Infection In India Research Articles

SARS-CoV-2 Sero-Prevalence Among General Population and Healthcare Workers in India, December 2020 - January 2021

Background: Repeated cross-sectional serosurveys in the same geographic area establish the trend of the evolving pandemic. We present the findings of the third round of a national serosurvey to estimate the seroprevalence of SARS-CoV-2 infection among the general population and health care workers of India. Methods: We conducted the third population-based serosurvey between Dec 18, 2020 and Jan 6, 2021 in the same 700 villages or wards from 70 districts in 21 states across India, which were selected for the first and second serosurveys. We enrolled from each district, at least 400 individuals aged ≥ 10 years from general population and 100 HCWs from sub-district level public health facilities. Serum samples from general population were tested for the presence of IgG antibodies against nucleocapsid (N) and spike protein (S1-RBD) of SARS-CoV-2 using the Abbott and Siemens assays respectively, whereas sera from HCWs were tested for anti-S1-RBD. For general population, sera positive for either of the antibodies were considered positive, while sera positive for anti-S1-RBD were considered as positive for HCW. Weighted seroprevalence estimates were adjusted for sensitivity and specificity of respective assays. Findings: Of the 28,598 sera from general population, 4585 (16%) had IgG antibodies against N, 6647 (23.2%) against S1-RBD and 7436 (26%) against either. The weighted and assay characteristic adjusted seroprevalence against either of the antibodies was 24.1 (95%CI: 23.0% to 25.3%). Seroprevalence was lower in rural areas (21.4%, 95% CI: 20.3% to 22.6%) compared to urban non-slum (29.4%, 95% CI: 26.9% - 32.1%) and slum areas (34.6%, 95% CI: 31.0% to 38.3%). Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI: 23.5% to 27.8%). Interpretation: Nearly one in four individuals aged 10 years or older from general population as well as HCWs were exposed to SARS-CoV-2 by December 2020 amounting to 271 million infections in India.Funding Statement: Indian Council of Medical ResearchDeclaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no competing interestsEthics Approval Statement: The project was approved by Institutional Human Ethics Committee at ICMR-National Institute of Epidemiology.

Prevalence of Anti-HBc Antibodies among HBsAg Negative Individuals and Its Association with Occult Hepatitis B.

Introduction Hepatitis B virus (HBV) infection is an endemic in many Asian countries, and among the major routes of transmission, transfusion is the one that should be prevented. Occult HBV infection (OBI) is defined as the presence of HBV DNA in the absence of detectable HBsAg, with or without anti-HBV antibodies. The aim of this study was to detect the prevalence of anti-HBc total antibodies among the HB surface antigen (HBsAg) negative individuals by way of enzyme-linked immunosorbent assay (ELISA), and detect the presence of HBV DNA among the anti-HBc seropositives by polymerase chain reaction (PCR). Anti-HBs among the HBV DNA positives were also found out by enzyme-linked fluorescent assay (ELFA). Materials and Methods A total of 910 serum samples was subjected to initial screening for HBsAg by MERILISA HBsAg ELISA kits. The anti-HB core (HBc) total antibody titer was evaluated using MONOLISA ELISA (Biorad) kits. If found negative, the samples were discarded. If found positive, the samples underwent HBV DNA testing by nested PCR. Antibody to hepatitis B surface antigen (anti-HBs) was calculated among the DNA positives by ELFA. Results A total of 133 samples were positive for anti-HBC total antibody, resulting in an overall prevalence of 14.6%. Overall prevalence of HBV DNA among the anti-HBc seropositives was 2.2%. Conclusion Among the three HBV DNA positive patients, two belonged to the preoperative screening group, which is an alarming situation. Screening of blood for HBsAg has reduced the incidence of posttransfusion hepatitis, but HBV still remains the major source of transfusion transmitted infection in India.

Sero-epidemiology of porcine parvovirus, circovirus, and classical swine fever virus infections in India.

Reproductive problems in swine caused by porcine viruses pose a serious threat to the pig industry in developing countries like India. For evaluating the true extent of porcine infections, a total of 1308 representative sera samples were collected from 92 different pig farms covering 8 North-Eastern states and Punjab state of Northern India during a period of 2 years (2011-2013). Sera samples were tested for the presence of antibodies against porcine parvovirus (PPV), porcine circovirus-2 (PCV-2), and classical swine fever virus (CSFV) using commercial enzyme-linked immunosorbent assay (ELISA) kits. In the North-Eastern states, the seroprevalence of CSFV in non-vaccinated animals was 6.30% and that of PCV2 and PPV was 6.28% and 1.24%, respectively. In Punjab, the seroprevalence of CSFV in non-vaccinated animals was 44.44% and seroprevalence of PCV-2 and PPV was 34.07% and 39.10%, respectively. Detection of antibodies against more than one virus revealed that 4.66% animals had co-infection with PCV-2 and PPV, 1.75% with CSF and PPV, 1.98% with CSF and PCV-2, and 1.75% with all the three viruses. The receiver operator characteristics (ROC) curve analysis depicted that piglet mortality, parvovirus, and CSFV were the most important parameters with an AUC value of 0.997, 0.897, and 0.973, respectively. Incidence of single or co-infection with different viruses showed that the occurrence of single infection was significantly more prevalent than co-infection. This study provides useful information to set up future epidemiologic, flock management, and public animal health policies for the prevention and control of PCV-2, PPV, and CSF in India.

Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16).

To assess the spatial pattern and determinants of HIV infection in India. We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. 230213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR=2.58, 95% CI: 1.22-5.40), living in an urban area (aOR=2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR=4.25, 95% CI: 2.60-6.93), Southern (aOR=3.13, 95% CI: 1.99-4.91) or Western region (aOR=2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR=1.99, 95% CI:1.42-2.79), a suspected STI (aOR=2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR=7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. HIV infection among adults aged 15-54years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.

Antibiotic Choice, Effectiveness, and Outcome Among Hospitalized Neonates with Gram-Negative Bloodstream Infection in India: A Prospective Cohort Study

Background: Neonatal sepsis is a leading cause of childhood mortality. Antimicrobial resistance complicates management in high burden countries, such as India. We sought to determine whether early use of microbiologically active antibiotics is associated with reduced mortality of neonatal Gram-negative (GN) bloodstream infections (BSI). Methods: Between May 2017 and July 2019, we recruited neonates with GN BSI admitted to three neonatal intensive care units in India. Antibiotic use, microbial data, and clinical outcomes were prospectively collected. We assessed the association between empiric therapy including an active agent, defined by in vitro susceptibility, and 30-day all-cause mortality using Cox proportional hazard models. Findings: Of 9303 neonates admitted over a 27-month period, 3107 (33%) had at least one blood culture; 263 (3%) had a GN BSI identified at a median 6 days of life (IQR 3-11). Among isolates, 196 were Enterobacterales with 73 (37%) identified as carbapenem-resistant Enterobacterales (CRE), and 46 were Acinetobacter species with 28 (61%) being carbapenem-resistant Acinetobacter species (CRAb). Overall, 52 infants received initial empiric therapy including colistin, which was active in most (169 of 263, 64%) instances, but a minority of patients with CRE (33 of 73, 45%) and CRAb (11 of 28, 39%) received an active agent. Initial use of active antibiotics was not associated with decreased 30-day mortality for CRE or CRAb infections. Interpretation: Early initiation of currently available, active antibiotics was not associated with lower mortality among neonates with GN BSI in a setting with a high burden of carbapenem-resistant organisms. Funding: U.S. Centers for Disease Control and Prevention Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study was approved by the ethics committees of each participating hospital, the Johns Hopkins School of Medicine Institutional Review Board, and the Government of India Health Ministry Screening Committee.

First complete genome characterization of swinepox virus directly from a clinical sample indicates divergence of a Eurasian-lineage virus.

In this study, we report the complete genome sequence of swinepox virus from a clinical sample from a naturally occurring infection in India. The sequencing was done on a Nanopore MinION sequencer from Oxford Nanopore Technologies. Two new annotations were added to the genome. Three of the genes were found to have frameshifts, which might be of importance in relation to infection. When compared to the only other reported whole genome sequence of swinepox virus, which was obtained from an isolate from America in 1999, our sequence is only 98.19% identical at the nucleotide level. The average amino acid sequence identity of the viral proteins, based on the common 149 annotations, is also 98.19%, demonstrating that these viruses are distinctly divergent. Owing to the fact that swinepox virus infects only swine, it could not have entered America until the introduction of swine in the 16th century from Europe. The swinepox viruses in both continents have continued to evolve independently. The sequence divergence identified here indicates a Eurasian-lineage virus that is geographically distinct from the American-lineage swinepox virus.

Hepatocellular Carcinoma in India

Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world. The incidence of HCC is rising in India and is one of the leading GI cancers. The prevalence of HCC in India varies from 0.2 to 1.6%. The age adjusted incidence rate of HCC in India for men ranges from 0.7 to 7.5 per 100,000 populations, and for women 0.2 to 2.2 per 100,000 populations. The male to female ratio for HCC in India is 4:1. The incidence of HCC in cirrhotic in India is 1.6% per year. The age standardized mortality rate for HCC in India for men is 6.8/100,000 and for women is 5.1/100,000. HBV is the main etiological factor associated with HCC in India. Due to high prevalence of HBV infection in India, the surveillance is poor and there has been no comprehensively analyzed data for HCC. Despite recent advances in the treatment of HCC, many patients cannot be cured due to the advanced stage of HCC at the time of diagnosis in India. Optimal application of multidisciplinary team approach and active involvement in clinical studies with new agents in HCC patients are critically important.

First report of Dactylogyrus scorpius infection in Indian major carp, Labeo rohita from India: Host specificity and kinetics of immune gene expression in gills

Dactylogyrus is one of the major parasites ubiquitously present in the aquatic environment causing severe economic loss. The present study documented a new species of Dactylogyrus from India infecting the Indian major carp, i.e. rohu (Labeo rohita) both in natural and experimental conditions. The 18 s and 28 s rDNA sequence analyses revealed the present isolate of having 99.29% and 96.21% sequence homology, respectively with D. scorpius belonging to African Dactylogyrus lineage III. A co-habitational challenge study further confirmed that catla (Catla catla) and mrigal (Cirrhinus mrigala), two other species of Indian major carps, were resistant to this parasite in a 20-day infection trial. On the other hand, co-habitational challenge study showed 100% prevalence in rohu from 1-day post-infection (dpi) onwards with a gradual increase in average parasitic load of 4.8, 40.84, 61.50, 91.20 and 81.40 numbers on 1, 3, 5, 10 and 20 dpi of sampling, respectively. This study forms the first report of D. scorpius infection in India and rohu was found to be the preferred host of this parasite. The gill tissues collected from rohu fingerlings at the above time points were also subjected to expression analysis of different immune-related genes viz., genes involved in specific immunity (IgM, IgZ, MHC I), recognition molecule (TLR 22), pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-15, TNF α), anti-inflammatory cytokine (IL-10), antioxidant molecules (MnSOD, GPx, catalase) and antimicrobial peptides (apolipoprotein A-I, lysozyme G). A significant up-regulation of all immune-related genes except MHC I and IL-15 was observed in gill tissues of infected rohu at different time points, thus indicating the role of both specific and non-specific immune responses against D. scorpius infection. The progressive rise in parasitic load in gill tissues corresponding to days of infection clearly indicated immune evasion mechanism for its co-existence in the advent of up-regulation of an array of immune-related genes in the host. The results obtained in this study could be useful for understanding host-pathogen interaction and further development of any prophylactic measures against this important parasite.

Tracking SARS-CoV-2 infection in India with serology

The rapid spread of COVID-19 across the globe caught most countries off guard, in terms of their ability to detect, track, and contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. India, with 462 million of its 1·3 billion people living in densely populated urban settlements with high contact rates, was at risk of catastrophic spread of the virus.1 Decades of underinvestment in public health, with inadequate diagnostic capacity and programmatic agility, made the implementation of test, trace, and treat strategies at scale challenging.

Sources of spreading COVID-19 cases and afford made to control the infection in India

Sources of spreading COVID-19 cases and afford made to control the infection in India

Coronavirus infection in India: From the desk of dental surgeon

Coronavirus infection in India: From the desk of dental surgeon

Knowledge, attitude and practices for HBV and HCV (Hepatitis B virus and Hepatitis C virus) among the students of a central university in South Delhi (India) and strategies for prevention of disease

Hepatitis B and C are one of the major blood-borne viral infections in India and across the globe. There is an urgent need to address this public health problem at the community level. Aims and Objectives: This study aimed to assess knowledge, attitude, and practice (KAP) about hepatitis B virus (HBV) and hepatitis C virus (HCV) among the students of a central university, thus identifying and bridging the gaps in KAP by formulating strategies at the community level. Materials and Methods: A cross-sectional study was done among 127 participants between November 2019 and December 2019. Data for KAP were collected using self-structured questionnaire after obtaining written informed consent. The data included demography, basic knowledge, modes of transmission, attitude, practices, and preventive measures to control HBV and HCV. Descriptive data were analyzed using SPSS-18 software. Results: Overall awareness level was 60% among university students. Knowledge about transmission via blood/blood related products (71%), reuse of needle or syringes (66%), ear/nose piercing/tattooing (33%), prevention through vaccination (76.4%) was found. Overall negative attitude toward the infected patient was 82% and avoidance behavior was 29%. In practice, 55% of participants had completed all doses of vaccination. Eighty-five percent participants agreed to visit a doctor following any symptoms and 70% found proactive in containment and educating the masses. Conclusion: The lacunae in KAP can be bridged by active participation, training, and education of the students of university by focused strategies based on communication and behavior change and positive motivation using public platforms and social media by university authorities from time to time.

Seroprevalence of chikungunya virus infection in India, 2017: a cross-sectional population-based serosurvey

Since its re-emergence in 2005, chikungunya virus (CHIKV) transmission has been documented in most Indian states. Information is scarce regarding the seroprevalence of CHIKV in India. We aimed to estimate the age-specific seroprevalence, force of infection (FOI), and proportion of the population susceptible to CHIKV infection. We did a nationally representative, cross-sectional serosurvey, in which we randomly selected individuals in three age groups (5-8, 9-17, and 18-45 years), covering 240 clusters from 60 selected districts of 15 Indian states spread across all five geographical regions of India (north, northeast, east, south, and west). Age was the only inclusion criterion. We tested serum samples for IgG antibodies against CHIKV. We estimated the weighted age-group-specific seroprevalence of CHIKV infection for each region using the design weight (ie, the inverse of the overall probability of selection of state, district, village or ward, census enumeration block, and individual), adjusting for non-response. We constructed catalytic models to estimate the FOI and the proportion of the population susceptible to CHIKV in each region. From June 19, 2017, to April 12, 2018, we enumerated 117 675 individuals, of whom 77 640 were in the age group of 5-45 years. Of 17 930 randomly selected individuals, 12 300 individuals participated and their samples were used for estimation of CHIKV seroprevalence. The overall prevalence of IgG antibodies against CHIKV in the study population was 18·1% (95% CI 14·2-22·6). The overall seroprevalence was 9·2% (5·4-15·1) among individuals aged 5-8 years, 14·0% (8·8-21·4) among individuals aged 9-17 years, and 21·6% (15·9-28·5) among individuals aged 18-45 years. The seroprevalence was lowest in the northeast region (0·3% [95% CI 0·1-0·8]) and highest in the southern region (43·1% [34·3-52·3]). There was a significant difference in seroprevalence between rural (11·5% [8·8-15·0]) and urban (40·2% [31·7-49·3]) areas (p<0·0001). The seroprevalence did not differ by sex (male 18·8% [95% CI 15·2-23·0] vs female 17·6% [13·2-23·1]; p=0·50). Heterogeneous FOI models suggested that the FOI was higher during 2003-07 in the southern and western region and 2013-17 in the northern region. FOI was lowest in the eastern and northeastern regions. The estimated proportion of the population susceptible to CHIKV in 2017 was lowest in the southern region (56·3%) and highest in the northeastern region (98·0%). CHIKV transmission was higher in the southern, western, and northern regions of India than in the eastern and northeastern regions. However, a higher proportion of the population susceptible to CHIKV in the eastern and northeastern regions suggests a susceptibility of these regions to outbreaks in the future. Our survey findings will be useful in identifying appropriate target age groups and sites for setting up surveillance and for future CHIKV vaccine trials. Indian Council of Medical Research.

COVID-19 Immunoglobulin G Antibodies in Healthy Blood Donors Paving Way to Herd Immunity

Background and Objectives: Herd immunity is the immunity or resistance to particular infection that occurs in group of people when a very high percentage of individuals have been vaccinated or previously exposed to infection. The goal of this study was to assess the development of herd immunity to COVID-19 in parts of Western India. Methods: The study was conducted at a tertiary care hospital in India on routine blood donors who were tested for SARS-CoV-2 immunoglobulin G (IgG) antibody. We systematically investigated 808 healthy donors at various points of time in the 3-month period starting from September 2020 to November 2020 for SARS-CoV-2 seroprevalence. Results: The results of November month show a sudden increase (51.96%) in the later half. The seroprevalence in healthy donors in other towns and cities shows an aggregate average of SARS-CoV-2 IgG antibody 13.59% (200/1472) as against Jaipur city with 36.12% (292/808). Deedwana has higher seropositivity in blood donors 31.5% (24/76) whereas Sujangarh and Jhunjhunu did not have any donors with seropositive status. Conclusion: Our findings could be the tip of iceberg of emerging herd immunity to SARS-CoV-2 infection in India. Future research will determine how long these antibodies will last. Will they be protective toward future COVID-19 infection?

Impact of sars cov 2 pandemic on quality of life (qol) in aurangabad city- a crosssectional study

Background: More than 1.3 billion people are at risk of SARS-CoV-2 infection in India. The number of corona virus cases in Maharashtra had exceeded 5.6 million and 11.81% of Aurangabad district's population was affected with covid19 infection. Therefore, Knowing QOL of the population during pandemic would give us a broader idea on which components of QOL has to be improve in our society.Aim: To know impact of COVID-19 Pandemic on Quality of Life in people of Aurangabad city using WHO QOL-BREF Scale. Methods: A total of 246 participants were recruited in this crosssectional study. The patients included was with Post COVID-19 infection, Age 18 or above, both male and female. Participants with Cognitive Impairments, physical disability like Vision, Hearing, etc. was excluded. The QOL was assessed using WHO QOL-BREF Scale.Results: The Chi-square test showed all the domains was Significantly affected but social domain was Highly Significant in patients with post covid19 infection with p-value <0.05*. Conclusion: The study Demonstrated that Quality Of Life was affected in post covid19 patients living in Aurangabad city.

Oral itraconazole and topical eberconazole therapy in the treatment of tinea cruris and corporis

Background: Dermatophytosis is a common fungal infection in India. In recent times, there has been a change in the course of the disease with an increase in the number of chronic, widespread, and recurrent cases. Aims and Objectives: The aim of this study is to (1) To study the clinical efficacy of itraconazole as a monotherapy in the treatment of tinea cruris and corporis and (2) To study the predictors of noncompliance to treatment in recurrence of infection. Methods: The current study was an unblinded prospective study conducted at a private clinic on 100 randomly selected patients, with a clinical and mycological diagnosis of tinea cruris and corporis. A detailed history was taken regarding the total duration of disease, duration of previous therapy, causes of noncompliance to previous treatmentand associated comorbidities after obtaining informed consent. The patients were put on a regime of oral itraconazole 100 mg twice daily and topical eberconazole twice daily for 12 weeks. Patients were followed up at 2, 6, 12 weeks, 6 months, and 1 year. Statistical analysis was performed using the SPSS software version 22. using appropriate statistical tests. Results: In our study, the mean age of the participants was 38 years, with the male: female ratio being 2.15:1. Only nine patients were treatment naïve, whereas 91 had received treatment previously. Most common factor responsible for discontinuation of therapy was partial relief which was mistaken as cure by the patient. Clinical cure rate at 2, 6, and 12 weeks was 38%, 68%, and 83%, respectively. Mycological cure rate at 2, 6, and 12 weeks was 56%, 81%, and 83%, respectively. Conclusion: itraconazole 100 mg twice daily is an effective and safe treatment for tinea cruris and corporis. Improving the patient's compliance and treatment adherence enhances the rate of clinical as well as mycological cure and avoids recurrences.

Trend of Dengue Virus Infection with Seasonal Variation at HIMS, Varanasi, Uttar Pradesh, India

Introduction: Dengue is the most common mosquito borne arboviral infection in India, and it has become endemic in India with consistent episodes. Dengue is an acute febrile illness caused by Dengue Virus (DENV-1, DENV-2, DENV-3, DENV-4), an arthropod of family Flaviviridae, transmitted through the bite of female Aedes aegypti mosquitoes. Although, dengue is more prevalent in humans but also it may sometimes be seen in monkeys. The only animals to be affected when bitten by a mosquito, infected with dengue fever are monkeys other animals do not carry or spread dengue. Patient presents with hyperthermia, headache, severe joint and muscle pain, fatigue and skin rashes. Neurological manifestation in sever dengue results from multiorgan dysfunction due to cerebral edema, haemorrhage due to vascular leak, cerebral hypoperfusion, and electrolyte disturbances. Aim: To study serological markers with association of platelet count and trend of DENV infection with seasonal variation. Materials and Methods: The present retrospective study was conducted for a period of two years in Heritage Institute of Medical Sciences (HIMS), Varanasi, Uttar Pradesh, India, from January 2017 to December 2018. Blood samples were collected for 2140 suspected dengue patients. Out of the serologically positive cases, serological confirmation and platelet count was done for dengue infection. Data was presented as percentages. Results: Total 2140 suspected cases were admitted and out of them 199 (9.3%) were found to be seropositive for dengue infection. Non structural protein 1 (NS1) positive cases out of which total seropositive cases were reported to be 127 (63.81%) and 147 (73.86%) cases were positive for NS1 antigen either alone or along with antibody. Out of the total 199 positive cases thrombocytopenia was observed in 126 (63.31%) cases. Positive cases which were under 15 years of age were reported to be 92 (46.23%). Conclusion: The study concludes that NS1 antigen and IgM- IgG antibody consideration in the diagnosis of dengue infection builds the opportunity of early diagnosis so as to keep away the complications significantly.

A Case Series on Neuroborreliosis- An Emerging Infection in India

Lyme disease is a zoonotic disease spread by the bite of Ixodes ticks. These ticks are known to be found in wooded or grassy areas. The disease manifestations can be divided into early Lyme disease and late Lyme disease. The manifestations of late Lyme disease may include arthritis, cranial nerve palsies, short-term memory deficits and Lyme carditis. The disease is diagnosed by a two-step process of Enzyme immunoassay followed by Western blot Test. Disseminated disease is treated with Intravenous (IV) ceftriaxone, cefotaxime or penicillin G, or a combination of oral and IV regimens or in some cases, only oral drugs for up to 28 days. Lyme disease is endemic in temperate regions, especially in America. However, over the years the disease has been reported from various countries of Asia including in India, where there have been sporadic cases. Hereby, the author presents three paediatric cases with varied presentations. The neurological symptoms ranged from Lower Motor Neuron (LMN) facial nerve palsy to acute encephalitis. One patient also had non-erosive arthritis.

The incidence of anosmia in patients with laboratory-confirmed COVID 19 infection in India: An observational study.

Background and Aims:Acute loss of smell or anosmia is a common and sometimes the only symptom observed in patients with coronavirus disease-2019 (COVID-19). The objective of the study was to determine the prevalence, time of onset, and duration of anosmia in patients with COVID-19 infection and the association of anosmia with other symptoms and eosinophil count.Material and Methods:Two hundred patients with laboratory-confirmed COVID-19 infection, who were asymptomatic or mildly symptomatic were assessed for olfaction with a nonirritant odor. The presence of anosmia was recorded, and a questionnaire integrating the anosmia reporting tool was filled. Patients with anosmia/hyposmia were followed telephonically at 7 and 14 days for resolution of anosmia and other symptoms. The presence of anosmia was correlated with eosinophil count.Results:Of the 200 COVID-19 patients, 87% were symptomatic. More than half of the patients had fever (56%). Anosmia was observed in 30% of the patients and hyposmia in 4% of patients. In 41% of the patients, olfactory loss was reported before diagnosis. The mean duration of anosmia was 7.8 (± 5) days; 97% of patients recovered with a resolution of symptoms within 2 weeks. Ageusia was the most commonly and significantly associated symptom with anosmia (66%, n = 45) followed by sore throat (41%), and rhinorrhea (28%). The symptoms in both the sexes were comparable. Absolute eosinophil count of <40/μL was observed in 59 patients (29.5%) and an absolute eosinophil count of 0 in 17 patients (8.5%). Among the 68 anosmic patients, 36 (47%) patients had eosinopenia, which was statistically significant.Conclusion:Anosmia is an early and sometimes the only symptom in approximately one-third of the patients with COVID-19 infection. Eosinophil count should be checked in anosomic patient with suspicion of COVID-19 infection. Objective tools for olfactory and gustatory assessment should be brought into practice for early and prompt diagnosis to control the spread of the disease.

Iatrogenic Cushing's Syndrome in Patients with Superficial Dermatophytosis.

Background:The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome.Methods:This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma.Results:There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml).Conclusions:Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.