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
Backgrounds: Covid-19 pandemic has affected large population across the globe. As the cases around the world rise, Covid-1related complications are also reported from various areas of the world. Pulmonary complications are mostly reported all over thworld. In this review, we emphasized the pulmonary functions in Covid-19 survivors. Objectives: To determine the impact of Covid-19 on pulmonary functions and analysis of possible lung damage in long-term aftecovid recovery. Methods: Study includes lab-confirmed RT-PCR positive, both discharged and home-isolated from Tertiary Care Centre New MedicaCollege and attached Hospitals, Kota. All subjects were to undergo 6-min. walk test (6MWT) and included only those patients foPulmonary Function Test who could perform 6MWT. Results: 109 men and 57 women with age range, 21 to 77 years from the 166 subjects. Among these, 71 (42.77%) were discharged from hospitals and 95 (57.23%) were home-isolated. The predicted FVC% was 92.83 ± 12.42, predicted FEV1% 89.94 ± 12.71 and FEV1/FVC% predicted was 98.30 ± 14.13. 6MWT walked distance was 540.50 ± 2.40. 69 subjects (41.57%) faced fatigue during 6MWT. FEV valuwas significantly(p < 0.05) higher for hospitalised patients compared to home-isolated patients. The mean FVC value was higher fohome-isolated patients compared to hospitalised patients (p < 0.05). 23% of study subjects showed restrictive and 7.2% haobstructive pattern while 70.5% had normal PFT. Conclusion: Covid-19 patients showed compromised respiratory functions, mainly restriction in close to 23% and obstruction in 7% of patients. PFTs explain the possible lung damage by Covid-19.
ABSTRACT
Introduction: Coronavirus Disease-19 (COVID-19) infection is associated with high rates of pulmonary and extrapulmonary complications that may continue to incur morbidity, disability and delayed mortality in survivors. These include hyperglycaemia, cardiac injury, acute ischaemic or haemorrhagic stroke, neurological deficits, acute kidney injury and liver injury. Aim: To describe symptoms and complications being faced by COVID-19 recovered patients, as well their socio-demographic profile and co-morbidities. Materials and Methods: This was a cross-sectional descriptive study conducted for the period of 12 months from April 2020-March 2021. Out of nearly 10,000 recovered COVID-19 patients, 1000 (calculated sample size) patients were selected randomly. The patients were categorised gender-wise (male and female) and locality-wise (urban and rural) and an attempt was made to find if any significant difference exists in the symptoms and complications based on above categorisation. The test used for this purpose was Chi-square test and Fisher’s-exact test. Results: Mean age of participants was 50.2±15.7 years and 43.8% had co-morbidities. Common complications included hyperglycaemia (n=28), acute kidney injury (n=8), acute liver injury (n=5), cardio-vascular accident and stroke (n=5), septicaemia (n=8), ischaemic heart disease (n=7), deep vein thrombosis (n=2), cytokine release syndrome (n=10) and post COVID-19 fibrosis (n=3). For septicaemia, a statistically significant difference (p<0.001) was found between urban and rural areas whereas no significant difference in post COVID-19 complications between males and females was observed. conclusion: The most common co-morbidity was diabetes mellitus and most common complication reported was hyperglycaemia.
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Background and Aim: Surgical procedures in patients with COVID-19 disease are associated with increased perioperative morbidity and mortality. A retrospective study was conducted to evaluate the demographic and clinical data of surgical patients with suspected or confirmed COVID-19 disease. Methods: After taking hospital ethics committee approval, medical records of surgical patients operated during the period from May 2020 to November 2020 in a COVID-19-designated tertiary care hospital of northern India were assessed. The demographic data such as age, gender, associated comorbidities, type of surgery, intraoperative complications, and data on the postoperative status of the patients were collected and analyzed. Results: Ninety-four patients underwent surgical procedures during the study period. Out of all patients, 87.2% were females. The median age of patients was 28 years (range: 1 month-59 years). The emergency cesarean section was the most common surgery performed. The subarachnoid block was the most commonly used anesthesia technique. Out of 94 patients, 70 patients were confirmed COVID-19 positive, and 24 were suspected cases. Most of the patients were American Society of Anesthesiologists II (83%) and 43.6% of patients had comorbidities. Conclusion: The cesarean section was the most commonly performed surgical procedure. The most common anesthesia technique used was the subarachnoid block. The patients operated under subarachnoid block had a better prognosis and did not require intensive care unit stays in the postoperative period.
ABSTRACT
Introduction: Acute myocarditis has been reported in patients infected with COVID-19 in case series and imaging-based studies. We sought to assess this link by evaluating trends in hospital admissions due to acute myocarditis and COVID-19 on a national level during the pandemic. Methods: Data on all NHS England hospital admissions with a primary or secondary diagnosis of acute myocarditis were acquired and curated from the NHS Digital hospital episode statistics dataset from 2019-2020. COVID-19 data was obtained from the UK government daily statistics. Rolling averages over 28-day periods are presented. Results: Across all ages, there were 1,894 hospital admissions due to myocarditis in 2019 compared with 1,610 in 2020 (15% reduction). During the first national lockdown (23rdMar-19thJun 2020), myocarditis admissions were 32% lower than the same period in 2019. During the second lockdown (5thNov-2ndDec), myocarditis admissions were 9% greater than in 2019, although this increase was not sustained throughout December despite the subsequent surge in COVID-19 admissions. In general, patients admitted in 2020, compared to 2019, were older (median age 46 years, interquartile range 28-61 vs 41 years, IQR 26-58;p<0.001), but sex (66% men), ethnicity (39% non-Caucasian, 9% unknown) and duration of hospital admission (median 2 days;IQR 1-4) were similar for both years. Discussion: As COVID-19 admissions peaked in early 2020, there was a sharp decline in myocarditis admissions, probably attributed to profound disruptions in healthcare provision, but possibly due to reduced transmission of other viruses during lockdown. Whilst myocarditis admissions increased during the second lockdown, there was no clear association between COVID19 and myocarditis admission numbers. Further research may identify delayed presentations or sequelae of myocarditis, particularly following the larger COVID-19 peak in January 2021, as well as the impact of the vaccination programme.