Background: There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave. Aims: Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era. Methodology: Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis. Results: There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%. Conclusion: Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.

Introduction:Tuberculous meningitis remains a major health issue in the community affecting young adults of both genders predominantly from rural background. In India, the disease continues to kill 2 people every 3 min or nearly 1000 daily, according to the Tuberculosis Control Society India. Tuberculosis (TB) of central nervous system (CNS) is the most devastating form of TB. As this disease is associated with very high prevalence in young adults and will ultimately contribute to great workforce loss, we decided to assess the factors deciding the disease and its course in our patients.Patients and Methods:Seronegative patients with probable CNS TB and attending our outpatient department were included and followed up for 2 years.Results:Low body mass index, low proteins, albumin, and low CD3 and CD4, pulmonary TB appears to be a common denominator in a vast majority of these patients. Delay in diagnosis and hyponatremia contributes to morbidity. The location of exudates causes morbidity when they are seen in optochiasmal region. Bacille Calmette–Guerin (BCG) vaccination status in the community appears to be very small.Conclusion:CNS TB causes considerable morbidity and mortality in rural young adults resulting in severe manpower loss. Awareness into the possible role of BCG in reducing the complications of TB, role of nutrition and immunity even in seronegative patients and high-degree suspicion in medical professionals can bring down the burden of this deadly disease in the society.

As several COVID-19 vaccine candidates approach approval for human use, governments around the world are preparing comprehensive standards for vaccine distribution and monitoring to avoid long-term consequences that may result from rush-to-market. In this early draft article, we identify challenges for vaccine distribution in four core areas -logistics, health outcomes, user-centric impact, and communication. Each of these challenges is analyzed against five critical consequences impacting disease-spread, individual behaviour, society, the economy, and data privacy. Disparities in equitable distribution, vaccine efficacy, duration of immunity, multi-dose adherence, and privacy-focused record keeping are among the most critical difficulties that must be addressed. While many of these challenges have been previously identified and planned for, some have not been acknowledged from a comprehensive view to account for unprecedented repercussions in specific subsets of the population.The logistics of equitable, widespread vaccine distribution in disparate populations and countries of various economic, racial, and cultural constitutions requires careful planning and consideration for global vaccine success. We also describe unique challenges regarding vaccine efficacy in specialized populations including children, the elderly, and immunocompromised individuals [1,27]. Furthermore, we report the potential for understudied drug-vaccine interactions as well as the possibility that certain vaccine platforms may increase susceptibility to HIV infection [77,14]. Given these complicated issues, the importance of privacy-focused, user-centric systems for vaccine education and incentivization along with clear communication from governments, organizations, and academic institutions is imperative. These challenges are by no means insurmountable, but require thorough consideration to avoid consequences that span a range of disease-related, individual, societal, economic, and security domains.