Objectives:The Mycobacterium abscessus complex is a rapidly growing nontuberculous mycobacterium that causes chronic lung, skin, and soft-tissue infections. Disease management is challenging because of prolonged antibiotic therapy and resistance, making knowledge of local strain diversity and resistance patterns essential. However, the molecular epidemiology of M. abscessus in India remains largely unreported. Methods:Whole-genome sequencing and multilocus sequence typing (MLST) were performed on 50 clinical isolates collected from patients across 10 Indian states (2019-2024). Genomic DNA was extracted, and sequencing was performed using the Illumina platform. MLST was conducted according to the PubMLST scheme based on seven housekeeping genes. Results:Analysis of the 50 isolates from 10 states across India showed a predominance of M. abscessus subsp. abscessus (76%), with extrapulmonary infections, particularly skin and soft-tissue infections. No isolates of subsp. bolletii were detected. MLST revealed genetic heterogeneity. M. abscessus subsp. abscessus isolates were distributed across 8 known and 18 novel sequence types (STs), with ST-5 being the most common, while M. abscessus subsp. massiliense isolates were predominantly assigned to ST-46, ST-33, and ST-37, along with two novel STs. Overall, 40% of the isolates represented novel STs. Conclusion:This study revealed extensive genomic diversity, with 40% of the isolates representing novel STs. The predominance of subsp. abscessus and the high frequency of extrapulmonary infections highlight region-specific trends and underscore the need for strengthened genomic surveillance.

Objectives: Blood stream infections (BSIs) are potentially fatal healthcare associated infections (HAIs). The COVID pandemic had a huge impact on hospital processes and health care outcomes. We studied the impact of COVID pandemic on the prevalence of ICU acquired BSIs in our established Indian HAI surveillance network. Material and methods: This study included adult patients from ICUs in AIIMS HAI network that conducted BSI surveillance in COVID and non-COVID ICUs during and before the pandemic periods. Of the 40 hospitals in the network, ICUs from 16 hospitals conducted HAI surveillance in COVID ICUs and were included for the purposes of this study. Hospitals identified BSI and reported clinical and microbiological data to the network as per established and previously published protocols. Results: A total of 1,863 events of BSI were identified during pre-pandemic and 2,571 events during pandemic period. During the pandemic, 557 (21.6%) were reported from COVID ICUs. The BSI rate during the pandemic was 8.9/1,000 patient days, and during pre-pandemic 5.4/1,000 patient days (P < 0.01). The central line associated BSI (CLABSI) rates increased from 9.2/1,000 central line days during the pre-pandemic period to 11.3/1,000 central line days during pandemic. Conclusion: An increase in BSIs during the COVID pandemic was observed, which may be attributed to increased susceptibility of the patients or suboptimal infection control practices in COVID ICUs.

Diagnosing paediatric tuberculosis (TB) remains challenging. Currently available diagnostic tests have limited accuracy, and most sampling methods are invasive. In 2021, the World Health Organisation (WHO) endorsed the use of molecular WHO-recommended rapid diagnostic tests (mWRDs) with stool as an initial diagnostic tool for paediatric TB. In this study, we evaluated the diagnostic test accuracy (DTA) of stool samples processed with the Stool Processing Kit (SPK), one of three centrifugation-free methods available at the time. We conducted a multi-centre prospective diagnostic validation study in South Africa, Tanzania, Malawi, Mozambique, and India. Children (< 15 years) under investigation for TB provided at least two (induced) sputum samples at enrolment, one stool sample, and one nasopharyngeal aspirate (NPA) if aged < 5 years and a chest x-ray. TB testing included Xpert® MTB/RIF Ultra (Ultra) and culture. Diagnostic classification followed NIH consensus statements. Stool samples were processed using the SPK and tested with Ultra. We calculated DTA in the overall cohort and predefined subgroups of interest. Out of 5313 children screened, 975 were enrolled, and data from 817 children recruited between January 2019 and June 2021 were analysed. The overall microbiological confirmation rate was 203/817 (24.9

PURPOSE:The new drugs bedaquiline, delamanid, and pretomanid have been approved for treating drug-resistant tuberculosis. The World Health Organization currently recommends the BPaL(M) regimen, which lasts 6-9 months, for managing drug-resistant tuberculosis. This study aimed to perform phenotypic drug susceptibility testing and identify mutations linked to bedaquiline resistance through whole genome sequencing. METHODS:We conducted a prospective cohort study involving 297 drug-resistant Mycobacterium tuberculosis isolates from patients visiting the respiratory medicine outpatient department at Christian Medical College, Vellore, and district TB centers across six districts in Tamil Nadu over the course of five years (2019-2023). These isolates underwent phenotypic drug susceptibility testing for bedaquiline using the BACTEC™ MGIT™ 960 system, following WHO guidelines. WGS was performed on a subset of 150 isolates using the Illumina platform, followed by mutation analysis using BLASTIN. RESULTS:The study found a 7% prevalence of bedaquiline resistance. A total of 39 variants were identified across four candidate genes associated with BDQ resistance: Rv0678, mmpL5 (Rv0676c), pepQ, and Rv1979c. No variants were observed in the Rv0677c, Rv1304, or atpE genes in any of the tested isolates. All isolates (100%) had at least one variant in the Rv0676c gene. CONCLUSION:This study identified the most common genetic variants linked to BDQ resistance from a tertiary care center in India. Larger studies across the country are necessary to explore the phenotypic and genotypic resistance profiles of BDQ and other drugs used in all-oral shorter regimens being introduced in India for the treatment of multidrug-resistant TB.

We evaluated low-dose infliximab (5 mg/kg) as adjunctive therapy in 20 patients with severe central nervous system tuberculosis. At 3 months, 60% achieved disability-free survival (modified Rankin Scale ≤ 2), and 75% showed clinically meaningful improvement. Our outcomes matched reports of high-dose infliximab. Randomized trials to optimize dosing are needed.

BACKGROUND:Nontuberculous mycobacteria (NTM) are ubiquitous organisms with varied clinical syndromes. We conducted this study to identify the clinical spectrum, microbiological diagnosis, outcomes, and predictors of outcome in patients with NTM bloodstream infections (NTM BSIs). METHODS:This is a retrospective study of patients diagnosed with NTM BSI from January 2005 to December 2024. Poor outcomes were defined as patients who either expired or were lost to follow-up after being discharged against medical advice, subsequent to a poor prognosis. RESULTS:A total of 40 patients with NTM BSI were included. The median age was 43 years with male predominance (n = 25, 62.5%). Associated risk factors included human immunodeficiency virus (HIV) infection (n = 18, 45%) with a median CD4 count of 18 cells/mm3, diabetes mellitus (n = 7, 31.8%), and immunosuppressive medication use (n = 6, 27.3%). The spectrum of infections among HIV-negative patients (n = 22) were disseminated infection (n = 6), coronary stent infection (n = 5), infective endocarditis (n = 4), catheter-related BSI (n = 4), pacemaker lead infection (n = 1), aortic stent infection (n = 1), thecoperitoneal shunt infection (n = 1), and infected bedsore (n = 1). All HIV-positive patients presented with disseminated NTM infection. Poor outcome for NTM BSI was seen in 64.9% of patients. Among the rapid growers, Mycobacterium abscessus complex had the worst prognosis with a poor outcome in 71.4% of patients. CONCLUSION:The spectrum of diseases associated with NTM BSI was either disseminated disease in an immunosuppressed host or infection secondary to nosocomial contamination of a catheter, implant, or stent. NTM BSI is associated with poor prognosis. This underscores the need for early diagnosis, appropriate antibiotic therapy, and adequate source control to improve clinical outcomes.

Background & objectives The global target set by the United Nations (UN) high-level meeting on Tuberculosis (TB) for coverage of rapid molecular tests is 100 per cent by 2027. Rapid, affordable molecular tests for early detection of TB are the need of the hour. This study aimed to evaluate the diagnostic accuracy of an open real-time PCR (RT-PCR) assay, Quantiplus®, with reference to Mycobacteria Growth Indicator Tube (MGIT) liquid culture. Methods We conducted a prospective multi-centric diagnostic accuracy study of Quantiplus® assay (version 2.0) at three sites in India for the detection of pulmonary TB in sputum with culture as the reference standard, compared with Xpert® MTB/RIF. A total of 657 adults (>18 yr) with presumptive TB were enrolled consecutively. The Quantiplus® assay uses an extraction-free, quick-lysis protocol and three gene targets for RT-PCR. Results Of the 644 samples analysed, 37 per cent were culture-positive and 32 per cent were smear-positive. The sensitivity and specificity of Quantiplus® assay with reference to MGIT culture were 86 per cent [95% confidence interval (CI): 81-90] and 96 per cent (95% CI: 94-98), respectively, at Ct ≤ 38. The positive and negative predictive values (PPV/NPV) were 93 per cent (95% CI: 89-96%) and 92 per cent (95% CI: 89-94%), respectively. Among the 73 smear-negative culture-positive specimens, the sensitivity and specificity were 61.6 per cent (95% CI: 50-73) and 97 per cent (95% CI: 92-98.6), respectively. The performance of Quantiplus® assay(v2.0) was comparable to Xpert MTB/RIF® (κ=0.83, SE=0.02) at Ct ≤38. Interpretation & conclusions The flexibility of the open RT-PCR assay to be used in any RT-PCR machine makes it a very low-cost (<2 US$) alternative to the expensive cartridge-based tests. This is the first report of validation of an open system RT-PCR assay for the detection of pulmonary TB.

This retrospective, single-center study analyzed the clinical profile and outcomes of dematiaceous fungal infections in kidney transplant recipients over a 12-year period (2010-2022). Out of 1,041 transplant recipients, 69 developed major fungal infections, with dematiaceous fungi accounting for 8.6% of cases (n=6). These infections affected predominantly middle-aged adults (mean age 47 ± 13.1 years), with a slight male predominance. Most patients received kidneys from live-related donors and were maintained on standard immunosuppressive regimens. Dematiaceous fungal infections manifested on average 3.43 ± 1.8 years post-transplant, presenting as skin lesions, arthritis, or sinusitis. Diagnosis was confirmed through culture and histopathology, revealing phaeohyphomycosis in most cases. Management included long-term oral itraconazole therapy with regular monitoring; only one patient experienced a recurrence after five years. The findings underscore the need for heightened clinical suspicion in transplant recipients presenting with atypical skin or joint lesions, and highlight the importance of early microbiological and histopathological assessment. Prompt antifungal therapy, often alongside surgical intervention, is essential to prevent disease progression.

Introduction Rapid identification of tuberculosis (TB) and its drug resistance is crucial for starting effective treatment promptly and preventing the spread of resistant Mycobacterium tuberculosis (MTB) strains. Expanding the use of existing and new rapid molecular diagnostic tests is urgently needed to combat the rising threat of TB, multidrug-resistant TB (MDR-TB), and pre-extensively drug resistant TB (pre-XDR-TB). The mfloDx ™ diagnostic platform was developed to provide efficient, accurate, and accessible TB diagnostics. This study evaluates the performance of the mfloDx ™ pre-XDR-TB test for detecting TB and drug resistance against MGIT culture and drug susceptibility testing (DST). Methodology We have evaluated the performance of mfloDx ™ pre-XDR-TB test on 731 sputum samples received from a tertiary care center in India. This study compares the analytical and clinical efficiency of mfloDx ™ pre-XDR-TB test against the MGIT culture for M. tuberculosis complex (MTC) and MGIT-DST for rifampicin (RIF), isoniazid (INH), and fluoroquinolone (FQ) resistance. The clinical sensitivity and specificity were calculated for TB and drug-resistance detection using MedCalc statistical software. Results The mfloDx ™ pre-XDR-TB test showed 86.2% of sensitivity and 82.0% of specificity for MTC detection against MGIT culture. For drug resistance detection, sensitivity and specificity were found to be 98.2% and 99.7% for RIF, 86.2% and 99.2% for INH, and 93.3% and 100% for FQ, respectively, while the Indeterminate rates were 1.1% for RIF, 2.0% for INH, and <1% for FQ. The mfloDx ™ pre-XDR-TB test's high specificity minimized false positives, which is essential for preventing unnecessary treatments, while rapid results offered a significant advantage over conventional methods. Conclusion The mfloDx ™ pre-XDR-TB test efficiently provides a reliable, rapid and specific diagnostic results for TB and its drug resistance detection. While it shows potential for inclusion in the clinical diagnostic workflows, especially in high-burden areas, further optimization are required to enhance its sensitivity. Nonetheless, the test offers significant advantages for the prompt management of drug-resistant TB in resource-limited settings.

BackgroundTo investigate the geospatial epidemiology, clinical features, treatment patterns, and antimicrobial resistance (AMR) trends of Stenotrophomonas maltophilia bloodstream infections (BSIs) in Indian intensive care units (ICUs) participating in a standardized healthcare-associated infection (HAI) surveillance program from 2017 to 2024.MethodsThis retrospective, multicentric study analyzed surveillance data from 54 ICUs across India. Standardized HAI definitions and protocols were applied to characterize infection types, clinical outcomes, and antimicrobial susceptibility.ResultsA total of 271 S. maltophilia isolates were identified, with the highest burden in 2023–24 (n = 76, 28.0%). Central line-associated BSIs (CLABSIs) predominated (64.9%), though their proportion decreased over time, with non-CLABSIs rising from 7.4% (2017–18) to 42.1% (2023–24). Mortality was highest in secondary BSIs (60%), followed by CLABSIs (50.3%) and non-CLABSIs (36.4%). The median ICU stay for CLABSI patients was 21 days. No significant associations were observed between infection type and time to infection or length of stay. High resistance was observed to tobramycin (92%), amikacin (80%), and piperacillin-tazobactam (70%), while trimethoprim-sulfamethoxazole (64.7–94.7%), levofloxacin (93%), and minocycline (94.1%) retained activity.ConclusionS. maltophilia represents a significant ICU pathogen in India, underscoring the urgent need for genomic surveillance and resistance-guided therapeutic strategies.

Rationale: Melioidosis is a serious opportunistic infection caused by Burkholderia (B.) pseudomallei, primarily affecting immunocompromised individuals, particularly in endemic regions. Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes. Patient concerns: Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever, accompanied by liver and spleen abscesses. Case 2 was a 37-year- old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia. Blood cultures for both patients grew B. pseudomallei. Diagnosis: Both patients were diagnosed with melioidosis caused by B. pseudomallei, with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2. Interventions: Both patients were treated with an intensive regimen of meropenem (renal-adjusted doses), followed by a 3-month course of oral cotrimoxazole for eradication therapy. Outcomes: Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well. In Case 2, blood cultures became sterile after 4 weeks, with no further complications observed. Lessons: Melioidosis should be suspected in immunocompromised patients, especially kidney transplant recipients, who present with unexplained fever and sepsis-like symptoms. Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.

Lomentospora prolificans (formerly Scedosporium prolificans) is an emerging fungal pathogen, affecting both immunocompromised and immunocompetent individuals. Treatment is difficult due to intrinsic resistance against multiple anti-fungal agents. We describe five patients with L. prolificans infections attending a tertiary care center in South India. Out of the 5 patients, 4 patients presented with deep seated infection, and 1 with disseminated disease. Risk factors included uncontrolled diabetes mellitus, advanced HIV infection, T cell lymphoblastic leukemia, carcinoma breast, and immunosuppressant therapy. L. prolificans as an important causative agent of deep seated and disseminated mycoses among immunocompromised patients.

OBJECTIVES:To estimate the profile of non-central line-associated primary bloodstream infections (non-CLABSIs) in intensive care units of Indian hospitals participating in the standardized health-care-associated infection surveillance program. METHODS:This is a multicentric, network-based, prospective surveillance study conducted in 180 individual intensive care units of 47 Indian tertiary care hospitals that were part of the Health-Care-Associated Infection Surveillance Network between May 2017 and April 2024. The non-CLABSIs were defined, monitored, and observed using standardized definitions and surveillance protocols (www.haisindia.com). RESULTS:A total of 7092 laboratory-confirmed non-CLABSI cases and 30,74,954 patient days from 2017 to 2024 were recorded. The overall pooled non-CLABSI rate was 2.3 per 1000 patient days. Gram-negative isolates were the most predominant (5240/7659; 68.4%), including Klebsiella spp. (1766/5240; 33.7%), Acinetobacter baumannii (1613/5240; 30.8%), and Escherichia coli (582/5240; 11.1%). Gram-positive isolates (1728/7659; 22.6%) predominantly included Staphylococcus aureus (953/1728; 55.1%) and Enterococcus spp. (747/1728; 43.2%). Carbapenem resistance was common in Gram-negative infections, particularly in A. baumannii (1253/1554; 80.6%) and Klebsiella spp. (1209/1697; 71.2%). Among Gram-positive, S. aureus exhibited a high level of resistance to methicillin (529/748; 70.7%). CONCLUSIONS:This surveillance study underscores the need to expand infection prevention and control strategies to include non-device-associated risk factors. This will lead to the formulation of comprehensive infection prevention and control programs, mitigating the burden and clinical outcomes of non-CLABSI.

BACKGROUND:Swab-based molecular tests are emerging as more accessible and lower-cost options for tuberculosis (TB) diagnosis. We conducted multi-country diagnostic accuracy evaluations of late prototype versions of Truenat MTB Ultima (MTB Ultima) and MiniDock MTB Test (MiniDock MTB). METHODS:We enrolled consecutive people aged ≥12 years with presumptive TB at outpatient clinics in India, Uganda, and Vietnam. We evaluated the diagnostic accuracy of MTB Ultima and MiniDock MTB when using tongue and sputum swabs against a sputum liquid culture-based microbiological reference standard. Additionally, we compared the diagnostic accuracy of the swab-based molecular tests with that of sputum Xpert MTB/RIF Ultra (Xpert) and sputum smear microscopy. FINDINGS:From January to September 2024, 1050 participants were included in the tongue swab MTB Ultima evaluation, 197 in the sputum swab MTB Ultima evaluation and 322 in the MiniDock MTB evaluations. With tongue swab-based testing, sensitivity was 77.9%, 95% CI: 70.3, 84.2 for MTB Ultima and 85.7%, 95% CI: 75.3, 92.9 for MiniDock MTB. Both were more sensitive than sputum smear microscopy (p < 0.001, McNemar's test, for both comparisons). With sputum swab-based testing, sensitivity was 93.6%, 95% CI: 82.8, 97.8, for MTB Ultima and 91.1%, 95% CI: 82.1, 95.9 for MiniDock MTB. Compared to sputum Xpert, sensitivity differed by -6.4%, 95% CI: -15.5, 2.7 for MTB Ultima and -3.0%, 95% CI: -8.6, 2.6 for MiniDock MTB. Specificity exceeded 98% for all index tests. INTERPRETATION:MTB Ultima and MiniDock MTB exceed minimum World Health Organisation accuracy targets for sputum- and non-sputum-based near-point-of-care TB tests and offer strong potential to make universal molecular testing for TB a reality. FUNDING:National Institutes of Health (U01AI152087), Gates Foundation, and Global Health Labs.

Swab-based molecular platforms that enable testing of both sputum (via swabs swirled in sputum) and tongue swabs are emerging as a promising option for more accessible and lower cost molecular testing for tuberculosis (TB). We conducted a multi-country evaluation of two novel swab-based molecular tests: Molbio Truenat MTB Ultima (MTB Ultima) and Pluslife MiniDock MTB Test (MiniDock MTB). Consecutive people ≥12 years old with presumptive TB were enrolled at outpatient health centers in India, Uganda, and Vietnam. We collected two tongue swabs and prepared two sputum swabs for MTB Ultima and MiniDock MTB testing, then evaluated the diagnostic accuracy of MTB Ultima and MiniDock MTB using both swab types against a sputum liquid culture-based microbiological reference standard (MRS). The diagnostic accuracy of swab-based molecular tests was also compared to sputum Xpert MTB/RIF Ultra (Xpert Ultra) and auramine smear microscopy. From January to September 2024, 1,050 participants were included in the tongue swab MTB Ultima evaluation, 197 in the sputum swab MTB Ultima evaluation, and 322 in the MiniDock MTB evaluations. In comparison to sputum Xpert Ultra, sensitivity was similar for both sputum swab MTB Ultima (93.6% vs. 100.0%, difference -6.4%, [95% CI: -15.5, 2.7], p=0.25) and MiniDock MTB (91.0% vs. 94.0%, difference –3.0% [95% CI: -8.6, 2.6], p=0.50). In comparison to sputum smear microscopy, sensitivity was higher for both tongue swab MTB Ultima (77.9% vs. 59.1%, difference 18.8% [95% CI: 10.8, 26.8], p<0.0001) and MiniDock MTB (85.7% vs. 67.1%, difference 18.6% [95% CI: 7.2, 29.9], p=0.001). Specificity was high (>98%) for both tests with sputum swabs and tongue swabs. MTB Ultima and MiniDock MTB have similar accuracy to current sputum-based molecular tests with sputum swabs and meet minimum accuracy thresholds for a non-sputum, near point-of-care molecular test with tongue swabs. These tests offer strong potential to make universal molecular testing for TB a reality.

BACKGROUND:Central line-associated bloodstream infections (CLABSIs) are preventable health-care-associated infections (HAIs) that cause considerable morbidity and mortality. Understanding the epidemiology of CLABSIs through large, quality-assured, hospital-based datasets could help to enable development of preventive protocols suited to specific health-care systems. We aimed to describe the profile of CLABSIs in intensive care units (ICUs) at tertiary care centres in India. METHODS:We obtained data from around 200 adult, paediatric, and neonatal ICUs at 54 hospitals reporting to the Indian HAI surveillance network over a period of 7 years. All hospitals conducted bloodstream infection surveillance using standardised protocols. Cases of CLABSI were recorded on standard case report forms and were submitted to the HAI surveillance database. Denominator data (patient-days and central line-days) were entered monthly. Data quality was evaluated by a central team at the All-India Institute of Medical Sciences (New Delhi, India). We calculated CLABSI rates per 1000 central line-days and central-line utilisation ratio (CLUR) by year and ICU type (adult, paediatric, or neonatal). Commonly reported pathogens were ranked and the proportions of priority pathogens showing antimicrobial resistance were also estimated for each 1-year period and each ICU type. FINDINGS:During the surveillance period from May 1, 2017 to April 30, 2024, 8629 laboratory-confirmed CLABSI events, 3 054 124 patient-days, and 977 052 central line-days were recorded. The overall pooled CLABSI rate was 8·83 per 1000 central line-days and the pooled CLUR was 0·32. CLABSI rates were 8·68 per 1000 central line-days in adult ICUs (CLUR 0·38), 6·71 per 1000 central line-days in paediatric ICUs (0·27), and 13·86 per 1000 central line-days in neonatal ICUs (0·11). Among the total 10 042 pathogens reported, 8981 (89·4%) were bacterial and 1061 (10·6%) were fungal; Klebsiella pneumoniae (2294 [22·8%] isolates) and Acinetobacter baumannii (2047 [20·4%] isolates) were the most frequently reported for each ICU type. Among isolates tested, resistance to carbapenem was found to be highest in A baumannii (1607 [87·1%] resistant isolates of 1846 tested) and K pneumoniae (1589 [77·7%] of 2046). INTERPRETATION:This is the first large-scale observational study and standardised surveillance report of CLABSI in India. The data generated from this network provide a valuable opportunity for a quality improvement-based approach for the reduction of CLABSI. FUNDING:US Centers for Disease Control and Prevention cooperative agreement with the All-India Institute of Medical Sciences (New Delhi, India). TRANSLATION:For the Hindi translation of the abstract see Supplementary Materials section.

To study the clinical profile and outcomes of rare mycobacterial infections such as nontuberculous mycobacteria (NTM) and Mycobacterium leprae kidney transplant recipients. This is a retrospective analysis of clinical outcomes of the uncommon infections in renal allograft recipients over 22 years during 2000–2022 from a tertiary care center in southern India; the clinical data were obtained from electronic medical records of nephrology and clinical microbiology departments. Institutional review board approved this study vide minute number 13641 dated 02.12.2020. A total of 1970 patients underwent renal transplantation at our institute, from January 1, 2000, to December 31, 2022. During this period, five patients were diagnosed with mycobacterial infections, three of whom had NTM infections and two with Mycobacterium leprae infections. The patients were all diagnosed by isolating organism in blood and/or pus cultures. All patients were similarly managed initially with a reduction of immunosuppressive drugs and appropriate antibiotics as per protocol. At present, there is no standard serodiagnostic test available to reliably detect patients with rare infections. Initial cultures may yield negative results due to slow growth and inconsistent colony appearance. Our research revealed that the majority of patients had negative sputum cultures and negative Gram stains. Therefore, it is essential to maintain a high level of suspicion and conduct thorough investigations in postrenal transplant recipients to achieve early diagnosis, administer appropriate treatment, and prevent disease spread.

ObjectiveTo describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott’s puffy tumor (ROCM-PPT)MethodsThe records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT.ResultsROCM-PPT was diagnosed in 9 of 284 (3.2%) patients with ROCM seen during the study period. There were six (66.7%) males and the median age was 54 (IQR 46-60) years. Eight (88.9%) patients had diabetes mellitus and seven (77.8%) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18-23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75%) patients with follow-up imaging, and stable disease in two others.ConclusionsROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.

•Diagnosing tuberculosis in children remains challenging, mainly as children typically have paucibacillary disease.•First study to compare the performance of QuantiFERON TB and tuberculin skin test in immunocompromised children.•Our study showed QuantiFERON-TB does perform better than TST in children with TB disease in immunocompromised children.