Background Non-tuberculous mycobacteria (NTM) are gaining recognition as key causative agents of extrapulmonary infections, often mimicking tuberculosis (TB) and posing significant diagnostic and therapeutic challenges. Data on the prevalence and species distribution of NTM in extrapulmonary TB suspects remain limited in high TB-burden regions of India. Objective This study sought to determine the prevalence of microbiologically confirmed NTM among patients with CBNAAT-negative extrapulmonary tuberculosis (EPTB) at a tertiary care centre in Eastern India, and to characterize the species distribution, clinical spectrum, and drug susceptibility profiles. Methods This prospective cross-sectional observational study included 337 CBNAAT-negative extrapulmonary TB suspects over a period of two years. Specimens were processed using standard decontamination and culture protocols on MGIT and Lowenstein–Jensen media. Positive cultures were differentiated using MPT64 antigen testing, and presumptive NTM isolates underwent molecular identification via 16S rRNA and rpoB gene sequencing. Isolates of Mycobacterium tuberculosis complex (MTBC) were subjected to drug susceptibility testing (DST) along with selected NTM species. Demographic, clinical, and microbiological data were analyzed descriptively. Results Of 337 specimens, 144 (42.7%; 95% CI 37.6–47.9%) were culture-positive. MTBC comprised 109 isolates (32.3%; 95% CI 27.7–37.1%), while 35 (10.4%; 95% CI 7.6–14.0%) were confirmed NTM . NTM species included Mycobacterium avium complex (MAC, 34.3%), M. fortuitum (25.7%), M. abscessus (17.1%), M. kansasii (11.4%), and other rare species (11.4%). Lymph node aspirates and pus predominated as NTM-positive specimens. Rapid-growing species demonstrated high susceptibility to amikacin (85.7%) and clarithromycin (77.1%), while slow-growers exhibited moderate susceptibility to rifabutin (62.9%) and ethambutol (68.6%). Conclusion NTM accounted for a substantial proportion of culture-positive specimens among CBNAAT-negative extrapulmonary tuberculosis suspects in this high TB-burden Indian setting. Given the clinical overlap with TB, species-level identification and targeted DST are essential to guide appropriate therapy, avoid misdiagnosis, and optimize patient outcomes. These observations point to the need for more robust diagnostic algorithms and systematic surveillance of NTM in endemic regions.

Background: Whole saliva is a unique body fluid. It is a complex mixture deriving from the secretion of salivary glands, gingival fold and oral mucosa. Candidal infection in the epithelium may lead to epithelial dysplasia and malignancy. The etiopathogenesis of OSCC and oral possibly malignant diseases has been linked to Candida species. Materials and Methods: This prospective observational study was conducted. The purpose of the study was to look at the presence and speciation of Candida in unstimulated saliva as a possible biomarker for the early identification of oral diseases that are malignant or possibly malignant. Species-level identification was performed on unstimulated whole saliva, statistically analysis was done. Results: The presence of Candida varied significantly between groups (P < 0.001). Candida was detected in 17 (58.6%) OSCC patients, whereas its presence was much lower in both the oral potentially malignant disorder (2 cases, 6.2%) and healthy control groups (2 cases, 6.9%). The most commonly isolated species, especially in the OSCC group, was Candida albicans (12 cases), followed by 2 cases of Candida tropicalis, 1 case of Candida dubliniensis, and 1 case of Candida inconspicua. Conclusion: Research reveals a notable distinction between those with OSCC and those in good health with normal mucosa, indicating the significance of fungal in OSCC. In this sense, Candida species may be regarded as a risk factor for the development of OSCC.

Background:Chronic pulmonary aspergillosis (CPA) is a recognized complication in patients with pulmonary tuberculosis, particularly in high TB burden regions. Misdiagnosis and inappropriate treatment occur due to overlapping clinicoradiological features, leading to increased morbidity and mortality. Data on CPA occurrence and its association with PTB in tertiary care settings remain limited in resource-constrained countries. Methods:This study enrolled 143 adults from outpatient and inpatient departments. Newly and previously diagnosed PTB patients were included. The CPA diagnosis was based on symptoms lasting over three months, radiological findings, and microbiological/immunological evidence using Aspergillus IgG and BAL galactomannan testing. Data were analyzed using STATA 14.0. Descriptive statistics summarized demographic and clinical data, and comparative analyses between CPA and non-CPA groups used chi-square or Fisher's exact tests for categorical variables and Student's t-test for continuous variables. Results:CPA was diagnosed in 34.3% (49/143) of PTB patients. The CPA cohort showed male predominance (male-to-female ratio, 4:1), with associations with diabetes mellitus (70.8%, p=0.038) and post-tuberculosis lung disease (61.4%, p=0.040). Radiological features, including cavitation (47.4%, p=0.009), aspergilloma (55.9%, p=0.009), and infiltrates (72.3%, p=0.10) were more frequent in CPA patients. Aspergillus-specific IgG was positive in 69.4% (p<0.001) and BAL galactomannan in 43.9% (p<0.001) of CPA patients. Conclusion:CPA is prevalent among PTB patients, especially those with TB history and comorbidities like diabetes. Integrated diagnostic approaches, including immunological and antigen testing, are recommended to improve differentiation and management in resource-limited settings.

Background Modern health care advances in immunosuppressive therapy, particularly related to bone marrow transplantation, and increasing utilization of implantable devices have contributed to the rise of invasive Candida infections in recent decades. Objectives: An automated method based on the broth microdilution MIC technique was used to evaluate the susceptibility of fluconazole and voriconazole with that of the Gradient diffusion technique using brain heart infusion (BHI) agar. Additionally, to identify a low-cost, quick, accurate, and simple way to test for antifungal sensitivity. Materials and Methods Over a year, an observational study was conducted from November 2023 to October 2024. The study was carried out at the Department of Microbiology at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study included 120 participants in total. Results Out of 120 isolates of Candida species, a total of 40 isolates were found to be of Candida tropicalis. Most of the isolates were confirmed in blood samples 24 (60%), followed by deep aspirated pus 06 (15%), pleural fluid 05 (12.5%), CSF 03 (7.5%), and peritoneal fluid 02 (5%). Candida tropicalis isolates were sensitive to fluconazole in 37 (92.5%) of the species as well as to voriconazole in 39 (97.5%) of the species through Vitek 2 tests. Conclusion A standardized automated test for antifungal susceptibility, the AST-YS08Vitek 2 card system (bioMérieux), was shown to be dependable and produced findings that were comparable to the E test; as a result, it may be used in place of the E test. Recommendations Nevertheless, additional research is required to assess the VITEK 2 method's capacity to detect resistant isolates. Retesting of any resistant isolates generating inconsistent findings will be necessary to resolve this problem.

Non-fermenting gram-negative bacilli (NFGNB) have become a new vision of serious and clinically important nosocomial infection, with a growing multidrug resistance (MDR), as well as the production of metallo-beta-lactamase (MBL), which makes their intervention in tertiary care centres difficult. This 18-month prospective research carried out in Bihar scrutinized 342 NFGNB isolates, whereby the most dominant was Pseudomonas aeruginosa. MDR was observed in 72.8 percent of isolates and it was significantly higher in people in the ICU (p < 0.001), whereas MBL was seen in 41.2 percent of strains. The highest susceptibility was shown by colistin, polymyxin B and tigecycline. Thus, the urgent need for effective antimicrobial stewardship and infection control practices is reported.

Background Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, necessitating the identification of reliable biomarkers for early detection and risk assessment. Among these, high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) have emerged as crucial inflammatory mediators linked to the pathogenesis and development of CVD. Pro-inflammatory cytokine IL-6 is essential in endothelial dysfunction, atherosclerosis, and plaque instability, while hs-CRP serves as a systemic marker of inflammation, correlating with vascular injury and adverse cardiac events.n. This study aims to assess the association of baseline IL-6, hs-CRP, and LDL-C levels with cardiovascular events over one year in patients undergoing intensive cardiovascular treatment. Methods This research consisted of 100 patients with cardiovascular disease (CVD) and 100 healthy controls. After obtaining consent, demographic data, medication history, and cardiovascular risk factors were recorded. Clinical parameters, including age, sex, height, body weight, and blood pressure, were also recorded. Patients with liver diseases, renal dysfunctions, thyroid disorders, HIV, and acute inflammatory conditions were excluded. Blood samples were obtained for biochemical examination after a 12-hour fast. IL-6 levels were quantified using an ELISA kit (Ray Biotech, Inc.), Serum hs-CRP was measured using photometric analysis (autoimmune), and lipid profiles were assessed using enzymatic and colorimetric techniques. Results Patients with CVD showed significantly raised levels of total cholesterol, LDL, VLDL, triglycerides, hs-CRP, and IL-6 (p<0.0001), while HDL levels were lower. Increased BMI, waist circumference, and blood pressure were also noted. These results reinforce the link between dyslipidemia, inflammation, and CVD, emphasizing their importance in disease progression and risk evaluation. Conclusion Elevated hs-CRP and IL-6 levels may help in the prediction of cardiovascular risks and further improve the stratification in suspected coronary artery disease (CAD) cases. Managing risk factors in high-risk patients and further research on IL-6’s causal role are essential.

Background: Diagnosing childhood pulmonary tuberculosis (PTB) is challenging due to nonspecific symptoms and difficulties in obtaining respiratory specimens. This study evaluates the diagnostic performance of the stool-based Xpert MTB/RIF assay as a noninvasive alternative compared to respiratory specimens in suspected cases. Material and Methods: This prospective, hospital-based study was carried out at a tertiary care centre, from November 2022 to October 2024. A total of 244 pediatric patients under 15 years of age with suspected PTB were included. Both stool and respiratory samples were collected and analyzed using the Xpert MTB/RIF assay and Mycobacteria growth indicator tube (MGIT) culture. Data analysis was performed using IBM SPSS software (version 22). Results: The Xpert MTB/RIF assay detected Mycobacterium tuberculosis in 10.2% of respiratory specimens and 6.1% of stool samples, while MGIT culture identified it in 8.6% of respiratory specimens and 5.3% of stool samples. Detection rates were higher in respiratory specimens. Stool-based diagnostics showed comparable performance, with reported sensitivities of 32% to 83.3% in prior studies. Baseline characteristics showed a mean patient age of 7.19 years, with 59.02% males. Fever (74.18%) and cough (52.8%) were the most common clinical features. Conclusion: The stool Xpert MTB/RIF assay is a promising diagnostic tool for PTB in children, especially in resource-limited settings where respiratory sample collection is difficult. Although its sensitivity is lower compared to respiratory specimens, its high specificity makes it a reliable alternative. Future research should optimize stool sample processing and explore advanced diagnostic assays to improve sensitivity and accuracy.

AIM: Dengue is an acute systemic viral disease well known globally in both endemic and epidemic transmission cycles. Main aim is to study serotypes/genotypes and lineages of dengue virus (DENV) are associated with more severe outbreaks. Many reports from India have shown an association between change in DENV genotype/lineage and magnitude of the outbreak and disease severity. Study Design. It is a hospital based cross sectional study. Place and Duration of Study: Molecular Biology laboratory in department of Microbiology, Indira Gandhi Institute of Medical Science and duration study from January2021 to January 2023. Material and Methods: This cross- sectional study was aimed to investigate the circulating DENV serotypes and genotypes in Bihar during year 2021-2023. For genetic characterization of prevalent serotypes, real-time reverse transcription polymerase chain reaction assay was used. Representative samples were sequenced for the envelope (E) gene. Results: All four prevalent serotypes, DENV-1, DENV-2, DENV-3 and DENV-4 were found to be circulating in Bihar with dominance of DENV-2. Mixed infection cases of DENV-2 with DENV-3 and DENV-1 with DENV-2 were also seen. Phylogenetic analysis based on C-prM gene revealed DENV-1 sequences to be 92% similar with Vietnam genotype I (2003) strain, DENV-2 isolates clustered with genotype IV of North India strains, Haryana (1996), Delhi (1996) and Jammu (1993) with 95%, 94% and 94% sequence similarity respectively. DENV-3 isolate was more closely related to genotype III of Indian origin (2003), Gwalior and Delhi with 98% and 99% sequence similarity respectively. Conclusion: With this background data, molecular monitoring of viruses circulating in the locality provides baseline data on the circulating serotypes/ genotypes of dengue virus (DENV). So this monitoring and early detection of changes in the circulation pattern may help in the prediction of DENV outbreaks and can augment disease control efforts.

Background Tuberculosis (TB) and intestinal helminth infections often coexist, posing a significant health challenge. TB, caused by Mycobacterium tuberculosis, and helminths elicit distinct immune responses -Th1 for TB and Th2 for helminths. Co-infection introduces a complex immunological challenge, potentially compromising TB control. This study addresses the research gap by comparing cytokine profiles and monocyte responses in TB patients, helminth-infected individuals, and those with both. Insights gained may enhance diagnosis, treatment, and disease control strategies where TB and helminths prevail. Methods A cross-sectional observational study conducted at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, aimed to compare cytokine profiles and monocyte responses in TB patients and those coinfected with TB and helminths. The study included 150 newly diagnosed active TB individuals aged 18 to 65 years. TB diagnosis was confirmed through clinical assessment, sputum microscopy, and GeneXpert (Cepheid, Sunnyvale, CA, USA) testing. Stool examination employed various methods, including the Kato-Katz technique and formalin-ether concentration. Blood samples were collected for hematological analysis, cytokine profiling, and monocyte isolation. Statistical analysis, using SPSS version 20.0 (IBM Corp., Armonk, NY, USA), included descriptive statistics, and t-test analyses. Results In our study of 150 participants, half (50.0%) showed positive helminth status. The sociodemographic analysis revealed no significant differences in age, gender, education, occupation, marital status, smoking, alcohol, BMI, diabetes, and hypertension between TB patients (n=75) and TB+Helminth patients (n=75), ensuring baseline matching. The prevalence of specific helminth infections in TB+Helminth patients includedAscaris lumbricoides (24.0%), Trichuris trichiura (18.7%), and others. Hematological parameters showed significant differences, with TB+Helminth patients exhibiting higher RBC count, hemoglobin, hematocrit, neutrophil count, and monocyte count; also eosinophil count was more raised in TB+Helminth patients (0.36 x 103/mu L) when compared to TB patients (0.25 x 10 3/mu L). Cytokine profiles and monocyte responses varied significantly between the groups, with TB patients having higher IL-4, IL-6, IFN-gamma, TNF-alpha, and IL-1 beta levels, while TB+Helminth patients had elevated IL-10. Monocyte response time did not differ significantly. Conclusion The observed differences in hematological parameters and cytokine profiles emphasize the need for tailored approaches to diagnosis and treatment in co-infected individuals. These findings suggest that the management of TB patients should consider the potential influence of helminth co-infections.

BACKGROUND:C-reactive protein (CRP) is a routine inflammation biomarker. Increased CRP levels are correlated with COVID-19. We found a marked reduction in CRP concentration on corticosteroid therapy, which in turn led to reduced mortality and duration of hospital stay.METHODS:In this retrospective cohort study, CRP levels were measured on admission and at 72 hours and compared between two groups of patients, with and without corticosteroid therapy. The study sample consisted of 105 RT-PCR-confirmed patients admitted to the ICU of the COVID ward. Out of the total patients, 57 received one or more doses of dexamethasone in addition to usual treatment, and 48 were given only usual care.RESULT:CRP at the time of admission was comparable for both groups. Also, a significant decrease in the CRP was noted in both groups 72 hours post-admission. Moreover, the decline was more marked in the steroid-administered group (CRP-baseline: 34.3mg/dL (+/-8.44), CRP at 72 hours 18.5mg/dL(+/-7.95) (p <0.00) compared to non-steroid group (CRP_baseline: 34.04mg/dL (+/-10.06), CRP at 72. Those with comorbidities were administered steroids (n=38, 66.7%) compared to those who were not (n=08, 16.7%). The average duration of hospital stay was less (5 to 7 days) in the corticosteroid-administered group compared to the other group (7 to 10 days).CONCLUSION:Routine CRP tests can predict the outcome and treatment of severe coronavirus disease. Corticosteroid treatment in COVID-19 patients is associated with reduced CRP levels within 72 hours after therapy.

Background Tuberculosis (TB) remains a global health concern, with India bearing a substantial burden. Paediatric TB, especially extrapulmonary TB (EPTB), presents unique diagnostic challenges due to its paucibacillary nature and the difficulty in obtaining suitable samples in children. Accurate and timely diagnosis is crucial to initiate appropriate treatment and mitigate disease spread. The MPT64 antigen test has shown promise in diagnosing TB, but its performance in paediatric EPTB remains underexplored. This study aimed to evaluate the diagnostic utility of the MPT64 antigen test in paediatric EPTB cases at a tertiary care hospital in India. Methods We conducted a prospective cross-sectional study at the Indira Gandhi Institute of Medical Sciences (IGIMS), a tertiary care hospital in India. A total of 250 paediatric participants, aged 0-18 years, with clinical suspicion of extrapulmonary tuberculosis (EPTB) were included. Diagnostic samples (e.g., tissue biopsies, pus, cerebrospinal fluid (CSF), and lymph node aspirates) were obtained, and tests including microscopy for acid-fast bacilli (AFB), mycobacterial cultures, GeneXpert MTB/RIF assay, and the TB Antigen MPT64 Rapid ICT Kit were performed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the MPT64 antigen test were calculated using culture and GeneXpert as reference standards. Results Among the 250 participants, 34 (13.6%) were confirmed to have EPTB. The MPT64 antigen test demonstrated a sensitivity of 70.6% and specificity of 92.1% in detecting EPTB cases. Mycobacterial cultures had the highest sensitivity (91.2%) and specificity (97.7%). GeneXpert showed a sensitivity of 70.6% and specificity of 93.9%. Overall diagnostic accuracy ranged from 88.7% for acid-fast bacteria (AFB) staining to 96.9% for mycobacterial cultures. The MPT64 antigen test had an area under the curve (AUC) of 0.814, indicating a good diagnostic accuracy. Conclusion The MPT64 antigen test demonstrates promising sensitivity and specificity for diagnosing paediatric EPTB, making it a valuable diagnostic tool, especially in resource-limited settings. However, mycobacterial cultures maintain the highest accuracy. Combining the MPT64 antigen test with other methods may enhance diagnostic capabilities.

Background Oropharyngeal candidiasis (OPC) is a common fungal infection in HIV-seropositive patients. Understanding the spectrum of yeast isolates and their antifungal susceptibility patterns is crucial for effective management. This study aimed to determine the yeast isolates, antifungal susceptibility patterns, and associated factors in HIV-seropositive patients with OPC. Material and methods A prospective observational study was conducted on 350 HIV-seropositive patients attending an Integrated Counselling and Testing Centre (ICTC) at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar. Yeast isolates from oropharyngeal lesions were identified, and their antifungal susceptibility was determined by automated method VITEK 2. Demographic characteristics, highly active antiretroviral therapy (HAART) status, and CD4+ cell count categories were analyzed for associations. Results This study of 350 HIV-seropositive patients revealed that 100 tested positive for Candida , with distinct differences between HAART (n=67) and non-HAART (n=33) groups. HAART patients had a younger age distribution and higher median CD4+ cell counts (350 vs. 250 cells/mm(3 ), U = 175, p < 0.05) compared to nonHAART patients. Candida albicans was the most common species in both groups, but significant variations in species distribution (chi(2) = 9.23, p < 0.05) and antifungal susceptibility were noted. Specifically, susceptibility differences were significant for flucytosine (chi( 2) = 7.21, p = 0.027) and voriconazole (chi (2) = 8.64, p = 0.013), emphasizing the influence of HAART on managing immune function and antifungal resistance in HIV patients. Conclusion This study provides insights into the spectrum of yeast isolates and their antifungal susceptibility patterns in HIV-seropositive patients with OPC. The findings emphasize the importance of considering multiple factors, such as Candida species, HAART status, and individual patient characteristics, in treatment decisions. The results will aid in the development of evidence -based management protocols for this vulnerable population. Further research is warranted to explore additional factors influencing antifungal susceptibility and optimize treatment strategies for this patient population.

Introduction: Chronic Kidney Disease (CKD) has become an impending health concern due to the massive rise in the number of patients with diabetes mellitus and hypertension. Monitoring CKD patients typically requires regular invasive testing, and a simple diagnostic test that does not involve venipuncture would greatly benefit patients and healthcare professionals. Extensive research is being conducted to explore the use of saliva as a Non invasive tool for evaluation of systemic diseases like CKD. However, most of these studies have focused on End Stage Renal Disease (ESRD) patients. Aim: To investigate the correlation between salivary urea and creatinine levels and their serum counterparts in CKD patients and healthy controls. Additionally, the study aimed to assess the efficacy of salivary urea and creatinine compared to serum urea and creatinine in predicting CKD. Materials and Methods: The present cross-sectional study was conducted between January 2021 and July 2022 in the Department of Biochemistry, in collaboration with the Department of Medicine, at Heritage Institute of Medical Sciences in Varanasi, Uttar Pradesh, India. The study included a total of 60 participants: 30 CKD patients (stage 1-3) and 30 age-matched healthy controls. Serum and salivary urea were analysed using the Urease-Glutamate Dehydrogenase (GLDH) method, and creatinine was measured using the Modified Jaffe’s method on the Dirui-300B autoanalyser. Data were statistically analysed using Pearson’s correlation coefficient. The sensitivity, specificity, and Area Under the Curve (AUC) of salivary urea and creatinine were evaluated in comparison to their serum counterparts. Results: The participants consisted of 30 CKD patients with a mean age of 54.8±8.8 years and 30 age-matched healthy controls with a mean age of 52.42±8.4 years. A significant difference in salivary urea and creatinine levels was observed between the control and CKD groups. There was a strong and significant correlation (p-value <0.01) between salivary creatinine and serum creatinine in both the control group (r-value=0.76) and the CKD group (r-value=0.82). Additionally, a strong and significant correlation (p-value <0.01) was found between salivary urea and serum urea in the CKD group (r-value=0.63). However, the correlation between salivary and serum urea was not significant in the control group, with an r-value of 0.58 and a p-value of 0.24. Both salivary urea and creatinine demonstrated high sensitivity (90% and 89%, respectively), specificity (80% and 80%, respectively), and AUC (0.78 and 0.86, respectively) compared to their serum counterparts, validating their practical clinical utility. Conclusion: The concentration of urea and creatinine in saliva can reflect kidney damage and help monitor kidney function in CKD patients. Standardising the protocol for evaluation of salivary urea and creatinine and establishing a reference range will make it useful for screening for CKD.

Introduction: Tuberculous meningitis (TBM) is the infection of Mycobacterium tuberculosis (MTB) among extra-pulmonary organs. The diagnosis of TBM can be considered a double sword in low-resource settings. On one side, there is poor access to health-care services, limited diagnostic capacity, and poor affordability. These factors hamper early treatment initiation while in high-resource settings, clinical suspicion towards TBM is considered minimal, and this lack of recognition many times leads to treatment delay. Xpert MTB/RIF test has come up as the diagnostic rescue with overall sensitivities exceeding 80% and specificity up to 100%. Materials and Methods: An observational study was done on 368 children up to 14 years of either gender with suspected TBM in 18 months. This whole duration was consumed in the planning of the study, obtaining ethical clearance, data collection, data analysis and report writing. Cerebrospinal fluid was collected by lumbar puncture. Samples from all patients underwent testing based on GeneXpert, Ziehl–Neelsen (ZN) stain and mycobacteria growth indicator tube (MGIT) culture. IBM Statistical Package for the Social Sciences (SPSS version 22) was used for data analysis. Results: A total of 321 patients were included in the analysis. The male-to-female ratio was 1.55, thus showing a male preponderance. The majority belonged to Hinduism. The median age was 7.5 years. Based on clinical assessment and radiology, 48 patients were diagnosed with confirmed and probable TBM. Overall, the sensitivity of Gene Xpert, ZN smear and MGIT was 68.75%, 4.2% and 75.0%, respectively. Rifampicin sensitivity of the isolated organism was reported, and it was found that 18 out of 33 patients, implying 54.5% of patients were resistant to rifampicin. Conclusion: Till today, TBM poses a life-threatening situation despite advances made in the diagnosis have been achieved. In this context, Gene Xpert represents a step forward.

SARS-CoV-2 is highly contagious, which spreads even by patients having no clinical symptoms or also from people suffering with only mild symptoms. The gold standard test for its diagnosis is reverse-transcription PCR (RT-PCR) but at times of pandemic, Rapid antigen tests (RAT) are required, which has a very less turn-around time. Evaluation of the performance of COVID-19 Rapid antigen test in comparison to SARS-CoV-2 RT-PCR using nasopharyngeal swab, in relation to RNA dependent RNA polymerase (RdRp) Cycle threshold (Ct) values. This observational and cross-sectional study was done on patients coming with features of Influenza-like illness (ILI) or for any aerosol generating procedure or on high-risk patients seeking hospitalization. Both RT-PCR and RAT for COVID-19 were done on samples collected from each patient and results were compared. Altogether, 5314 samples were tested, out of which 104 (01.95 %) & 229 (04.31 %) samples were found positive by the RAT & RT PCR test, respectively. Sensitivity, specificity, PPV and NPV of RAT were found to be 44.54%, 99.96%, 98.08% and 97.56%, respectively. 98.9 % of samples with Ct value ≤ 20 were positive by RAT, whereas only 2.2% samples having Ct value ≥ 26 were found to be positive. Cases having lower Ct values were found to be more symptomatic and vice-versa. RAT are not efficient in detecting the virus in samples showing high Ct values (Ct ≥ 26) by RT-PCR test. Patients with samples showing low Ct values (Ct ≤ 20) had more severe symptoms and vice-versa.

Background: Cancer management is a dynamically developing field. Chemotherapy and radiation affect the level and duration of immunosuppression in the already immunocompromised cancer hosts, leaving them vulnerable to various opportunistic infections such as fungi, bacteria, viruses and parasites. Mucosal damage to the oral cavity induced by cytotoxic radiotherapy causes hypersecretion of saliva, which in turn can contribute to local invasion by colonizing microorganisms and subsequently lead to systemic infections. The aim of this study to identify the fungal isolates as well as their antifungal susceptibility in patients from undergoing chemo-radiotherapy. Materials and methods: The study was conducted on 188 patients with loco-regionally advanced head and neck cancer, undergoing chemoradiotherapy. Urine, throat swabs and blood were collected from the cancer patients at week 0, week 2 and week 6. These samples were inoculated on duplicate set of Saboraud's Dextrose Agar and incubated at 37 ​°C and 25 ​°C for 21 days. Candida species and other yeasts were identified using Germ tube test, Hichrome Agar, Corn Meal Agar and Carbon and Nitrogen assimilation tests. Antifungal susceptibility was done by disc diffusion method. Results: Out of 188 patient specimens, 83 throat swabs and 7 urines were positive for Candida species. In this study candida species didn't isolate in blood cultures specimens. Non-albicans Candida species (28.19%) predominate over Candida albicans (15.95%). Approximately 75.90% of isolates were susceptible to fluconazole and all isolates were susceptible to voriconazole and amphotericin-B. Maximum isolation of yeast occurred during the 6th week of radiotherapy. Conclusion: Oral candidiasis is a common fungal infection in patients with cancer on treatment with chemotherapy and radiotherapy. Candida albicans and non-Candida albicans differ significantly in their antifungal susceptibility pattern. Hence, species level identification in vitro antifungal susceptibility pattern is essential to choose the appropriate antifungal drug and to predict the outcome of therapy.

Introduction: Individuals with human immunodeficiency virus (HIV) infection have an increased likelihood of developing tuberculosis (TB). The primary objective of this study was to compare the diagnostic accuracy of microscopy, culture, and the Xpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) assay in the diagnosis of pulmonary TB in sputum samples of HIV-infected patients. The secondary objectives were to evaluate the sensitivity and specificity of these three methods along with a comparison of diagnostic approaches for detecting drug-resistant strains.Material and methods: This prospective, laboratory-based study was done in the Microbiology Department of IGIMS, Patna. The study included sputum samples of 102 individuals who were HIV-positive and exhibited symptoms indicative of tuberculosis.Results: Out of 102 individuals suspected of having tuberculosis, 18 tested positive for M. tuberculosis. Male individuals between the ages of 31 and 40 were more affected by both HIV and tuberculosis, and in most of these cases, their CD4 cell count was below 200 cells/pl. Among the 102 sputum samples collected, 18% (18 samples) were found to be positive using the Mycobacterium Growth Indicator Tube (MGIT) 960 liquid culture method. Two samples were contaminated, and 14.7% (15 cases) tested positive using the cartridge -based nucleic acid amplification test (CBNAAT) method. Additionally, 3.92% (four samples) were positive using the ZN staining method. Conclusion: The study found that Xpert MTB/RIF outperformed other methods in identifying resistance to RIF, showed better agreement with gene sequencing results for RIF resistance, and had higher accuracy in detecting tuberculosis cases, including both smear-positive and smear-negative cases.

Introduction Pulmonary tuberculosis (TB) has long been associated with opportunistic fungal infections and could prove lethal if these fungal infections are not detected in the early stages of tuberculosis. TB patients are mostly immunocompromised, and an association with a fungal infection fuels each other, thus decreasing host immunity and making it difficult to treat. Extensive use of antibiotics and steroids has resulted in increasing trends of these fungal infections globally. Material and methods This observational, retrospective hospital-based medical record review study was conducted in the Department of Microbiology at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. A total of 200 medical records of pulmonary tuberculosis patients diagnosed by using sputum as clinical samples were evaluated and analysed for two years, from January 2020 to December 2021. This study was started after approval from the institutional ethical committee. Data were obtained from the mycology test records from the Department of Microbiology and from the data files of the medical records section over a period of two years. Results Our study included the medical records of 200 pulmonary tuberculosis patients who underwent treatment at IGIMS Patna. Out of 200 patient records, 124 (62%) were males and 76 (38%) were females. The male-to-female ratio was 1.6:1. After analysis and evaluation of 200 medical records of pulmonary tuberculosis patients, fungal species were detected in 16 (8%) sputum samples. Among 16 culture-positive sputum samples, 10 (8.06%) and six (7.1%) were diagnosed in male and female patients, respectively. Fisher's exact test showed a non-significant two-sided p-value of 1.000 with a relative risk of 0.9982. The prevalence, or positivity rate, was 8% in two years. The age group of 31-45 years had the most fungal co-infection at 37.5%. Among the fungal isolates, 5/16 (31.25%) were yeasts, and the remaining 11/16 (68.75%) isolates were mycelial fungi. Conclusion According to the findings of the present study, pulmonary fungal infections co-exist in tuberculosis patients, although the prevalence rates of all the coinfections are low and statistically not significant. Being chronic in nature and with confusing clinical and radiological findings, these fungal infections are misdiagnosed as reactivation of tuberculosis. Hence, the increasing rate of morbidity and mortality can decrease if adequate measures are taken for the diagnosis at an early stage and appropriate treatment of these fungal mycoses with antifungal therapy is instituted.

The coronavirus disease 2019 (COVID-19) pandemic has manifested as a multifaceted paradigm but has primarily affected the respiratory system. Though a rare sequela after-COVID-19, we present a case of cavitary lung lesion in an adult patient, which manifested with common symptoms such as fever, cough and dyspnoea during the post-COVID-19 recovery period. Aspergillus flavus and Enterobacter cloacae were found to be the main causative organisms. Fungal and bacterial coinfection may be thought of in similar situations and appropriate treatment may be given to prevent further morbidity and mortality.