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   Table of Contents - Current issue
January-March 2021
Volume 13 | Issue 1
Page Nos. 1-63

Online since Friday, February 26, 2021

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State of the globe: Addressing gender in adolescent tuberculosis p. 1
Sunil Kumar Raina
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Adolescent females are more susceptible than males for tuberculosis p. 3
Suman Thakur, Vivek Chauhan, Ravinder Kumar, Gopal Beri
Background and Objectives: Published literature is silent about the gender gap in tuberculosis (TB) among adolescent (10–19 years) population despite extensive information on increased susceptibility of the male gender after 20 years. We analyzed the data from 1113 adolescent microbiologically confirmed TB cases using cartridge-based nucleic acid amplification test (CBNAAT) in 2019 in the State of Himachal Pradesh (HP), India. Materials and Methods: The data generated by 39 CBNAAT sites in HP were analyzed with an objective to describe the gender gap in TB among adolescents. Results: Among 983 patients with pulmonary TB (PTB), the male: female ratio was 1:1.5 (P = 0.0001), whereas in 130 patients with extra PTB (EPTB), the male: female ratio was 1:1.8 (P = 0.0001). This male: female ratio was seen to reverse after 20 years for PTB, and but it persisted till 40 years for EPTB. Two main forms of TB that were significantly high in females during adolescence were PTB and lymph node TB (P = 0.0001). Interpretation and Conclusions: Significant gender difference with female susceptibility was seen for TB among adolescents, a fact that needs more research. Adolescent TB is a neglected area with little published data driven mainly by the fact that most countries report their TB population above and below 15 years, dividing the adolescent population into two halves. The world needs to acknowledge adolescents (10–19 years) as a separate important group for reporting TB statistics.
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Nocardiosis at an organ transplant center in Saudi Arabia: 15 years' experience p. 7
Ihab Weheba, Abeer Abdelsayed, Abdulrahman A Alrajhi, Sahar I Al-Thawadi, Abdullah Mobeireek
Background: No cardiosis is a rare infection that affects immunocompromised patients on immunosuppressive medications used for transplantation and cancer therapy. Such therapies are becoming more widely available in the Middle East region. Yet, reports on nocardiosis are scarce. Materials and Methods: This was a retrospective analysis of patients who were diagnosed with nocardiosis from 2004 to 2018 at a transplantation and cancer center. Nocardiosis were defined per the European Organization for Research and Treatment of Cancer criteria. Results: During the study period, 35 patients with nocardiosis (male: 68.5%) were identified. The most common underlying associated condition was transplantation 11 (31.4%), followed by malignancy 7 (20%), connective tissue disease and sarcoidosis 7 (20%), chronic lung disease 5 (14%), miscellaneous conditions 4 (11%), and one patient with human immunodeficiency virus. Nocardia was disseminated in 8 patients (22.9%) and isolated in 27 (77.1%); the latter included 13 patients (37.1%) with bronchial form, 11 (31.4%) with isolated visceral form, and 3 (8.6%) with cutaneous form. Pulmonary involvement occurred in 90% of the cases with cough, fever, and dyspnea being the most common symptoms. The main strain isolate was Nocardia asteroides, and the cure rate was 90%. Mortality related to nocardiosis occurred in 3 transplant patients (8.6%). Conclusion: Wider use of immunosuppressive therapy warrants vigilance to nocardiosis, which can present in a myriad of clinical forms. In our series, mortality was confined to the transplantation group, probably because of the relatively heavy immunosuppression. Nonetheless, prognosis is favorable if the infection is recognized and treated early.
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Clinical determinants of severe COVID-19 disease – A systematic review and meta-analysis p. 13
Ankit Kumar Sahu, Roshan Mathew, Praveen Aggarwal, Jamshed Nayer, Sanjeev Bhoi, Swayamjeet Satapathy, Meera Ekka
Background: A systematic review and meta-analysis of available studies was performed to investigate the clinical characteristics that can predict COVID-19 disease severity. Materials and Methods: Databases including PubMed, Embase, and Web of Science were searched from December 31, 2019, to May 24, 2020. Random-effects meta-analysis was used for summarizing the Pooled odds ratio (pOR) of individual clinical characteristics to describe their association with severe COVID-19 disease. Results: A total of 3895 articles were identified, and finally, 22 studies comprising 4380 patients were included. Severe disease was more common in males than females (pOR: 1.36, 95% confidence interval [CI]: 1.08–1.70). Clinical features that were associated with significantly higher odds of severe disease were abdominal pain (pOR: 6.58, 95% CI: 1.56–27.67), breathlessness (pOR: 3.94, 95% CI: 2.55–6.07), and hemoptysis (pOR: 3.35, 95% CI: 1.05–10.74). pOR was highest for chronic obstructive pulmonary disease (pOR: 2.92, 95% CI: 1.70–5.02), followed by obesity (pOR: 2.84, 95% CI: 1.19–6.77), malignancy (pOR: 2.38, 95% CI: 1.25–4.52), diabetes (pOR: 2.29, 95% CI: 1.56–3.39), hypertension (pOR: 1.72, 95% CI: 1.23–2.42), cardiovascular disease (pOR: 1.61, 95% CI: 1.31–1.98) and chronic kidney disease (pOR: 1.46, 95% CI: 1.06–2.02), for predicting severe COVID-19. Conclusion: Our analysis describes the association of specific symptoms and comorbidities with severe COVID-19 disease. Knowledge of these clinical determinants will assist the clinicians in the risk-stratification of these patients for better triage and clinical management.
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Maternal and perinatal outcomes of influenza in pregnancy after treatment with oseltamivir p. 20
Kavitha Abraham, Anuja Abraham, Annie Regi, Jessie Lionel, Elsy Thomas, Reeta Vijayaselvi, L Jeyaseelan, Asha Mary Abraham, Sridhar Santhanam, Kurian Anil Kuruvilla, Mark C Steinhoff
Context: Influenza infection in pregnancy causes 4%–8% case fatality and five times more perinatal mortality. Influenza is a major contributor to mortality in developing countries; however, the morbidity has largely been underestimated. Public health interventions for prevention are also lacking. Aims: This study aimed to determine the seasonality of influenza in pregnant Indian women and to estimate the maternal and perinatal morbidity after treatment with oseltamivir. Settings and Design: This was a prospective observational cohort study, conducted in a tertiary hospital. Subjects and Methods: Pregnant women with ILI (influenza-like illness) were recruited into Cohort 1 (polymerase chain reaction [PCR] positive) and Cohort 2 (PCR negative). Gestational age-matched asymptomatic controls formed Cohort 3. Women in Cohort 1 received oseltamivir for 5 days. The incidence of small-for-gestational age (SGA) and preterm birth were the primary outcomes. Maternal and neonatal morbidity formed the secondary outcomes. Statistical Analysis: Unmatched (Cohort 1 and 2) and matched analysis (Cohort 1 and 3) were done. Student's t-test and Chi-square test were used to compare between variables. Results: Year-round incidence of influenza was recorded. Severe illness was more in Cohort 1 compared to Cohort 2 (36.2% vs. 6.3%; P < 0.001). SGA was comparable in all the cohorts (13%). Preterm birth (7.8% vs. 3.3%; P < 0.08; relative risk-2.75) was considerably high in Cohort 1. Secondary maternal and neonatal outcomes were similar between the groups. Conclusion: Influenza in pregnancy showed year-round incidence and increased maternal and neonatal morbidity despite treatment with oseltamivir. We suggest the need for newer interventions to curtail the illness in pregnancy.
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Legal and environmental implications of COVID‑19 outbreak in India p. 27
Nancy Maurya, Devendra Dwarg
The present work is an attempt to look at the legal and environmental implications of coronavirus disease-2019 outbreak in India. It looks at both sides of this tragedy focusing specifically on the environmental and legal aspects in the Indian context. However, the article does not refrain from discussing examples of other countries or some global aspects if necessary.
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Nonsevere acute respiratory syndrome human coronaviruses in children hospitalized with acute lower respiratory infection p. 33
Rashmi Ranjan Das, Mohamed Fajrudheen, Monalisa Mohanty, Joseph John, Sutapa Rath, Amit Kumar Satapathy, Bhagirathi Dwibedi, Baijayantimala Mishra
Background: The nonzoonotic (nonsevere acute respiratory syndrome (SARS)/Middle East respiratory syndrome) human coronaviruses (HCoVs) are usually considered as the causative agent for acute respiratory infection. We studied the characteristics and outcome of children with non-SARS HCoV acute lower respiratory infection (ALRI). Methods: This was a cross-sectional study from a tertiary care teaching hospital in eastern India. Results: Of 137 samples tested positive for respiratory viruses, 13 were due to HCoV (7 boys, median age: 2 years). Cough was the most common symptom, followed by breathing difficulty and fever. An underlying comorbid condition present in 38.4%. Co-infection with other viruses was seen in 69% of cases. Chest radiograph was abnormal in 69.3% of children. Antibiotics were administered in 53.8%. The median length of hospitalization was 5 d, irrespective of underlying disease. There was no mortality. Conclusions: HCoV is an uncommon but increasingly recognized cause of ALRI in hospitalized children. No severe illness was found in children with underlying comorbidities. This study underscores the importance of HCoV in causation of childhood ALRI, necessitating a surveillance system in India.
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Spina ventosa: An often missed diagnosis p. 36
Ankur Agarwal, Sheetal Agarwal, Savitri Singh, Sumi Nandwani
Rare and varied presentations of tuberculosis make it difficult for treating clinicians to arrive at the diagnosis. An adolescent female presented to the orthopedic outpatient department with slowly increasing swelling over the dorsum of the hand near the base of the third digit for 5 months. With multiple consultations, she was being treated with antibiotics as a case of abscess. On examination, the swelling was soft bulging with whitish watery discharge. Plain radiography revealed periosteal elevation with bony destruction of the proximal phalanx. Magnetic resonance imaging revealed signal intensity changes with collection suggestive of infection. Blood investigations were within the normal limits, except slightly raised erythrocyte sedimentation rate. A differential diagnosis of chronic osteomyelitis was performed. Since the swelling was growing with the overlying skin likely to give way, it was treated with incision and drainage. Cytology with Gram's and auramine staining helped in confirming the diagnosis of spina ventosa. Biopsy is the gold standard for diagnosis, and antitubercular therapy forms the mainstay of treatment.
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Persistent hypercoagulable state in COVID-19: A case series of COVID-19 associated pulmonary embolism p. 38
Kok Hoe Chan, Su Lin Lim, Hamid Shaaban, Gunwant Guron, Jihad Slim
Coronavirus disease 2019 (COVID-19) has swept through the world with millions of cases and hundreds of thousands of deaths. COVID-19-associated coagulopathy has been recognized as the major cause of morbidity and mortality. To the best of our knowledge, a majority of the cases of coagulopathy have been reported in patients with moderate-to-severe COVID-19 and limited to observations during the recovery/postcytokine storm state. Herein, we report a case series of two patients with COVID-19 who developed pulmonary embolism in the late phase of the disease. This raised the hypothesis that the risk of hypercoagulability in patients with COVID-19 can persist until the recovery phase, which would warrant a follow-up with D-dimer and fibrinogen trending, as well as postdischarge thromboprophylaxis for at least 2 weeks during the recovery phase.
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Positive SARS-CoV-2 RNA with significant inflammatory state and thrombophilia after 12 weeks of initial diagnosis of COVID-19 infection p. 42
Manuel Francisco Betancourt, Kimberly Michelle Grant, James Scott Johnson, Dhanashree S Kelkar, Kamal Sharma
The ongoing COVID-19 pandemic has affected most countries in the world, with significant economic and public health implications. There is rising concern that patients who recover from COVID-19 may be at risk of reinfection. Another potential concern is the uncommon clinical scenario of a patient having persistent SARS-CoV-2 RNA test over 3 months after the initial COVID-19 infection, as the patient presented. Whether presenting as a long-term infection (12 weeks) or reinfection, patients with COVID-19 will continue to have a severe inflammatory and prothrombotic state that could carry potential life-threatening thrombosis.
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Intravenous immunoglobulin for overwhelming postsplenectomy infection p. 44
Kensuke Nakamura, Yuji Takahashi, Tomohiro Sonoo, Hideki Hashimoto
Overwhelming postsplenectomy infection (OPSI) is a life-threatening condition causing fulminant bacteremia in asplenic patients. Intravenous immunoglobulin (IVIG) therapy is theoretically effective for OPSI. Herein, we present a case of OPSI treated successfully with IVIG, along with results of a literature review. An asplenic 70-year-old male with acute ischemic stroke presented with rapid and fulminant septic shock from pneumococcus pneumonia and bacteremia. Resuscitation and antibiotics including IVIG therapy were instituted. The patient survived with favorable outcomes. We analyzed all case reports or case series of OPSI from 1971 through 2017. Cases with IVIG treatment showed a significantly higher survival rate than those without IVIG, even with multivariable regression analysis, suggesting IVIG as an independent predictive factor for survival. It suggests that IVIG is effective for OPSI and that it can be regarded as an adjunctive treatment option for OPSI.
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Unusual presentations of abdominal melioidosis p. 52
Vignesh Kumar Mohan, Komalavalli Rajesh, Sripriya Srinivas, R Ravi, Jimmy Prabhakaran, K Srinivasan, Subha Sundaramoorthy
Melioidosis is an endemic bacterial infection caused by soil saprophyte, Burkholderia pseudomallei. It infects adults with risk factors or immunosuppressed and exposed to moist soil. Its significance lies in its varied clinical presentation and high mortality (40%). We present two cases of abdominal melioidosis with unusual clinical presentations. The first case presented with intractable hiccups and had isolated splenic melioidosis with contained rupture. The second case presented with fever and acute abdominal pain found to have pancreatic melioidosis and splenic vein thrombosis. Both the patients were treated with IV antibiotics and subsequently discharged after improvement in symptoms. The imaging findings of isolated type of melioidosis can mimic various other infections and granulomatous disease. Hence high index of clinical suspicion for patients presenting from endemic areas will narrow down the differential diagnosis.
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Idiopathic CD4 lymphocytopenia presenting as cryptococcal meningitis p. 56
Preet Mukesh Shah, Ankita Prashant Hingolikar, Shruti Tandan, Vijay Waman Dhakre
A 54-year-old male presented to our center with a 3-month history of headache, giddiness, and blurring of vision. Cerebrospinal fluid examination revealed him to be having cryptococcal meningitis. He was worked up for probable causes of immunosuppression including HIV and other infections and had an autoimmune profile as well as a bone marrow examination, none of which revealed any abnormality. Lymphocyte flow cytometry revealed low counts of CD4 T lymphocytes, likely secondary to idiopathic CD4 lymphocytopenia. He was treated for cryptococcal meningitis. Due to marked immunosuppression, the disease progressed rapidly with deterioration in neurological and hemodynamic status, leading to his demise.
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The emergency challenges of coronavirus disease 2019 pandemic in Brazilian favelas: How to face it? p. 59
Samuel Cota Teixeira
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Knowledge, attitudes and practice survey among health-care workers in times of COVID-19 pandemic: Identifying gaps to strengthen infection control program for future outbreaks p. 60
Manju Bala, Vikramjeet Arora
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Impacts of lockdown interventions on the spread of COVID-19 in India p. 61
Nitin Bhardwaj, Harish Chandra
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Rigorizing COVID-19 blind-spotting for competent political leadership and public health cognizance p. 62
John C Johnson, Peter A Johnson
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008