through the ileostomy opening in a young adult male who had recently migrated to Delhi and had met with a road traffic accident. Finding this parasite in the national capital, a non endemic area for Fasciolopsiasis, prompted us to emphasize the importance of changes in the ecology, human demography, and human behaviour that may provide an environment conducive to their adaptability to the new geographical requirements. Awareness of Fasciolopsiasis, which is endemic in some regions of India, especially in rural settings, is an important issue because early diagnosis is essential. Hence, a surveillance mechanism among the migratory population to institute preventive interventions is necessary.

Salmonella enterica serotype Typhi from a case of breast abscess.

Enteric fever is an acute systemic febrile infection caused by Salmonella enterica serotype Typhi. Breast abscess due to S. typhi infection is a rare sequelae. We report here a classical case of Salmonella typhi infection in a rare clinical form of a breast abscess in a non-lactating immuno-compromised female.