Hypereosinophilia presented as thromboembolic event: a rare manifestation

Eosinophilia refers to peripheral blood absolute eosinophil count above the ULN, normal range of AEC is 0.05-0.5× 109/l (1-6%). Hyper eosinophilia refers to AEC above 1.5×109/l. Hypereosinophilia can affect multiple organs and can cause cardiomyopathy, gastroenteritis, cutaneous lesions, pneumonitis, and neuritis. In addition, some patients develop thromboembolic complications. We are presenting a case who presented to us with thromboembolic complication later diagnosed as hypereosinophilia with Bone marrow showing myeloid associated eosinophilia (Primary eosinophilia)

COVID-19 pneumonia and mucormycosis a new challenging duo- rhino-occulo-cerebral mucormycosis: a case report

The pandemic of corona virus disease 2019 (COVID-19) has posed challenge not only in management of the primary disease but the emerging complications associated with COVID-19 has further complicated the course of disease. The course of COVID-19 disease is associated with infectious and noninfectious complications former include secondary bacterial and fungal infection adding to mortality and morbidity. COVID-19 disease associated candidiasis and aspergillosis have been reported as super infections but with the steroid and supplemental oxygen as mainstay treatment modality mucormycosis is now complicating the course of disease and presently posing challenge in India with already overburdened health care service. Mucorales is a saphrophytic fungi causes rhinocerebral infection involving nasal passages, sinuses, oral cavity and brain. It is usually seen in immunocompromised host and in diabetics with poorly controlled blood sugar level. High degree of clinical suspicion is needed to suspect and diagnose mucormycosis. It is a fatal disease because of its angioinvasive pathogenesis and treatment is promptly initiated to salvage mortality and morbidity. Authors report a case of rhino-oculo-cerebral mucormycosis in a middle-aged diabetic patient with severe COVID-19 disease

Scrub typhus in North India: clinical spectrum, laboratory parameters and treatment outcome in tertiary care teaching hospital

Background: Scrub typhus is an acute febrile illness causing serious complications leading to significant mortality especially if there is delay in diagnosis and treatment. It is caused by Orentia tsutsugamushi a gram negative bacterium and transmitted by the bite of the trombiculid mite (chigger). This study was undertaken to document the clinical manifestations, laboratory parameters and treatment outcomes of scrub typhus cases.Methods: This retrospective study was done in a tertiary care teaching hospital which included 40 confirmed cases of scrub typhus. The diagnosis was confirmed by positive IgM ELISA. Clinical spectrum and manifestations, laboratory parameters and course in hospital with outcomes were evaluated. Factors associated with complications and mortality were analyzed.Results: The mean age of the patients was 40 ±15 yrs with almost equal proportion of males and females (47.5 vs 52.5%). The most common presenting symptoms were Fever (100%), shortness of breath (40%), altered sensorium (22.5%), nausea/vomiting (10%), and diarrhea (7.5%). Mean duration of fever before presentation to hospital was 11.1±4.9 days. Eschar was seen in 15% of patients. Common laboratory abnormalities documented was thrombocytopenia (85%), elevated transaminases (57%) leukocytosis (45%), and leucopenia (15%). About 37.5% of patients developed multiple organ dysfunction syndrome (MODS) with case fatality rate was 10%. Acute renal failure, acute hepatitis, need of ventilator support and CNS dysfunction was higher among patient with MODS.Conclusions: Scrub typhus patients can have a wide range of manifestation ranging from mild illness to serious and life threatening complications like acute respiratory distress syndrome, acute renal failure, and acute hepatitis and CNS dysfunction. High index of suspicion with early recognition and treatment is key for good outcome. Use of empirical doxycycline may be lifesaving