A B S T R A C TObjectives: To describe the direct cost of illness in pediatric and adult inpatients at a referral hospital in India. Methods: Inpatients who tested positive for dengue were identified in the hospital records of a single private non-profit hospital over a period of 1 year and line-listed. Hospital discharge bills were obtained for pediatric and adult patients and the median costs by severity of illness for bed and treatment were estimated. Costs were also converted to US dollars (1 USD = 64.6 Indian rupees (INR)). Results: The median and interquartile range (IQR) direct costs for pediatric dengue without warning signs, dengue with warning signs, and severe dengue were 179.80 (IQR 85.51-428.51) USD, 145.06 (IQR 90.89-321.86) USD, and 933.51 (IQR 400.50-1117.43) USD, respectively. The median and IQR direct costs for adult dengue without warning signs, dengue with warning signs, and severe dengue were 312.75 (IQR 174.55-531.03) USD, 287.22 (IQR 210.96-389.34) USD, and 720.39 (IQR 389.23-1035.51) USD, respectively. Conclusions: Children and adults with dengue incur high costs when hospitalized for dengue. Since most medical costs in India are out-of-pocket expenses, these illnesses can impact households.

Anthrax is a zoonotic disease and is caused by Bacillus anthracis which is a Gram-positive, nonmotile, spore-forming rod, found in soil. The spores can remain viable for decades. Transmission occurs naturally in humans by direct contact with infected animals or the contaminated animal products. Anthrax is a major health problem in eastern and southern India, with a significant human incidence because the disease is poorly controlled. Here, we discuss such a case of naturally occurring fatal anthrax in North-East India. A 48-year-old man from Assam presented with seizures, hematemesis, and fever. Apart from altered mental status and nonreactive pupils, his cutaneous and systemic examination was unremarkable. Noncontrast computed tomography head showed multiple hemorrhages. Blood and cerebrospinal fluid showed heavy growth of anthrax Bacilli. He was started on specific antibiotics after the reports, but unfortunately, the patient succumbed to infection. Due to high prevalence of anthrax in the endemic regions, a high degree of suspicion is required to clinch the diagnosis. Early initiation of therapy before developing the intracranial hemorrhagic complications might result in a better outcome. Careful history for a possible exposure to animal carcass or a suspected animal death due to anthrax will also help in early diagnosis of the disease and effective therapy.