Case Series of Burkholderia Pseudomallei Causing Melioidosis (Pulmonary, Cerebral, and Splenic Abscess)

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.

Omicron infection increases IgG binding to spike protein of predecessor variants.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in India in 2020-2022 was driven predominantly by Wild (Wuhan-Hu-1 and D614G), Delta, and Omicron variants. The aim of this study was to examine the effect of infections on the humoral immune response and cross-reactivity to spike proteins of Wuhan-Hu-1, Delta, C.1.2., and Omicron. Residual archival sera (N = 81) received between January 2020 and March 2022 were included. Infection status was inferred by a positive SARS-CoV-2 RT-PCR and/or serology (anti-N and anti-S antibodies) and sequencing of contemporaneous samples (N = 18) to infer lineage. We estimated the levels and cross-reactivity of infection-induced sera including Wild, Delta, Omicron as well as vaccine breakthrough infections (Delta and Omicron). We found an approximately two-fold increase in spike-specific IgG antibody binding in post-Omicron infection compared with the pre-Omicron period, whilst the change in pre- and post-Delta infections were similar. Further investigation of Omicron-specific humoral responses revealed primary Omicron infection as an inducer of cross-reactive antibodies against predecessor variants, in spite of the weaker degree of humoral response compared to Wuhan-Hu-1 and Delta infection. Intriguingly, Omicron vaccine-breakthrough infections when compared with primary infections, exhibited increased humoral responses against RBD (7.7-fold) and Trimeric S (Trimeric form of spike protein) (34.6-fold) in addition to increased binding of IgGs towards previously circulating variants (4.2 - 6.5-fold). Despite Delta breakthrough infections showing a higher level of humoral response against RBD (2.9-fold) and Trimeric S (5.7-fold) compared to primary Delta sera, a demonstrably reduced binding (36%-49%) was observed to Omicron spike protein. Omicron vaccine breakthrough infection results in increased intensity of humoral response and wider breadth of IgG binding to spike proteins of antigenically-distinct, predecessor variants.

Case series of invasive lung infections by Aspergillus species and zygomycosis among post COVID-19 and post-transplant individuals.

Airborne pathogens like Aspergillus bring the lungs in the frontline for defense. Pulmonary diseases caused by Aspergillus species are broadly classified as aspergilloma, chronic necrotizing pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA), and bronchopulmonary aspergillosis. Intensive care unit (ICU) admission is required for a large number of patients associated with IPA. It is not yet known whether patients with coronavirus disease 2019 (COVID-19) are at a similar risk for IPA as for influenza. However, usage of steroids plays a leading role in COVID-19. The family Mucoraceae includes filamentous fungi of the order Mucorales, causing a rare opportunistic fungal infection known as mucormycosis. The most commonly reported clinical presentations of mucormycosis are rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and others. Here, we report a case series of invasive pulmonary infection by various fungi like Aspergillus niger, Aspergillus fumigatus, Rhizopus oryzae, and Mucor species. Specific diagnosis was made based on microscopy, histology, culture, lactophenol cotton blue (LPCB) mount, and chest radiography and computed tomography (CT). To conclude, opportunistic fungal infections like those due to Aspergillus species and mucormycosis are most commonly associated with hematological malignancies, neutropenia, transplant patients, and diabetes. Therefore, early diagnosis by direct microscopy, surgical interventions, and effective antifungal treatment form the ideal management for invasive fungal infections like aspergillosis and mucormycosis, instead of waiting for the culture reports.

How much can we rely on a scrambled COVID-19 vaccine? It is not the only way out!

The COVID-19 pandemic has engulfed the world in the blink of an eye and created a state of panic. Vaccine is one of the suggested ways to counter the menace. Smallpox was an ideal vaccine candidate yet, it took about 182 years to eradicate. Vaccines are associated with incidents of mishap like the 'Cutter incident'. COVID-19 vaccine has a political, commercial angle to it, with at least 62 vaccine candidates in the pipeline. Potential obstacles in development of vaccines are mutations in strains of SARS-CoV-2, lack of details of biological properties of the virus and incomplete information of pathogenicity, lack of suitable animal models. The potential side effects of the vaccine are eosinophilic infiltration, increased infectivity following challenge infections, antibody-dependent enhancement of infections. The general public has to stop anticipating that a vaccine is nearby and believe that for now, vaccine is face mask, hand wash, and social distancing and hope that either the virus goes weak or an effective vaccine arrives rather early than late. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Post Covid-19 mixed fungal orbito-pansinusitis caused by Rhizopus Oryzae and Exophiala Jeanselmei-review and reports

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.

Remote monitoring of indoor/outdoor movement in epidemiological situations utilising UWB transceivers

A global pandemic has reduced mobility, impacting the healthcare assessment, and diagnostics on co-morbid patients. Various challenges for location finding and indoor signalling issues give rise to the necessity for compact and low-cost ultra-wideband sensor technology. Lockdown has played a vital role during crisis in engaging with specific conditions like position estimation in areas under LOS and NLOS caused by diffraction and reflection of UWB signals across obstacles. UWB-based localisation system with edge/fog computing is used to analyse the indoor/outdoor usage of quarantined patients reducing the transmission, which becomes a threat for society and healthcare personals. The mathematical models to symbolise various patterns utilising UWB sensors with anchors and tags were used to determine the flow of all rapid and random movements within the specified clustered locations. The proposed system achieves high classification accuracy with SVM to classify the patterns and assist frontline medical workers in containing pandemics through human interaction. Copyright © 2021 Inderscience Enterprises Ltd.

Clinical and epidemiological profile of children with COVID-19 in a tertiary care center in Tamil Nadu

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, leading to Corona Virus Disease-2019 (COVID-19) has been a recent pandemic and has spread all over India. Many children with SARS-CoV-2 infection wete referred to our tertiary care center from April 2020 to till date. COVID-19 has been an extremely severe infectious disease. However, very few studies have focused on the epidemiological characteristics of this disease in children. Aim: To identify the clinical and epidemiological profile of children with COVID-19 in a tertiary care centre in South India. Materials and Methods: During the recent pandemic of COVID-19, in Chengalpattu district, Tamil Nadu, this cross-sectional study was done in children with SARS-CoV-2 infection, from March 2020 to June 2021 at Paediatric Department, Chengalpattu Medical College Hospital, Tamil Nadu. A total of 191 children who were tested positive for SARS-CoV-2 were admitted to the isolation ward of our institution, as per the Indian Council of Medical Research (ICMR) guidelines and was monitored till discharge or death. The clinical features including fever, cough, diarrhoea, respiratory distress were noted with mean duration of symptoms. Laboratory parameters like leucocytosis/leucopenia, thrombocytosis/thrombocytopenia, c-reactive protein (CRP), D-dimer (D fragments of protein fibrin) and serum ferritin were noted. Results: Among the total study population of 191 children, 108 (56.54%) children were of age group between 5 years to 12 years. Majority of children, 136 (71.2%), were asymptomatic and the disease has more incidence in boys than girls {104 (54.45) % vs. 87 (45.55%)}. Eight (4.19%) children had comorbid illness. A total of 166 (86.91%) children were infected with SARS-CoV-2 during first wave and 25 (13.09%) children were infected during second wave. Among the study population of 55 (28.8%) symptomatic children, fever was the predominant symptom in 27 (14.14%) children followed by fever with cough in 10 (5.23%) children. Mean duration of symptoms were 4.5±1.3 days. The CRP was elevated in 13 (6.80%) of children. Out of 11 (5.79%) children who required oxygen and ventilator support, 6 (3.14%) required only oxygen. Three children had features suggestive of Multisystem Inflammatory Syndrome in Children (MIS-C) of which one child died. Conclusion: In the present study, most of the children were asymptomatic. The prevalence of symptomatic COVID-19 was low in children. The incidence of severe COVID-19 infection in this study was very low. The most severe form of the disease was MIS-C. Mortality is low in the present study group and it occurs in patients with underlying disease or morbid obesity.

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries.

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Occurrence and characterization of Bipolaris setariae associated with leaf blight of browntop millet (Brachiaria ramosa) in India

A new leaf blight disease of browntop millet (Brachiaria ramosa) was noticed during rainy season (Kharif) 2018 at small millet experimental field, University of Agricultural Sciences, Gandhi Krishi Vignana Kendra (GKVK), Bengaluru, India. To assess the disease severity, an intensive roving survey was conducted during the 2019 cropping season. Based on the morphological characterization, the causal agent of leaf blight disease was identified as Bipolaris spp. Further sequencing and combined gene analysis of ITS (internal transcribed spacer of rDNA), GAPDH (glyceraldehyde 3‐phosphate dehydrogenase) and LSU (large subunit) of all the nine isolates confirmed the pathogen as B. setariae. Pathogenicity study showed that all the isolates were pathogenic and caused leaf blight symptoms on browntop millet. The B. setariae isolates showed marked variability with respect to disease incidence on browntop millet (cv. Dundu korale) under artificial inoculation conditions. However, the host range was limited only to browntop millet and found non‐pathogenic to other six small millets examined. To our knowledge, this is the first completely described study on characterization of B. setariae causing leaf blight disease of browntop millet in India. [ABSTRACT FROM AUTHOR] Copyright of Journal of Phytopathology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)