Monkeypox Disease Outbreak (2022): Epidemiology, Challenges, and the Way Forward

The biggest-ever outbreak of monkeypox disease in non-endemic countries started in May, 2022. Though no monkeypox case has been reported from India, till mid-June, 2022, yet, considering the rate of spread to the non-endemic countries, there is an urgent need of better understanding of the monkeypox virus and disease epidemiology to help clinicians, public health specialists, and policymakers to be prepared for any eventuality. This review summarises the monkeypox disease epidemiology, clinical features, therapies, vaccines and outlines the measures for preparedness and response for a possible outbreak. The disease is known to cause severe outcome in children, pregnant women, and immunocompromised hosts and this group need to be given special attention. The monkeypox disease outbreak (2022) in non-endemic countries should be used as an opportunity by India and other low and middle income countries to strengthen public health surveillance and health system capacity for outbreak and epidemic preparedness and response..

A hospital based cross sectional study on surgical profile of patients with chronic leg ulcers

Background: Treatment of chronic leg ulcer is not easy. Appropriate diagnosis and proper treatment are the cornerstone for successful outcome. To study the profile of patients with chronic leg ulcers.Methods: Hospital based observational study was carried out in 108 cases. All patients coming to surgery OPD in our set up with chronic leg ulcers of duration of more than 6 weeks were advised admission if they were willing for the same. Then detailed history was recorded. Detailed examination of venous system was done for varicosities, incompetent perforators, sapheno-femoral or poplitio-femoral junction incompetence. In case of patient’s peripheral vascular diseases, detailed examination of arterial system was done. Descriptive statistics like frequencies and percentage for categorical data, mean and SD for numerical data has been depicted.Results: Majority of study subjects were in age range of 60 to 70 years. percentage of male patient (76.9%) was higher than that of the female (23.1%). 43.5% of participants with ulcer on left side and 56.5% participants had ulcer on right side. 47% of participants had complaints between 7 to 8 weeks. main etiological factor was infective etiology in 38.9% patients. 54.1% ulcers were found in lower 1/3rd of the leg. About 88.9% cases had positive culture. The most common organism grown was of pseudomonas in 45.8% cases.Conclusions: The most common etiology of chronic leg ulcer in this study is infective followed by traumatic ulcer. The most common associated condition found in chronic leg ulcer is diabetes mellitus.

Tigecycline Susceptibility of Carbapenem Resistant Enterobacteriaceae and Acinetobacter spp. isolates from Respiratory Tract: A Tertiary Care Centre Study.

Background: Tigecycline is used as a last line ofdefence against Multidrug Resistant (MDR) strains,and increasing rates of resistance are a growing concernglobally. Tigecycline resistance has been reported invarious pathogens including Acinetobacter spp.,Klebsiella spp., Enterobacter spp., E. faecalis, S.aureus, S. pneumoniae and Serratia marcescens. Aimand Objectives: To study Tigecycline susceptibilitypattern of isolates of Enterobacteriaceae andAcinetobacter spp. from Respiratory Tract Infections(RTI) in a tertiary care hospital. Material and Methods:A total of 7573 respiratory samples were received inMicrobiology Department of Govind Ballabh PantInstitute of Postgraduate Medical Education andst st Research (GIPMER) from 1 January 2018 to 31December 2018. The samples were processed as perstandard techniques. Identification and antimicrobialsusceptibility testing was done by VITEK-2 Compactautomated system and Kirby – Bauer Disc DiffusionMethod as per CLSI Guidelines. Results: Out of total7573 respiratory samples received in laboratory, 1017(13.42%) were culture positive for pathogens.Klebsiella pneumoniae 420(41.29%) waspredominantly isolated microorganism followed byPseudomonas aeruginosa 206(20.25%) andAcinetobacter spp. 193(18.97%). Most of Gramnegative organisms were resistant to commonly usedantibiotics. Carbapenem resistance was observed as67.25%. Conclusion: Overall Tigecycline resistanceamong Carbapenem Resistant Enterobacteriaceae(CRE) and Carbapenem Resistant Acinetobacter(CRA) was found to be 15.50% and 10.69%respectively. Although Tigecycline is a promisingantibiotic for the treatment of infections caused by drugresistant problematic pathogens, Tigecycline resistanceis most frequently observed in A. baumannii andEnterobacteriaceae, especially in MDR strains. Hence,we advocate judicious use of Tigecycline in MDRinfections and it should be kept as reserve.

Morbidity pattern and health seeking behaviour of the geriatric population in a rural area of district Faridabad, Haryana: a cross-sectional study

Background: The increase in life expectancy has resulted in changes in age composition of India and tripling of geriatric population in last 50 years. To provide adequate and comprehensive care to elderly, understanding their health problems and health seeking behavior is imperative. Hence, this study aimed to assess the morbidity pattern and health-seeking behavior and factors affecting them among geriatric population of a rural area of district Faridabad.Methods: A cross-sectional study was carried out among 300 elderly above 60 years of age in village Pali of Faridabad district for a period of 3 months. The list of elderly was obtained from health workers’ records and they were interviewed regarding socio-demographic factors, morbidity status and health seeking behaviour using a predesigned and pretested structured questionnaire.Results: Out of 300 subjects, 56% were females and 63% were in age group of 60-69 years. Overall 93.3% subjects had one or more morbidities with musculoskeletal disorders being most common (57.3%) followed by visual impairment and cataract (54.0%) and hypertension (49.0%). Morbidities were significantly higher among females (p= 0.006), divorced/separated (p=0.014) and illiterate elderly (p=0.026). 77.7% elderly preferred allopathic system of medicine with private facilities preferred by 40%.Conclusions: Morbidity load among elderly was very high and health seeking behaviour was poor. So, strong efforts are needed to provide them with comprehensive and specialised care so that they contribute to their maximum potential to our society. Primary healthcare strategies targeting elderly needs to be strengthened and area specific strategies need to be formulated.

Prevalence of Gram-negative Septicemia in a Tertiary Care Center

Increased mortality due to sepsis and bacteremia impacts health-care activities severely. Administration of broad-spectrum antibiotics empirically may lead to failure of treatment. Toxic effects of non-susceptible drugs can be harmful for the patients and lead

Evaluation Of Charlson’s Co-Morbidity Index And Risk Factors Among Patients With And Without Extended Spectrum Β-Lactamase Producing Enterobacteriaceae Spp. Urinary Isolates In A Super-Specialty Hospital.

Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]

Allergic Bronchopulmonary Aspergillosis: An Occult Disease Waiting To Be Explored- Case Report And Review Of Literature.

Allergic bronchopulmonary aspergillosis (ABPA) is a slowly progressive disease caused by hypersensitivity to Aspergillus fumigatus. This condition is most commonly seen in patients with asthma and cystic fibrosis. ABPA mimics a wide range of diseases, thereby further accentuating the difficulties faced by medical practitioners in diagnosing this condition. Even today, this condition remains under diagnosed in many countries with reports of mean diagnostic latency of ten years between the occurrence of symptoms and the diagnosis. We present a case report and review of literature with the aim of highlighting the complicated nature of this enigmatic illness.

Post-operative sinus formation due to Mycobacterium abscessus: A case report.

Summary: Mycobacterium abscessus is ubiquitously found rapidly growing mycobacteria. Although it is an uncommon pathogen, it has been known to cause cutaneous infection following inoculation, minor trauma or surgery. This communication reports an immuno-competent patient developing multiple sinuses due to Mycobacterium abscessus in the post- operative period.

Candiduria in catheterized intensive care unit patients : Emerging microbiological trends.

Objectives: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Pseudomonas aeruginosa meningitis in post neurosurgical patients

Background and Objective: Pseudomonas meningitis is a rare complication following neurosurgical procedures and is associated with high mortality and mortality. The aim of the study was to describe the clinical characteristics and risk factors associated with mortality in patients who developed nosocomial Pseudomonas meningitis following neurosurgical procedure. Methods: All patients with nosocomial post-surgical meningitis due to Pseudomonas aeruginosa diagnosed in the year were reviewed retrospectively. Results: During the period of the study, 121 cases of post surgical meningitis were diagnosed. Ten (9.9%) nosocomial Pseudomonas meningitis were identifi ed. Eight patients had external ventricular drain. The antibiotic susceptibility of 10 strains was: imipenem (9/10), meropenem (7/10), amikacin (7/10), piperacillin / tazobactum (5/10), ceftrizxone (4/10), cefepime (3/10). The overall mortality was high at 80%, despite most receiving appropriate antibiotics. Conclusion: Postoperative Pseudomonas meningitis is associated with high mortality.

Cryptococcal granulomas in an immunocompromised HIV-negative patient.

Disseminated cryptococcosis usually occurs in immunocompromised individuals with defective cell-mediated immunity, most commonly seen with HIV infection. We present a case of disseminated cryptococcosis in an HIV-negative male patient who presented with headache, fever, altered sensorium of short duration and multiple cutaneous lesions. An emergency CT scan of the head showed multiple intracranial and intraventricular granulomas. Routine laboratory investigations were within the normal range. A CSF examination revealed capsulated yeasts on India ink and a culture yielded cryptococcus neoformans. A cryptococcal antigen test by latex agglutination kit was positive. A biopsy revealed multiple capsulated yeasts cells in the cutaneous lesions, which were consistent with cryptococcus neoformans. The patient was successfully treated with Amphotericin B and Fluconazole with regression of cranial and cutaneous lesions.

Tumor necrosis factor alpha and interleukin 6 in infants with sepsis.

Thirty-two infants above one month of age admitted to a tertiary care hospital with signs of infection and presumptive diagnosis of sepsis were included. Cytokine levels of tumor necrosis factor alpha (TNFmu) and interleukin-6 (IL 6) were estimated at admission and after 48 to 72 hr, and their relationship examined to the outcome. Significantly higher TNFalpha and IL-6 levels were seen in infants with sepsis compared to control. The TNFalpha levels significantly decreased in patients with sepsis, septic shock and the survivors, while the patients who did not survive, the levels showed no significant change after 48 hr. The initial levels of IL6 were comparatively higher in patients with septic shock and non-survivors, and increased at 48 hr of admission in patients with sepsis, septic shock and non-survivors.