A case report of secondary cutaneous cryptococcosis in a retrovirus positive patient

Cryptococcosis is a systemic mycosis caused by the capsulated yeast Cryptococcus neoformans. Cryptococcus remains an important opportunistic pathogen in HIV positive patients. It is usually acquired through inhalation of spores and by invasion of the respiratory system, and then, the organisms may spread hematogenously to other viscera mainly central nervous system. Although there are some reports of primary cutaneous cryptococcosis, cryptococcal skin disease is a rare feature of disseminated cryptococcosis and has poor outcome if undiagnosed and untreated. We present a case of secondary cutaneous cryptococcosis in a 50-year-old male, who was diagnosed as a case of retroviral disease 3 years back but not on anti-retroviral therapy

Role of GeneXpert in Rapid Molecular Detection of Extrapulmonary Tuberculosis in Tertiary Care Hospital

Introduction: Tuberculosis, the most common infectious disease with prevalence of 9.6 million globally. Most prevalent (23%) in India. Extrapulmonary tuberculosis (EPTB) accounts for 20% of total burden of tuberculosis. Rapid detection of Mycobacterium Tuberculosis (MTB) is essential for effective disease management. CBNAAT (Cartridge Based NucleicAcid Amplification Test) or GeneXpert MTB/RIF assay - novel diagnostic tool to detect MTB and RIF resistance simultaneously. WHO recommends its utility for non-respiratory samples also. Burden of EPTB and drug resistance vary from place to place. Objective: Study was conducted to gather information about burden of disease in our locality and to assesutility of CBNAAT in detecting MTB and rifampicin resistance in suspected EPTB cases. Methods: Retrospective analysis of 281 samples from suspected cases collected in falcon tubes and processed using CBNAAT. Result: Total of 281 extrapulmonary samples received, 67(23.8%) were positive and 214(76.1%) were negative for MTB. Of 67 positives, RIF resistance detected in 1(1.49%) case. Maximum number of MTB detected in the age group 21-30 years (n=23, 34.3%). Among 165 males and 116 females, MTB detected in 44(26.6%) and 23(19.8%) respectively. Out of 281 patients, 24(8.54%) were HIV positive. Of these 24, only 8(33.3%) found positive for MTB. Among 257 non-HIV patients, MTB detected in 59(22.9%). Among different samples received, maximum number were Pleural fluid n=115(40.9%) and Maximum MTB positives found in FNAC (of lymphnodes) samples [n=35(52.2%)]. : CBNAAT is a rapid test to detect MTB and rifampicin resistance simultaneously in EPTB and it reduced the treatment abuse in suspected cases

Asymptomatic bacteriuria and associated host factors in Diabetic patients with special reference to UTI Chromagar

Introduction: To study the prevalence of asymptomatic bacteriuria (ASB) in diabetics compared to non-diabetics and to determine the associated host factors responsible for ASB in diabetics. Materials and Methods: 250 diabetics and 100 controls were enrolled in the study and were screened for ASB using semi-quantitative culture methods and UTIchrom agar. The samples were screened for glucosuria, ketonuria and pyuria. Results: ASB was more common in diabetics compared to non-diabetics(12.8% v/s 6% ) and the increase was more in female diabetics when compared to female non-diabetics(16% v/s 6.15%) whereas male counterparts did not show much difference from the non-diabetics (6.09% v/s 5.71%). There was significant influence of age, duration of diabetes, glucosuria, ketonuria, proteinuria and pyuria on the incidence of ASB in diabetics thus proving them as possible risk factors for development of ASB. E.coli was the most common organism found in both diabetic as well as non diabetic cases of ASB (40.6% and 57.14% respectively). The next frequent organisms were Klebsiella and Staphylococcus. The sensitivity pattern was similar in both the population with ASB. Culture on UTI CHROMagar yielded quicker results when compared to standard culture methods. Conclusion: ASB is almost 3 times more common in female diabetics compared to female non-diabetics whereas there is not much difference among the male counterparts. The risk factors for ASB in diabetics included age, longer duration of diabetes, poor glycaemic control and renal dysfunction indicated by proteinuria. Culture on UTI CHROMagar is an easy and faster means of identification of organisms

Study of opportunistic intestinal parasitic infections in people living with HIVand their relationship with immune status

Introduction: Diarrhea is one of the most common complaintspeople living with HIV(PLHIV), occurring in almost 90% of them. Intestinal parasites are one of the main causes of diarrhea in developing countries. Objective: The present study was undertaken to detect enteric parasites in PLHIV with different levels of immune status (CD 4+ Counts). Materials and Methods: The study included a total of 209 HIV seropositive subjects. Stool samples from each subject was examined microscopically for the presence of ova and cysts using wet mount preparations and stained smears (modified ZN stain). Results: Enteric pathogens were detected in 57 (27.27%) of the 209 patients. The parasites identified were Cryptosporidium (25), Isospora belli (3), Strongoloides larvae (2), Ascaris ova (1).In our study it was observed that the prevalence of cryptosporidium in HIV sero-positive subjects was 49.01%, 33.33%, 17.6% in those having CD4 <200, 200-499, >500 cells/μl respectively. Conclusion: Intestinal opportunistic parasitic infections were detected in 27.27 % among HIV-seropositive patients. Cryptosporidiumis an important emerging pathogen in HIV-seropositive individuals with or without symptoms.Early detection of opportunistic intestinal parasitic infections using simple techniques like wet mount and modified ZN staining will help in the timely management and will improve the quality of life of HIV infected individuals

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality