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Burkholderia pseudomallei is soil saprophytic Gram-negative bacilli that cause a fatal disease called melioidosis. Melioidosis is capable of causing cutaneous infection and systemic infections in the respiratory tract, cardiovascular, gastrointestinal, urinary, skin and soft tissue, and musculoskeletal and central nervous systems. Here, we report rare forms of pulmonary, cerebral, and splenic abscess case series of melioidosis caused by B. pseudomallei. Imported cases have been reported among tourists, immigrants, and soldiers who returned from endemic areas. The acquisition of infection is through percutaneous, inhalation, and ingestion of contaminated water;person-to-person transmission is very rare. Melioidosis cases are primarily found in the rainfall season and are usually associated with risk factors such as diabetes, alcoholism, and chronic renal diseases. However, 20-26% of cases were not associated with predisposing conditions. The identification is based on colony morphology, Gram stain, antibiotic susceptibility testing, and other supportive automated and molecular assays when we suspect B. pseudomallei. There are two phases, the intensive and eradication phases, in managing melioidosis. In the intensive phase, ceftazidime for 2 weeks showed efficacy in almost 50% of cases, and the eradication phase treatment with co-trimoxazole and doxycycline or amoxicillin/clavulanic acid for 3-6 months showed an excellent response. The improper clinical diagnosis and management of B. pseudomallei can lead to complications. Hence, early diagnosis with microbiological approaches such as culture, biochemical reactions, or automated systems available and antimicrobial sensitivity testing will cure the patient quickly without mortality.Copyright © 2023 The Authors.
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The Covid-19 pandemic has led to infodemic of low quality information leading to poor health decisions. Combating the outcomes of this infodemic is not only a question of identifying false claims, but also reasoning about the decisions individuals make. In this work we propose a holistic analysis framework connecting stance and reason analysis, and fine-grained entity level moral sentiment analysis. We study how to model the dependencies between the different level of analysis and incorporate human insights into the learning process. Experiments show that our framework provides reliable predictions even in the low-supervision settings.
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We report a rare case of mixed fungal orbito-pansinusitis caused by Rhizopus oryzae and Exophiala jeanselmei in post-COVID-19 individuals. A 65-year-old patient was COVID-19-positive and treated as per the protocols. Following recovery after 3 weeks presents to the otorhinolaryngology outpatient department with complaints of nasal obstruction, stuffiness, pain over the maxilla, occasional fever spikes, and swelling over eyelids. He was diagnosed with a case of orbito-pansinusitis mucormycosis based on magnetic resonance imaging, nasal endoscopy, and microbiological findings. Intravenous (IV) fluconazole and amphotericin B were the conservative management initially followed by surgical debridement later. There was minimal residual deformity after patient recovery. Generally, secondary to immunosuppression or debilitating diseases leads to mucormycosis. The mode of entry for molds and spores of zygomycetes are through the respiratory tract through the nose and then reaches the sinuses, orbit, and intracranial structures. Hence, a good prognosis and to reduce morbidity by zygomycosis can be achieved by early clinical diagnosis, direct smears, and proper interventions. The diagnosis of fungal infections at the earliest is very important because the therapeutic management of fungal infection is quite challenging, especially in the case of R. oryzae and E. jeanselmei with immunocompromised state. The prophylactic drugs, steroids, and immunosuppressants for the treatment of COVID-19 should not be misused and must be used as per protocol and guidelines judiciously. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Long-COVID syndrome is now a real and pressing public health concern. We cannot reliably predict who will recover quickly or suffer with mild debilitating long COVID-19 symptoms or battle life-threatening complications. In order to address some of these questions, we studied the presence of (post covid) symptoms and various correlates in COVID-19 patients who were discharged from hospital, 3 months and up to 12 months after acute COVID-19 illness. Methods: This is an observational follow-up study of RT-PCR confirmed COVID-19 patients admitted at 3 hospitals in north India between April – August 2020. Patients were interviewed telephonically using a questionnaire regarding the post-COVID symptoms. The first tele-calling was done in the month of September 2020, which corresponded to 4- 16 weeks after disease onset. All those who reported presence of long COVID symptoms, were followed-up with a second call, in the month of March 2021, corresponding to around 9-12 months after the onset of disease. Results: Of 990 patients who responded to the first call, 615 (62.2%) had mild illness, 227 (22.9%) had moderate and 148 (15.0%) had severe COVID-19 illness at the time of admission. Nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, 311 (almost 78%) responded to the second follow-up. Nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months. Nearly 11% patients continued to have at least one symptom even at the time of the second interview (9-12 months after the disease onset). Overall, we observed Long-COVID in almost 40% of our study group. Incidence of the symptoms in both the follow-ups remained almost same across age-groups, gender, severity of illness at admission and presence of comorbidity, with no significant association with any of them. Most common symptoms experienced in long COVID phase in our cohort were fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder, and breathlessness. Fatigue was found to be significantly more often reported in the elderly population and in those patients who had a severe COVID-19 illness at the time of admission. Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset. The overall median duration of long COVID symptoms was 16.9 weeks with inter-quartile range of 12.4 to 35.6 weeks. The duration of symptom resolution was not associated with age, gender or comorbidity but was significantly associated with severity of illness at the time of admission (P=0.006). Conclusions: Long-COVID was seen in almost 40% of our study group with no correlation to age, gender, comorbidities or to the disease severity. The duration of symptom resolution was significantly associated with severity of illness at the time of admission (P = 0.006). In our study, all patients reported minor symptoms such as fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness.
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There is minimal information on coronavirus disease 2019 (COVID-19) in developing countries regarding renal transplant recipients (RTRs). This paper aimed to study the clinical profile, immunosuppressive regimen, treatment, and outcomes in an RTR with COVID-19. This retrospective study was conducted in the nephrology department of Sri Aurobindo Medical College & Postgraduate Institute, Indore (MP), India, from April 1, 2020 to December 15, 2020. We studied 15 patients, of which 13 were treated at our hospital and two were treated in OPD. The median age of transplant recipients was 45 (Interquartile range [IQR]: 26–62) years, the majority being males, and recipients presented at a median of 4 (IQR: 0.3–11) years after transplant. The most common comorbidities included hypertension in 14 (94%) and diabetes 3 (20%) patients. The presenting symptoms at presentation were cough (80%), headache (52%), fever (46%), and breathlessness (26%). Clinical severity as per computerized tomography (CT) severity score ranged from mild (20%), moderate (53%), and severe (27%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (100%). Antiviral therapy (Favipiravir and Remdesivir) was associated with better outcomes and reduced hospital stay. Risk factors for mortality included ABO-incompatibility, severity of disease, high Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) score, allograft dysfunction before COVID-19 infection, acute kidney injury, elevated inflammatory markers, and intensive care unit/ventilator requirement. Overall patient mortality was 13.2%. Risk factor for mortality in COVID-19 positive with RTR appears to be ABO-incompatible transplant, having a previous history of rejection, and patient requiring ventilatory support.
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The new coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure to multisystem organ dysfunction and death. Healthcare workers, particularly anesthesiologists, are at increased risk since their airway management expertise is required in situations where suspected or confirmed cases of COVID-19 require surgical procedures and in critical care settings. Such patients undergoing surgery have a higher perioperative morbidity and mortality. Additionally, aerosol-generating procedures place the operating room staff at high risk of contracting the COVID-19 infection. Here, we present a review of COVID-19 management, particularly in the perioperative setting. In addition, this article highlights specific concerns with the use of transesophageal echocardiography and the precautions to be taken during cardiopulmonary resuscitation. This review article is based on this institutional protocol supported by literature from recent publications and guidelines from major health organizations on COVID-19.