ABSTRACT
Context: COVID-19 response needs to be enlightened with representative data regarding the humoral response to the virus, and its relationship with the clinico-epidemiological profile of the general population. Aims: To estimate the titres of IgG antibodies against SARS-CoV-2 and study the factors associated with the same among the general population of the Pimpri Chinchwad Municipal Corporation area. Settings and Design: Population-based cross-sectional study was carried out among the general population aged 6 years and above in the Pimpri Chinchwad Municipal Corporation area. Methods and Material: A total of 10,082 individuals from 106 wards of the PCMC area were studied between June 16, 2021 and June 26, 2021. The survey form questionnaire included sociodemographic details, COVID-19 exposure history, symptoms, tests, and vaccination status. About 3 to 5 ml blood samples were collected from each subject. Testing of samples was done using ABBOTT CMIA, SARS-CoV-2 quant assay - sensitivity 92.7% and specificity 99.9%. Statistical Analysis Used: Frequency analysis was done for sociodemographic variables, and antibody titres. An appropriate test of association was applied to the association between antibody titres and the sociodemographic and clinical profile of participants. Results: Antibody titres were significantly higher in males, aged 45 years and above, participants of upper socioeconomic class, participants residing in elite areas, subjects with a history of COVID-like symptoms in the past, and those who were vaccinated. Conclusions: Anti-SARS-CoV-2 IgG antibodies titres were found to be significantly associated with age, sex, socioeconomic status, area of residence, vaccination status, and history of COVID symptoms. © Medical Journal of Dr. D.Y. Patil Vidyapeeth 2022.
ABSTRACT
Case Report A male infant is born at 37w to a 34-year-old G3P2 mother by vaginal delivery after an uncomplicated pregnancy. Prenatal screens are negative. The patient had a birth weight of 2,620 g, with Apgar scores of 9 and 9. On day 2 after birth, had increased work of breathing which prompted transfer to a level II NICU for further management. On arrival to the unit, the infant is tachypneic with mild chest wall retractions and thick nasal secretions. A CBC and blood culture were collected and empiric antibiotic therapy was started. Respiratory viral panel and COVID test are negative. A chest radiograph shows a middle lobe opacity concerning for pneumonia (figure 1). His clinical status failed to improve and on day 4 after birth, supplemental oxygen was provided. The primary team consulted ENT and Pulmonology services. Flexible laryngoscopy showed a normal anatomy. Pulmonology recommended transferring to our NICU for a chest CT with bronchoscopy. Our differential diagnosis for this neonate with respiratory distress that fails to improve over time or with antibiotics was broad, but further testing revealed this infant's condition. A CBC, CRP and a blood gas were collected on admission and were normal. ID service was consulted. A Chest CT showed bilateral atelectasis. Bronchoscopy showed a normal anatomy. Bronchoalveolar lavage was sent. Umbilicus swab was positive for MRSA, nasal wash/sputum culture/bronchoalveolar fluid also grew moderate S. aureus. Nasal ciliary biopsy sent for electron microscopy. Positive umbilicus and nasal swab, and subsequently BAL for MRSA led to a diagnosis of MRSA neonatal rhinitis. Therapy with IV vancomycin was initiated and later changed to oral clindamycin to complete a total of 14 days of therapy. The neonate was weaned off oxygen support on day 11. His clinical symptoms improved. He was discharged on oral clindamycin with follow up appointments with pulmonology and ID clinics. His ciliary biopsy showed absence of outer and inner dynein arms, compatible with the diagnosis of primary ciliary dyskinesia (PCD) (figure 2). Genetic testing for PCD showed mutations in the DNAAF1 and CCDC40 genes. This neonate was diagnosed with primary ciliary dyskinesia (PCD) but his presentation at birth was nonspecific and the differential diagnosis was broad. There is no gold standard diagnostic test for PCD and high clinical suspicion is important. Since it is most likely an AR inheritance, screening of family members is essential. Initial management of neonates may include measures that manage the respiratory distress, airway clearance to prevent respiratory infections and treat bacterial infections. Chest physiotherapy may help if recurrent atelectasis. Flexible bronchoscopy and bronchoalveolar lavage may help both to diagnose and treat the underlying infection. Antibiotic therapy based on organism growth for exacerbations may prevent development of bronchiectasis. (Figure Presented).