Sneha S. Bowalekar

Abstract

Background: Pyrexia of unknown origin (PUO) was described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital. It may be caused by over numerous infectious, rheumatic/ inflammatory, malignant/neoplastic and miscellaneous disorders. Materials and Methods: Blood specimen of 55 pediatric patients with fever of more than two weeks duration were tested for Typhoid, Rickettsial and Brucella infection serologically. Blood cultures of these patients were tested simultaneously. Results: Positivity of Immunochromatographic testing for S. Typhi, Widal slide and tube agglutination test was 20%, 23.6% and 21.8% respectively. Titres of >=1:320 were observed in 4 (33.3%) of widal positive patients against H agglutinins. Positivity in Weil-Felix Tube Agglutination test was observed in 1(1.8%) patient against OX-K antigen, in 8 (14.5%) patients against OX-2 and in 6 (10.9%) against OX-19 antigen. Titre of 1:640 was observed in 1(1.82%) of patients against OX-2. One (1.8%) patient showed positive result in Brucella A/M Tube agglutination test. Conclusion: Although serological investigations provide early and presumptive diagnosis of diseases, clinical features and epidemiological factors play an important role for initiation of treatment where facilities for culture and molecular testing are lacking or the results of the same are negative.   Keywords: Widal, Typhoid, Rickettsia, Brucella, Pediatric

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Abstract

Background: Fungal infections are on rise globally owing to use of immunosuppressant drugs for various diseases, increased use of antimicrobials and in-situ devices, long duration of stay in hospitalized patients. There was sharp rise in mucormycosis infections in patients post COVID 19 illness which were previously limited to patients of end stage diabetic ketoacidosis. Materials and Methods: We studied the epidemiological, clinical, microbiological and radiological aspects for culture positive cases of fungal sinusitis from April 2021 to June 2021. Results: The mean age of our patients was 55.4 years (range 38 to 70 years). M:F ratio was 1.5:1. All fungal infections occurred in laboratory and/or radiologically diagnosed cases of COVID 1970% patients (n=7) had diabetes mellitus as co-morbidity. 60% of the cases (n=6) grew Rhizopus arrhizus, 30% grew Aspergillus species (n=3) and 10% grew Penicillium species (n=1). 90% of the cases (n=9) improved after treatment whereas 10% (n=1) succumbed to the illness. Conclusion: Along with rhino-orbito-cerebral mucormycosis infections, nasal aspergillosis was also noted as a prominent cause of fungal sinusitis in post COVID 19 illness. As the antifungal therapy for these two fungal infections differs significantly, caution must be adhered to while diagnosing and treating.   Keywords: Sinusitis, Mucormycosis, COVID 19, Aspergillosis.

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