Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.

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Background and Aims: Escherichia coli is the most common etiological agent in both community acquired and hospital acquired urinary tract infections. Emergence of multidrug resistance (MDR) among E. coli isolates is quite alarming. The aim of this study was to define the current prevalence of MDR and extended spectrum beta-lactamases (ESBL) production among E. coli isolates from urine samples in our hospital. Materials and Methods: Urine samples from 1225 patients were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on to Hi Media Hi chrome agar plates (HiMedia Laboratories Pvt. Ltd., Mumbai, India) and growth showing significant bacteriuria (≥10 ⁵ cfu/ml) were further identified by the standard biochemical procedures and antibiotic sensitivity done as per Clinical and Laboratory Standards Institute guidelines. Detection of ESBL was done by the combined disc method. Percentage of antibiotic resistance and sensitivity and Chi-square test were used. Results: Out of 1225 samples processed, significant bacterial isolates were obtained in 357 (29.1%). The total number of E. coli isolated were 179 (50.1%) of which multidrug resistant E. coli isolates were 148 (82.6%) and 71 (39.66%) were ESBL producers. High degree of resistance was observed to amoxycillin (93.2%) and amoxycillin-clavulanic acid (90.5%). More than 80% sensitivity was seen only to imipenem (98.4%), amikacin (83.3%) and nitrofurantoin (86.6%). Conclusion: Multidrug resistant strains of E. coli are widely prevalent in the community. Antibiotics like imipenem require hospitalization, parenteral administration, drug monitoring for toxicity, all of which incur high cost to the patient and have to be used judiciously.

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Strong evidence supports the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF) to prevent endotracheal intubation (ETI) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and immunocompromised patients. However, weaker evidence supports NIV used in acute respiratory distress syndrome (ARDS) and ARF due to community-acquired pneumonia (CAP) in immunocompetent patients owing to high rates of treatment failure. In all patients, NIV should be applied under close monitoring for signs of treatment failure and, in such case, ETI should be promptly available. A trained team, at an appropriate location, with careful patient selection and optimal choice of devices can optimize NIV outcome. In this short review we examine past and more recent literature regarding the use of NIV in ARF due to CAP, discussing the application of both continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).

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Exacerbations are significant events in the course of bronchiectasis. Exacerbations are associated with accelerated lung function decline and deterioration in quality of life (QoL). Prevention of exacerbations is therefore one of the key objectives of management of bronchiectasis. A few treatments have been proven to reduce the risk of exacerbations, but these include the treatment of underlying causes of bronchiectasis and the use of prophylactic antibiotic therapies (macrolides and inhaled antibiotics). Nonantibiotic therapies, such as airway clearance and pulmonary rehabilitation, also play an important role in the prevention of exacerbations. Acute exacerbations are treated with antibiotics directed against the known bronchiectasis pathogens and guided by previous sputum culture results. This emphasizes the importance of screening sputum cultures in stable patients. Assessment of severity is used to determine whether patients should be treated at home or in hospital. Supportive therapy for exacerbations should include airway clearance alongside oxygen, hydration, and treatment of bronchospasm as required. Bronchiectasis is a rapidly developing field and new therapies, both for the prevention of exacerbations and the treatment of acute exacerbations, are currently being developed.

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Gastrointestinal tract infection with CMV can occur from mouth to anal canal. In the immunocompetent subjects, the upper GI tract is most commonly involved while immunocompromised individuals have colon as the most common site of involvement. In a study of CMV infection among AIDS patients, the most common site of CMV infection in the GI tract was the colon (55%), while gastric involvement was reported in 40% of cases. CMV mononucleosis, hepatitis and pneumonitis are among the most common manifestations.' GI tract involvement is common and it is easy to access for taking the diagnostic biopsies. Severity and extent of involvement within the GI tract is variable.

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In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.

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Community-acquired pneumonia (CAP) is a frequent infectious disease that can be usually treated in an ambulatory setting. A small percentage of these cases require hospitalization and yet it is the leading infectious cause of hospitalization and death in some countries. A number of these infections is caused by gram-negative bacteria (GNB), which have repeatedly been found to bear an adverse prognostic potential. Its incidence is variable (0-9%) and some species carry a special pathogenicity. Enterobacteriaceae in these studies were more commonly isolated than P. aeruginosa while Acinetobacter spp. and B. cepacia were only occasionally described. The present review has the aim to update the current knowledge about the etiology, classifi cation, antimicrobial resistance, diagnosis, and therapy in CAP due to GNB.

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Neoscytalidium dimidiatum is a plant pathogen capable of causing infection in humans. The infections are generally indolent and found in the nails and skin. Corneal infection due to this fungus is rare. A case of keratitis caused by Neoscytalidium dimidiatum in an adult male resulting from trauma to the eye is reported.

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We present the case of necrotizing pneumonia in a young patient without chronic comorbidities, who presented a torpid with subsequent death, highlighting in this case, subacute evolution, as well as the isolation of Staphylococcus epidermidis coagulase-negative resistant to vancomycin, acquired in the community, which finally resulted in a poor prognosis. The importance of the tomographic image is emphasized, as well as the evaluation for chest surgery, as it is important invasive surgical management or chest, coupled with broad-spectrum drugs according to targeted crops or pleuropulmonary expectoration secretions.

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Background and Aim: Prevalence of sexually transmitted infections (STIs) shows regional variations. Various epidemiological studies report a diminishing prevalence of syphilis including other bacterial STIs and a rising incidence of viral STIs. However, a resurgence of syphilis has been observed and reported. The aim of our study was to find out the trends of syphilis among blood donors in Bastar region. Materials and Methods: This study was carried in a blood bank, attached to the Government Medical College in Bastar region, Chhattisgarh. This was a retrospective study. A total of 12,680 blood donors were screened for syphilis during 3 years (from 2011 to 2013) by Syphichik Rapid Dipstick test (Modified Treponema pallidum hemagglutination assay) and data was analyzed with respect to sero-reactive cases. Results: Out of 12,680 blood donors screened for transfusion transmitted infections, 134 donors were sero-reactive for syphilis, five donors had co-infections syphilis and hepatitis B infections, while four donors had syphilis with human immunodeficiency virus (HIV) infections. Prevalence of syphilis was more in replacement donors than voluntary donors and was in raising trend. Conclusions: Prevalence of syphilis among blood donors was in raising trends in this region and was more in replacement donors. The most common co-infections in our study were syphilis with hepatitis B infection, followed by syphilis with HIV infection. Increasing prevalence of syphilis among the donors underscores the concern about growing infection of this disease in the community as these blood donors represent the highly selective community. Proper counseling prior to blood donation, brief medical examination of blood donors and awareness about syphilis among blood donors may increase the safety of blood as well as community.

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Background and Objectives: Trachoma is the most common cause of infectious blindness worldwide and despite various control programs, it persists, leads to significant ocular morbidity. In this article, we aim to determine the burden of trachoma and its related risk factors amongst the urban and rural populations of Sagar, Madhya Pradesh. Materials and Methods: Rapid assessment for trachoma was conducted in urban and rural Community Health Center (CHC) of Bundelkhand Medical College, Sagar according to standard World Health Organization guidelines. An average of 60 children in rural CHC and 50 children in urban CHC aged 1-10 years was assessed clinically for signs of active trachoma with status of hygiene. Additionally, all adults above 15 years of age in these centers community were examined for evidence of trachomatous trichiasis (TT) and corneal opacity. Environmental risk factors contributing to trachoma like limited access to potable water and functional latrine, presence of animal pen, hand wash and garbage within the urban and rural CHCs populations. Results: Overall, 18 of 110 children (16.36%; confidence interval [CI]: 9.5-23.2) had evidence of follicular stage of trachoma and 12 children (10.91%; CI: 5.2-16.6) had evidence of intense trachomatous inflammation intense and scarring stages trachomatous scarring of trachoma. Nearly 19 (17.27%; CI: 10.3-24.2) children were noted to have unclean faces and 17 (15.45%; CI: 8.8-22.1) children were found with unclean hands in both the centers. TTs & TO was noted in 19 adults (1.05%; CI: 0.8-1.2). The environmental sanitation was not found to be satisfactory in the study centers mainly due to the co-habitance of people with domestic animals like pigs, hens, goats, dogs, etc., in most (66.67%) of the person households. Conclusion: Active trachoma and trachomatous trichiasis were observed actively in both urban and rural populations wherein trachoma surveillance and control measures are needed.

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Background: In the USA, up to 2 million health-care-associated infections (HAIs) per year are reported, of which 80,000 are lethal. Materials and Methods: This was a hospital-based observational (retrospective) study. Results: Hospital-wide rate of HAI ranges from 0.35 to 1.96 per thousand patients per day. The most common organism observed in the last 5 years is Acenatobacter (88 [27%]) followed by Pseudomonas aeruginosa (73 [22%]). Significant cases in these 5 years were reported from Intensive Care Unit (157 [48%]) followed by medical wards (males and females) (106 [32%]). The common site reported in the present study is catheter-associated urinary tract infection which was significantly higher (CA-UTI) (152 [46%]) followed by ventilator-associated pneumonia (VAP) (66 [20%]). The common organisms reported to cause UTI are P. aeruginosa (22%) followed by Escherichia coli (19%), and the most common microbial agent associated with VAP is Acenatobacter baumannii (48 [72%]) which was found to be significantly higher. The antibiogram of microorganism responsible for HAI was observed, and 56% isolates of Acinetobacter baumannii were sensitive to aztreonam followed by imipenem 54%, ceftazidime 47%, and amikacin 36%. Another common organism reported was P. aeruginosa, and the majority of isolates of this were sensitive to imipenem 79% followed by amikacin 68%, ceftazidime 53%, aztreonam, and ciprofloxacin 49% and least sensitive to meropenem 9%. Most of the Klebsiella pneumoniae strains during the same period were found to be sensitive to imipenem 94% followed by piperacillin/tazobactam 71%, amikacin 69%, cefepime 59%, and ceftriaxone 56% and least sensitive to nitrofurantoin 11% only. Conclusion: HAI is a big threat for patients' safety and prolongs patients' stay and cost of health care, so effective utilization of hospital data is crucial for prevention and control.

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Background and Objectives: Antitubercular drugs just like other drugs used in clinical practice are not free from ADRs(Adverse drug reactions).The added problem is that combination of drugs are used for prolonged periods of time. Moreover the ADRs to drugs used is one of the major reasons for patient default, hence leading to emergence of resistant organisms. Identification of the ADR profile of drugs in a hospital setup can be useful for the prevention, early detection and management of ADRs. 1) We aim to study the demographic profile of patients receiving Antitubercular therapy. 2) To identify the pattern and incidence of ADRs in the intensive phase Antitubercular therapy following DOTS strategy. Materials and Methods: A descriptive longitudinal study conducted for twelve months at tertiary care hospital in Eastern India. All the adult T.B. patients attending the outpatient department from January 2015 till December 2015 were included as per the study criteria and were monitored for ADRs. The data were evaluated for patient demography, type of DOTS treatment, type of ADRs and Organ site/system affected. ADRs were then subjected to severity assessment as per Hartwig scale.Statistical analysis was done using statistical software Graf Pad Prism version 4.03 for Windows. Results: Out of 296 patients, majority were males (59.79%), belonged to the age group of 20-30years(53.37%). Out of 296 patients 196 patients developed 312 detected ADRS mostly reported in the 5th week of DOTS therapy. In 11(5.61%) cases drugs were withdrawn, 21(10.71%) cases drugs were reduced and remaining 164 (83.67%) cases drugs were continued in original dose. Among them 164 cases received symptomatic treatment. The most common organ system involved was G.I.T. The most common type of ADR was nausea and vomiting (23.07%). On evaluation of severity assessment showed that most of the patients ADRs were of mild level-1(79.39%). Conclusion: Regular ADR monitoring is required to reduce morbidity and development of multiple drug resistance among patients with ADRs and also to improve patient compliance.

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An increasing prevalence of pneumonia caused by drug-resistant pathogens (DRPs) has been identifi ed. The 2005 American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines proposed the health care-associated pneumonia (HCAP) model in order to identify an increased risk of DRPs in patients coming from the community. These patients are known to have a worse prognosis, mostly due to poor functional status and treatment restrictions. New useful scores have been developed to help physicians in predicting DRPs. This manuscript is a review of currently published literature concerning the impact of CAP caused by DRPs and the different predictive models available.

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Human infection with Lophomonas sp. a protozoan that parasitizes the intestinal tracts of termites and cockroaches is extremely rare; also clinical features are not fully understood. China is the country with the majority of cases reported in the literature. Here, we reported a case of Lophomonas sp. infection confirmed by tracheal aspirate on the microscopic observations. The patient was a 49-year-old male from a jungle city called "Madre de Dios" where he works as taxi driver and stonemason. He was admitted to the Intensive Care Unit on February 5, 2013, because the course with respiratory failure and hypoxemia, high fever, and generalized myalgias. The patient was successfully treated by metronidazole 500 mg t.i.d. for 17 days. This is the first case report of Lophomonas sp. in Madre de Dios city in Peru.

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The recent upsurge of Zika virus infection has alarmed public health officials because of its possible association with thousands of suspected cases of microcephaly, thereby sparking a public health emergency. This mosquito-borne arboviral disease majorly remains asymptomatic. Unavailability of specific prophylaxis or vaccines or treatment necessitates the need to advocate preventive personal measures to get protected from these daytime bitters. Prevention and control measures should be aimed at reducing the vector density and minimizing the vector-patient contact.

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Background and Objective: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB, has become a significant public health problem globally. In spite newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from the disease. The present study was aimed to study the prevalence of initial drug resistance and the treatment outcome at the end of 6 months in TB patients attending a dedicated TB outpatient department (OPD) in North India. Materials and Methods: A cross-sectional, observational study was carried out on 100 patients of newly diagnosed pulmonary TB with or without glandular involvement attending TB OPD of a tertiary care hospital over a period of 6 months. Results: Culture positivity was encountered in 82% of the cases, while 14% were smear positive though culture negative. Out of all culture positive patients, 56.1% were susceptible to all antitubercular drugs, while 43.9% were resistant to one or other antitubercular drugs (isoniazid, rifampicin, streptomycin or ethambutol). Of the 46 drug-susceptible cases, 93.48% got cured, while 2.2% defaulted and 2.2% had treatment failure. About 86.1% of the 36 initial drug resistant were cured with 2RHZE/4RH, while 5.6% (n = 2) defaulted treatment and 8.3% were treatment failures. Conclusion: Treatment outcomes of this small group of drug-resistant pulmonary TB patients treated with the standardized regimen was encouraging in this setting. Close attention needs to be paid to ensure early identification of drug-resistant cases; good laboratory methodology and quality control measures; regular supply of quality antitubercular drugs; adherence to the prescribed regimen; effective patient education and counseling; and to the timely recognition and treatment of adverse drug reactions for better treatment outcome.

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Bronchiectasis is a common progressive respiratory disease characterized by exacerbations and recurrent chest infections with high morbidity and reduced quality of life. Cole's vicious cycle model explains the evolution of this disease, in which an initial insult in the bronchi, often on a background of impaired mucociliary clearance or bactericidal activity, results in persistence of microbes in the sinobronchial tree and microbial colonization. Microbial overgrowth then causes infection and chronic inflammation, resulting in tissue damage, and impaired mucociliary motility. Subsequent antimicrobial treatments, microbiota interactions, and hypermutation can favor the development of resistance and the appearance of multidrug-resistant (MDR) bacteria. In this paper, we summarize the current knowledge on how bacteria become MDR in noncystic fibrosis bronchiectasis, and which are the most common bacterial pathogens, excluding Mycobacteria.

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Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for a great morbidity and mortality worldwide. It is known that poor outcome in CAP patients is not only directly related to pneumonia but also to comorbidities both during hospitalization and long term after discharge. Evidences show a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs), such as acute myocardial infarction, arrhythmias, congestive heart failure, and stroke. The excessive systemic inflammatory response is responsible for hypoperfusion and activation of cytokines causing endothelial dysfunction, pro-coagulant effects, and atheroma instability. An established diagnostic tool to identify high-risk patients is not yet available, but cardiovascular biomarkers seem to be more effective than inflammatory molecules. Early identification of patients at higher risk for CVEs is mandatory to treat them effectively with prophylaxis medications, to establish adequate clinical surveillance and prevention with vaccinations. The present article reviews the epidemiology, pathophysiology, clinical presentation, risk factors, diagnosis, outcomes, and prevention of CVEs in patients hospitalized for CAP.

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Background: Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients. Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer serological techniques like ß-D-Glucan Assay and Galactomannan assay are used in diagnosis and monitoring therapy in such patients. Aim: To early diagnose Invasive pulmonary aspergillosis and to decrease mortality. Methods: A total of 150 patients of hemato-oncological malignancies were prospectively enrolled intostudy. Results: Only 10 (6.6 %) patients developed invasive pulmonary aspergillosis and mortality was 30%.Patients were treated medically with never azoles and echinocandin antifungals, with long term survival in seven patients and early mortality in rest of patients. Conclusion: IPA is a difficult infection to treat in immucompromised state. It needs very high degree of suspicion to diagnose. Sick patients should be treated with combination antifungal of different mechanisms at outset and therapy should be continued for six months.

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Background and Objectives: Hepatitis, a condition with liver inflammation, mostly follows hepatitis virus infection of different types A, B, C, D, and E. Each year, numerous outbreaks of hepatitis virus are being reported from around the country, more so from the “Empowered Action Group (EAG) States.” The present outbreak investigation was performed in Odisha, India to study the epidemiology, explore the reasons behind it, and suggest preventive measures for the future. Materials and Methods: A team consisting of public health doctors from All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India investigated the hepatitis E outbreak as per standard guidelines in one of the villages of Tangi block in the state of Odisha, using a questionnaire between January 1, 2015 and January 15, 2015. The data were entered and analyzed in Microsoft Excel 2007. Time, place, and person analysis were performed for all case patients. Result: Hepatitis E outbreak occurred between November 16, 2014 and January 1, 2015, affecting 22 individuals. The attack rate was 44/1,000 in the population and young males were mostly infected. Spot map of the outbreak probably points toward point source epidemic. Most of the infected cases had visited allopathic doctors as well as traditional healers. Less than 50% people had some knowledge about the prevention and control of hepatitis virus infection. Open defecation was highly prevalent in the village. The well was the commonest source of drinking water and the condition of wells was non-sanitary. Less than 2% started hand-washing after the end of the outbreak in the community. Conclusion: Focus of outbreak investigation should not restrict only to immediate control but should rather lead to intervention by the health system in the area for construction of community toilets, improved drinking water facilities, and sustained information, education, and communication (IEC) activities to promote personal hygiene and water safety behavior in the community.

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Background and Objectives: Although tuberculosis (TB) is a notifi able disease in India, most of the cases of TB are either not recorded or reported. Among diagnosed cases, for improving reporting, proper feedback on referral outcome needs to be ensured to all health care providers who refer cases to the public health system. Materials and Methods: All the received feedbacks for TB patients referred for treatment from July 2013 to December 2013 were analyzed. Feedback reports including referral date, the age and sex of patients, type of disease, and date of treatment initiation were examined. Results: Of the total 1,259 referred TB patients during the study period, feedback was received for 54% of them. Only 42.3% (n = 532) of the referred patients were successfully linked at the treatment facility. Seven (0.6%) referred patients died before the initiation of treatment while 3.7% migrated, 2.4% gave the wrong address, 1.0% started private treatment, and 0.6% were nontraceable; in 3.2% cases only was the TB number given. Feedback was signifi cantly associated with sex, age group, type of treatment, disease type, and place of residence. Conclusion: The feedback received for referred patients was poor and for improving the care of TB patients, there is a need to strengthen the feedback mechanism in Revised National Tuberculosis Control Programme (RNTCP) for referred patients.

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