Tuberculous pericarditis (TBP) is an uncommon but serious manifestation of extrapulmonary tuberculosis, accounting for approximately 1-2% of extrapulmonary tuberculosis (TB) cases. Its diagnosis remains challenging because of the paucibacillary nature of the infection and the limited sensitivity of conventional diagnostic methods. Patients suspected of having tuberculous pericarditis between 2022 and 2024 were analyzed in this prospective case series. Various diagnostic tests were performed in suspected cases of tuberculous pericarditis, and the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) detected Mycobacterium tuberculosis in three samples. Clinical data, radiological findings, pericardial fluid characteristics, and microbiological test results were reviewed and analyzed for the patients with tuberculous pericarditis. Our study suggests that men in the middle to older age groups may be at higher risk. The most common clinical findings were fever, dyspnoea, and pericardial effusion. This study highlights the heterogeneous clinical and laboratory profile of TBP, which can occur in diverse patient populations, ranging from immunocompromised individuals to otherwise healthy adults.

Objectives: To understand the epidemiology of various pathogens, it is imperative to understand the carriage of these pathogens in asymptomatic individuals. This helps in understanding the transmission of disease and thus the control measures. This study was carried out to detect the carriage of various pathogenic bacteria, parasites, and Rotaviruses in stool samples of the healthy population of Chandigarh. Materials and Methods: 500 non-duplicate fecal samples from healthy subjects were collected and processed for isolation of pathogenic bacteria by microbiological culture. An enzyme-linked immunosorbent Assay was performed for Clostridium difficile toxins and Rotavirus antigen detection. Intestinal parasites were detected by wet mount and iodine mount directly, and after the formol-ether concentration technique for parasites. The data were analyzed descriptively using Microsoft Excel, and the results were summarized as percentages to provide a clear understanding of the distribution and trends in the dataset. Results: Carriage of intestinal pathogens was found to be 44.4% and 55.6% in children and adults, respectively. Carriage of Shigella species, Salmonella species, and Vibrio cholerae was nil in our study, with 2.6% carriage of Clostridium difficile. Rotavirus carriage was 3.6% in children. The carriage of parasites was more in adults than in children. Conclusions: The two main concerns in our study were C.difficile carriage and intestinal parasite carriage in adults. Educating the masses regarding hand hygiene is the most important step in this regard. Regarding parasitic infections, a single dose albendazole in school-going children has resulted in lower carriage in children than adults. The same approach, along with education regarding hygienic practices, can be started in the adult population also.

The middle stretch of the Ganga River is exposed to sustained anthropogenic pressure from industrial, urban and agricultural activities, leading to chronic heavy metal contamination and ecological stress. In this study, we evaluated spatial patterns of heavy metal pollution in river water and sediment and examined associated biological responses in the edible catfish Rita rita from Haridwar to Kanpur. The study area was categorized into three pollution-gradient zones representing upstream reference and downstream impacted regions. Concentrations of Cu, Cr, Cd and Pb were analyzed in water and sediment, while fish health was assessed using pooled morphometric and physiological indicators including body length, body weight, liver weight, condition factor (K), hepatosomatic index (HSI) and liver colour. Heavy metal concentrations showed a clear spatial gradient, with significantly higher levels in downstream zones than in the upstream reference stretch. Sediments consistently accumulated higher metal loads than water, underscoring their role as long-term pollutant reservoirs. Correspondingly, R. rita from downstream zones exhibited reduced growth, lower condition factor and HSI values indicating chronic physiological stress. Two-way ANOVA revealed significant effects of zone and gender on key biological parameters, while zone × gender interactions were non-significant, confirming spatial pollution gradients as the primary drivers of biological impairment. Overall, integrating abiotic contamination data with pooled biological health indices demonstrates sustained ecological stress in the downstream reaches of the River Ganga and highlights Rita rita as an effective sentinel species for long-term river health monitoring.

Background:Globally, tuberculosis (TB) poses a severe threat to human health. Prior to the COVID-19 pandemic, TB was the commonest infectious cause of mortality, surpassing HIV/AIDS. A strong index of suspicion is required for the diagnosis of extrapulmonary tuberculosis (EPTB) because of the paucibacillary nature of biological specimens. Primary care physicians, as the first point of contact for patients, are in an ideal position to detect TB early due to its multisystemic nature and varied presentation. This study aims to determine microbiological, demographic, clinical, and changing trends of EPTB in our region.Aim:To study the clinico-microbiological and drug susceptibility profile of patients with confirmed EPTB.Methodology:This was a prospective observational study in which all presumptive EPTB cases were screened, and confirmed EPTB cases were studied using various demographic criteria and clinical aspects.Results:A total of 1425 extrapulmonary samples were obtained from suspected TB cases between 2023-24. Of these, 194 samples with various diagnostic modalities and 68 patients were selected for the study based on inclusion and exclusion criteria. The prevalence of EPTB cases was found to be more prevalent in males, with majority of cases belonging to the 21-30 years age group. The maximum positivity was reported in pleural samples, followed by lymph node aspirates. Cartridge-based nucleic acid amplification test (CBNAAT) was found to be having highest sensitivity followed by solid culture. Rifampicin resistance was 4.4% cases.Conclusions:Since most of the tests rely on the presence of mycobacteria in the specimen, none of them have a 100% sensitivity; thus, suboptimal performance of all assays in the diagnosis of EPTB cases underlines the continuing relevance of systematic clinical investigations for making the diagnosis of EPTB and also calls for the need for novel tests.

Objectives: Human immunodeficiency virus (HIV) is one of the most dreadful infections worldwide. Although the most common mode of transmission is unprotected sex in India, the threat of parent-to-child transmission (PTCT) serves as a major roadblock in curbing infection. The study was conducted to decipher trends of PTCT at tertiary care centers in North India. Materials and Methods: This was a prospective study conducted over 8 years, wherein all pregnant women (19,996) attending antenatal clinics were included in the study. Testing was done free of cost, following a three-test protocol of the National Acquired Immunodeficiency Syndrome control organization. All newborns to HIV-positive females were tested and followed up to 18 months. Dry blood samples (DBS) collected at 1.5, 6, 12, and 18 months were tested using polymerase chain reaction (PCR). We also divulged the trend of HIV for all individuals attending integrated counseling and testing centers (ICTC). Statistical analysis: Descriptive analysis was performed using Microsoft Excel and interpreted as percentages. Results: A total of 36 (0.18%) reported HIV-positive and were counseled for implications on their health risk of sexual and vertical transmission. The yearly trend divulged decreasing HIV positivity, from 0.14% in 2014-2015 to zero in 2021-2022, ranging from 0.11-0.22%. A similar trend was noted among ICTC, with 1.26% positivity (2020) and 2.23% in 2021, with overall positivity of 1.49%. All DBS samples reported negative for HIV deoxyribonucleic acid PCR. Conclusions: The study underlines the role of monitoring, diagnostic, and counseling strategies in curbing transmission. Although the trend of HIV is declining, there is a constant need to screen all antenatal females to prevent vertical transmission.

BACKGROUND:Neonatal sepsis continues to be a leading cause of mortality among the NICU admitted neonates. The most common causative organisms have been proven to be hospital-acquired organisms. AIMS AND OBJECTIVES:This study was planned with aim of understanding the pathological colonization of neonatal skin and associated risk factors as well as finding a possible correlation between blood culture isolates and neonatal skin colonizers and their antimicrobial resistance patterns. METHODS:This prospective cohort study was conducted at a tertiary care centre in Northern India from January 2021 to June 2022. The study participants were 50 pre-term neonates and 50 term neonates, who were born in our hospital and subsequently admitted to the NICU. Skin swabs, taken from 5 body sites within 24 h of birth and at discharge, were cultured for isolation of pathological bacteria. Neonates were followed-up during their hospital stay for observing any occurrence of blood culture positive sepsis. RESULTS:Out of 100 neonates, 31 pre-term and 28 term neonates were colonized within 24 h of birth while almost all were colonized by discharge. Posterior auricular fossa was the most colonized site. Coagulase Negative Staphylococcus (n = 195) and Escherichia coli (n = 51) were the most common isolates. Risk factors found to be significantly associated with colonization were low birth weight (<2500g), premature rupture of membranes (PROM), invasive mechanical ventilation and positive urine and vaginal cultures of mothers. Neonates with culture positive sepsis also had colonization with MDROs. CONCLUSIONS:Neonatal skin colonization and their antimicrobial resistance rates increased over the course of hospital stay, having a possible contribution towards culture positive sepsis.

Acute Disseminated Encephalomyelitis (ADEM) is an autoimmune condition frequently caused by infections or immunisation activities and is characterised by inflammation and demyelination in the central nervous system (CNS). It primarily affects the brain and spinal cord, typically triggered by an immune response, and most often occurs in children but can also affect adults. The condition usually presents with a rapid onset of neurological symptoms and is considered a monophasic illness, meaning it generally occurs as a single episode. Its attack leads to inflammation and demyelination, impairing nerve signal transmission. Although the exact mechanism is not fully understood, molecular mimicry is thought to play a role, wherein an infection induces an immune response that mistakenly targets CNS antigens resembling the infectious agent. Despite improvements in knowledge and therapies, ADEM is still difficult to diagnose and treat. This chapter covers ADEM's diagnosis, etiology, prognosis, and clinical aspects. It emphasises the interactions between the immune system and the CNS, the individualised treatment plans, and the role of neuroimaging and cerebrospinal fluid investigations in diagnosis. Promising immunomodulatory medications and customised medicine strategies are being developed to enhance patient outcomes, even if corticosteroids are still the primary therapy.

Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa are among the multidrug-resistant (MDR) Gram-negative pathogens that pose a growing threat, necessitating novel preventive measures in addition to traditional antibiotics. By using advanced immunoinformatics methods, highly conserved and immunogenic epitopes for B-cells and T-cells were selected from major virulence-associated proteins (LptE, YiaD, MrkD, PhoE, OprF, and Zot), which exhibited high antigenicity (VaxiJen scores 0.74-2.75) and 98.87% global population coverage. The construct vaccine comprises 50S ribosomal protein L7/L12 adjuvant and PADRE sequence for immunogenicity enhancement, with structural validation indicating stability (96.3% residues in the total allowed Ramachandran regions). High-affinity interactions with TLR2/TLR4 (binding energies: -1009.6 to -1079.6 kcal/mol) were found through molecular docking, and immune simulations suggested strong humoral (IgM/IgG) and cellular (IFN-γ/IL-12) responses. Importantly, MEP vaccines can overcome major drawbacks of traditional vaccines by (1) offering cross-strain protection via conserved epitopes, (2) lowering the need for antibiotics through infection prevention, and (3) providing affordable options for healthcare systems affected by MDR infections. These findings demonstrate the MEP construct’s potential as a preventative measure against nosocomial infections, which may have implications for combating the global AMR epidemic. Further experimental validation is needed to verify its efficacy. ### Competing Interest Statement The authors have declared no competing interest.

Gaps in infection control practices have long been significant contributors to healthcare-associated infections (HAIs). Both multidrug-resistant isolates and outbreaks caused by rarely reported bacterial species are increasingly being recognized adding to the concern. This study reports an outbreak of Providencia stuartii in a single Intensive Care Unit (ICU) of a tertiary care center. The reported observational study was initiated with the identification the index case of Providencia stuartii during routine HAI surveillance in an adult ICU. Subsequently, four additional cases with the same pathogen and susceptibility profile were detected in the same unit. Infection control practices were immediately reinforced, and environmental sampling taken from multiple sites of the concerned ICU was carried out to trace the source. Multiple interventions, including additional teaching sessions and audits, were implemented. Providencia stuartii was first isolated from the index case during routine surveillance and later from samples of four additional patients in the same ICU. The pathogen was identified in a total of eleven samples over three months, with all isolates showing identical susceptibility profiles. Although the source could not be determined despite extensive sampling, the implemented interventions, including enhanced teaching sessions and hand hygiene audits helped control the outbreak and strengthen infection control practices. The pathogen was transferred possibly due to the lapses in the infection control practices. Reinforcement of infection control measures, in addition to regular teaching sessions and audits for hand hygiene, played a major role in controlling the outbreak and further highlighted the importance for their periodic implementation to prevent such lapses.

Problem considered: Infectious diseases continue to number among the leading causes of morbidity and mortality in a number of developing countries, including India. The Integrated Disease Surveillance Project (IDSP) was established by the Government of India in 2004 to monitor trends related to the testing and diagnosis of common infections, with one objective being to periodically update programs against infectious diseases based on the data obtained. Methods: This cross-sectional study analyses data for 11 diseases, reported as part of the IDSP to Government Medical College and Hospital, Chandigarh from 2020 to 2023; rare or clinically-diagnosed conditions were excluded from this analysis. Data analyzed includes percentage of positive cases, and linear trends of each disease. Result: Significant positive trends were observed for Chikungunya (r = 0.203), Viral Hepatitis A (r = 0.307), and Typhoid (r = 0.436); on the other hand, the incidence of Leptospirosis (r = -0.307), Shigella (r = -0.183), and Scrub Typhus (r = -0.389) were seen to decline during the same period. Dengue and Chikungunya were also associated with seasonal variations, with both diseases peaking in winter. Conclusion: The findings of this study emphasize the need for improved control of those infectious diseases which show increasing secular trends; in particular, the rise of Typhoid and Hepatitis A may indicate the need for improved control of fecal-oral transmission. The fall in Scrub Typhus, which runs counter to the prevailing national trend, may indicate the increased effectiveness of decentralized disease control programs. Insight gained from this study and other community-based studies is essential to guide effective policy-making and program implementation.

Emerging infectious diseases and increasing resistance to available antimicrobials are mapping the evolution of clinical microbiology and escalating the nature of undertakings required. Rapid diagnosis has become the need of the hour, which can affect diagnostic algorithms and therapeutic decisions simultaneously. Subsequently, the concept of 'diagnostic stewardship' was introduced into clinical practice for coherent implementation of available diagnostic modalities to ensure that these new rapid diagnostic technologies are conserved, rather than consumed as part of health care resources, with a view to improve the patient care and reduce Turnaround Time (TAT) and treatment expense. The present study highlights the requisite of diagnostic stewardship and outlines the infectious disease diagnostic modalities that can assist in its successful implementation. Diagnostic stewardship promotes precise, timely diagnostics, from the initial specimen collection and identification to reporting with appropriate TAT, so as to enable timely management of the patient. The main aim of diagnostic stewardship is to optimize the right choice of diagnostic test for the right patient to attain clinically significant reports with the least possible TAT for timely management and the least expected adverse effects for the patient, community, and the healthcare system. This underlines the requisite of a multifaceted approach to make technological advancements effective and successful for implementation as a part of diagnostic stewardship for the best patient care.

Introduction: The world has been affected by COVID-19 in recent years. There are various sampling sites which have given different yields. Methods: In cross sectional, prospective and descriptive study, 3 sampling sites namely oropharyngeal (OP), nasopharyngeal (NP) and oral saliva (OS) were compared as regards to COVID-19 yield. Results: A total of 939 samples were collected from 313 patients. Among these patients, 16 had samples positive from all three sites. There were 6 patients who had both nasopharyngeal and oropharyngeal swabs which showed positive results for COVID-19, while there were 4 patients each in whom only either oropharyngeal or nasopharyngeal swabs were positive. One patient had positive sample for oropharyngeal and oral saliva, while there was no patient in whom only saliva was positive. Thus a total of 27 patients had atleast one sample which was positive. Conclusion: Both nasopharyngeal and oropharyngeal samples are important and also both samples should be taken from all patients in order to reduce false negative results. Oral saliva as the only sampling site cannot be relied on owing to its low yields.

Objectives: Despite advances in diagnosis and management, urinary tract infection (UTI) remains one of the substantial causes of morbidity and mortality, owing to varied etiological agents and antimicrobial resistance. The present study was conducted to establish etiological agents implicated in community-acquired UTI, along with genotypic characterization of Enterobacterales. Materials and Methods: We performed phenotypic and genotypic characterization of resistance using disc diffusion, singleplex, and multiplex polymerase chain reaction (PCR). Statistical analysis: Descriptive analysis was performed using Microsoft Excel and interpreted as percentages. Results: A total of 250 isolates were included in the study, and the mean age of patients was 34.6 years. The most common etiological agent isolated was Escherichia coli (63%), followed by Klebsiella pneumoniae (12%). Susceptibility pattern revealed maximum susceptibility of Enterobacterales to fosfomycin, followed by piperacillintazobactam. Multidrug resistance (MDR) was noted among 81.2% of the isolates (76.8% Enterobacterales), and 5% of these isolates were resistant to all except colistin. Genotypic characterization revealed the presence of blaTEM in 54% of the isolates, followed by blaCTX-M1. Carbapenemase-encoding enzymes, namely blaIMP, blaNDM, blaVIM, and blaKPC, were noted in 1.3%, 1.3%, 2%, and 2%, respectively. Additionally, 5.6% of phenotypically resistant isolates did not harbor any tested resistance-encoding genes, whereas 6.1% of the pan-susceptible isolates harbored blaTEM, blaSHV, and blaCTX-M1 genes. Conclusions: The present study revealed a high prevalence of resistance to commonly used beta-lactams and less commonly recommended carbapenems. The findings of the present study highlight the need for judicious use of antimicrobials in the community, the need for periodic surveillance, and raising awareness for compliance and hand hygiene, owing to inter-and intra-genic transfer potential of resistance determinants.

Scrofuloderma is most common presentation of cutaneous tuberculosis in India. A 15-years-old immunocompetent male presented with bilateral cervical necrotising lesions and was treated with ATTx9 months, without improvement. Patient was diagnosed with scrofuloderma and ZN staining revealed 2+acid-fast bacilli. Cartridge-based nucleic acid amplification test showed rifampicin resistance. Patient was initiated on shorter regimen, but deferred treatment owing to technical portal problems. After 3 months, neck swelling had enlarged and he was started on multi-drug regimen x24 months. This underlines requisite to consider scrofuloderma in differentials of bilateral cervical lesions and to periodically monitor compliance to prevent subsequent emergence of resistance.

Purpose Tuberculosis is one of the dreadful infections and India contributes to substantial burden of TB cases globally. Though majority of cases are pulmonary, extra-pulmonary tuberculosis (EPTB) share significant burden, more in HIV-positive persons. Despite the striking burden, very few studies have been conducted in India and present study was undertaken to determine trends of EPTB at our tertiary care centre. Methods This was a retrospective study conducted over a period of 4 years 3 months. Diagnosis of EPTB was based on suspected clinical features, with positive micobiological evidence with cartridge based nucleic acid amplification test (CBNAAT) with/without microscopy. Results A total of 10,560 samples (pulmonary and extra-pulmonary) were received during the study period, of which 3972 were extrapulmonary. Of these, a total of 18% were noted to be positive for EPTB. Trend of positivity revealed highest burden in 2018 and a decline was noted over the years, however, rise in cases was noted in 2022. Pleural, meningitis, musculoskeletal, peritoneal and pericardial TB was more common in males, while lymphadenitis was more common in females (p value: <0.0001). Pleural TB (31%) was the most common presentation, followed by lymphadenitis. A gradual decline in lymphadenitis was noted with significantly increasing trend only for musculoskeletal TB. Rifampicin resistance was detected in 7.45% of positive samples, of which the maximum rate of resistance was noted in lymph node aspirates (11.11%), followed by musculoskeletal and pleural samples. Conclusion The present study showed a gradual decline in positivity of EPTB cases over the years. Younger productive age group with more propensity to transmit infection was the most commonly affected, with pleural TB as the most common presentation. Rare presentations of EPTB also contributed major share. Higher rates of resistance underline requisite to strengthen ongoing programs, to achieve the End TB strategy by 2025.

BACKGROUND:Typhoid fever poses a significant health challenge in low- and middleincome countries (LMiCs), impacting millions of individuals across various age groups. Its prevalence is particularly pronounced in South Asia. Factors contributing to its transmission in South Asia include rapid unplanned urbanization, urban-rural disparities, provision of poor water and sanitation facilities, and open defecation. The mortality rate of typhoid fever is up to 1%, and those who survive have a protracted period of poor health and carry an enormous financial burden. The treatment is further complicated by the emerging antibiotic resistance leaving few treatment options in hands. This issue has become more urgent due to the further emergence of extended drug-resistant (XDR) and multidrug-resistant (MDR) typhoid strains, as well as their subsequent global spread. Fluoroquinolone-resistant Salmonella spp. is currently classified by the World Health Organization (WHO) as a high (Priority 2) pathogen. As a result, establishing minimum inhibitory concentrations (MIC) according to the latest guidelines may prove effective in treating typhoid fever and minimizing the rising threat of drug resistance.

After the eradication of smallpox (SPX), a new zoonotic threat that can trigger outbreaks has emerged. It may be fatal during the COVID19 outbreak. Humanity continues to be threatened due to re-emergence of the outbreaks. In most cases, new emerging viral agents originate from nonhuman hosts with zoonotic origins. Recent outbreaks of zoonotic infectious diseases with the potential to cause epidemics and pandemics continue to pose a major threat to the health security of entire regions, continents, and the world at large. Around five decades backthat Monkeypox (MPX) was reported for the first time in the Democratic Republic of the Congo (DRC) and was then confined to Central Africa only. Over the time, it has spread to other regions of Africa as well as outside Africa. As of August 2022, 40398 infections have been confirmed in almost 68 countries that have never reported MPX before. The majority of infections have been reported in Europe and Southeast Asia. On 23rd August 2022, MPX was declared a public health emergency of international concern, a step below declaring any disease as a pandemic. The article discusses the recent history of MPX outbreaks, as well as the evolving clinical manifestations of the disease, and the possible causes of the increase in cases, including the cessation of SPX vaccinations.

BACKGROUND:Widespread antibiotic resistance has sparked interest in the identification of nonantibiotic strategies, particularly probiotics for the prevention of recurrent urinary tract infections (UTIs). We evaluated the effectiveness of prophylactic probiotic supplementation through oral and intravaginal routes in the prevention of recurrent UTIs. METHODS:This double-blind, placebo-controlled study enrolled 174 premenopausal women with a history of recurrent UTIs and randomized them to 1 of the 4 treatment groups: placebo (G1, oral placebo + vaginal placebo), oral probiotic (G2, oral lactic acid bacteria and bifidobacteria + vaginal placebo), vaginal probiotic (G3, oral placebo + vaginal lactobacilli), and probiotic combination (oral lactic acid bacteria and bifidobacteria + vaginal lactobacilli), for 4 months. Participants were followed up for symptomatic UTIs for 1 year. The primary end points were the number of symptomatic UTIs at 4 months, the proportion of participants with at least 1 symptomatic UTI, and the time to the first symptomatic UTI. RESULTS:The incidence of UTI at 4 months in G1, G2, G3, and G4 was 70.4%, 61.3%, 40.9%, and 31.8%, respectively. The mean number of symptomatic UTI recurrences at 4 months was significantly lower (P < .05) in G3 (1.06) and G4 (1.07) compared with G1 (2.1) and G2 (1.63). Further, the time to first symptomatic UTI (days) was significantly longer (P < .05) in G3 (123.8) and G4 (141.8) compared with G1 (69.3) and G2 (71.9). Probiotic supplementations were well tolerated with no serious adverse events. CONCLUSIONS:Prophylactic supplementation with either vaginal probiotics or in combination with oral probiotics demonstrated effectiveness in preventing recurrent symptomatic UTI episodes. CLINICAL TRIALS REGISTRATION:Registered at Clinical Trials Registry India (CTRI): CTRI/2014/02/004425 (https://ctri.nic.in).