Diagnostic Approach to Extrapulmonary Tuberculosis by Cartridge-based Nucleic Acid Amplification Test.

BACKGROUND: Tuberculosis (TB) is a highly infectious disease causing millions of cases worldwide. Though pulmonary TB is the most common form of infection, extrapulmonary cases are also very rampant and are responsible for a large number of cases. But the diagnosis of extrapulmonary cases is quite difficult because of varied manifestations and the paucibacillary nature of the infection. Cartridge-based nucleic acid amplification test (CBNAAT) is a simple, rapid test that is very efficient in the early diagnosis of these extrapulmonary cases [extrapulmonary TB (EPTB)]. AIM: A study was done to establish the usefulness of CBNAAT in the early diagnosis of EPTB cases. MATERIALS AND METHODS: A comparative study was conducted in a rural tertiary care hospital in West Bengal, India, for 8 months (July 2021-February 2022). Samples were collected from different sites like pleural fluid, lymph nodes, cerebrospinal fluid (CSF), pus, ascitic fluid, and tissue aspirate and subjected to both CBNAAT and smear staining and examination under a fluorescent microscope. Positive samples were cultured, examined, and compared. RESULT: From 593 samples collected from different sites in suspected cases of EPTB-52 samples were positive by CBNAAT, and six cases showed rifampicin resistance (RIF resistant). Smear staining of the samples by auramine-rhodamine stains and examined under the fluorescent microscope for acid-fast bacilli identifying 33 samples; the rest were negative. Slides showing acid-fast bacilli were cultured on Lowenstein-Jensen media. CONCLUSION: Cartridge-based nucleic acid amplification test (CBNAAT) is a very useful assay for the early diagnosis of extrapulmonary cases as it can accurately identify false negative samples by smear microscopy.

Prevalence of Urinary Tract Infection among Hospitalized Covid 19 Patients: A Study in Eastern India.

COVID-19 is the disease caused by SARS-CoV-2. The present hospital based study was performed to find out prevalence of Urinary Tract Infection among COVID 19 patients. The cross sectional study was performed with seven hundred fifty three laboratory confirmed COVID 19 cases over six months (from 1st July to 31st December, 2020). Urine samples collected from laboratory confirmed COVID-19 cases in appropriate sterile manner and were screened for pus cells and bacteria. This was followed by plating on Mac-conkey's agar media and 5% Sheep Blood agar media. Inoculated plates were incubated overnight in aerobic condition at 37°C. Discrete colonies were further studied by Gram staining, tests for motility, battery of biochemical tests. Antibiogram was performed by disk diffusion method as per CLSI guidelines. Species confirmation and MIC (Minimum Inhibitory Concentration) values of the tested antibiotics were detected by automation. Results were analyzed according to standard statistical methods. Ninety urine samples were culture positive (11.95%). Escherichia coli was found to be the commonest pathogen, isolated in forty three cases (47.78%) followed by Enterococcus faecalis in twenty nine (32.22%) and Klebsiella pneumoniae subspp. pneumonia in eighteen occasions (20%). Enterococcus faecalis isolates were sensitive to Vancomycin, Linezolid and Nitrofurantoin and nineteen isolates were resistant to fluroquinolones (65.51%). Majority of the Gram Negative isolates were susceptible to nitrofurantoin (80.32%) where as fifteen carbapenemase producers, thirteen AmpC Betalactamase producers and twenty one Extended Spectrum Beta Lactamase (ESBL) producers have been recorded. Constant awareness regarding the antibiotic guidelines for COVID-19 cases is the need of the hour.

Liver Function Status in COVID-19: An Indian Perspective.

INTRODUCTION: In SARS-CoV2 infection multi-organ involvement of heart, kidney pancreas and liver are reported. Most studies suggest that though mild derangements of liver function may be experienced by most COVID-19 patients but significant liver injury is not common. The aim of this study was to describe clinical characteristics of COVID-19 patients admitted to this level 4 COVID hospital and find out their relation to the liver parameters. MATERIALS AND METHODS: COVID-19 patients admitted in this level -4 COVID hospital during the study period were classified as mild (Group 1,n=42), moderate (Group 2,n=40) and severe (Group 3,n=35) cases as per national guidelines. Serum samples were analyzed using biochemistry autoanalyzer. Serum levels of total and direct bilirubin, Alanine Transaminase (ALT) and Aspartate Transaminase (AST), Alkaline Phosphatase (ALKP), total protein and albumin were assayed. RESULTS: Patients with higher BMI (Body mass index) had developed greater COVID-19 related complications and hence had to be admitted either in HDU (Group 2) or in ICU (Group 3) set up. Total and direct serum bilirubin levels were normal and almost similar in the various study groups. The primary liver enzymes ALT and AST were raised in the entire study population. However differences between the study groups were statistically insignificant. ALKP was within normal reference range for all the cases. Serum total Protein levels were within normal physiological limits in all the three groups. However serum albumin levels were reduced significantly in Groups 3 and 2 in comparison to Group 1. CONCLUSION: Derangements of LFT in COVID-19 Patients are common especially in patients with severe disease but its long term impact is unknown. Hence, further investigation and long term follow up of recovered COVID-19 cases is warranted to understand the pathophysiology and implication of liver injury that occurs both in overt and covert forms during infection.

Status of Health-care Workers in Relation to COVID-19 Infection: A Retrospective Study in a Level 4 COVID Hospital in Eastern India.

INTRODUCTION: Healthcare workers (HCWs) have a high risk of acquiring SARSCoV- 2 infection, due to repeated occupational exposure, long working hours, stress and fatigue. In India, there is lack of data regarding the prevalence of COVID-19 amongst HCWs due to absence of routine screening programme within the hospital premises. We have designed this study in order to improve our understanding of the incidence of SARS-CoV2 within the health care workers working in a level 4 COVID hospital in Kolkata. MATERIALS AND METHODS: A retrospective observational study was conducted at the Department of Microbiology, ID and BG Hospital, Kolkata upon health care workers who presented with symptoms suggestive of Covid 19 and their direct contacts. Oropharyngeal and nasopharyngeal swabs collected from the participants were subjected to Real time RT-PCR for detection of E, RDRP and ORF1B N gene for Covid 19 detection. RESULT: Out of the 274 HCW tested, 75 (27%) of total HCWs were found to be positive. Among them 33(44%) were frontline workers and rest of them 42 (56%) were non-frontline workers. Predominance of SARS- CoV2 infection was found in male HCWs (57%) than female HCWs (43%). HCWs younger than 45 years (68%) were more infected.52 (69%) HCWs presented with symptoms like fever, sore throat, bodyache, loss of sensation of smell, coughs etc. 23(31%) were asymptomatic with history of direct contact with Covid-19 positive cases. CONCLUSION: Heath care workers are at higher risk of being exposed to SARS-CoV2 and could potentially has a role in transmission in and out of the hospital. Hence, routine screening of both symptomatic as well as asymptomatic hospital staff is essential for early diagnosis to prevent transmission of COVID 19 infection.