Seroprevalence, clinical profile and knowledge, attitudes, and practices (KAPs) of brucellosis in North India in patients with pyrexia of unknown origin and chronic joint pain

Introduction: Brucellosis is a significant but lesser-known cause of pyrexia of unknown origin (PUO) in India. Studies documenting the prevalence of Brucellosis in different parts of India are sparse and few. Clinicians thus usually don’t consider it in their differential diagnosis. This study assesses its prevalence in two groups: febrile patients with unknown etiology and individuals presenting with arthritis and/or joint pains. Knowledge, Attitude, and Practices (KAP) among clinicians about the disease was evaluated.Materials and Methods: This is a prospective study conducted at a tertiary care center of North India catering to urban, semi-urban, and rural populace. Ninety-two patients with fever of unknown origin, arthralgia, or similar constitutional symptoms were recruited in this study. Detailed clinical history was elicited from all patients as per predesigned proforma and a rigorous physical examination was conducted. Following primary screening to rule out malaria, enteric fever, and leptospirosis, secondary screening for Brucellosis was done by Rapid Screen Test (PUO screen) and IgM and IgG ELISA. A predesigned survey was used for assessing KAP among clinicians about Brucellosis.Results: Brucella infection was diagnosed in 27 (29.3%) cases. The most common symptoms among the patients apart from fever were arthralgia (77.8%), fatigue (70.8%), pallor (66.1%), headache (59.2%), backache (53.8%) and cough (33.3%). PUO screen is a specific test for brucellosis but lacks sensitivity. It detects acute cases but misses chronic cases. IgM ELISA being more sensitive should be used for confirmation. Low ODs point to chronic brucellosis which was confirmed by IgG ELISA. Normal CRP levels in patients with PUO and chronic joint pains should point to brucellosis. KAP revealed that 25% to 50% of doctors considered Brucella in their differential diagnosis of acute and chronic fever respectively while 10% Orthopedics considered it in cases of arthralgia.Conclusion: Our results highlight the significance of Brucella as a cause of PUO and arthralgia. Brucellosis is an underrecognized but important cause of pyrexia of unknown origin and chronic joint pain. It should be actively suspected, diagnosed, and treated.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 80-88

682. Implantable Cardioverter-Defibrillator Lead Vegetation with Long-Standing Actinomyces neuii Bacteremia

Background Endocarditis caused by Actinomyces species is uncommon with only 30 cases reported in contemporary literature. Methods We present a novel case of cardiovascular implantable electronic device (CIED) endocarditis secondary to infection by Actinomyces neuii – a unique non-branching member of the species that grows in both anaerobic and aerobic media. Results Our patient, a 51-year-old female, with a history of implantable cardioverter-defibrillator (ICD) placement 17 years prior for heart failure, presented with six weeks of fevers and rigors. She was referred to the infectious disease clinic for evaluation of pyrexia of unknown origin. Her examination was unremarkable, and the ICD pocket was uninflamed. Her initial labs revealed mildly elevated inflammatory markers and renal insufficiency. Blood cultures were positive for slow-growing non-branching gram-positive rods in both aerobic and anaerobic media. These were identified as Actinomyces neuii by mass spectrometry. Review of outside records showed positive blood cultures with Actinomyces neuii at another facility two weeks prior to our evaluation which were not acted upon and thought to be bacterial contamination. The patient was further evaluated with a transesophageal echocardiogram that demonstrated a 3.3 x 2.2cm mobile vegetation attached to the ICD lead. She subsequently underwent removal of her Saint Jude cardiac resynchronization therapy defibrillator and leads using laser and snaring techniques, but the tail end of the ventricular lead fractured and could not be retrieved. The ICD pocket was also found to be infected. A planned 6-week course of IV ampicillin was interrupted by 2 weeks of ceftriaxone for treatment of an intercurrent lower respiratory tract infection. The patient regained her baseline health and was discharged 2 weeks after ICD removal with a LifeVest. She is to complete 12 months of oral amoxicillin therapy after completion of IV antibiotics in view of retained lead fragment, and long standing Actinomyces bacteremia - consistent with published management strategies. Figure 1. Transesophageal echocardiogram demonstrating size of vegetation. Figure 2. Three-dimensional view demonstrating vegetation on the ICD lead. Conclusion Here we describe the first known case of Actinomyces neuii CIED endocarditis with a large lead vegetation and long-standing bacteremia, presenting as pyrexia of unknown origin. Disclosures All Authors: No reported disclosures

Rare presentation of subcutaneous panniculitis-like T cell lymphoma in pediatric age group

Leukaemia and lymphoma are the commonly seen malignancies in children, subcutaneous panniculitis-like T-cell lymphoma (SPTL) is not only a rare cause of malignancy but also rare cause of panniculitis in children. We report an unusual presentation of this malignancy in the form of pyrexia of unknown origin (PUO), where rash was seen as very late symptom. Histopathology is seen as key in diagnosis of the disorder.

Granulomatous nephritis: A rare presentation of juvenile-onset sarcoidosis

ABSTRACT Sarcoidosis is rare in children. Incidence and prevalence of sarcoidosis in India are not known. Renal involvement in childhood sarcoidosis is further rare with no clear data about prevalence. Here we report a case of a 13-year-old girl who presented with sarcoidosis with multi-system involvement including renal sarcoidosis. She initially presented with pyrexia of unknown origin and cervical lymphadenopathy – evaluation of which led to diagnosis of sarcoidosis. Later, after development of pulmonary involvement, she was treated with oral prednisolone and azathioprine. She again defaulted on medicines and later presented with renal failure and was diagnosed with a renal sarcoidosis. She was treated with oral prednisolone and mycophenolate mofetil with which she gradually improved with normal renal functions.