ABSTRACT
Intro: Invasive aspergillosis of CNS is a severe form of aspergillosis & is associated with high mortality. Most of these cases are suspected & diagnosed in neutropenic patients. We hereby describe a series of 15 patients with CNS aspergillosis in non-neutropenic patients from a tertiary care hospital in India. Method(s): All patients with clinical & radiological features suggestive of CNS aspergillosis were screened for microbiological evidence of invasive aspergillosis, either by demonstration of hyphae by microscopy or histology, culture or galactomannan assay. Patients demographic details, clinical features, risk factors, diagnosis, management & outcome details were documented. Finding(s): A total of 15 patients were found to have CNS aspergillosis, 5 isolated CNS infections & 10 showing concomitant CNS & pulmonary aspergillosis in one between January 2021 to July 2022. The average age was 41.46+/-14.6y, with majority being male. Among the risk factors, most common ones were fungal sinusitis (46.6%), steroid use (40%), COVID-19 (33.3%). One patient had history of endoscopic sinus repair, another had h/o lung abscess. Most common symptoms of CNS aspergillosis were headache (73.3%), fever (60%), altered sensorium (53.3%) & seizures (47.6%). Radiologically, the common findings included ring enhancing lesion, s/o cerebral abscesses were observed in four patients. Direct microscopy s/o fungal hyphae were reported in 5 patients, with 4 culture positives. Average serum galactomannan was 1, while CSF galactomannan showed better sensitivity with mean CSF galactomannan being 2.53. Almost all patients were treated with Voriconazole based on weight, but showed high mortality of 60% even after initiation of therapy. Complete resolution were seen in only two patients, while 4 patients remaining static in improvement during 6 months follow up. Conclusion(s): Invasive CNS aspergillosis must be suspected even with nonneutropenic patients with newer emerging risk factors like steroid use, COVID-19 & h/o fungal sinusitis presenting with clinical & radiological manifestations.Copyright © 2023
ABSTRACT
Background. Invasive aspergillosis(IA) is known to occur in immunocompromised patients including neutropenic patients. But there has been a trend of increasing cases in non-neutropenic host with the emergence of newer risk factors like DM, cirrhosis etc. The aim of this study was to evaluate the clinical features & risk factors of IA in non-neutropenic patients & to look at the clinical utility of galactomannan in diagnosis of IA. Methods. This was a prospective observational study which included the suspected cases of IA, based on the clinical & radiological criteria. Patients with haematological & solid organ malignancy were excluded. In patients with suspected Invasive pulmonary aspergillosis (IPA), serum & BAL, while in patients with suspected CNS IA CSF & serum samples were sent for galactomannan analysis (Platelia ELISA). The clinical features, risk factors, outcomes were analysed. Results. We screened 243 patients with suspected IA, of which 49 nonneutropenic patients with IA (16 Proven & 33 Probable cases) were included. The mean age was 47.8 years. Of all IA cases 69.5% (n=34) were IPA, 20.4% (n=10) were CNS aspergillosis & 10.2% (n=5) showed disseminated form of IA. The common symptoms included Fever (71.4%), cough (71.3%), expectoration (44.7%) & dyspnoea (59.1%) in IPA, while in CNS aspergillosis, presented with fever (73.3%), altered sensorium (53%).The predominant risk factor included previous TB, DM, COVID-19. The radiological manifestations in IPA included the typical cavity (40.4%, n=17), Centrilobular nodules with tree in bud appearance in 56.5% (n=23). The CNS aspergillosis was associated with ring enhancing lesion (41.6%, n=5) with leptomeningeal enhancement (50%, n=6), while cerebral abscess was seen in 16.6% (n=2) patients. The positivity of galactomannan were 24.4%, 91.3% & 87.5% in serum, BALF & CSF respectively. Culture positivity & Direct smear positivity was 18.3% & 28.5% respectively. The overall mortality was 20.4%. Complete response in 3 months follow-up period was seen in 69.3% patients. Conclusion. The clinical manifestations of IA in non-neutropenic are diverse & nonspecific. Also, culture & direct microscopy lack sensitivity, hence diagnostic markers like Galactomannan can be used for early diagnosis of IA in patients with newer emerging risk factors.
ABSTRACT
Aims & Objectives: To study coagulation parameters and its effect on outcome in patients with COVID-19. Patients/Materials & Methods: : It was an observational crosssectional study conducted in single tertiary hospital. The study was conducted on samples from 230 patients. All the patients were positive for SARS-CoV-2 by RT-PCR. Patients were categorized as asymptomatic, mild, moderate, or severe according to the guidelines published by the Ministry of Health and Family Welfare (MoHFW), Government of India and World Health Organisation. Following parameters were analysed for these patients- Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, fibrinogen, factor-VIII, protein-C (PC), protein-S (PS) and antithrombin. Results: Our study conducted on 230 adults showed that there is increase in coagulation abnormalities with increase in severity of COVID-19. There is increase in pro-coagulant and anticoagulant activity with increase in severity of disease. 230 patients included 132 (57.4%) males and had mean age 51.82 ± 16.6 years. In this cohort, 61.3% of patients were either asymptomatic (34.3%) or had mild disease (27%), whereas 20% and 18.7% patients had moderate or severe disease, respectively. 12 (5.2%) and 26 (11.3%) patients had prolongation of PT and APTT, respectively. D-dimer levels increased with increasing disease severity and were significantly higher in nonsurvivors when compared to survivors (6.32 ± 7.62 vs 1.69 ± 3.8 lg/mL;p<0.0001). Mean levels of fibrinogen, PC, PS and antithrombin levels though remained in normal range but increased from asymptomatic to moderate disease. However, factor VIII showed significant increase in all stages. Discussion & Conclusion: Number of patients with abnormal procoagulant and anticoagulant parameters increased with increasing severity but didn't differ among survivor and non-survivors except PS. This study reveals age, D-dimer, APTT, fibrinogen and Factor VIII levels were significantly higher in patients with moderate and severe disease as compared to asymptomatic and mild disease.