Christopher RA, Lohanathan A, Hazra D
… +3 more, Pal R, Vegiraju V, Abhilash KPP
J Glob Infect Dis
· 2023 · PMID 37090151
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INTRODUCTION: In the backdrop of the COVID-19 pandemic, endotracheal intubation using an aerosol box (AB) became the norm in the emergency department (ED) and the intensive care unit. We compared two models of AB with di...INTRODUCTION: In the backdrop of the COVID-19 pandemic, endotracheal intubation using an aerosol box (AB) became the norm in the emergency department (ED) and the intensive care unit. We compared two models of AB with different dimensions to compare and identify a device that helps in reducing viral exposure without compromising successful airway management. METHODS: We conducted this prospective observational study for 7 months (October 20-April 21) on 143 patients presenting with an acute airway compromise to the ED. All intubations were performed using one of the two models available. The primary outcome was time taken for intubation (TTI). RESULTS: The overall median time taken to intubate using any AB was 63 (interquartile range [IQR]: 46.2-87.7) s with an 81.9% first-pass success (FPS) rate. TTI for AB I was 67 (IQR: 53-106) s with a 76.3% FPS rate, while TTI for AB II was 57 (IQR: 44-75) s with an 85.9% FPS rate. TTI was much shorter without the use of an AB (34: IQR: 24-53 s) with a 92% FPS rate. Intubations done by emergency physicians with more than 2 years of experience were faster in both with or without AB when compared to intubations done by physicians with <2 years of experience. CONCLUSION: The use of an AB is associated with a longer TTI when compared to intubations done without an AB. TTI was relatively shorter when more experienced emergency physicians performed intubation. FPS rates were low with intubations done using AB.
J Glob Infect Dis
· 2023 · PMID 37090149
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is a Gram-positive bacillus, a zoonotic pathogen rarely causing human infections ranging from localized skin infections to invasive infections such as endocarditis. In this report, we present two cases of bacteremia. Th...is a Gram-positive bacillus, a zoonotic pathogen rarely causing human infections ranging from localized skin infections to invasive infections such as endocarditis. In this report, we present two cases of bacteremia. The first case is a native valve tricuspid endocarditis, which is a highly unusual valve to be involved. The second case is bacteremia, probably secondary to a minor skin breach, which did not involve heart valves. bacteremia is considered highly associated with infective endocarditis and a high mortality rate, which could be a bias due to underreporting of bacteremia without endocarditis. is intrinsically resistant to vancomycin, the first-line agent for Gram-positive bacteremia. Both the patients in this report were treated successfully with ceftriaxone.
J Glob Infect Dis
· 2023 · PMID 37090148
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A 37-year-old male presented with left-sided hydropneumothorax. After drainage of fluid and air from the pleural cavity, chest radiograph and computed tomography of chest showed characteristic radiological image of ruptu...A 37-year-old male presented with left-sided hydropneumothorax. After drainage of fluid and air from the pleural cavity, chest radiograph and computed tomography of chest showed characteristic radiological image of ruptured hydatid cyst. The diagnosis was supported by positive echinococcal serology.
Kumar S, Hepat S, Acharya S
… +5 more, Shukla S, Jain S, Wadekar A, Jagtap G, Reddy S
J Glob Infect Dis
· 2023 · PMID 37090147
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Infectious mononucleosis (IM) caused by Epstein-Barr virus is a self-limiting condition and usually carries a benign course. It is usually seen in adolescents and young adults. However, complications can occur in a small...Infectious mononucleosis (IM) caused by Epstein-Barr virus is a self-limiting condition and usually carries a benign course. It is usually seen in adolescents and young adults. However, complications can occur in a small percentage of patients such as splenic rupture, myocarditis, and meningitis. Tracheal obstruction as a result of IM is extremely rare. In this case report, we highlighted a rare complication of nearly fatal tracheal obstruction in a young patient of IM that was managed timely by emergency tracheostomy.
Goel S, Jhajra SD, Nangia S
… +2 more, Kumar A, Nanda D
J Glob Infect Dis
· 2023 · PMID 37090142
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INTRODUCTION: , a rare cause of sepsis and meningitis in neonates, often associated with a wide spectrum of clinical presentation. The objective of the study was to describe the clinical characteristics and outcome of ne...INTRODUCTION: , a rare cause of sepsis and meningitis in neonates, often associated with a wide spectrum of clinical presentation. The objective of the study was to describe the clinical characteristics and outcome of neonates, who developed meningitis secondary to infection at a tertiary care Neonatal unit in India. METHODS: This retrospective study was conducted in the neonatal unit of a tertiary care hospital in New Delhi. The clinical data including demographic data, clinical presentation, management, and outcome data were collected and analyzed. RESULTS: During the study, 7 neonates with meningitis secondary to infection were identified. Majority of the neonates were preterm with a median gestational age of 31 (interquartile range: 29-33.5) weeks and a median birth weight of 1250 g (interquartile range: 1024-2065). The median age of onset of symptoms was 7 days. Lethargy (100%), apnea (85%), seizure (71%), and feeding difficulties (42%) were the common clinical presentations. Overall mortality during the period was 28.5%, and 60% of the survivor developed hydrocephalus. Isolated strains were resistant to the commonly used antibiotics (piperacillin-tazobactam, aminoglycosides, meropenem, and colistin) effective against Gram-negative organisms. The environmental screening was done but the potential source of infection could not be identified conclusively. CONCLUSION: Meningitis in neonates caused by represents a potentially life-threatening infection and is often associated with significant neurological impairment, especially in premature neonates. A prolonged duration of antibiotic therapy, longer hospital stay, and likelihood of adverse neurologic sequelae during the hospital stay and follow-up should be anticipated in such cases of meningitis.
Haritay S, Patil R, Maldar A
… +10 more, Kumar A, Reddy V, Oswal D, Tahashildar MA, Kolakar A, Kabbur S, Prasad JB, Shivaswamy MS, Paranjape R, Angolkar M
J Glob Infect Dis
· 2023 · PMID 37090141
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INTRODUCTION: There are limited data available on the long-term presence of SARS-CoV-2-specific binding antibodies and neutralizing antibodies in circulation among the elderly population. This study aims to examine level...INTRODUCTION: There are limited data available on the long-term presence of SARS-CoV-2-specific binding antibodies and neutralizing antibodies in circulation among the elderly population. This study aims to examine levels of anti-SARS-CoV-2 antibodies in vaccines who have completed at least 6 months since the second vaccine dose. A cross-sectional study was conducted from November 2021 to January 2022 among 199 vaccines aged 60 years and above residing in Belagavi city, who received two doses of the Covishield vaccine. METHODS: Antibody response to SARS-COV-2 virus whole cell antigen was measured by a kit COVID KAWACH IgG Micro LISA (J Mitra and Company, India) in 199 participants who had completed at least 6 months after receiving the second dose of Covishield vaccine. The antibody response was measured as a ratio of optical density (OD) in the participant's sample to the mean OD in negative control test by normal (T/N). Independent Kruskal-Wallis test was applied to test the difference between the T/N ratio by months of vaccination since the second dose and by the age group strata. RESULTS: The median T/N values among participants who completed 6, 7, 8, and 9 months since the second vaccine dose were 14.17, 10.46, 7.93, and 5.11, respectively, and this decline in T/N values was statistically significant. Antibody response values showed a decline with increasing age for participants in the age strata 60-69, 70-79, and 80 and above, respectively. CONCLUSIONS: A significant decline was observed in antibody response over 9 months supporting the administration of booster dose of vaccine.
Rajaseker C, Sharmila PF, Munisamy M
… +3 more, Kandhasamy V, Sundaramurthy R, Dhodapkar R
J Glob Infect Dis
· 2023 · PMID 37090140
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INTRODUCTION: Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease, caused by enteroviruses (EVs) which can present with typical or atypical lesions. Although the disease is self-limiting, it can...INTRODUCTION: Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease, caused by enteroviruses (EVs) which can present with typical or atypical lesions. Although the disease is self-limiting, it can also lead to serious complications. In the era of polio eradication, it is important to understand the population dynamics of enteroviruses causing HFMD as one of the circulating strains may become dominant. METHODS: It was a collaborative study carried out in the Department of Dermatology and Microbiology of a tertiary care teaching hospital. The throat swabs were collected from 132 suspected HFMD cases. Real-time polymerase chain reaction (PCR) was performed to detect the presence of pan enteroviruses, followed by genotype-specific PCR targeting Human Enterovirus 71 (HEV-71) and Coxsackie virus A16 (CVA-16) and CVA-6 for pan Enterovirus-positive samples. Follow-up samples were collected from 14 children in the 2 week and subjected to molecular testing to detect enteroviruses. RESULTS: Among 132 children suspected to have HFMD, 44 were girls and 88 were boys, and the majority of them 76.5% (101/132) were under 2 years of age. A history of exposure to a similar clinical presentation was present in 15 children. Of 132 suspected cases, 60 samples (45.5%) were positive for pan Enterovirus. The predominantly circulating genotype was found to be CVA-6 (31.6% [19/60]). There were about 10 cases (16.6%) which had co-infection with both HEV71 and CVA-6. Rash with fever was the most common presentation (57%). In most of the cases with HEV 71, 92.3% (12/13) presented within 3 days of illness to the health-care facility. Of 60 positive cases, 25% (15/60) of children had the atypical distribution of rashes in the face, trunk, genitalia, thigh, neck, and axilla and 16.7% of children (10/60) had the atypical type of lesion either only papular lesions or erythema multiforme. Out of 14 follow-up samples, 13 were negative for EVs; one was positive for pan EV in the 2 week, however, the patient lost to follow-up after that. CONCLUSION: HFMD outbreaks in our region were caused by various genotypes of enteroviruses. No severe complications were seen in the affected children. Nearly 30% had atypical presentation either in the form of lesion or site. Robust molecular epidemiological surveillance of HFMD is required to know the strain variations and other emerging genotypes in our setup.
Iswarya PS, Jayaraman D, Rajan XJ
… +1 more, Prabaharan K
J Glob Infect Dis
· 2022 · PMID 36636307
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Cytomegalovirus (CMV) reactivation is well known in post-transplant immunocompromised children. However, the incidence in non-transplant patients is significantly less, and only scarce case reports are available in the l...Cytomegalovirus (CMV) reactivation is well known in post-transplant immunocompromised children. However, the incidence in non-transplant patients is significantly less, and only scarce case reports are available in the literature regarding CMV disease in children with solid tumors. We present a 3-year-old male child with multisystem refractory Langerhans cell histiocytosis, who had very high CMV viremia and disseminated CMV infection with secondary hemophagocytic lymphohistiocytosis and was successfully treated without organ damage and sequelae. Although routine screening is not recommended, CMV viremia/disease needs to be considered in non-transplant immunocompromised children with multisystem involvement with unexplained cytopenia.
J Glob Infect Dis
· 2022 · PMID 36636306
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INTRODUCTION: Diarrhea is a global leading cause of morbidity and mortality among children under five, with rotaviruses being the most common cause. This study aimed to determine the genotypes of rotavirus in children un...INTRODUCTION: Diarrhea is a global leading cause of morbidity and mortality among children under five, with rotaviruses being the most common cause. This study aimed to determine the genotypes of rotavirus in children under 5 years with diarrhea in Bandung, Indonesia. METHODS: This cross-sectional study was conducted from 2014 to 2018 on 450 children under five with acute diarrhea in primary health centers in Bandung, Indonesia. Fecal samples were examined for rotavirus antigen using an enzyme-linked immunosorbent assay method, and genotype was determined through sequencing using polymerase chain reaction. Results were statistically analyzed using Pearson Chi-square in Epi Info version 3.5.4, with < 0.05 considered statistically significant. RESULTS: Rotavirus was identified in 8.9% of the subjects, slightly higher in boys ( = 24, 9.8%) than girls ( = 16, 7.8%). We found that the most rotavirus positive in age group is >12-24 months and >24-59 months, while the highest percentage is at the age of ≤6 months (11.8%). Moderate malnutrition was observed in more subjects (12.8%). Vomiting was more frequent in patients positive (55%, = 0.013) and fever was seen in 32.5% ( = 0.645). No signs of dehydration were seen in most subjects (75%), = 0.227. Rotavirus genotypes identified were G1P[8] (18, 45%), G3P[8] (14, 35%), G3P[6] (4, 10%), G3P[9] (2, 5%), G2P[4] (1, 2.5%), and nontypeable (NT) (1, 2.5%). CONCLUSIONS: The dominant rotavirus genotype is G1P[8], followed by G3P[8], G3P[6], G3P[9], G2P[4], and NT. The most common rotavirus positive in age group is >12-24 months and >24-59 months, while the highest percentage is at the age of ≤6 months.
J Glob Infect Dis
· 2022 · PMID 36636303
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INTRODUCTION: Diagnosis of extrapulmonary tuberculosis (EPTB) has been challenging owing to its paucibacillary nature and diverse clinical manifestations. Immunohistochemistry (IHC) on biopsy specimens has presented a ne...INTRODUCTION: Diagnosis of extrapulmonary tuberculosis (EPTB) has been challenging owing to its paucibacillary nature and diverse clinical manifestations. Immunohistochemistry (IHC) on biopsy specimens has presented a new perspective toward improving tuberculosis diagnosis. MPT64 is a unique antigen that has shown high sensitivity and specificity compared to other conventional techniques in its ability to diagnose tuberculosis as well as differentiate it from nontubercular mycobacteria. In this study, we aimed to analyze the utility of anti-MPT64 in the diagnosis of EPTB. METHODS: In this cross-sectional study, conducted over a period of 1 year, 52 nonrepetitive samples from 52 participants with a presumptive diagnosis of EPTB were collected and processed. The specimens were subjected to Ziehl-Neelsen staining, GeneXpert, tissue culture by mycobacterium growth indicator tube, H and E staining, and IHC with anti-MPT64. The sensitivity and specificity of anti-MPT64 was computed against a composite diagnostic criterion. RESULTS: Fifty-two consecutive participants satisfying the study criteria were recruited. The mean age of the study population was 37.35 ± 18.71 years. Lymph node specimen accounted for majority of the specimen processed ( = 20, 38.5%). The sensitivity of anti-MPT64 in the diagnosis of EPTB was 68.29%, specificity was 90.90%, positive predictive value was 96.55%, and negative predictive value was 43.47%, when composite criteria were considered standard for diagnosis. CONCLUSION: Immunohistochemical staining by anti-MPT64 is useful in establishing microbiological diagnosis of EPTB on biopsy specimens.
Katoch O, Sharad N, Singh P
… +4 more, Srivastav S, Aggrawal R, Malhotra R, Mathur P
J Glob Infect Dis
· 2022 · PMID 36636302
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INTRODUCTION: During the second wave of coronavirus disease 2019 (COVID-19), superinfection caused by fungus and multidrug-resistant bacteria worsened the severity of illness in COVID-19 patients. Limited studies from In...INTRODUCTION: During the second wave of coronavirus disease 2019 (COVID-19), superinfection caused by fungus and multidrug-resistant bacteria worsened the severity of illness in COVID-19 patients. Limited studies from India reported the antimicrobial resistance pattern of secondary infections. In this study, we aim to study the epidemiology of pathogens causing superinfections and genotyping of Gram-negative isolates in COVID-19 patients. METHODS: This retrospective study was conducted at a dedicated COVID-19 center, India. The identification of bacteria/fungi was done by Vitek2 and matrix-assisted laser desorption/ionization-time of flight mass spectrometry system. Identification of beta-lactamase genes was done using thermal cycler. The diagnosis of mucormycosis was based on 10% potassium hydroxide direct microscopy. Statistical analyses were performed using STATA version 15.1 (StataCorp., College Station, TX, USA). For continuous variables, mean and standard deviation were computed. For comparing proportions of secondary infections across admission location and outcomes, the Chi-squared test of independence was used. To compare the mean and median between intensive care units and outcomes, an independent -test and a Mann-Whitney test were used. RESULTS: Of all the clinical samples, 45.4% of samples were cultured positive for secondary infections. (35%) was the most common Gram-negative pathogen, while among Gram positive, it was (40%). Among fungus, Candida spp. (61%) predominates followed by molds. Colistin and tigecycline proved effective against these pathogens. was the most prevalent gene followed by the among the carbapenemase genes. CONCLUSIONS: The mortality rate among COVID-19 patients with secondary infection was significantly higher compared to the overall mortality rate in COVID-19 patients.
Deshkar S, Patil N, Amberkar S
… +3 more, Lad A, Siddiqui F, Sharan S
J Glob Infect Dis
· 2022 · PMID 36636301
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INTRODUCTION: has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of . METHODS: Isolates of...INTRODUCTION: has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of . METHODS: Isolates of were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method. RESULTS: Out of 50 isolates , 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% ( = 42) isolates were found to be resistant and 16% ( = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5-16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% ( = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% ( = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin. CONCLUSION: Correct identification of can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of are on rise.