Brucellosis, a common zoonosis, is under reported in India despite its endemicity and increased exposure to livestock among the population. This study was conducted to determine the clinical manifestations, antibiotic susceptibility pattern, treatment and outcome of culture confirmed brucellosis. Adult patients with culture confirmed brucellosis who presented to a large teaching hospital in South India between 2009 and 2015 were included. A diagnosis of brucellosis was confirmed on automated culture. Clinical profile, laboratory parameters, drug susceptibility, treatment and outcome were documented by reviewing the medical records. The cohort comprised of 22 patients with mean ± SD age of 42 ± 13 years. Twenty one (95.5%) was male. Thirteen (59%) patients were from rural area and risk of acquisition of brucellosis including occupational exposure or consumption of unpasteurized milk was evident in 16 (72.7%) patients. The mean duration of symptoms before presentation was 54.5 ± 52 days. The commonest clinical presentation was prolonged fever without a definite focus in 18 patients (82%), whereas 2 (9%) patients had osteoarticular involvement and one patient (4.5%) each had genital involvement and endocarditis. Eighteen patients (82%) with uncomplicated brucellosis were treated with aminoglycoside and doxycycline for 6 weeks. There was no relapse or mortality at 18 ± 9 months of follow up. Brucellosis in this cohort had acute or subacute presentation with prolonged fever and bacteremia. High index of clinical suspicion based on significant epidemiological history along with automated blood culture improves the efficiency of diagnosis. Cure with lack of relapse among these cases suggests a combination therapy with doxycycline and aminoglycoside is highly effective for the treatment.

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Introduction The role of NIV in SARS-CoV2 (COVID-19) related acute respiratory failure (C-ARF) is unclear. Methods C-ARF patients managed on NIV were categorised as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as Odds ratio (OR) with 95% Confidence Interval (CI). Results Between 1 st April 2020 and 15 th September 2020, 286 patients, age (Mean, SD) 53.1±11.6 years and APACHE-II score 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe Acute Respiratory Distress Syndrome (ARDS). When compared with NIV success, NIV failure was associated with lower admission PaO 2 /FiO 2 ratio (p<0.001) and higher respiratory rate (p<0.001). On penalized logistic regression analysis, NIV failure was associated with higher APACHE (OR 1.12; 95%CI 1.01-1.24), severe ARDS (OR 3.99; 1.24-12.9), D-dimer ≥1000 ng/ml (OR 2.60; 1.16-5.87), need for inotropes or dialysis (OR 12.7; 4.3-37.7) and nosocomial infections (OR 13.6; 4.06-45.9). Overall mortality was 30.1%. In patients requiring intubation, time to intubation was longer in non-survivors than survivors (Median IQR 5 (3-8) vs. 3 (2-3) days, p<0.001). Conclusions NIV can be used successfully in C-ARF. Illness severity and need for non-respiratory organ support predict NIV failure.

Introduction:Varicella zoster virus is an exclusively human neurotrophic virus. The primary infection with the virus causes varicella. The virus remains latent in nervous tissue and upon secondary activation causes a variety of syndromes involving the central nervous system (CNS) including meningoencephalitis and cerebellitis.Materials and Methods:In this study, we looked at the epidemiology, clinical and laboratory features, and outcomes of patients who were admitted with varicella zoster of the CNS from 2005 to 2014.Results:There were 17 patients. Fever was present in 13 patients, seizures in 9 patients and headache and vomiting in 4 patients each. A generalized varicella rash was present in 8 out of 17 patients. A single dermatomal herpes zoster was present in seven patients. Two patients had no rash. Varicella zoster polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) was done in 5 patients of which 4 were positive and 1 was negative. Nine patients had diabetes with an average glycated hemoglobin of 8.6%. Total number of deaths was five.Conclusions:Patients with diabetes who develop varicella or herpes zoster may be at risk for CNS complications. The diagnosis of varicella encephalitis has to rest on a combination of clinical findings and CSF PCR, as neither the rash nor the PCR is sensitive enough to diagnose all the cases with varicella encephalitis.

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