Rhino-orbital COVID-19 associated mucormycosis- A case report

COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increased mortality & morbidity in India during this second wave of the pandemic. The country has reported more than 30,000 cases and over 2,000 deaths by Mucormycosis so far, according to sources from Union Health Ministry. CAM is now a notifiable disease. At our Tertiary care teaching hospital, which caters for COVID 19 management, we are reporting the first case of Rhino orbital CAM, which was caused by Rhizopus spp. Our patient had a history of contact with a suspected COVID 19 patient and was recently diagnosed with uncontrolled diabetes mellitus. A direct KOH microscopic examination of purulent material aspirated from the sinonasal polyp of the patient revealed fungal elements, and Rhizopus spp was isolated. Due to a shortage of Amphotericin B, the patient was referred to a government higher speciality centre for further management. The patient was followed up & was noted that he was treated with antifungal and discharged following recovery.

To determine the resistance pattern of Staphylococcus aureus in pus samples

Staphylococcus aureus is a common health problem occuring as an important nosocomial pathogen, causing urinary tract infection, surgical site, blood stream and soft tissue infection. The aim of this research was conducted to determine MRSA and VRSA from the pus samples of admitted patients.The aim and objective of study was to isolate the resistance pattern of Staphylococcus aureus in pus samples and their AST. A total of 158 positive culture Staph aureus were taken from pus samples for the study during December 2019 - October 2020. Samples were cultured on Blood and MacConkey agar then incubated at 37C for 24 hours. The modified Kirby Bauer's disc diffusion method was used to test antibiotic sensitivity of staphylococcus isolates. In total of 158 positive culture of Staphylococcus aureus, 66 (41.7%) were found to be MRSA and 4 (2.5%) were found to be VRSA. Out of 158 Staph aureus, 146 (92.4%) were resistant to Penicillin, followed by Amoxycillin 140 (88.6%), Ampicillin 139 (87.9%), Erythromycin 91 (57.5%), Cefoxitin 66 (41.7%), Gentamycin 56 (35.4%), Amikacin 52 (32.9%) and Teicoplanin 37 (23.4%).: An antibiotic policy and screening of susceptibility patterns of MRSA may help in reducing the prevalence rate of MRSA and antibiotic resistance. To stop its spread to the population, it is very important to eliminate MRSA colonization in patients and health care workers. Accurate treatment helps to reduce the rate of morbidity and improvement of patient’s outcome.

Spectrum of all microorganism isolated from surgical site infection and their antimicrobial susceptibility profile

Surgical site infection are the most common nosocomial infection accounting for 14% healthcare associated infection and are estimated to double the post-operative stay and significantly increase the cost of care. Surgical site infection has been considered as the third regularly occurring infection according to national nosocomial infection surveillance system.To determine the bacterial agents causing surgical site infection and antimicrobial susceptibility pattern of isolated microorganisms.: Isolate and identify pathogens of surgical site infection. To determine antimicrobial resistance and sensitivity pattern of isolated wound microbes. To determine the frequency of pathogens of surgical site infection.: Samples were cultured on Blood agar and MacConkey agar then incubated at 37 C for 24 hours. Any growth for further confirmed by Gram stain and appropriate biochemical tests, and then Antibiotic sensitivity test was done.: In this study 106 (61.7) were of male and 66 (38.3) were of female total 172 were examined. In our study total 172 patients included in which 142 pathogenic organism were isolated. The most common pathogenic organism found to be 44 isolates (30.99%) followed by 41 isolates (28.87%) 23 isolates (16.20%), 18 isolates (12.68%), 9 isolates (6.34%), 5 isolates (3.52%), 1 isolate (0.70%) and 1 isolate (0.70%). Antimicrobial resistance always pose challenges for clinician for treating wound infection the present study guide clinician about common pathogens and countered in pus sample furthermore it help the clinician to select and treat patients with proper antibiotics and decreased mortality and morbidity.

Neonatal septicemia and current scenario of antibiotic sensitivity pattern – A study of blood culture isolates in a tertiary care hospital, Rajkot

Neonatal sepsis is one of the leading causes of neonatal mortality in developing countries. Neonatal sepsis can be classified into two subtypes depending upon onset of symptoms- before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). Bacteriological profile and antibiotic susceptibility pattern in neonatal septicemia are changing time-to-time and place-to-place. This study is aimed to know the current scenario of neonatal septicemia and antibiotic susceptibility pattern for determining effective treatment, hence reducing burden of antibiotic resistance.This is a Retrospective study. Data was collected from Bacteriology lab, PDUMC Rajkot (May 2020 – May 2021). Blood cultures were performed on suspected neonates. Both BACTEC and conventional methods were used. Organisms were isolated by standard microbiological protocols and antibiotic sensitivity was performed by Kirby-Bauer disc diffusion method as per CLSI- 2020/2021 guidelines. Total 1402 samples were screened. 326 were positive (23.25%). 214(65.64%) were male and 112(34.36%) were female. CONS (32.21%) was found to be the predominant pathogen followed by Klebsiella (19.63%), Staphylococcus aureus (18.10%), E. coli (15.95%), Acinetobacter (12.27%) and Enterococcus spp. (1.84%). EONS was seen in 195(59.82%) cases and LONS was seen in 131(40.18%) cases. Gram-negative bacteria are predominant in EONS (76.28%) and gram-positive bacteria is predominant in LONS (64.12%). Gram negative isolates are mostly susceptible to Meropenem, Piperacillin-tazobactam, Cefepime, Ceftazidime. Gram positive isolates mostly showed sensitivity to Vancomycin, Linezolid.Multi-drug resistant organism are emerging in neonatal septicemia. Strict antibiotic stewardship should be practiced to avoid the upcoming treatment difficulties.

Co-infection of mucormycosis and aspergillosis in post COVID-19 patient: A concerning rare case report during second wave of COVID-19 pandemic

COVID-19 manifestations have been evolving and affect different parts of the body every time a new wave comes. Association of mucormycosis in COVID-19, Covid Associated Mucormycosis (CAM) affected patients especially affecting paranasal sinuses must be given serious and timely consideration. Prolonged history of uncontrolled diabetes and over the counter use of steroids and abrupt stoppage of steroids are two main factors aggravating the illness, and both these factors must be critically checked. Clinical condition like Mucormycosis are caused by pathogenic moulds of family Mucorales and Aspergillosis is caused by Aspergillus species and both can cause an invasive disease with high case fatality rate, especially in immunosuppressed patients. In the present study we are discussing a case of co-infection in Post COVID-19 patient affected with mucormycosis and aspergillosis. A 55-year-old male patient with Type 2 diabetes mellitus presented post covid with ptosis and diplopia. Mixed infections of Rhizopus arrhizus and Aspergillus flavus were diagnosed by means of fungal microscopy and culture from biopsy sample. Treatment with Amphotericin B was started, the patient responded clinically within 15 days.

Invasive fungal rhinosinusitis associated with COVID-19: An observational study

Respiratory Viral infections predispose patients to various coinfections and this may lead to enhanced disease severity and mortality. Despite the proven importance of co-infections, these are understudied during the large outbreaks of respiratory infections. Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention recently. This study aims to assess Clinical & Microbiological profile of patients with invasive sinusitis in setting of COVID-19 disease at our institute Study Design: A retrospective observational study. Study included patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) suffering from or having a history of coronavirus disease infection over the period of three months.(April 21 – June 21). The patients’ presentation details, imaging findings, co-morbidities, management details, and follow-up information were obtained, recorded and analysed. A total of 32 patients with AIFR with a mean age of 54.46±13.13 years old were included. Most common associated disease was diabetes mellitus (62.5%). Mycological analysis revealed most common fungi isolated from these patients were Mucor species.(56.25%) followed by Aspergillus species(15.62%) while coinfection with both of these species was seen in 5 patients.(15.62%) Candida species was isolated from samples of 4 patients (12.5%). Radiological studies of nose and paranasal sinuses showed that ethmoid (62.5%) and maxillary (46.87%) sinuses being the most commonly affected sinuses followed by Frontal (31.25%) and sphenoid (21.87%) sinuses. Peri-orbital invasion was seen in 5 (15.62%) cases whereas intracranial involvement was seen in 1 patient.(3.12%) In 8 (25%) patients only medical line of treatment was sufficient whereas 20 (62.5%) patients required surgical debridement during the treatment. 4 patients were lost to follow up. Overall survival was 90.62% (29/32) at the conclusion of the study. We are still learning the new and long-term complications of COVID- 19.The puzzle still remains unsolved about the cause and increased prevalence of invasive fungal infections in post-covid-19 population. High clinical suspicion and early and accurate diagnosis of AIFR in COVID-19 patients are essential for better prognosis.

The study of prevalence of needle stick and sharp injuries among healthcare workes in tertiary care hospital, Navi Mumbai

Needlestick injuries (NSIs) as defined by accidentally puncture the skin by needles. The occupational exposures to NSIs are considered to be much higher in the developing world and multiple risk factors eg. improper use of protective equipment (like failure to use suitable-sized gloves), working in surgical or intensive care units, insufficient work experience, young age, needle recapping, unsuitable needle disposal, intravenous cannulation may contribute to NSIs. To determine the occurrence/ prevalence of needle stick and sharp injuries (NSIs) among healthcare workers working in a tertiary care hospital and the factors responsible for NSIs. A cross-sectional study was conducted in a tertiary care hospital among HCws in the hospital over a period of one year Jan 2020-December 2020. Nursing staffs are most frequently reported NSI. Among the groups, most common cause of NSIs was found to be recapping of needle followed by cleaning, HGT and procedure. The most common cause of NSI among housekeeping staffs found to be needle lying on the floor and accidental mixing of sharp biomedical waste with other waste. The HCWs from critical care unit eg. ICUs are the most commonly reported NSIs HCWs are always at high risk of attaining NSIs. The nursing staffs followed are the most vulnerable group who gets the sharp/NSI and require extra attention. As a preventive measures regular training and education of nursing staffs and all other categories of health care workers to be ensured in healthcare settings.

Bacteriological profile and their antibiogram from Endotracheal aspirate and Bronchoalveolar lavage fluid samples from intensive care unit patients

Bacterial respiratory infections are most commonly causes of illness for all age group patients in ICU. Most of the patients suffer from urosepsis, postoperative disease and lower respiratory infection when admitted in ICU’s. The main purpose of this study is control in ICU’s infection & determine their antibiotic sensitivity pattern for better treatment of patients. Bacteriological profile and their antibiogram from endotracheal aspirate and bronchoalveolar lavage fluid samples from intensive care unit patients.We performed manual culture of Endotracheal aspirate & BAL fluid specimens collected from ICU’s patients. Samples were cultured on Blood agar and Mac-Conkey agar then incubated at 37C for 24 hours. Any growth were further confirmed by Gram stain and appropriate biochemical tests, and then Antibiotic sensitivity test was done. Among the 123 mechanically ventilated patients and 68 of them developed positive samples. In this study 55.3% (68) pathogenic isolates, 4.1% (5) were non pathogenic isolates and 40.6 (50) were no growth isolates in BAL and endotracheal aspirate samples. In which 67.6% (46) male and 32.4% (22) female patients. Older population falling in the 40-50 years of age group contributes the majority (27.64%) of the infection undergoing treatment for LRT infection in ICU’s patients in TMMC & RC, Moradabad, and in 70-80 years of age group (4.06%) was less contributes of this infection. Among the causative agents, were most common among gram negatives and was common among the gram positive isolates. In our study more resistance gram positive antibiotics were CIP, E, LE, and most sensitive antibiotics were VA, LZ, GEN and TEI. And gram negative bacteria most resistant antibiotics were OF, CPM, CAZ, CIP, CTR, MRP, LE, IPM, PIT and most sensitive antibiotics were AK, GEN, CL, TGC. In this study we conclude that Gram-negative bacilli were predominant in BAL fluid and endotracheal aspirates of ICU patients. Out of 68 multidrug resistance isolates, 1.47% were MRSA, 41.17% were ESBL and 57.36% were MBL isolates higher rate of ESBL production seen in spp., and higher rate of MBL production in spp.High incidence of VAP and the potential MDR pathogens are a real threat in our ICU’s. Combined approach of judicious antibiotic usage and training programs to health care personnel might be of help in combatting high incidence of antibiotic resistance in our institute.

A study of Acute Encephalitis Syndrome – Clinical profile, aetiology, and outcome

We aimed to study the clinical profile and etiology of Acute Encephalitis Syndrome (AES) in a tertiary care centre of western India.All patients evaluated by the neurology department, who fulfilled the standardised case definition for encephalitis (given by International Encephalitis Consortium) over 2 year period were screened. Routine laboratory investigations, CSF, Neuroimaging and EEG were done in all patients. Short term follow-up of one month was done to see the outcome.: Out of total 85 patients of AES seen over two years; viral etiology was identified in 26 (30.5%) patients; 8 (9.4%) patients had autoimmune cause and in 53 (62.4%) patients, no specific ethology could be found. Long duration of symptom onset to hospitalisation, seizures, abnormal behaviour, involuntary movements (automatism, dyskinesia, or dystonia), and autonomic dysfunction favours a diagnosis of autoimmune encephalitis. At one month, good outcome (mRS <2) was seen in 51(60%) patients and 34 (40%) patients had a poor outcome (mRS > 2), out of which 29(34.1%) patients expired. Viral encephalitis was the commonest cause of AES; followed by autoimmune encephalitis. Specific cause could not be ascertained in large number of patients, even after extensive evaluation. AES patients had prolonged hospital stay and significant morbidity and mortality.