Disseminated strongyloidiasis in patients on immuno-suppressive therapy

Strongyloidiasis is a disease that causes significant morbidity and rarely mortality in immunocompromised patients. We report two cases of disseminated strongyloidiasis infection while on steroids. The first patient was a known diabetic, hypertensive, and coronary artery disease who began on steroids with hemodialysis for biopsy-proven rapidly progressive glomerulo nephritis (RPGN). He presented to the emergency department (ED) with fever, loose stools, worsening dyspnea on exertion, cough, conjunctival congestion, and bilateral lower limb pain of 1-week duration while on hemodialysis (HD). He was started on intravenous (IV) antibiotics, suspecting a catheter-related septicemia. Stool and sputum examination revealed strongyloid infection. The patient was treated with Albendazole, Ivermectin, empirical antibiotics, and tapering and stopping of steroids. Symptoms improved and the patient was discharged in stable condition. The second case is a known case of systemic hypertension and biopsy-proven IgAN on maintenance steroids, with recently detected diabetes mellitus. He presented to the ED with tiredness, fever, cough, dyspnea, and occasional hemoptysis of 1-week duration. On evaluation, he had maculopapular rash over the chest and abdomen, along with hypoxia requiring oxygen support, thrombocytopenia, and worsening renal function. He was initially started on IV antibiotics, suspecting a lower respiratory tract infection with sepsis. Bronchoalveolar lavage (BAL) cytology yielded strogyloid larvae. The patient received ivermectin along with empirical IV antibiotics and supportive treatment but succumbed to the infection. These case reports signify the need for an active search for opportunistic infections in patients who are on continuous immunosuppressive therapy

Clinical profile of post flood fever in a tertiary care hospital in Kerala

Background: Floods are an important source of infection epidemic worldwide. Analysis of different infections presenting during floods can lead us to have a unified approach during such periods.Methods: This study describes the clinical features of fever patients presented to a tertiary care hospital in Kerala after the 2018 flood. Clinical findings of the confirmed leptospirosis cases were also compared with non-leptospirosis cases.Results: A total of 48 patients with fever and myalgia were studied and majority of them were males (77%). 40 patients had contact with contaminated water. But only 10 of them had taken prophylactic doxycycline. Complications were seen less among those who took prophylactic doxycycline. The mean time from the first symptom to first medical care was 4.4 days. Leptospirosis was seen among 15 patients and 2 patients had dengue fever. Hepatic involvement and renal involvement were seen significantly higher among leptospirosis patients.Conclusions: This study emphasized the importance of prophylactic doxycycline and early initiation of antibiotics during flood outbreaks. Awareness among treating doctors and patients is required for the control of outbreaks and prevention of mortality during floods.

Effect of casirivimab-imdevimab on mild COVID-19 patients with diabetes in reducing oxygen supplementation at 28 days: an observational study

Background: Monoclonal antibody therapy is one of the most promising treatments for COVID-19 infection. Casirivimab-imdevimab is a monoclonal antibody cocktail which is approved for high-risk patients with mild to moderate COVID-19 infection. The aim of the study was to determine the safety and efficacy of casirivimab-imdevimab on diabetic patients with COVID-19.Methods: This was an observational study conducted on diabetic patients admitted with mild to moderate COVID-19 infection. The patients were divided into 2 groups. While 101 patients were administered with casirivimab-imdevimab (test group), 100 of them were provided with standard treatment (control group). Regular follow-ups ensued for 10 days during the period of their hospitalization and finally on the 28th day through a telephonic enquiry. Apart from this, safety of administering the drug was assessed in all patients who belonged to the test group.Results: One of the patients who were administered casirivimab-imdevimab developed anaphylactic reaction. Three fourth of the patients who participated in the study were vaccinated and the oxygen requirement up to 10 days of admission was significantly lower in the vaccinated group (p=0.018). Oxygen requirement, mechanical ventilation and death up to 10 days of admission were less for patients who were administered monoclonal antibody, but it was not statistically significant. Oxygen requirement, and death after 10 days up to 28 days were also less for patients who were administered monoclonal antibody, even though not statistically significant.Conclusions: Casirivimab-imdevimab was not found to be beneficial in diabetic patients with mild COVID-19. More studies with higher sample size are required to prove the clinical benefit of casirivimab-imdevimab beyond doubt