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Background: Scrub typhus is a zoonotic infectious disease caused by the Gram-negative coccobacillus Orientia tsutsugamushi. Meningoencephalitis occurs in two-thirds of all the infected cases. Aims and Objectives: The study of these cases was conducted to study the clinical, biochemical, and hematological features of scrub typhus meningoencephalitis. Materials and Methods: We included 12 patients who were admitted in the General Medicine Ward of Medical College and Hospital, Kolkata, between May 2021 and July 2022. The serum scrub typhus immunoglobulin M (IgM) test was used to diagnose the cases after ruling out dengue, malaria, leptospirosis, bacterial, tubercular, and viral meningoencephalitis. Results: A triad of fever, altered sensorium, and meningeal signs were present in all of the cases. 2 patients had seizures, 1 patient had lateral rectus palsy, 1 patient had a generalized maculopapular rash, and eschar was seen in only 2 cases. The most common laboratory abnormalities were hyponatremia, anemia, and transaminitis (each 83.33%). 8 cases (66.7%) had a combination of anemia, hyponatremia, and transaminitis. Cerebrospinal fluid abnormalities included protein elevation (75%) and lymphocytic pleocytosis (83.33%). Scrub typhus IgM was positive in all of them. All the cases showed excellent response to doxycycline. Conclusion: A high degree of clinical suspicion is required to diagnose scrub typhus meningoencephalitis. The eschar is detected in very few cases and it may be difficult to recognize the same among the dark-skinned Indian population. However, as per our study, any case of meningoencephalitis with a combination of anemia, hyponatremia, and deranged liver function tests should always raise the possibility of the aforementioned disease and doxycycline therapy must be started promptly. [ABSTRACT FROM AUTHOR]

Background: Snake bite is one of the most neglected diseases in South East Asian region. Common Krait (CK) (Bungarus caeruleus) is the deadliest snake found in the dry zones of India. With the polyvalent anti-venom serum (AVS) remaining the cornerstone of treatment of neurotoxic snake envenomation, there is no universally accepted treatment for CK envenomationassociated neuroparalysis, except supportive measures. Aims and Objectives: Our study was conducted to describe the epidemiology, define clinical features, study outcome, and apparent efficacy of calcium gluconate in preventing or reversing neuromuscular paralysis with respiratory failure in CK bite patients. Materials and Methods: This study is a prospective observational study done on 52 CK bite patients. Patients were enrolled according to inclusion and exclusion criteria and were treated with AVS and calcium gluconate infusion according to National Standard Guideline, 2016. Patients developing severe respiratory muscle paralysis were offered mechanical ventilation. Results: Patients developed ptosis and dysphagia, pain abdomen, cyanosis, paralysis of jaw and tongue, perioral numbness, altered sensorium, dysphonia, ophthalmoplegia, and paradoxical breathing. 21.15% of patients developed respiratory failure and needed ventilator support with average critical care unit stay of 3 days and average stay on a ventilator of 2 days. 3 patients expired (case fatality rate 5.77%). The average hospital stay was 3.33 days. Conclusion: Our study shows that early intervention in patients of CK bite with neurotoxic envenomation, with calcium gluconate infusion, leads to less mortality and morbidity compared to other relevant studies. Further large-scale studies are required for better understanding and implementation. [ABSTRACT FROM AUTHOR]

Background: Mucormycosis is a serious but rare fungal infection with increasing incidence of rhino-orbito-cerebral mucormycosis (ROCM) in the setting of COVID-19. Some studies have shown presence of hypoalbuminemia in cases of mucormycosis, which can affect the prognosis, outcome, and also the drug toxicity in a significant way. A staging of ROCM was proposed and is being used widely based on clinical symptoms and signs, evaluation, and diagnosis. Aims and Objectives: Our objective was to look for any relationship between two factors, occurrence of hypoalbuminemia and severity of ROCM according to staging. Materials and Methods: The study was a hospital-based prospective cross-sectional study done on 41 ROCM patients. All patients of diagnosed ROCM were included by complete enumeration method. Serum albumin of every patient was measured using standard biochemical procedures and patients were divided into groups of normoalbuminemia (Serum albumin level >3.5 gm/dl), mild hypoalbuminemia (Serum albumin level 2.5-3.5 gm/dl), and severe hypoalbuminemia (Serum albumin level <2.5 gm/dl). All the patients were divided into Stage 1, 2, 3, and 4 according to severity of ROCM. Then, the occurrence of hypoalbuminemia was calculated among the patients and correlation between ROCM stages and severity of hypoalbuminemia was measured using standard statistical tools. Results: Among the patients of ROCM, 15% patients did not develop any hypoalbuminemia. About 51% developed mild hypoalbuminemia and 34% developed severe hypoalbuminemia. Maximum number of severe hypoalbuminemia patients were found in the Stage 3 group [total 6 (35%)], but the incidence of the same was maximum in the Stage 4 group (56%). Mild hypoalbuminemia is most common (10) and also most prevalent in the Stage 3 group (59%). Conclusion: We found out that serum albumin level is significantly affected by ROCM severity, that is, more severe the disease, more chance to develop hypoalbuminemia. [ABSTRACT FROM AUTHOR]