Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

BACKGROUND: We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). METHODS: From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). RESULTS: Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p < 0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. CONCLUSIONS: The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Mycetoma: A Common Yet Unrecognized Health Burden in Central India.

CONTEXT: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. AIMS: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. SETTINGS AND DESIGN: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. SUBJECTS AND METHODS: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. STATISTICAL ANALYSIS: Statistical analysis was done using proportion, mean, and percentages. RESULTS: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium. Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole-trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. CONCLUSION: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India.

Fusarium soloni mycetoma.

A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram's, and H and E-stained smears. All the three inoculated slants of Sabouraud's media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.

Evaluation of extended spectrum beta lactamase in urinary isolates.

BACKGROUND & OBJECTIVES: Urinary tract infection (UTI) remain the common infections diagnosed in outpatients as well as in hospitalized patients. Current knowledge on antimicrobial susceptibility pattern of uropathogens is mandatory for appropriate therapy. Extended spectrum beta lactamases (ESBL) hydrolyse expanded spectrum cephalosporins like ceftazidime, cephotaxime which are used in the treatment of UTI. ESBL producing bacteria may not be detectable by routine disk diffusion susceptibility test, leading to inappropriate use of antibiotics and treatment failure. Not much information on ESBL producing organisms causing UTI is available from India. An effort was therefore made to study the ESBL producing uropathogens and also the susceptibility patterns of ESBL and nonESBL producers. METHODS: Urinary isolates from symptomatic UTI cases attending or admitted to the Indira Gandhi Medical College and Hospital, Nagpur were identified by conventional methods. Antimicrobial susceptibility testing was done by Kirbey Bauer's disc diffusion method. Isolates resistant to cephotaxime were tested for ESBL production by double disc synergy test method. RESULTS: Of the 217 isolates, 87 were cephotaxime resistant Gram-negative bacilli. Of these, 42 (48.3%) were found to be ESBL producers. Escherichia coli, Klebsiella pnuemoniae and Acinetobacter were ESBL producing species. Multidrug resistance was found to be significantly (P<0.05) more in ESBL producing isolates (90.5%) than non ESBL producers (68.9%). INTERPRETATION & CONCLUSION: In the present study a large number of uropathogens were found to be ESBL producers. Most of the ESBL producing isolates were multidrug resistant. Monitoring of ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with UTI.