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) 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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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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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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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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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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Streptococcus pneumoniae causes invasive and noninvasive infections. Among infectious diseases, invasive pneumococcal disease (IPD) is a leading cause of morbidity and mortality in children and adults. Community acquired pneumonia in adults is the main presentation of non-IPD and is the most common infectious source of IPD. The incidence, severity and mortality of pneumococcal disease vary widely depending on several factors, some are host related, and others are organism related. After introduction of the vaccine, rates of pneumococcal disease caused by vaccine serotypes have dramatically decreased among vaccinated children, nonvaccinated children, and adults. However, incidents of pneumococcal disease due to new emerging nonvaccine serotypes and antimicrobial resistance have increased. Continuous monitoring and surveillance studies focused on the clinical and molecular epidemiology of pneumococcal disease will be required to understand the impact of the new vaccines and possible alteration in the pattern of disease presentation.

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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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Background and Objectives: Human immunodeficiency virus (HIV)-related stigma is present at all levels which act as critical barriers for effectively addressing it. This also influences the treatment uptake and under or nonparticipation in treatment available. In view of this, the present study was aimed to assess the stigma of otherwise healthy individuals of the community toward HIV infection/acquired immunodeficiency syndrome (AIDS). Methods: The study was conducted on 100 healthy individuals. Their responses were taken on a self-designed semi-structured questionnaire. Results: The results showed that there is more perceived stigma as compared to enacted stigma. Nearly 46% of the individuals feel that HIV-infected persons should be blamed for their illness and 41% individuals feel that they will feel ashamed if they have HIV. It was also seen that older adults. (between 46 and 55 years) had more stigma as compared to the younger adults (between 16 and 25 years). The educated individuals still have stigma to a certain extent. Most of the individuals would like to tell their partner if they were diagnosed with HIV. Participants were divided into two groups on the basis of their level of education. (<12 years of formal education and >12 years of formal education). Stigma related to HIV/AIDS was compared among these two groups, and there was no significant difference in the level of stigma in these distinctly different educational groups. Conclusion: There is still stigma present to a certain extent in the society in the educated and urban individuals. Level of stigma may not be significantly different in people with educational difference. Stigma needs to be addressed for prevention and better management of HIV/AIDS.

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Background and Aims: Since 1959, treatment of infections caused by S. aureus included semi synthetic penicillin drugs such as Methicillin. Sooner a year later in 1960 Methicillin resistant S. aureus came into existence. Decade after decade the MRSA strains increased and these bacteria were marked as major cause of nosocomial infections in early 1980s. The invasion of MRSA into community is now day's matter of concern for microbiologist. This study was conducted to detect the prevalence of MRSA resistance and to prepare antibiogram of HA-MRSA and CA-MRSA isolates at our hospital. Materials and Methods: A total of 201 staphylococcus isolates were detected as MRSA. They were then separated into two categories i.e. community acquired MRSA (CA-MRSA) and hospital acquired MRSA (HA-MRSA) according prescribed criteria. Antibiogram was prepared by Kirby- Bauer disk diffusion method. Results: Out of 201 isolates, HA-MRSA prevalence was 143(28.6%) and CA-MRSA was 58(11.6%). The HA-MRSA isolates showed were 10- 30% more resistant when compared to CA-MRSA. All isolates were 100 % sensitive to Vancomycin and Linezolid. Conclusion: We strongly suggest that time to time monitoring of MRSA should be done and proper hand wash must be done to avoid spread of MRSA.

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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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Bronchiectasis (BE) is a heterogeneous disease. Similarly, to other chronic airway diseases, such as asthma and chronic obstructive pulmonary disease, management of BE patients requires a specific and personalized treatment that depends on many clinical, functional, and microbiological variables. Therefore, developing phenotyping methods that can help clinical and therapeutic choices is of paramount importance. Various methodological approaches have been used to personalize patients' management. In this review, we explore the main tools identified so far to classify and phenotype BE patients, including the approaches based on BE etiologies, disease severity, cluster analysis, and endotyping. We also discuss the strengths and limitations of every approach and highlight the similarities and differences between these studies. Finally, we review the therapeutic implications and clinical management connected with each approach.

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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 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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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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Bronchiectasis, defined as permanent dilatation of the airways, usually causes chronic cough and sputum production with intermittent bacterial exacerbations. Bronchiectasis can have a severe impact on quality of life for many patients due to these symptoms. Establishing the cause of bronchiectasis may be difficult. Even with exhaustive clinical, laboratory, and pathologic testing, up to 50-80% of cases of bronchiectasis may still be idiopathic. Congenital bronchiectasis is much rarer than previously considered. A variety of respiratory and systemic diseases such as autoimmune or rheumatologic diseases may be complicated by pathological bronchial dilatation, and therefore various medical specialists will be dealing with the condition in one-way or another. Some bowel diseases are associated with a variety of systemic manifestations including large and small airway involvement: One of the most commonly associated airway diseases is bronchiectasis. On this regard, we report five patients with bronchiectasis and rare diseases admitted to our hospitals since 2012. Patients were recruited over a period of 36 months after opening a bronchiectasis outpatient clinic.

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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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In human history, there have been several times of influenza raging, which have caused tens of millions of deaths and brought serious social and economic burdens. Although with the development of science, the emergence of vaccines has significantly reduced the incidence and mortality of influenza, due to the high variability of viruses, there is still a lack of effective treatment. More and more studies have found that bacterial pneumonia secondary to influenza was an important cause of the progression to critical illness or even death. Hence, diagnosis and treatment timely of secondary bacterial pneumonia are valuable. Therefore, we discuss the pathogens of bacterial pneumonia secondary to influenza, associated morbidity, mortality, and risk factors. Hopefully, it can provide some valuable references for clinical practice. Since some clinical studies have not separated pneumonia from lower respiratory tract infections, we will discuss these two situations together.

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Respiratory viruses (RV) have become an important cause of community-acquired pneumonia in immunocompromised patients with the highest rates of morbidity and mortality. The advances in molecular diagnostic methods have increased our understanding of the role of viruses in pneumonia. However, little is known about their impact on patients with human immunodeficiency virus (HIV) infection. In this review, we focus on the most prevalent RV that has been implicated in viral respiratory infections, particularly in pneumonia in HIV infected patients. We discuss the epidemiologic characteristics and clinical presentations of these viral infections and the most appropriate diagnostic approaches and therapies if available.

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Idiopathic CD4 lymphocytopenia (ICL) is a rare entity of immune deficit of CD4+ T cells (below 300/mm³) which was first defined in 1992, unrelated to human immunodeficiency virus (HIV) syndrome without predefined clinical presentation and natural history. The etiology, pathogenesis, and management of ICL remains poorly understood and inadequately defined. The clinical presentation can range from serious opportunistic infections to incidentally diagnosed asymptomatic individuals. Cryptococcal and nontuberculous mycobacterial infections and progressive multifocal leukoencephalopathy are the most significant presenting infections, although the spectrum of opportunistic diseases can be similar to that in patients with lymphopenia and HIV infection. The prognosis is influenced by the accompanying opportunistic infections and response to the treatment. This rare disease invites uncountable opportunistic infections sometimes leading to lethal outcome. We report a case of ICL in an immunocompetent 18-year-old male with a history of intermittent epistaxis, fungal nasal polyp diagnosed to have Rhizopus with drug-induced acute kidney injury during the course of treatment, a rarest diagnosis as underlying main disease entity. To the best of our knowledge, ICL presenting with opportunistic infection of Rhizopus is the first case to be reported here from a tertiary care center of India, a developing country where a major population lives with poor hygiene and low socioeconomic status.

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Emphysematous pyelonephritis (EPN) is a rare form of renal suppuration. It is associated with a high mortality in the absence of rapid and effective treatment. Nephrectomy is suggested as the reference treatment associated to medical treatment. However, medical treatment exclusive is a conservative therapeutic option which is effective and successful in some cases. Many clinical and radiological criteria must be analyzed and gathered; we describe three cases of EPN treated successfully with medical treatment alone in two cases and associated to nephrectomy in one case.

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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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