The 2022 outbreak and the pathobiology of the coxsackie virus [hand foot and mouth disease] in India.

Outbreaks of HFMD in children aged <5 years have been reported worldwide and the major causative agents are Coxsackievirus (CV) A16, enterovirus (EV)-A71 and recently CVA6. In India, HFMD is a disease that is not commonly reported. The purpose of the study was to identify the enterovirus type(s) associated with large outbreak of Hand, foot, and mouth disease during COVID-19 pandemic in 2022. Four hundred and twenty five clinical samples from 196-suspected cases were collected from different parts of the country. This finding indicated the emergence of CVA6 in HFMD along with CVA16, soon after the gradual easing of non-pharmaceutical interventions during-pandemic COVID-19 and the relevance of continued surveillance of circulating enterovirus types in the post-COVID pandemic era.

Clinical Characterization and Genomic Analysis of Samples from COVID-19 Breakthrough Infections during the Second Wave among the Various States of India.

From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality.

Clinical Profile and Prognostic Indicators in Adults Hospitalized with Severe Malaria Caused by Different Plasmodium Species.

INTRODUCTION: Severe malaria remains a major cause of death and morbidity among adults in the Asiatic tropics. This study was planned to evaluate clinical profile and prognostic indicators of severe malaria in adults so as to improve insight into this highly prevalent disease. MATERIALS AND METHODS: This prospective observational study was conducted on 60 confirmed cases of malaria. Cases were divided into two groups: (a) study group: suffering from severe malaria and (b) control group: no severe manifestations. All cases were thoroughly studied for clinical features, laboratory evaluation, and outcome. Prognostic evaluation was also done by different score systems. RESULTS: In all, 40 cases suffer from severe malaria (study group), while 20 cases belong to the control group. The majority of our cases were males of age 21-40 years. The most common species of malaria in the study group was vivax (52.5%), followed by falciparum (25%) and mixed malaria species (22.5%). The clinical predictors for severe malaria were rural habitat, longer duration of fever, marked chills, tiredness, giddiness, nausea, vomiting, decreased urine output, jaundice, and altered sensorium. Extreme weakness (80%), jaundice (55%), renal failure (50%), and severe anemia (27.5%) were the most common presenting features in severe malaria. Two patients died of severe mixed malaria. The mortality rate was significantly associated with lower hemoglobin level (P = 0.002); higher total leukocyte count (P = 0.006), blood urea (P < 0.001), serum creatinine (P < 0.001), SGOT (P = 0.001), SGPT (P < 0.007), serum bilirubin (P = 0.003), and parasite density (P = 0.033); lower platelet count (P = 0.043); and those who had more APACHE II score (P = 0.003), SOFA score (P = 0.04), and Multiple Organ Dysfunction Score (P < 0.001) and lower Glasgow Coma Scale (P < 0.001). CONCLUSIONS: Manifestations of severe malaria is becoming increasingly more prevalent specifically in vivax and mixed malaria cases. Our study proposes that there are certain clinical predictors and prognostic indicators that should be kept in mind for better management of severe malaria.

Clinical and histopathological profile of acute renal failure caused by falciparum and vivax monoinfection: an observational study from Bikaner, northwest zone of Rajasthan, India.

BACKGROUND & OBJECTIVES: Acute renal failure (ARF) is a known manifestation of severe Plasmodium falciparum (Pf) malaria but recently it has also been observed with P. vivax (Pv) monoinfection. A clinical observational study has been conducted to evaluate the clinical and histopathological profile of ARF in malaria. METHODS: This study was conducted on 288 consecutive cases of malaria with monoinfection (Pf 191 and Pv 97) diagnosed by peripheral blood film examination and rapid card test. ARF was diagnosed as per WHO criterion (serum creatinine >3 mg%). The data were analysed by Standard t-test using ANOVA software. RESULTS: ARF was seen in 52 cases of Pf and 14 cases of Pv malaria. Mean age was 32.58 yr (ranging 15-65; Pf 33.37 and Pv 29.14) and male to female ratio was 2:1 (Pf 3:1 and Pv 1:1). Most of the cases developed ARF within 10 days of onset of the disease. Associated severe manifestations were jaundice (53 cases: Pf 44 and Pv 9), cerebral malaria (28 cases: Pf 25 and Pv 3), severe anemia (18 cases: Pf 17 and Pv 1), hypotension (16 cases: Pf 11 and Pv 5), bleeding manifestations (16 cases: Pf 14 and Pv 2), multiorgan failure (12 cases: Pf 9 and Pv 3) and ARDS (6 cases: Pf 5 and Pv 1). Kidney biopsy (16 Pf and 2 Pv) showed acute tubular necrosis (5 Pf and 1 Pv), mesangioproliferative glomerulonephritis (2 Pf) or both (9 Pf and 1 Pv). Haemodialysis was done in 7 (Pf 4 and Pv 3) cases, out of which four survived. Most of the cases (48.49%) recovered within two weeks (range 3-20 days). Total mortality was 27.27% (Pf 28.85% and Pv 21.43%). INTERPRETATION & CONCLUSION: ARF can also be caused by vivax monoinfection with similar clinical and histopathological features although outcome is less severe as compared to falciparum monoinfection.

Evaluation of antibiotic sensitivity pattern in cases of enteric fever in north west Rajasthan.

A total of 50 cases of blood culture proved enteric fever were studied for clinical response to the treatment and compared with in vivo antibiotic sensitivity pattern. Out of 50 Salmonella strains isolated, 37 were S typhi and 13 S paratyphi A. All S typhi isolates were sensitive in vitro to gentamicin and ceftriaxone while sensitivity to ciprofloxacin was 73%, ampicillin 29.7%, chloromphenicol 27%, tetracycline 27% and co-trimoxazole 13.5%. Multidrug resistance (Ampicillin, Chloramphenicol, Cotrimoxazale and Tetracycline) was observed in 62% isolates. All Sparatyphi A isolates were sensitive to all the antibiotics. Clinical response to the antibiotic therapy was as follows: Group I--Ampicillin + Gentamicin: 15 cases, clinical response (CR), 9.1% (S typhi) and 75% (S paratyphi A), mean day of defervescence 5.33 days. Group II--Ciprofloxacin: 29 cases, clinical response 47.6% (S typhi) and 75% (S paratyphi A), mean day of defervescence--5.22 days. Group--III Ceftriaxone: 30 cases, clinical response 100% in all, mean day of defervescence--4.93 days. Thus we observed highly significant discrepancy in antibiotic sensitivity pattern of the isolates and clinical response. Most importantly we observed significantly delayed clinical response to the ceftriaxone. This may be indicative of evolving resistance to ceftriaxone.

Hospital-based case series of 175 cases of serologically confirmed brucellosis in Bikaner.

OBJECTIVE: To study the clinical spectrum of brucellosis in Bikaner (Northwest India). METHODS: A total of 175 cases were diagnosed as brucellosis during the period of six year (June 1997 to May 2003). They were studied for clinical profile and treated by rifampicin and doxycyclin and additionally streptomycin for initial 14 days in patients of neurobrucellosis. These patients were followed up to 3 months. RESULTS: Patients of brucellosis presented with a wide spectrum of clinical manifestations. Out of 175 cases 155 were from rural area. Age ranged between 12-60 years (124 males, 51 females). Analysis of risk factors revealed history of raw milk ingestion (86.86%), occupational contact with animals (81.14%), handling of infected material (62.28%), household contact (16%) and 2 patients were veterinarian. Joint pain (83.43%) and fever (77.71%) were the commonest presenting feature. Sacroiliac joint was most commonly involved (46.86%). 31 cases had involvement of multiple joints. Other mode of presentation were neurobrucellosis (18.86%), manifested as polyradiculoneuropathy, myeloradiculopathy, meningoencephalopathy and polyradiculomyeloencephalopathy; predominant pulmonary involvement (4.0%) presented as bronchitis, pneumonia and pleural effusion; epididymoorchitis, infective endocarditis, nephrotic syndrome and recurrent abortion. All patients responded well to the treatment. CONCLUSION: Brucellosis is an important emerging zoonotic disease but it is often under-diagnosed due to lack of suspicion and diagnostic facilities despite the fact that cattle farming (an important high risk group) is one of the main occupation in rural area. This report should infuse the awareness about this reemerging disease specifically in high-risk group.