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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.
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Background:Ample of studies have been carried out on the causative agent, pattern of illness, treatment options which mainly concern regarding the patients and general population affected from COVID -19, however few studies have fo- cused on its adverse effects on front line health care workers ( HCW ) and other employees of health care facilities. The present retrospective study was planned to analyse the clinico-viro-epidemiological profile of different covid clusters in HCWs and non-health care employees of AIIMS, Bhubaneswar. Methods:A hospital based retrospective study was carried out on the HCWs and other employees of AIIMS, Bhubanes- war, who tested positive SARS-CoV-2 infection by RT-PCR test. The clinical and demographic information were analysed with corresponding virological data of the patient. Results:Of the 671 employees of AIIMS, Bhubaneswar who tested positive for SARS-CoV-2, 92 were from eight clusters that could be traced. The eight clusters involved 4 clusters each from both the HCWs group containing 66 individuals and non-HCWs group with 32. Male to female ratio was 2.5:1. Maximum 55(59.7%) individuals belonged to 20 -30yrs age group followed by 30-40yrs 28(30.4%) and least 3(3.2%) in 50-60yrs. Asymptomatic COVID positive individuals were more as compared to symptomatic in all the age groups. All the individuals with cycle threshold value (CT) ≤ 20 were symptomatic;of the 21 persons with CT value 21-30, seven were symptomatic and 14 were asymptomatic. Majority with >30 CT value (35/44) were asymptomatic. Conclusions:Frontline HCWs are constantly at increased risk of getting infection, but the disease burden and post -covid stigma can be substantially decreased among non-HCWS if COVID appropriate behaviour are strictly implemented and followe
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Background:COVID-19 RT-PCR kits of various manufacturers categorize certain samples as inconclusive and repeat testing or re-sampling is advised in those cases to ascertain positivity or a negative result. This is of paramount im- portance because a definite result helps in effective implementation of public health measures, leading to implicit con- tainment. Our study aims to ascertain criteria through which the inconclusive can be definitively categorized as either positive or negative. This will be of help in conserving manpower and resources which are utilized in re -testing of pa- tients with inconclusive RT-PCR result. Methods:Hundred samples which were inconclusive (IC) as per Q-Line Covid-19 RT-PCR kit from 1st September, 2020 to 31st October, 2020 were included in the study. These were classified into 4 groups based on Ct value of N gene;namely A (<25;3 samples), B (25-30.9;31), C (31-34;62) and D (>34;4) and were tested by NIV kit. RNA extracts of these sam- ples were run through ICMR-NIV rRT-PCR screening and confirmatory assay to ascertain a criteria with which inconclu- sives can be definitively reported as either positive or negative. Results:Majority (62%) of IC samples were in group C (Ct 31-34) followed by 31% in group B, 4% in D and 3% in group A (<25). Confirmed positivity by NIV kit was 100% in group A and 51.6%, 20.96% and 25% respectively in B, C & D groups.29% of group B and 24% group C samples remained inconclusive by NIV kit. Majority of confirmed negatives were found in group D (75%), followed by group C (54.83%). Conclusions:All inconclusive samples with Ct values of N gene less than 25 were positive with ICMR -NIV kit, whereas >50% of samples of Ct >30 became negative. Repeat sampling could be avoided in 76% cases by following strategy of repeat testing in NIV kit.
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Background: The burden of corona virus disease of 2019 (COVID-19) in children is less well studied compared to adults.This study is to provide Clinical Profile of children positive for COVID-19 admitted to a tertiary care hospital with focus on mode of presentation, severity of disease, associated co-morbidities, radiological and biochemical abnormali- ties and outcome. Methods: This retrospective study included 74 children positive for COVID-19 admitted to a tertiary care hospital in eastern India between March 24 and August 31, 2020. Symptomatic screening and testing for SARS -CoV-2 through RT PCR in the hospital was started on 16th March 2020 as per the prevalent national guidelines. Universal screening for COVID 19 of all the newly admitted patients to the hospital started in middle of June 2020. Results: Of the 74 children included in the study 45 (60.8%) were male, and the median age was 5 years (range: 5 days –14 years). 35 patients (47.3 %) had pre-existing comorbidities, 27 patients (36.5 %) were diagnosed incidentally and 47 patients (63.5 %) presented with respiratory symptoms. 8 patients (10.8 %) required supplemental oxygen support. The median length of hospital stay was 8 days (range: 5 days -20 days). Chest X ray was abnormal in 11/32 (34.4%) of chil- dren imaged. 21/73 (27.8 %) patients were from containment zones. In 31/54 (57.4%) patients, at least one family member tested positive. Hydroxychloroquine therapy was used in 10 patients (13.5 %), and azithromycin was used in 34 patients (45.9%). The case fatality rate was 2 (2.7%). Conclusions: In this single centre retrospective study, severe illness in children in terms of Intensive care unit admission and death was far less frequent. However, as the pandemic is still evolving, larger and more extensive studies with fol- low up are required for better understanding of Covid-19 in Children
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Background:From the day of the detection of 1st case in India on 30th January 2020, COVID -19, has infected 8.96 mil- lion people in India, from around 128 million samples tested. The clinico -epidemiological characteristics of COVID 19 have been varied in different countries. The present study was undertaken to understand the clinico -epidemiological characteristics of COVID-19 in Odisha. Methods:This was a retrospective, single centre study. The epidemiological, demographic & clinical parameters were analysed of the samples tested in AIIMS Bhubaneswar between March 2020 to November 2020. Results:A total of 56,547 samples were tested for SARS CoV-2 by RT-PCR from March 24th 2020 till 15th November 2020. Of the total samples tested, 9754 were tested positive, with an average positivity rate of 17.25%. The mean age of the patients 38.21 years, with male to female ratio of 3:1. Among the various age groups, the majority affected were the middle ages (31-50 years) constituting around 38.77% (n = 3782) of the total cases followed by 15 -30 years (31.48%, n=3071) &> 50 years (23.64% n = 2305) & was least in children (<14years) with 6.11% (n = 596). Among the COVID -19 positives, 64.5% (n=6295) were asymptomatic & only 35.5% (n=3459) were symptomatic. Of the symptomatic patients, 81.1% (n=2805) presented with mild, 17.7 %( n=612) cases moderate, and only around 1.12% (n=39) had severe COVID - 19 disease. Of the severe cases, majority belong to the age group 31-50 (38.46%, n = 17), followed by 15-30 (15.3%, n=11). The monthly trend showed an increasing trend up to September, with maximum positivity rate of 38%, followed by a decline during October (14.7%) & November (5.8%) Conclusions: In this study of 9754 patients with confirmed COVID-19 in Odisha, the characteristic findings included younger age, male predominance, high proportion of asymptomatic patients & a declining trend in the positivity rate over the months
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Background:COVID-19 pandemic is posing a major burden on society. Measures taken to reduce its spread critically de- pend on timely and accurate identification of virus-infected individuals by the most sensitive and specific method availa- ble, i.e. real-time reverse transcriptase PCR (RT-PCR). RT PCR can detect SARS-CoV-2 as early as day one of symptom onset. There are various RT PCR kits approved by FDA & ICMR, performance of which vary widely. Here, we assessed the performance of four PCR kits with the ICMR NIV Screening & Confirmatory assay used for diagnosis of COVID -19 in Od- isha. Methods:A total of 20 samples, which included five positives, one inconclusive & 14 negative samples by NIV assay were evaluated in the four commercially available RT-PCR kits ie;Q-line Molecular (Q-line), Allplex™ 2019-nCoV Assay (Allplex), Liferiver Novel Coronavirus (COVID-19) Multiplex RT PCR (Liferiver), LabGun™ COVID-19 kit (LabGun). Results:The sensitivity of the four PCR kits varied with the high cycle threshold (Ct) value (30-35 by NIV) & the lower Ct value (<30 by NIV). Among the negative results of NIV (n=14), LabGun, Allplex kits showed 100% concordance, while Q - line & Life river were shown to have 92.8% & 50% concordance respectively. In the inconclusive results (n=1), only All- plex Assay documented a concordance of 100% with the NIV assay, while the Q -line (n=6) & Life river (n=7) showed higher number of inconclusive results. The different kits showed lesser variations with positive results (n=5), with Life river, Allplex & LabGun showing 100% concordance for positive results with NIV assay. However, Q -line was able to de- tect only 1 positive out of all positives. Conclusions:PCR kits vary in sensitivity & it is imperial to evaluate the various kits in order to deliver accurate results at optimum time in order to detect the cases to initiate adequate treatment & control measures