Dengue fever is an arthropod-borne viral haemorrhagic fever. Suspected dengue patients admitted in the of School of Tropical Medicine, Kolkata were taken as a case after considering inclusion and exclusion criteria. Aim of this study was to determine the effect of doxycycline in course and final outcome of dengue fever. Selected patients were subjected to history, examination, necessary investigations and then were managed according to NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) guidelines. A total of 24 serology proven dengue patients were included and followed up. Two groups (twelve in each) were allocated by simple random sampling. Treatment group was given doxycycline and control group were given placebo. Age and sex profile were similar in both groups. 75% of patients in treatment group had no bleeding with no patients having major bleed; where in control group 25% of had major bleeding. Plasma leakage were less in treatment group (25%) as compared to control group (58.3%). Hemodynamic compromise was more in control group (16.7%) as compared to treatment group (8.30%). 41.70% of patients in treatment group had no thrombocytopenia in comparison to control group (16.70%). Also, only 8.30% of patients had platelets below 10,000/cmm in treatment group where it is 16.70% in control group. Platelet transfusion was necessary in 8.30% of treatment group patient in comparison to 16.70% of control group patients. Liver involvement in control group was more in comparison to treatment group. Control group has pancreatic involvement in 16.60% of patients; renal involvement in 8.30% of patients; cardiac involvement in 8.30% of patients. Whereas no pancreatic, renal or cardiac involvement were seen in treatment group. An initial report of this study showed significant reduction in complications of dengue fever in respect to different organ involvement when treated with doxycycline.

A number of cases of mucormycosis, often fatal, were reported among severe COVID-19 patients from India as well as from some other parts of the world. However, specific immunocellular mechanisms that underlie susceptibility to this fungal infection in COVID-19 remain largely unexplored.

Dengue fever is an important viral hemorrhagic fever amongst the arthropodborne virus illnesses. Dengue suspect patients admitted in the School of Tropical Medicine, Kolkata after being screened for inclusion and exclusion criteria and taken as a case. Objective of the study was to evaluate the detailed clinical picture, laboratory parameters, complications of Dengue fever, its outcome and epidemiological profile. After detailed history, clinical examination and necessary investigations patients were managed according to NVBDCP guidelines. In this study, a total of 103 dengue IgM ELISA positive or Dengue NS1Ag ELISA positive or both patients were included and analyzed. Amongst clinical manifestations most of the patients had myalgia (85.4%), followed by rash (56.3%), vomiting (37.9%) and arthralgia (24.3%). Bleeding manifestations were noted in 37% of patients. 21% of the patients had plasma leakage. Only 13% patients had hypotension which was corrected by only volume replacement in 9% patients. In LFT 85.43% patients showed raised SGOT, 67.86% showed raised SGPT and only minority (1.9%) had raised bilirubin level. SGOT>SGPT were present in 83% patients. In analysis of SGOT elevation 2-5-fold elevation was common (62%). But in analysis of SGPT elevation 2-5-fold elevation and 1-2-fold elevation were comparable. In making a diagnosis 41% cases Dengue IgM was helpful followed by 35% for Dengue NS1Ag and only 1/5th of patients had both tests reactive. Platelet values and days counted from the onset of fever were followed and no specific association was noted. 13.4% of patients had pancreatic involvement and all of them had remarkable/significant lipase elevation than amylase. In our study, some new clinic-biochemical parameters were noted in hepatic, pancreatic involvement, sero-diagnosis, bleeding patterns, platelet count trends and plasma leakage. These should always be kept in mind during an epidemic which would help in managing dengue fever and predicting its outcome.

The present case report is about a 52-year-old hypothyroid female who was brought by family members with history of recurrent episodes of seizures in last ten days with progressively increasing altered behavior for same duration. There is history of recent, remote memory loss associated inability to carry out activities of daily living. Amongst medical co-morbidities she is hypothyroid (on regular thyroxin replacement 75 mcg/day). Upon neurological examination GCS was 10, no meningeal signs, no cranial nerve palsy, power 3/5 in all four limbs with normal tone. Pupils are bilaterally symmetrical and normally reacting to light, plantar bilateral flexor, deep tendon reflexes are normal. No sensory loss, no meningeal or cerebellar signs, no cranial nerve palsies. Fundus was normal. At admission, complete hemogram, fasting blood sugar, electrolytes, kidney function tests and liver function tests were normal. CSF study at admission had 62 cells with all lymphocytes, protein of 151 mg/dl with sugar of 76 mg/dl. HIV, HBsAg, Anti-HCV-nonreactive. ANA (Hep2 method)-negative, ANA profile-negative. CSF and serum VDRL were negative. Thyroid profile revealed euthyroid state. Anti-Thyroid peroxidase (TPO) Antibody-431.8; (normal<35). Anti-TG antibody-negative. Anti-NAE autoantibodies were positive. VGKC Ab, NMDA receptor Ab A 52-year-old hypothyroid presented with episodes of seizures in last ten days with altered behavior. CT scan of brain showed cerebral atrophy and MRI of brain revealed non-specific changes. In EEG, there was slow wave pattern. CSF study showed increased cell count with all lymphocytes and raised protein with normal glucose. Anti-TPO Antibody was positive. All relevant investigations like HIV, HBsAg, Anti-HCV Ab, ANA (Hep2 method), ANA profile, P-ANCA, c-ANCA, VGKC (voltage gated potassium channel) Ab, NMDA Receptor/Anti-Glutamate Antibody) Ab, VDRL were negative. She was given pulse doses of methylprednisolone followed by maintenance prednisolone. Then her GCS improved followed by sudden deterioration. Repeat CSF showed marginal decrement of protein and cell count. Then she was given IV Immunoglobulin and patient improved. At discharge her CSF study normalized. Anti-TPO Ab titre came to normal level and EEG normalized. Hashimoto's encephalopathy(HE) should be suspected in a case of sub-acute encephalopathy with high levels of anti-thyroid antibodies may be with normal thyroid functions. Here the patient did not have improvement on steroids. The patient needed immunoglobulin to improve.