Tomato Flu in the Time of COVID-19: Another Challenge for the Indian Health System.

Just as the country has recently dealt with the increase in COVID-19 and monkey pox cases, another dark cloud of "Tomato flu/ Tomato fever" loomed the skies of the nation. As of 24 august, 2022, 100 kids mainly below the age of 5 have been reported showing symptoms of the flu. Another state of Odisha, suspected similar infectious etiology in 36 cases out of which 26 Children were below the age of 10. This endemic viral illness has triggered an alert to the neighboring states of Tamil Nadu and Karnataka, along with the entire nation at large. The wrath of this disease is not just restricted to India but crossing borders. Tang, et al reported a case of a 13-month-old female child and her 5-year old brother based in United kingdom with similar etiology. Through this report, we aim to alert the frontline pediatricians, who are most likely to come across and manage such daunting cases with these non-specific clinical features in their routine clinical practice across the globe. Early and extreme preventive and surveillance measures must be undertaken to prevent substantial loss in public and private sector.

Bronchial mucus plug mimicking fragmented Ascaris worm: An ambiguous case presentation.

With increasing travel and immunosuppression, parasitic lung and pleural diseases are increasingly been reported. The diagnosis in certain cases is very challenging because of nonspecific clinical and radiological features. We hereby present a case of a 60-year-old immunocompetent female complaining of difficulty in breathing for 4-5 days for which sputum sample along with the coughed-up fragment of the parasite under investigation was sent to the laboratory. All the blood parameters along with blood and sputum culture were within normal limits. Direct microscopy for sputum and multiple fecal samples did not yield any significant information. Chest X-ray was normal, whereas contrast-enhanced computed tomography scan changes were suggestive of fibrotic changes and mucoid impaction. The histopathological examination showed thick mucus content and no evidence of a parasitic infestation, worm, larva, or ova. So the differential diagnosis of the right lower lobe obstruction probably due to mucus plug was made, and the patient was referred to a pulmonologist for further follow-up. This case highlights the importance of common respiratory disorders characterized by mucus plugs and that some may mimic parasitic segments. Specific clinical, radiological, and pathologic features, microscopic examination, or serological testing can help to narrow the differential diagnosis of infective or noninfective causes and help the patients in early and accurate diagnosis and treatment and save them from unnecessary expensive and invasive investigations.

Varicella Infection in an Immunized Pediatric Living Donor Liver-Transplant Recipient.

Varicella-zoster virus (VZV) is a DNA virus belonging to the Herpesviridae family. Primary infection causes chickenpox followed by latency in the sensory ganglia, which can sometimes reactivate leading to herpes zoster. Chicken pox is generally a mild disease of childhood with a secondary attack rate of >85%, but disseminated VZV infection with visceral involvement and fatal outcome may occur in immunocompromised individuals. Indian Academy of Pediatrics recommends two doses of live-attenuated varicella vaccine in healthy unexposed children at 15-18 months and then at 4-6 years of age. The effectiveness of a single dose of vaccine is around 85% and with a two-dose schedule is as high as 92%. Despite the vaccine-induced protection, community-acquired VZV infections still remain a problem in immunocompromised population. We hereby report a case of a previously immunized pediatric liver-transplant recipient who acquired VZV infection. This case report clearly highlights the importance of strict environmental infection control practices, early suspicion, diagnosis, and management in such cases.

A Comprehensive Review of Trichosporon spp.: An Invasive and Emerging Fungus.

Trichosporon species are basidiomycetous yeast-like organisms found ubiquitous in nature. They are increasingly been recognized as opportunistic pathogens capable of causing life-threatening invasive diseases (trichosporonosis), especially in immuno-suppressed patients and rarely in immuno-competent patients too. Earlier multiple members of the genus Trichosporon were clubbed together as T. beigelli but after the advent of molecular techniques, more than 50 different subspecies and around 16 different strains causing human diseases are reported. It is known to cause a wide range of diseases, from superficial to probable and proven invasive diseases to summer hypersensitivity. The ability of Trichosporon strains to form biofilms on implanted devices, glucuronoxylomannan in their cell walls, and production of proteases and lipases lead to the virulence of this genus. This ubiquitous fungus exhibits intrinsic resistance to echinocandins, variable minimum inhibitory concentrations (MIC) for amphotericin B, and moderate susceptibility to fluconazole and Itraconazole, which are the commonly used anti-fungal agents for any invasive fungal infections which lead to the re-emergence of this notorious yet neglected pathogen and hence the reports of breakthrough infections among patients receiving these antifungals. This review is to understand the epidemiological, clinical details, and antifungal susceptibility pattern of various Trichosporon infections and it highlights the importance of early detection and treatment for this emerging yeast and also will add to the ongoing surveillance for the anti-fungal susceptibility pattern for this fungus.

Epidemiological profile and antifungal susceptibility pattern of Trichosporon species in a tertiary care hospital in Chandigarh, India.

BACKGROUND AND PURPOSE: Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections. MATERIALS AND METHODS: In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%), followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%). RESULTS: Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low. CONCLUSION: Trichosporonosis is being increasingly reported all around the world, including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.

Assessment of cognitive and psychomotor domains regarding biomedical waste management and hand hygiene among various categories of health-care professionals at a tertiary care center in Northern India.

BACKGROUND: Health care-associated infections (HAIs) are associated with high morbidity, mortality, and costs in the health-care sector. Large proportions of HAIs are preventable by following infection prevention activities such as hand hygiene (HH) and biomedical waste management (BMWM). AIM: The aim was to evaluate the effectiveness of a structured teaching session on the cognitive and psychomotor domains of BMWM and HH practices in a tertiary health-care institute. MATERIALS AND METHODS: Every participant was evaluated for pretest knowledge assessment using a prestructured format along with skill demonstration. The training included interactive sessions, open discussion, and demonstration of various skills with the active participation of various participants by trained faculty and infection control nursing officers. On completion, every participant underwent posttest evaluation. RESULTS: During 11-month study period, 450 health-care professionals (HCPs) participated in the training program. Cognitive domain score increased from 16.3 ± 2.4 to 21.3 ± 2.0 from pre- to post-test, respectively. In psychomotor domain, pre- and post-test scores for HH were 8.3 ± 3.5 and 14.3 ± 1.4, for BMWM, the corresponding values were 8.6 ± 2.1 and 9.8 ± 0.7, respectively. Overall change in the mean (± standard deviation) score between pre- and post-test for various domains of assessment was 5.0 (±2.7), 6.0 (±3.5), 1.1 (±1.8), and 12.2 (±5.3) for knowledge, HH skill demonstration, BMW segregation skill, and cumulative assessment, respectively. CONCLUSION: The initiation of a structured training program can result in a significant increase in participants' cognitive and psychomotor domains of learning, which may have an indirect impact on the prevention of HAIs.

Pooled RNA sample reverse transcriptase real time PCR assay for SARS CoV-2 infection: A reliable, faster and economical method.

BACKGROUND: Corona virus disease 2019 (COVID-19) which initially started as a cluster of pneumonia cases in the Wuhan city of China has now become a full-blown pandemic. Timely diagnosis of COVID-19 is the key in containing the pandemic and breaking the chain of transmission. In low- and middle-income countries availability of testing kits has become the major bottleneck in testing. Novel methods like pooling of samples are the need of the hour. OBJECTIVE: We undertook this study to evaluate a novel protocol of pooling of RNA samples/elutes in performance of PCR for SARS CoV-2 virus. STUDY DESIGN: Extracted RNA samples were randomly placed in pools of 8 on a 96 well plate. Both individual RNA (ID) and pooled RNA RT-qPCR for the screening E gene were done in the same plate and the positivity for the E gene was seen. RESULTS: The present study demonstrated that pool testing with RNA samples can easily detect even up to a single positive sample with Ct value as high as 38. The present study also showed that the results of pool testing is not affected by number of positive samples in a pool. CONCLUSION: Pooling of RNA samples can reduce the time and expense, and can help expand diagnostic capabilities, especially during constrained supply of reagents and PCR kits for the diagnosis of SARS-CoV-2 infection.

Actinomycotic Osteomyelitis of the Hand and Wrist Treated with Pharmacotherapy Alone: A Case Report.

CASE: Primary infection by Actinomyces is uncommon because susceptibility to infection requires breakdown of the normal protective mucosal barrier. Furthermore, involvement of the upper extremity is rare. This case report presents clinical, radiological, and pathological findings in a 26-year-old patient with actinomycosis of the hand that was treated successfully by pharmacotherapy alone without any surgical debridement. CONCLUSION: Primary actinomycoses of the hand and upper extremity present as a challenging condition. It requires a high index of clinical suspicion and histopathologic diagnosis to guide treatment, typically involving antimicrobial therapy. This case highlights the usefulness of conservative treatment with antimicrobial therapy without surgical debridement.

Wickerhamomyces anomalous: A Rare Cause of Fungemia Causing Febrile Neutropenia in Acute Lymphoblastic Leukemia.

Candida bloodstream infection is the major cause of increased morbidity and mortality (20-49%) in hospitalized patients in both paediatric and adult age groups. Due to the increase in the number of immunocompromised patients, other important species such as Trichosporon asahii and Debaryomyces hansenii are emerging. One such organism, Wickerhamomyces anomalous, previously known as Pichia anomala (teleomorph stages of several Candida species), is increasingly being reported as a cause of fungemia in neonatal intensive care units and is now increasingly being reported in a lot of immunosuppressive conditions such as interstitial lung disease, endocarditis, enteritis, corticosteroids, and chemotherapy uptake. Though this yeast is ubiquitous in nature, systemic infections from isolated cases and sporadic outbreaks with high mortality have been reported in ICUs, which emphasize the importance to consider this fungus within the diagnostic possibilities. Here, we report a case of catheter-related bloodstream infection (CRBSI) caused by W. anomalus in a leukemic immunosuppressed patient who was successfully treated by early detection and treatment of this emerging fungus.

A coinfection of severe leptospirosis and scrub typhus in Indian Himalayas.

Scrub typhus and leptospirosis are zoonosis and systemic febrile illnesses with diverse, nonspecific clinical manifestations, and shared risk factors for coinfection. Diagnosis of the coinfection is dependent on laboratory serological tests, which are under used. A coinfection from Uttarakhand Himalayan region is not yet reported. A 25-year-old man from altitude of 2126 feet above sea level presented with fever, myalgia, jaundice, oliguria, mental confusion, and tender hepatomegaly. Investigations revealed leukocytosis, thrombocytopenia, impaired liver function tests, renal dysfunction with neurological involvement. Leptospira immunoglobulin IgM enzyme linked immunosorbent assay (ELISA) and scrub typhus immunochromatography test were positive. This coinfection is first to be documented in this holy Indian Himalayas. Clinical suspicion, early laboratory diagnosis, and early treatment could prevent complications and fatal outcomes. Coinfection of this type may be considered when there is persistence of fever and a treatment response to doxycycline.