Ary KA, Singh H, Suri V
… +7 more, Sharma K, Biswal M, Singh MP, Ahuja CK, Kharbanda P, Sharma N, Bhalla A
J Glob Infect Dis
· 2023 · PMID 37800084
·
Full text
INTRODUCTION: Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countrie...INTRODUCTION: Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countries, infections are the predominant cause of AES. Prominent infections known to cause AES include viruses (such as herpes simplex virus [HSV], Japanese Encephalitis [JE] virus, dengue, enteroviruses [EVs]), bacteria, fungus, and parasites. In the present study, we aim to analyze the etiology, clinical features, and predictors of mortality in patients presenting with acute febrile encephalopathy or acute encephalitic syndrome. The present study was a prospective observational study conducted at Post Graduate Institute of Medical Education and Research a tertiary care center in Chandigarh, India. METHODS: A total of 105 patients with ≥18 years of age with fever (body temperature >101° F for duration ≤14 days) and altered sensorium (Glasgow coma scale [GCS] score ≤10) lasting for more than 24 h, either accompanying the fever or following it were enrolled. Demographic and clinical details were recorded on pro forma. Cerebrospinal fluid (CSF) analysis was performed for all the enrolled patients at admission for cytology, CSF glucose to blood glucose ratio, protein levels, gram stain and culture sensitivity, adenosine deaminase levels, polymerase chain reaction for HSV/EV/mycobacterium tuberculosis (TB) and immunoglobulin M Enzyme-linked immune assay for JE. Computed tomography of the brain was done in all patients while magnetic resonance imaging (MRI) of the brain was carried out in 75 patients. RESULTS: Among the 105 patients, tubercular meningitis was seen in 27 (25.7%) patients followed by acute pyogenic meningitis in 18 (17.1%) patients. Probable viral encephalitis was present in 12 (11.4%) cases. Septic encephalopathy ( = 10) and scrub typhus encephalitis ( = 8), HSV encephalitis ( = 6), dengue encephalitis ( = 4), leptospirosis ( = 3) were the other infections causing acute febrile encephalitis in our study. In addition to fever and altered sensorium common symptoms observed were headache (52.4%), vomiting (35.2%), and seizures (29.5%). The factors predicting increased mortality were female gender, fever of more than 38°C at admission, GCS <7, MRI showing disease-related findings like altered signal intensity bilateral medial temporal and insular area in herpes simplex encephalitis, etc., changes, and the group of patients where a definite diagnosis could not be established during the hospital stay. CONCLUSIONS: Tubercular meningitis/central nervous system TB is the predominant cause of acute febrile encephalopathy in developing countries. Scrub and dengue encephalitis are emerging as an important cause of acute febrile encephalopathy and occur predominantly in postmonsoon seasons. Acute febrile encephalopathy remains an important cause of mortality in patients presenting to Emergency Department (ER). The strongest predictors of mortality are low GCS and undiagnosed cases of AES.
de Macedo V, Meneghete BP, Koaski JC
… +2 more, Albuquerque AS, Fachi MM
J Glob Infect Dis
· 2023 · PMID 37800083
·
Full text
INTRODUCTION: Multidrug-resistant bacterial infections limit available therapeutic options. Doxycycline is an old antibiotic from the tetracycline class that exhibits a wide antibacterial action, including Gram-negative...INTRODUCTION: Multidrug-resistant bacterial infections limit available therapeutic options. Doxycycline is an old antibiotic from the tetracycline class that exhibits a wide antibacterial action, including Gram-negative bacteria (GNB), and could be an alternative for the treatment of multidrug-resistant (MDR) . The study aimed to systematically identify, evaluate, and summarize the results of studies related to outcomes of treatments for MDR-GNB infections in patients treated with doxycycline. METHODS: This review was conducted in four databases during weeks 41-52 of 2022: PubMed, Medline, Scopus, and Web of Science, from the earliest year available on each database to December 2022. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed in conducting this study, and PICO was used for the research question of this review. RESULTS: This scoping review found 8 retrospective studies that included 59 patients. Of these, 69% were treated for ventilator-associated pneumonia (VAP), 27% for urinary tract infections, 2% for bloodstream infections, and 2% for wound infections, both of which were associated with VAP. The usual dosage of doxycycline was 100 mg intravenously or orally. Clinical and microbiologic improvements were achieved in 81.3% and 87% of all patients, respectively. The mortality rate was 17.3% and was exclusively due to VAP. CONCLUSIONS: Doxycycline showed promising results in this review; however, randomized clinical trials or prospective cohorts are recommended to demonstrate the efficacy of doxycycline in the treatment of MDR infections with GNB.
Divyashree K, Singh H, Parkhi M
… +4 more, Karmakar I, Sachdeva MUS, Suri V, Bhalla A
J Glob Infect Dis
· 2023 · PMID 37800079
·
Full text
Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are t...Hemophagocytic lymphohistiocytosis is usually considered a rapidly progressive fatal illness with poor outcomes. It is of two types: primary or familial and secondary. In patients with HIV, opportunistic infections are the secondary triggers of HLH. First line of management of infection associated HLH is treatment of the underlying infection. Here, we present a case of HLH in HIV infection due to disseminated histoplasmosis managed with liposomal amphotericin B, who required immunosuppressive therapy with intravenous immunoglobulin and dexamethasone due to nonresponse to primary therapy.
Arunan B, Ahmed NH, Kapil A
… +5 more, Vikram NK, Sinha S, Biswas A, Satpathy G, Wig N
J Glob Infect Dis
· 2023 · PMID 37469474
·
Full text
INTRODUCTION: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious c...INTRODUCTION: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, as the infections difficult to treat. In this study, we evaluated the common bacteria causing CLABSI, and various patient and pathogen factors affecting the clinical outcome. METHODS: In the prospective observational study, patients diagnosed with CLABSI were recruited. Extensive clinical, microbiological, and other laboratory workup was done, and observations were recorded. Congo red agar method, tube test, and microtiter plate assay were used for eliciting the biofilm-forming attributes of the bacterial pathogens. RESULTS: was responsible for 48% of CLABSI, followed by Coagulase-negative (16%) and and (12% each). Fifty-six percent of the isolates produced biofilms. The median (interquartile range) duration of hospital stay till death or discharge was 30 (20, 43) days. The all-cause mortality was 44%. Patients having a deranged liver function on the day of diagnosis ( value for total bilirubin 0.001 and for aspartate transaminase 0.02), and those infected with multidrug-resistant organisms ( value = 0.04) had significantly poor prognosis. The difference in the demographic, clinical, laboratory profile, and outcome of patients infected with biofilm producers and nonproducers was not found to be statistically significant. CONCLUSION: The study throws light on various host and pathogen factors determining the cause and outcome of CLABSI patients. To the best of our knowledge, this is the first study trying to decipher the role of biofilm formation in the virulence of pathogens and the prognosis of CLABSI.
Kumar VS, Sivasubramanian S, Padmanabhan P
… +5 more, Anupama CP, Ramesh K, Gunasekaran P, Krishnasamy K, Kitambi SS
J Glob Infect Dis
· 2023 · PMID 37469472
·
Full text
INTRODUCTION: Establishing the etiological cause of acute encephalitis syndrome (AES) is challenging due to the distinct distribution of various etiological agents. This study aims to determine the etiological profiles o...INTRODUCTION: Establishing the etiological cause of acute encephalitis syndrome (AES) is challenging due to the distinct distribution of various etiological agents. This study aims to determine the etiological profiles of both viruses and bacteria and their associated clinico-epidemiological features among the AES suspected cases in Tamil Nadu, India. METHODS: Samples of 5136 suspected AES cases from January 2016 to December 2020 (5 years) were subjected to the detection of etiological agents for AES through serological and molecular diagnosis methods. Further, the clinical profile, age- and gender-wise susceptibility of cases, co-infection with other AES etiological agents, and seasonality pattern with respect to various etiological agents were examined. RESULTS: AES positivity was established in 1480 cases (28.82%) among the 5136 suspected cases and the positivity for male and female groups were 57.77% and 42.23%, respectively. The pediatric group was found to be more susceptible than others. Among the etiological agents tested, the Japanese encephalitis virus (JEV) was the predominant followed by , Herpes Simplex virus, Epstein-Barr virus, Varicella Zoster virus, and others. Co-infection with other AES etiological agents was observed in 3.5% of AES-positive cases. Seasonality was observed only for vector-borne diseases such as JEV, dengue virus, and West Nile virus infections in this study. CONCLUSION: AES was found to be a significant burden for Tamil Nadu with a diverse etiological spectrum including both sporadic and outbreak forms. Overlapping clinical manifestations of AES agents necessitate the development of region-specific diagnostic algorithm with distinct etiological profiles for early detection and effective case management.
Srivastava SR, Sarkar P, Ganguly P
… +10 more, Mukherjee D, Ray BK, Dubey S, Pandit A, Sengupta A, Bandopadhyay M, Ghosh AK, Poddar KG, Guha S, Ayub A
J Glob Infect Dis
· 2023 · PMID 37469471
·
Full text
INTRODUCTION: Significant surge of mucormycosis was reported in the Indian Subcontinent during the second wave of the COVID-19 pandemic. COVID-associated mucormycosis (CAM) was defined as the development of features of m...INTRODUCTION: Significant surge of mucormycosis was reported in the Indian Subcontinent during the second wave of the COVID-19 pandemic. COVID-associated mucormycosis (CAM) was defined as the development of features of mucormycosis with prior or current history of COVID-19 infection. Rapid angioinvasion is an important characteristic of mucormycosis. Authors intended to find out the prevalence of retinal arterial occlusion and its association with vascular embolic occlusion elsewhere in the body among CAM patients in this study. METHODS: This was an observational study. All consecutive-confirmed cases of mucormycosis ( = 89) and age-/gender-/risk factor-matched controls ( = 324) admitted in the designated COVID center were included in the study. All cases and controls underwent comprehensive ophthalmological, otorhinological, and neurological examinations. All necessary investigations to support the clinical diagnosis were done. Qualitative data were analyzed using the Chi-square test. Quantitative data for comparison of means between the cases and controls were done using unpaired -test. RESULTS: Twenty-one (23.59%) patients manifested the defined outcome of central retinal artery occlusion (CRAO). Among age-matched control, with similar diabetic status, none had developed the final outcome as defined ( < 0.05). About 90.47% of subjects with CRAO presented with no perception of light vision. Thirteen subjects (61.9%) with the final outcome developed clinical manifestations of stroke during the course of their illness with radiological evidence of watershed infarction ( = 0.001). Orbital debridement was performed in 9 (42.85%) subjects while orbital exenteration was done in 8 (38.09%) subjects. CONCLUSIONS: CRAO in CAM patients was found to have aggressive nature turning the eye blind in a very short period of time. CRAO can serve as a harbinger for subsequent development of more debilitating and life-threatening conditions such as stroke among CAM patients.
J Glob Infect Dis
· 2023 · PMID 37469468
·
Full text
Purple urine bag syndrome (PUBS) is an unusual manifestation of urinary tract infection, characterized by purple discoloration of urine. Due to its rarity, it can be challenging for some physicians to manage it properly....Purple urine bag syndrome (PUBS) is an unusual manifestation of urinary tract infection, characterized by purple discoloration of urine. Due to its rarity, it can be challenging for some physicians to manage it properly. In addition, its striking appearance can cause concern to some patients. This condition usually occurs in the debilitated geriatric population with prolonged use of an indwelling urinary catheter. However, our case highlights the development of PUBS in a young adult with a relatively short period of urinary catheterization.
Ostapchuk YO, Dmitrovskiy AM, Pak EA
… +1 more, Perfilyeva YV
J Glob Infect Dis
· 2023 · PMID 37469466
·
Full text
Here, we present a case of severe meningoencephalitis caused by combined infection with tick-borne encephalitis (TBE) and Lyme borreliosis (LB) in a 25-year-old woman in a rural area of Zhambyl region, Kazakhstan. She pr...Here, we present a case of severe meningoencephalitis caused by combined infection with tick-borne encephalitis (TBE) and Lyme borreliosis (LB) in a 25-year-old woman in a rural area of Zhambyl region, Kazakhstan. She presented with fever, nausea, vomiting, weakness, sweating, severe headache, arthralgia, and malaise. The course of illness was further complicated by encephalitis with symmetric lesions of the midbrain cerebral peduncles and serous meningitis. TBE and LB co-infection were established by a two-fold increase in serum IgG titers between day 21 and day 25 of illness. Both infections responded well to combined therapy with human TBE immunoglobulins, antibiotics, antiviral drugs, glucocorticoids, and diuretics. The outcome of the disease was favorable and the patient recovered completely.
J Glob Infect Dis
· 2023 · PMID 37469465
·
Full text
INTRODUCTION: Melioidosis is an under-recognized but important infection with high mortality and morbidity. It is endemic along the coastal regions of the Southern part of India. The present study focuses on the varied c...INTRODUCTION: Melioidosis is an under-recognized but important infection with high mortality and morbidity. It is endemic along the coastal regions of the Southern part of India. The present study focuses on the varied clinical manifestations, associated risk factors, and outcomes in patients from the Southeastern part of India. METHODS: Seventy patients from January 2018 to June 2021 from a Tertiary Care Hospital were included and prospectively followed up from 6 months to 3 years. Cox regression was performed to test for the association of various clinical and demographic factors with overall survival. RESULTS: Diabetes and occupational exposure to soil and water (78.6%) followed by alcoholism (61.4%) were the most common risk factors for melioidosis. The most frequent presentation was sepsis (47.1%), followed by skin and soft tissue infection (32.9%) and pneumonia (25.7%). Mortality was 50%. Patients with sepsis had a 3.5-fold higher risk of mortality (adjusted hazard ratio = 3.50; = 0.01) while other risk factors were not significantly associated with mortality. CONCLUSION: Lifestyle-dependent risk factors (diabetes, occupational exposure, and alcoholism) were most common among patients with melioidosis. Hospitalization among patients with sepsis is associated with high mortality despite the initiation of specific therapy.
Gopalan V, Chandran A, Arumugam K
… +8 more, Sundaram M, Velladurai S, Govindan K, Azhagesan N, Jeyavel P, Dhandapani P, Sivasubramanian S, Kitambi SS
J Glob Infect Dis
· 2023 · PMID 37469462
·
Full text
INTRODUCTION: Prolonged COVID-19 pandemic accelerates the emergence and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants through the accumulation of adaptive mutations. Particular...INTRODUCTION: Prolonged COVID-19 pandemic accelerates the emergence and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants through the accumulation of adaptive mutations. Particularly, adaptive mutations in spike (S) protein of SARS-CoV-2 leads to increased viral infectivity, severe morbidity and mortality, and immune evasion. This study focuses on the phylodynamic distribution of SARS-CoV-2 variants during the year 2021 in India besides analyzing the functional significance of mutations in S-protein of SARS-CoV-2 variants. METHODS: Whole genome of SARS-CoV-2 sequences ( = 87957) from the various parts of India over the period of January to December 2021 was retrieved from Global Initiative on Sharing All Influenza Data. All the S-protein sequences were subjected to clade analysis, variant calling, protein stability, immune escape potential, structural divergence, Furin cleavage efficiency, and phylogenetic analysis using various tools. RESULTS: Delta variant belonging to 21A, 21I, and 21J clades was found to be predominant throughout the year 2021 though many variants were also present. A total of 4639 amino acid mutations were found in S-protein. D614G was the most predominant mutation in the S-protein followed by P681R, L452R, T19R, T478K, and D950N. The highest number of mutations was found in the N-terminal domain of S-protein. Mutations in the crucial sites of S-protein impacting pathogenicity, immunogenicity, and fusogenicity were identified. Intralineage diversity analysis showed that certain variants of SARS-CoV-2 possess high diversification. CONCLUSIONS: The study has disclosed the distribution of various variants including the Delta, the predominant variant, in India throughout the year 2021. The study has identified mutations in S-protein of each SARS-CoV-2 variant that can significantly impact the virulence, immune evasion, increased transmissibility, high morbidity, and mortality. In addition, it is found that mutations acquired during each viral replication cycle introduce new sub-lineages as studied by intralineage diversity analysis.