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
Unanticipated information in December 2019 changed the world around us. A relatively contagious disease unfolded through the SARS-CoV-2 virus that travelled throughout the globe and was declared an epidemic by WHO in March 2020. The need of examining the scenario became the inducement behind this research. The assessment of COVID-19 in India is performed from 1 April 2020 to 20 May 2021 which amassed a total of 415 instances. Further, preprocessing of the dataset is executed with the use of normalization. The experimentation is executed through the use of four ensemble strategies which are bagging, boosting, stacking and voting with four distinct machine learning algorithms linear regression, sequential minimal optimizer for regression, multilayer perceptron and Gaussian process. The splitting of the dataset is completed at 75%, and machine learning algorithms with ensemble techniques are applied. Linear regression with the bagging ensemble method gives satisfactory outcomes with the correlation coefficient of 0.935 and 0.919 for confirmed cases and recovered cases, respectively, and Gaussian process presented the best results for deceased cases. In the case of ensemble strategies, bagging indicates the best correlation coefficient in each case. Therefore, with the help of the three best algorithms, confirmed cases, recovered cases and deceased cases predictions are performed. The paper has potential implementations that can foresee the COVID-19 confirmed cases, recovered cases and deceased cases based on historic data and subsequently structure the plan for the future. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.