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Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AAR, Kumar RV, Kumar S, Manusrut M, Kumar SCR, Rathod R, Babu DM, Gonuguntla HK, Yedlapati GK, Mallu GR, Reddy YS, Reddy VV, Alwala S, Bongu VK, Kamalesh A, Kumar RNK, Jaishetwar GS, Bagapally RS, Srinivas JS, Balasubramaniam A, Rajagopalan BK, Pullikanti B, Prakasham SP, Nimmala P, Nagaraju B, Sahoo PR. COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection 2022; 51:407-416. [PMID: 35922704 PMCID: PMC9362592 DOI: 10.1007/s15010-022-01891-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
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Affiliation(s)
- Monalisa Sahu
- Department of Infectious Diseases, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India.
| | - Milap Shah
- Department of Pathology, Yashoda Hospital, Hyderabad, India
| | | | - Venkat Raman Kola
- Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | - R Vijay Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Sairaj Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Manusrut Manusrut
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - S Ch Raghu Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Rajkumar Rathod
- Department of Laboratory and Transfusion Medicine, Yashoda Hospital, Hyderabad, 500003, India
| | - Dilip M Babu
- Department of Nephrology, Yashoda Hospital Somajiguda, Hyderabad, 500028, India
| | | | | | | | - Y Sai Reddy
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Vedire Vishnu Reddy
- Department of Anaesthesia, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Surendar Alwala
- Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | - A Kamalesh
- Department of Medicine, Yashoda Hospital, Hyderabad, India
| | - R N Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Ganesh S Jaishetwar
- Department of Hematology and BMT, Yashoda Hospital, Somajiguda, Hyderabad, 500082, India
| | - Ravi Shankar Bagapally
- Department of Gastroenterology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Jammula S Srinivas
- Department of Plastic and Cosmetic Surgery, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | | | | | - Pavani Nimmala
- Department of Microbiology, Yashoda Hospital, Hyderabad, India
| | - Barla Nagaraju
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Pradipt R Sahoo
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
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Anand M, Nimmala P. Seasonal incidence of respiratory viral infections in Telangana, India: utility of a multiplex PCR assay to bridge the knowledge gap. Trop Med Int Health 2020; 25:1503-1509. [PMID: 32996228 DOI: 10.1111/tmi.13501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The diagnosis of acute viral respiratory tract infections (RTI) is a challenge due to overlapping clinical presentations and lack of availability of robust diagnostic methods. This in turn leads to lack of data regarding incidence and seasonality of viral RTIs which could potentially help to implement efficient strategies of antimicrobial stewardship as well as vaccine administration. Here we utilise a commercial Multiplex PCR assay for the early diagnosis of acute respiratory tract infections and discuss their epidemiology. METHODS A prospective, observational study was conducted over a period of 3 years (2017-2019). Respiratory samples received from outpatients and inpatients with suspected acute RTIs from three multispeciality hospitals located in the twin cities of Hyderabad-Secunderabad were subjected to FilmArray Respiratory Panel (RP) (BioFire Diagnostics, Salt Lake City, Utah, USA). Results were tabulated and statistically analysed. RESULTS Of 513 samples, 261 (50.9%) were positive for one or more pathogens. The viruses detected included influenza A H1 2009 (26.0%), human rhinovirus/enterovirus (21.5%), influenza A H3N2 (17.0%), human metapneumovirus (9.4%), influenza B (6.6%), coronavirus (4.9%), parainfluenza virus (4.5%), respiratory syncytial virus (3.1%) and adenovirus (2.1%). The largest number of samples was positive during the monsoon season (43.8%). Influenza A H1 2009 peaked in the monsoon season with another, smaller peak in February. CONCLUSIONS There is a bimodal peak of respiratory infections relative to the seasons, and vaccine administration should take place in April-May before the advent of the monsoons in this part of the country. Multiplexed PCR may be used as first line for diagnosis of viral infections so that infection control measures can be prioritised and antibiotic administration can be avoided in those who do not require it.
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Affiliation(s)
- Mridu Anand
- Department of Clinical Microbiology, Yashoda Hospital, Secunderabad, Telangana, 500003, India
| | - Pavani Nimmala
- Department of Clinical Microbiology, Yashoda Hospital, Secunderabad, Telangana, 500003, India
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Ramesh V, Rao Polati V, Nimmala P, Anand M, Narreddy S, Saidulu G. An unusual cause for rib osteomyelitis in the tropics: Cryptococcal osteomyelitis. Trop Doct 2020; 50:361-365. [PMID: 32525454 DOI: 10.1177/0049475520929827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The more common manifestations of cryptococcal infections are restricted to the central nervous system and lungs. We report an unusual case of fungal osteomyelitis due to Cryptococcus. The patient was a young man who had been adequately treated for pulmonary tuberculosis three years prior. Three months before, he sustained a minor road-traffic accident with only minor abrasions. He presented with subacute chest pain of 15 days' duration and was found to have radiological evidence of a lytic lesion of the fifth rib. Given prior tuberculosis, he was thought to have a relapse of disease with tuberculous osteomyelitis. Surprisingly, a biopsy revealed evidence of fungal osteomyelitis with Cryptococcus. An evaluation for primary immunodeficiency revealed low CD4 cell counts with undetectable serum IgA and IgM levels. Genetic sequencing proved a genetic mutation consistent with primary T-cell immunodeficiency. The patient responded well to treatment and is asymptomatic on follow-up.
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Affiliation(s)
- Venkat Ramesh
- Registrar, Department of Infectious Diseases, 75429Apollo Hospitals, Hyderabad, Telangana, India
| | - Vishnu Rao Polati
- Consultant, Department of Infectious Diseases, 75429Apollo Hospitals, Hyderabad, Telangana, India
| | - Pavani Nimmala
- Consultant, Department of Microbiology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Mridu Anand
- Consultant, Department of Microbiology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Suneetha Narreddy
- Consultant, Department of Infectious Diseases, 75429Apollo Hospitals, Hyderabad, Telangana, India
| | - Ganta Saidulu
- Clinical Pharmacist, Department of Infectious Diseases, Yashoda Super Specialty Hospitals, Telangana, India
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Abstract
Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.
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Affiliation(s)
- Suhasini Tirumala
- Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | - Bijayini Behera
- Department of Microbiology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | - Srikanth Jawalkar
- Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | - Pradeep Kumar Mishra
- Department of General Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | | | - Sudha Ayyagari
- Department of Pathology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
| | - Pavani Nimmala
- Department of Microbiology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
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