Infection In India Research Articles

Protocol for a prospective, hospital-based registry of pregnant women with SARS-CoV-2 infection in India: PregCovid Registry study

IntroductionPregnant women are at increased risk of contracting COVID-19 due to several factors and therefore require special attention. However, the consequences of the COVID-19 pandemic on pregnant women and their...

Exposure to fine particulate matter and acute upper- and lower-respiratory tract infections (AURI and ALRI) in children under five years of age in India

As one of the world’s polluted regions, we assessed the association between ambient PM2.5 levels and acute lower and upper respiratory infection in India. We assessed 55,118 children from the 2015–2016 Demographic Health Survey in India using the information on levels of PM2.5 in 2015 and 2016 from the Atmospheric Composition Analysis Group. We used the generalized estimating equation for the analysis reported as odds ratios and 95% confidence intervals for every 10 µg/m3 increase and quartiles in PM2.5. Every 10 µg/m3 increase in levels of PM2.5 associated with acute upper respiratory infection (OR 1.02, 95%CI: 1.02–1.03) and acute lower respiratory infection (OR 1.05, 95%CI: 1.03–1.06). This association was confirmed by quartile exposure assessments. Mitigation efforts must be continued implementing higher restrictions in India to ensure safe levels of air.

Study of prevalence of human immunodeficiency virus in various sexually transmitted diseases patients at tertiary care center

<p class="abstract"><strong>Background:</strong> The presentation and course of sexually transmitted diseases (STD) may be altered by presence of coexisting HIV (human immunodeficiency virus) status. The purpose of the study was to study the prevalence of HIV in 278 cases of STDs.</p><p class="abstract"><strong>Methods:</strong> From September 2018 to December 2021, all STDs presented in dermatology outpatient department of a tertiary care center, were assessed to determine the prevalence of HIV. A thorough history was taken along with proper general and cutaneous examination as per predesigned case record proforma.<strong></strong></p><p class="abstract"><strong>Results:</strong> Prevalence of HIV was observed in 29 (10.43%) out of 278 STD patients, out of which 18 were males and 11 were females with the male:female ratio of 1.63:1. Maximum patients belonged to the age group of 31-40 years (44.72%). Herpes genitalis was the most common STD associated in HIV seropositivity (9.56%).</p><p class="abstract"><strong>Conclusions:</strong> HIV prevalence in STDs has been showing decreasing trends in our study. In view of this, prevention and control of STDs play an important role in efforts to control HIV infection in India. Hence Focusing on this STD and HIV relationship is of vital importance.</p>

The Current Epidemiology of Rotavirus Infection in Children Less than 5 Years of Age after Introduction of RV Vaccine in India

Rotavirus is a major cause of severe acute gastroenteritis in infants and young children worldwide. It is responsible for 40% of childhood hospitalization. It has been estimated that about 23% of diarrhoeal death occurs due to the rotavirus infection in India. To study the epidemiology of rotavirus infection in children less than 5 years of age at a tertiary care teaching hospital. A total of 240 stool samples were collected from children <5 years of age suffering from acute diarrhea at a tertiary health care referral hospital in Western Uttar Pradesh, India. Rotavirus antigen was detected in stool by Enzyme immunoassay (EIA) which utilizes monoclonal antibodies directed against VP6 antigen. Molecular genotyping was done by nested multiplex PCR. The rotavirus antigen positivity rate was found to be 14.58% in this study. There was male preponderance and the male: female ratio was 1.5:1. Rotavirus diarrhoea was reported predominantly (42.85 %) in the age group of 13 to 24 months. The most common circulating G/P genotype strain was G9P[4] accounting for 36% of cases. Rotavirus remains a major cause of diarrhoea in children <5 years of age in Uttar Pradesh. However, the positivity rate has decreased after introduction of rotavirus vaccine into the Universal immunization program (UIP) in UP.

ART-associated ADRs frequent in children with HIV infection in India

ART-associated ADRs frequent in children with HIV infection in India

COVID-19 vaccine inequity, dependency, and production capability in low-income and middle-income countries: the case of Bangladesh

COVID-19 vaccine inequity, dependency, and production capability in low-income and middle-income countries: the case of Bangladesh

Invasive Fungal Sinusitis in Patients With Coronavirus Disease 2019 Seen in South India.

Coronavirus disease 2019 (COVID-19) has a vast array of presentations and associations with neuro-ophthalmic diseases. There has been a recent surge in ophthalmic manifestations secondary to fungal sinus infections in India especially in diabetic patients who were given systemic steroids. We present our COVID-19-related cranial neuropathies presenting in our clinic. This is a retrospective case series of 10 patients affected with COVID-19 disease and who presented with cranial nerve palsies at the neuro-ophthalmic department of a tertiary eye care hospital in South India. An analysis of electronic medical records data was performed, including their comorbidities, symptoms, cranial nerves involved, ocular and neuroimaging findings, site of lesion, etiology, and prognosis. Most of the patients (7 of 10) presented with multiple cranial nerve palsies (MCNP) with poor visual acuity. 2 of the 10 cases succumbed to death due to the intracranial involvement. All MCNP cases had uncontrolled diabetes with a history of systemic steroids, and neuroimaging of these cases showed sinusitis of varying severity most of which were suggestive of fungal invasive type. Our study emphasizes the need to screen for fungal involvement in COVID-19 cases presenting with MCNP especially on diabetic patients on systemic steroids so that an early diagnosis may reduce visual loss and mortality. Physicians treating COVID-19 cases need to be aware of this dreadful complication.

Clostridioides difficile Infection

In the past decade Clostrdioides difficile has become a leading enteric pathogen causing antibiotic-associated diarrohoea and colitis. The manifestations range from diarrhoea to life-threatening damage to the large intestine. It is noted as a nosocomial and community acquired infection in most of the countries including India. It affects elderly persons most commonly in hospital settings. Actual burden of C. difficile infection in India is underestimated due to paucity of diagnostic techniques. Reports from different regions of India have shown a varying prevalence from 4 to 37 The condition presents with diarrhoea and abdominal cramps. Severe cases may lead to fulminant colitis. Metronidazole andor vancomycin are the drugs of choice in the treatment.

Seroprevalence of COVID-19 antibody among children aged 5-17 years in an urban and rural area of Ernakulam District, Kerala.

The age group of 5-17 years belongs to the vulnerable segment of the population for COVID-19 infection in India. Seroprevalence in this population can therefore allow inferences to be made about the extent of infection. The objective of this study was to assess the seroprevalence and to determine the factors associated with COVID-19 antibody among children aged 5-17 years in an urban and rural area of Kochi, Kerala. A community-based cross-sectional study was undertaken in the urban and rural field practice areas of the community medicine department in a medical college, Kochi. A semi-structured questionnaire was used to collect information about sociodemographic data, history related to COVID-19, and the severe acute respiratory syndrome coronavirus 2 antibody test result. Blood samples were collected and tested for the presence of COVID-19 antibodies using the Wantai test kit after attaining informed assent from the parent/guardian. The seroprevalence of the COVID-19 antibody was 48.3% among participants. The seroprevalence of COVID-19 antibody was higher among children of mothers with skilled/unskilled occupation, residents of rural area, above poverty line category, those with a history of COVID-19, and those who had a history of contact with COVID-19-positive patients. Half of the study population were COVID antibody positive, and the rest were at risk of infection. Therefore, adherence to COVID-19 guidelines is essential to control further spread of infection among children.

Evaluation of Sensitivity and Specificity of Direct Microscopical Examination of Suspected Mucor Mycosis Samples by Potassium Hydroxide (KOH) during Covid-19 Pandemic Era

Introduction: Mucormycosis is a common fungal infection in India even before the COVID-19 pandemic. The incidence of Mucor mycosis has entered public consciousness in response to an outbreak of cases in India during COVID-19 pandemic. Mortality is unacceptably high, reaching 80% in some case series. Prompt diagnosis is crucial because treatment initiation is time-critical due to the rapid progression of the infection. Direct KOH mount is a simple, rapid, inexpensive point-of-care test, which requires minimum technical aids. Interpretation of KOH smears requires some amount of experience. The present study was to evaluate the sensitivity and specificity of Direct Microscopical examination by KOH preparation of suspected Mucor mycosis samples taking the fungal culture as gold standard. Material and Methods: 230 samples were received in Microbiology Department from May 2021 to August 2021 from the patients suspected of Mucor mycosis. Samples were processed for KOH preparation using different concentrations of KOH like 20% and 40% till all tissues get digested. Samples were cultured also in Sabourauds dextrose agar (SDA) medium. Results of microscopy and culture were statistically analyzed using SPSS software version 23. Result: Sensitivity of KOH preparation was 67%, specificity was 87%. Positive predictive value was 76% and negative predictive value was 81% and accuracy was 80% when compared with the fungal culture. Discussion: Direct microscopic examinations using KOH preparation are the simplest, cheapest method used for the diagnosis of mycotic infections. This study is valuable in establishing a reliable method for early information on diagnosis of Mucor mycosis that may be crucial for determining appropriate therapy for the successful treatment of Mucor mycosis patients. Conclusion: KOH examination plays an important role in the diagnosis of Mucor mycosis suspected patients during COVID-19 pandemic era when compared with fungal culture which is a gold standard test in diagnosis of Fungal infection. It is the simplest and cheapest method that can be developed easily with minimal infrastructure or human resources in resource-limited countries during the COVID-19 era.

Mucormycosis in post-covid patients: An epidemic in pandemic.

ABSTRACTRhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25–60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases.

BCG VACCINATION STATUS AND EARLY OUTCOME OF COVID 19 : AN OBSERVATIONAL STUDY

BACKGROUND AND OBJECTIVES: Hypothesis regarding the protective effect of BCG vaccine on Covid 19 has been proposed since the start of the SARS CoV2 pandemic. BCG vaccination seems to have non- specic benecial effects against other viral infections like RSV, HSV2, Yellow fever and Inuenza. The aim was to nd out signicant association between childhood BCG vaccination and the outcome of COVID 19 in a sample of adult patients who were admitted during the peak of the infection in India. METHODS: We enrolled 370 adult patients by complete enumeration method, admitted in our hospital in July 2020. We looked for the presence of BCG scar and studied the clinical prole of every patient. All of them were followed up till discharge or death and their outcomes were categorised as favourable or unfavourable. The clinical data and the signicance of the presence of scar on the outcome was analysed. RESULTS: 87% patients had a favourable outcome.25% patients had comorbidities like Hypertension, Diabetes Mellitus, Chronic lung disease and Chronic kidney disease. BCG scar was present in 73% of all patients. 75.78% of the patients who had favourable outcome had evidence of the vaccination as compared to the 24.22% without the scar (p value=0.001). This result was however not seen in patients with hypertension and diabetes mellitus suggesting that they could be confounding variables in the study and independent risk factors of poorer outcome. CONCLUSIONS: Adults vaccinated with BCG in childhood seem to have better progression and outcome of Covid 19. Prospective clinical trials would help conrm these results.

Transboundary Swine Infections in India: An Overview

In the recent past, India has seen a number of outbreaks and epidemics of transboundary infectious virus diseases associated with swine. Classical swine fever (CSF), African swine fever (ASF), Porcine reproductive and respiratory syndrome (PRRS), Porcine circovirus 2 (PCV2) infections, Porcine parvovirus, Swine Influenza and Japanese Encephalitis (JE) infections are the major transboundary viral diseases prevalent in Indian swine populations. Understanding the impact of factors that provoke the emergence of viral infections is the major challenge faced in the control and prevention of emerging transboundary viral diseases. In-depth knowledge on disease status is crucial in successfully implementing disease control programs. The movement of animals influences the spread of pathogens in swine populations. This article gives insight into major emerging transboundary emerging viral infections of swine and their current status in India.

Pharyngeal-cervical-brachial variant of Landry Guillain Barre syndrome after dengue infection: a case report

Dengue is a common mosquito-borne infection in India. We reported a rare Pharyngeal cervical brachial (PCB) variant of Landry Guillain Barre syndrome (LGBS) associated with the dengue virus infection. The pathogenesis seems to be molecular mimicry between gangliosides and microbial lipo-oligosaccharides. PCB usually presents with oropharyngeal or cervicobrachial weakness. Therefore, it must be recognised early and distinguished from conditions presenting with cephalocaudal progressing weakness, such as Myasthenia Gravis, Miller-Fisher syndrome, botulism, diphtheria, porphyria or brain stem stroke. The aim of the study was to add to the limited literature on the PCB variant of LGBS after dengue infection and shed some light on presentation and management options for this rare entity.

Clinical, Virological, Immunological, and Genomic Characterization of Asymptomatic and Symptomatic Cases With SARS-CoV-2 Infection in India.

PurposeThe current global pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to the investigation with clinical, biochemical, immunological, and genomic characterization from patients to understand the pathophysiology of viral infection.MethodsSamples were collected from six asymptomatic and six symptomatic SARS-CoV-2-confirmed hospitalized patients in Bhubaneswar, Odisha, India. Clinical details, biochemical parameters, and treatment regimen were collected from a hospital; viral load was determined by RT-PCR; and the levels of cytokines and circulating antibodies in plasma were assessed by Bio-Plex and isotyping, respectively. In addition, whole-genome sequencing of viral strains and mutational analysis were carried out.ResultsAnalysis of the biochemical parameters highlighted the increased levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), serum SGPT, serum SGOT, and ferritin in symptomatic patients. Symptomatic patients were mostly with one or more comorbidities, especially type 2 diabetes (66.6%). The virological estimation revealed that there was no significant difference in viral load of oropharyngeal (OP) samples between the two groups. On the other hand, viral load was higher in plasma and serum samples of symptomatic patients, and they develop sufficient amounts of antibodies (IgG, IgM, and IgA). The levels of seven cytokines (IL-6, IL-1α, IP-10, IL-8, IL-10, IFN-α2, IL-15) were found to be highly elevated in symptomatic patients, while three cytokines (soluble CD40L, GRO, and MDC) were remarkably higher in asymptomatic patients. The whole-genome sequence analysis revealed that the current isolates were clustered with 19B, 20A, and 20B clades; however, 11 additional changes in Orf1ab, spike, Orf3a, Orf8, and nucleocapsid proteins were acquired. The D614G mutation in spike protein is linked with higher virus replication efficiency and severe SARS-CoV-2 infection as three patients had higher viral load, and among them, two patients with this mutation passed away.ConclusionsThis is the first comprehensive study of SARS-CoV-2 patients from India. This will contribute to a better understanding of the pathophysiology of SARS-CoV-2 infection and thereby advance the implementation of effective disease control strategies.

SARS-CoV-2 Delta Variant Displays Moderate Resistance to Neutralizing Antibodies and Spike Protein Properties of Higher Soluble ACE2 Sensitivity, Enhanced Cleavage and Fusogenic Activity.

The SARS-CoV-2 B.1.617 lineage variants, Kappa (B.1.617.1) and Delta (B.1.617.2, AY) emerged during the second wave of infections in India, but the Delta variants have become dominant worldwide and continue to evolve. Here, we compared B.1.617 variants for neutralization resistance by convalescent sera, mRNA vaccine-elicited sera, and therapeutic neutralizing antibodies using a pseudovirus neutralization assay. B.1.617.1, B.1.617.2, and AY.1 pseudoviruses showed a modest 1.5- to 4.4-fold reduction in neutralization by convalescent sera and vaccine-elicited sera. In comparison, similar modest reductions were also observed for C.37, P.1, R.1, and B.1.526 pseudoviruses, but 7- and 16-fold reductions for vaccine-elicited and convalescent sera, respectively, were seen for B.1.351 pseudoviruses. Among twenty-three therapeutic antibodies tested, four antibodies showed either complete or partial loss of neutralization against B.1.617.2 pseudoviruses and six antibodies showed either complete or partial loss of neutralization against B.1.617.1 and AY.1 pseudoviruses. Our results indicate that the current mRNA-based vaccines will likely remain effective in protecting against B.1.617 variants. Finally, the P681R substitution confers efficient cleavage of B.1.617 variants’ spike proteins and the spike of Delta variants exhibited greater sensitivity to soluble ACE2 neutralization, as well as fusogenic activity, which may contribute to enhanced spread of Delta variants.

Treatment of MRSA infections in India: Clinical insights from a Delphi analysis

PurposeInternational and Indian guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections are available, but the local guidelines are not MRSA-specific. This study aimed to provide clinical insights for the treatment of MRSA infections in India. MethodsWe used a three-step modified Delphi method to obtain insights. Ten experts comprising infectious disease specialists, microbiologists, pulmonologists, and critical care experts agreed to participate in the analysis. In round 1, a total of 161 statements were circulated to the panel and the experts were asked to ‘agree’ or ‘disagree’ by responding ‘yes’ or ‘no’ to each statement and provide comments. The same process was used for 73 statements in round 2. Direct interaction with the experts was carried out in round 3 wherein 35 statements were discussed. At least 80% of the experts had to agree for a statement to reach concordance. ResultsEighty-eight statements in round 1, thirty-eight statements in round 2, and eight statements in round 3 reached concordance and were accepted without modification. The final document comprised 152 statements on the management of various syndromes associated with MRSA such as skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections. ConclusionsThis analysis will assist clinicians in India to choose an appropriate course of action for MRSA infections.

Reduced neutralisation of the Delta (B.1.617.2) SARS-CoV-2 variant of concern following vaccination.

Vaccines are proving to be highly effective in controlling hospitalisation and deaths associated with SARS-CoV-2 infection but the emergence of viral variants with novel antigenic profiles threatens to diminish their efficacy. Assessment of the ability of sera from vaccine recipients to neutralise SARS-CoV-2 variants will inform the success of strategies for minimising COVID19 cases and the design of effective antigenic formulations. Here, we examine the sensitivity of variants of concern (VOCs) representative of the B.1.617.1 and B.1.617.2 (first associated with infections in India) and B.1.351 (first associated with infection in South Africa) lineages of SARS-CoV-2 to neutralisation by sera from individuals vaccinated with the BNT162b2 (Pfizer/BioNTech) and ChAdOx1 (Oxford/AstraZeneca) vaccines. Across all vaccinated individuals, the spike glycoproteins from B.1.617.1 and B.1.617.2 conferred reductions in neutralisation of 4.31 and 5.11-fold respectively. The reduction seen with the B.1.617.2 lineage approached that conferred by the glycoprotein from B.1.351 (South African) variant (6.29-fold reduction) that is known to be associated with reduced vaccine efficacy. Neutralising antibody titres elicited by vaccination with two doses of BNT162b2 were significantly higher than those elicited by vaccination with two doses of ChAdOx1. Fold decreases in the magnitude of neutralisation titre following two doses of BNT162b2, conferred reductions in titre of 7.77, 11.30 and 9.56-fold respectively to B.1.617.1, B.1.617.2 and B.1.351 pseudoviruses, the reduction in neutralisation of the delta variant B.1.617.2 surpassing that of B.1.351. Fold changes in those vaccinated with two doses of ChAdOx1 were 0.69, 4.01 and 1.48 respectively. The accumulation of mutations in these VOCs, and others, demonstrate the quantifiable risk of antigenic drift and subsequent reduction in vaccine efficacy. Accordingly, booster vaccines based on updated variants are likely to be required over time to prevent productive infection. This study also suggests that two dose regimes of vaccine are required for maximal BNT162b2 and ChAdOx1-induced immunity.

Concerns of older adults during second COVID wave in India

AbstractBackgroundA second wave of COVID infections in India, lockdown, restriction on services, and strain on an unprepared health system has had significant impact on older adults. It is important to examine impact of the lockdown on the elderly and their caregivers, useful coping strategies and requirements for support going forwards.MethodAs part of an ongoing community engagement initiative with older adults, an online survey was conducted in 2020 during the first wave of the pandemic investigating mental health and wellbeing of older adults. Participants who shared details were contacted one year later to understand impact of the second COIVD wave on their wellbeing and coping. An in‐depth telephonic interview was conducted and General Health Questionnaire 5 item were used for data collection. Audio consent was taken prior to interviews which were recorded and transcribed for thematic analysis.ResultOut of 58 participants who shared contact details, 16 % (N=9) agreed to participate in the interview. about 40 % refused mentioning they were unwell/ too busy/or agreed to speak at a later date. One female and 8 males participated in the interview between the ages of 36 to 83 years. All participants held post graduate/ professional degrees. 33 % (N=3) participants obtained a GHQ score of 2 and above on the five item General Health Questionnaire indicating presence of depressive features. As compared to the first lockdown, older adults found the second lockdown more stressful due to deaths of close friends and family members. Increased fears about family members with comorbidities contracting the virus, difficulties managing emotional wellbeing, and challenges helping younger family members manage their routines and follow basic COVID protocols were key concerns. Coping strategies found useful were remaining active and engaged at home, attending online mental wellness sessions, practicing yoga/ meditation and spending time with friends/family. Older adults highlighted a need for more emotional support through creation of social media networks and online platforms.ConclusionPreliminary findings from this study emphasize a need for leveraging technology to support emotional wellbeing of older adults during lockdown and COVID restrictions.

Role of topical nadifloxacin as an empirical treatment in patients with skin and soft-tissue infections in India: A review and consensus

Dermatologists often come across cases of skin and soft-tissue infections (SSTIs) which have diverse clinical presentations. Various local, systemic, and environmental risk factors predispose an individual to develop SSTIs. Topical antimicrobial agents are frequently used in superficial uncomplicated SSTIs, whereas systemic therapy is generally reserved for use in severe cases. However, emergence of resistance to these agents is becoming a common problem in clinical practice. This necessitates the use of other classes of antimicrobials for the effective treatment of SSTIs. Nadifloxacin, a potential drug belonging to the fluoroquinolone group, has various advantages such as binding to bacterial DNA gyrase and topoisomerase IV enzymes, inhibition of nor-A efflux pump, survival in acidic pH, anti-MRSA activity, and biofilms penetration. It has also shown least development of resistance since its introduction. Although its topical formulation has shown superior efficacy as an anti-acne agent, there are no specific guidelines for its appropriate use in SSTIs. Hence, a panel of experts was formed, under whose guidance an extensive literature search was performed in MEDLINE, Cochrane Library, and Science Direct databases. Using the modified Delphi technique, the available evidence was reviewed and corresponding recommendations were given for the use of topical Nadifloxacin as an empirical treatment in SSTIs.