No abstract

A bstract Key Points (1) Diabetes, hazardous alcohol use, and/or significant heart disease are more likely to develop a critical illness with melioidosis. (2) Pneumonia is the most common presentation. Those with pneumonia or bacteremia are most likely to require intensive care unit admissions. (3) Culture is the mainstay for the diagnosis. However, it is noted that Burkholderia pseudomallei is often wrongly identified as Pseudomonas or other Burkholderia species by commonly available commercial techniques. (4) Therapy consists of an intensive phase with intravenous antibiotics to prevent mortality followed by an eradication phase with oral antibiotics to prevent relapse. (5) Meropenem is the drug of choice for those with septic shock or neurological involvement. For patients with nonpulmonary organ focal sites of infection (neurologic, prostatic, bone, joint, cutaneous, and soft tissue melioidosis), the addition of trimethoprim-sulfamethoxazole (TMP-SMX) to ceftazidime/carbapenem during intensive therapy is recommended. TMP-SMX is the drug of choice for oral antibiotic therapy during the eradication phase. (6) Adequate source control is essential for successful treatment and to prevent relapse. (7) The use of granulocyte-colony stimulating factor (G-CSF) those with septic shock is controversial. How to cite this article Sridharan S, B Princess I, Ramakrishnan N. Melioidosis in Critical Care: A Review. Indian J Crit Care Med 2021; 25(Suppl 2):S161–S165.

A bstract Introduction: Invasive candidiasis (IC) is a major cause of morbidity and mortality in critically ill patients in the intensive care unit (ICU). In this study, we aim to analyze the clinical profile, species distribution, and susceptibility pattern of patients with IC. Methods: Case records of non-neutropenic patients ≥18 years of age with IC between January 2016 and June 2019 at a tertiary care referral hospital were analyzed. IC was defined as either candidemia or isolation of Candida species from a sterile site (such as CSF; ascitic, pleural, or pericardial fluid; or pus or tissue from an intraoperative sample) in a patient with clinical signs and symptoms of infection. Results: A total of 114 patients were analyzed, out of which 105 (92.1%) patients had bloodstream infection (BSI) due to Candida and 9 (7.9%) had IC identified from a sterile site. Central line-associated blood stream infection (27 patients, 23.6%) and a gastrointestinal source (30 patients, 26.3%) were the most common presumed sources for candidemia. The commonest species was Candida tropicalis 42 (36.8%), followed by Candida glabrata 20 (17.5%). Serum beta-D-glucan (BDG) was done only in 32 patients of the 114 (35.3%); among those who were tested, 5 (15.6%) had a BDG value of less than 80 pg/mL despite having Candida BSI. Fluconazole sensitivity was 69.5% overall. At 14 days after diagnosis of IC, 49.1% had recovered, with the remainder having an unfavorable outcome (32.4% had died and 18.4% had left against medical advice). Clinical significance: IC is a major concern in Indian ICUs, with a satisfactory outcome in only half of our patients. Serum BDG is a valuable test to diagnose blood culture-negative IC, but more studies are needed to determine its role in the exclusion of IC, as we had a small minority of patients with negative tests despite proven IC. Conclusion: We recommend sending two sets of blood cultures and serum BDG assay for all suspected patients. Initiating empiric antifungal therapy with an echinocandin is advisable, in view of increasing azole resistance and the emergence of Candida auris , with de-escalation to fluconazole for sensitive isolates after clinical stability and blood culture clearance. How to cite this article: Sridharan S, Gopalakrishnan R, Nambi PS, Kumar S, Sethuraman N, Ramasubramanian V. Indian J Crit Care Med 2021;25(3):267-272.

Aim: During the second wave of the COVID 19 pandemic, a life threatening fungal infection, mucormycosis have been detected in patients post COVID 19 disease. Commonly known as the ‘black fungus’ can causes tissue necrosis, inflammation and necrosis of the head and neck regions, paranasal sinuses, facial bones, orbits and it can also cause intracranial spread. In the current study we describe a series of cases of COVID 19 associated mucormycosis (CAM), the clinical presentations, risk factors, diagnosis, management and follow up experience from a tertiary care centre in India. Methods: This is a retrospective observational study conducted over a period of one year (April 2021 to April 2022) at our tertiary care centre. The diagnosis of COVID 19 was done by RT PCR (reverse transcription-polymerase chain reaction). The diagnosis of Mucormycosis was done by Histopathology and fungal cultures. The demographic details of the patients were retrieved from the medical records. Results: In the present study we report four cases of Rhino-orbital-cerebral Mucormycosis, three cases of Rhino-orbital Mucormycosis, two cases of Pulmonary Mucormycosis and one case of Disseminated Mucormycosis. All the patients had undergone extensive surgical debridement and received Liposomal Amphotericin B as initial antifungal medication and Posaconazole or Isavuconazole as step down therapy. Six patients responded to treatment while four patients did not have a favorable outcome and succumbed to the illness.   Conclusion: Mucormycosis is a deadly disease with high mortality and morbidity if not diagnosed and treated at an early stage. Factors like poor control of blood sugars, inadvertent use of corticosteroids, immune dysfunction due to COVID 19 can result in poor outcome of the disease despite aggressive treatment interventions.

No abstract