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Background: Acute Kidney Injury (AKI) posed a dreaded health complication in COVID-19 infection in paediatrics. In this review we systematically documented evidence on AKI incidence and associated death in COVID-19 infection among paediatric populations to aid healthcare workers towards appropriate clinical management. Methods: Documentation on AKI incidence and associated death in COVID-19 infection worldwide in paediatrics in PubMed and medRxiv databases during December, 2019-June19, 2021 was included in this study. Guidelines laid by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed which facilitated clarity and transparency in the reporting. Result: 23 out of 1976 total articles were eligible with mean age of 8.6 years. Database of Abstract of Reviews of Effects (DARE) tool was used for quality assessment. Studies on AKI incidence (19), mortality (19) and AKI related mortality (10) respectively were included for meta-analysis. An estimated AKI incidence of 28.8%with overall death of 2.3% and AKI related death of 5.2% were reported. Overall pooled AKI incidence in the paediatric population was statistically significant. Conclusion: Therefore, aggressive investigation of COVID-19 infection associated with AKI in paediatrics posed a necessity for efficient health-care management. Keywords: Acute kidney injury; Box plot; COVID-19; Forest plot; Meta-analysis

Anaemia is one of the major causes of severe and complicated malaria. Malaria associated anaemia are due to decreased production of RBCs and lysis of infected and uninfected erythrocytes. The role of anti-malarial treatment in correcting anaemia are not studied extensively. The present work was undertaken to study the changing pattern of haemoglobin level following anti-malarial therapy. A total of 201 microscopically positive mono-infected with P. vivax (103) and P falciparum (98) patients were recruited and treated with antimalarial drugs and followed up on day 3, 14, and 28 to study the changing pattern of haemoglobin level. Among the P. falciparum positive patients mean haemoglobin level on Day 0 and day 28 was 13.17 g/dl and 13.31 g/dl whereas among P. vivax cases mean haemoglobin level was 13.28 g/dl and 13.29g/dl, respectively. Among the P. falciparum cases (n = 98), 4.08%, 16.33% and 79.59% was classied as moderate anaemia, mild anaemia and normal, respectively. Similarly, among the P. vivax cases (n = 103), 1.94%, 17.47% and 80.58% had moderate anaemia, mild anaemia and normal, respectively. Mean haemoglobin level was declined on day 3 which gradually increased to its initial level by day 28 among both P. falciparum and P. vivax cases. Similar study in other malaria endemic areas will be helpful for better understanding the changing pattern of haemoglobin level among malaria patients.

Early diagnosis and complete treatment is one of the important aspects of malaria elimination programme worldwide. In many areas the diagnosis is based on detection of malarial antigen using commercially available rapid diagnostic kits. The problem remains with persistence of antigen following parasite clearance by proper treatment. The present work was undertaken to study the pattern of persistent antigen of P. vivax and P. falciparum following antimalarial treatment. Atotal of 300 microscopically positive mono-infected with P. vivax (160) and P. vivax (140) patients were recruited, treated with antimalarial drugs and followed up on day 3, 7, 14, 21 and 28 for persistent parasites and antigen. P. vivax specic pLDH antigen was disappeared from peripheral blood within 14 days post treatment period. P. falciparum specic HRP-2 antigen was persisted even after 28 days of treatment. Depending only on antigen based diagnosis, attention should be paid before treatment, particularly in areas with high malaria transmission

Forbes Albright syndrome is a hyperprolactinemia syndrome characterised by galactorrhea and amenorrhea associated with a pituitary tumour. Here we report a case of 30 years female who was admitted with menstrual irregularities for 4 months, galatorrhea and headache with recurrent episodes of loss of consciousness for 3months. Her serum prolactin level was highly raised. MRI brain (plain plus contrast) showed enlarged pituitary gland- pituitary macroadenoma. She was diagnosed as a case of Forbes Albright Syndrome and was treated with Tablet Cabergoline. With the medication, size of her tumour markedly reduced and symptoms resolved as she was followed up after 3 months.

Background For the past several decades, dengue fever has been emerging in epidemic proportions in several regions of the world. During August-September 2019 increasing number of fever cases were being reported from some area of North 24 Parganas district of West Bengal, India. Accordingly, outbreak investigation of fever cases from these affected areas of Bongoan, Barasat and Habra were carried out. Objective To characterize clinical and biochemical features of fever cases as well as to investigate the utility of CRP as a Dengue severity marker in resource limited settings. Study design We systematically enrolled 108 patients from affected region of North 24 Parganas. Standard diagnostic assays along with routine serological and biochemical parameters were performed. Result Of the 108 patients, 77 (71%) were confirmed with Dengue infection followed by 22 (20%) DENV seronegative and 9 (8%) co-infected DENV cases. Among the 77 confirmed Dengue patients, 53 (69%) had primary infection while 24 (31%) had secondary infection. Among the DENV clinical symptoms, fever (r=0.50; p=0.004), headache (r=0.40;p=0.03) and abdominal pain (r=-0.40;p=0.02) were found to bear significant correlation with DENV viral load. The predominant circulating serotype was found to be DENV2. CRP Dengue severity cut-off level of 10.15mg/L (AUC 0.85; 86% sensitivity, 77% specificity) was obtained. CRP had correlation with viral load (r=0.4, p=0.05) within febrile phase of infection. Conclusion Performance of biomarkers can be influenced by local epidemiology, geography, and several patient factors, therefore, CRP Dengue severity cut off value may be region specific. This study for the first time attempts to estimate CRP Dengue severity cut off value based on routine immunoturbidometric evaluation from Dengue Hyperendemic zones of North 24 Parganas, West Bengal, Eastern India. This article is protected by copyright. All rights reserved.

Dengue fever is an acute viral infection transmitted by arthropods but may evolve to severe clinical manifestations. Descriptions of the role of circulating immune modulators such as cytokines or chemokines in dengue immunopathogenesis have largely relied on data from South-east Asia and America, while India is poorly represented. This study characterizes dengue cases from West Bengal, eastern India, with respect to clinical profile and pro-inflammatory and inflammatory cytokines. We evaluated the profile of both inflammatory and anti-inflammatory cytokines (IFNγ, IL6, IL10, IL12 and TGFβ) and chemokines (IL8, CXCL9, CXCL10 and RANTES) in 100 hospitalized NS1/IgM confirmed Dengue patients during the epidemic in West Bengal during 2017. Additionally, all necessary blood investigations of the study subjects were performed. The patients mostly hailed from Kolkata, followed by Nadia, 24 Parganas (North and South), Murshidabad and Midnapore. The most common presentations apart from fever and bodyache were gastrointestinal symptoms. An elevated levels of cytokines IL6 and IL10 chemokine IL8 and CXCL10 along with decreased RANTES were found in the patients with Severe Dengue as compared to mild forms of dengue (p 0.0001) during 3-6 days of infections. A significant association was obtained between most of cytokine and increased SGPT, haematocrit, albumin and decreased platelet count, whereas a negative correlation with the level of RANTES to haematocrit (r=-0.220 with p = 0.029) was found in severe dengue cases with altered liver function parameters. This is the first study demonstrating cytokine and chemokine association with dengue severity from the eastern part of India. Taken together, this study demonstrated that the altered expression levels of IL6, IL10, IL8, CXCL10 and RANTES had significant associations with dengue severity parameters.

Dengue fever is an arthropod-borne viral haemorrhagic fever. Suspected dengue patients admitted in the of School of Tropical Medicine, Kolkata were taken as a case after considering inclusion and exclusion criteria. Aim of this study was to determine the effect of doxycycline in course and final outcome of dengue fever. Selected patients were subjected to history, examination, necessary investigations and then were managed according to NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) guidelines. A total of 24 serology proven dengue patients were included and followed up. Two groups (twelve in each) were allocated by simple random sampling. Treatment group was given doxycycline and control group were given placebo. Age and sex profile were similar in both groups. 75% of patients in treatment group had no bleeding with no patients having major bleed; where in control group 25% of had major bleeding. Plasma leakage were less in treatment group (25%) as compared to control group (58.3%). Hemodynamic compromise was more in control group (16.7%) as compared to treatment group (8.30%). 41.70% of patients in treatment group had no thrombocytopenia in comparison to control group (16.70%). Also, only 8.30% of patients had platelets below 10,000/cmm in treatment group where it is 16.70% in control group. Platelet transfusion was necessary in 8.30% of treatment group patient in comparison to 16.70% of control group patients. Liver involvement in control group was more in comparison to treatment group. Control group has pancreatic involvement in 16.60% of patients; renal involvement in 8.30% of patients; cardiac involvement in 8.30% of patients. Whereas no pancreatic, renal or cardiac involvement were seen in treatment group. An initial report of this study showed significant reduction in complications of dengue fever in respect to different organ involvement when treated with doxycycline.

Cryptococcal meningitis is a major HIV-related opportunistic infection, occurring when CD4 counts are below 100. Ocular involvement is seen with up to 30% of patients with cryptococcal meningitis. A young HIV infected male was admitted to in patient department of School of Tropical Medicine, Calcutta with complaints of headache for two months with dimness of vision for 10 days. Examination showed decreased visual acuity on both eyes, neck rigidity with right sided extensor plantar reflex, external ophthalmoplegia in the form of left 6th cranial nerve palsy, bilaterally absent light reflex, power 5/5 in all four limbs with normal tone and right eye hypermetropic tilted disc, left eye normal on ophthalmoscopy. India Ink preparation of CSF showed encapsulated budding yeast cells. Fungal culture grows Cryptococcus sp. CSF CRAG (cryptococcal antigen measured by immunochromatographic method) was positive in high titre (1:2560). MRI of brain revealed multiple tiny hypo to isointense lesions on T1 and hyperintense lesions on T2, T2 flair sequences are seen in basal ganglia, peri & paraventricular white matter and centrum semi-ovale on both sides. He was managed with injection amphotericin B deoxycholate along with fluconazole as per WHO recommendations and treatment related complications were managed accordingly. Visual acuity was followed in the entire treatment period but vision did not improve, but GCS improved to 15/15, there was no headache, no neck rigidity. Repeat MRI of brain after three weeks of treatment showed absence of above mentioned lesions. After 12 months of follow up the patient had no perception of light in both eyes and no wave in VEP study of both eyes suggestive of permanent visual loss following cryptococcal meningitis. So, cryptococcal meningitis after completion of treatment may have irreversible visual loss.

A 52-year-old hypothyroid presented with episodes of seizures in last ten days with altered behavior. CT scan of brain showed cerebral atrophy and MRI of brain revealed non-specific changes. In EEG, there was slow wave pattern. CSF study showed increased cell count with all lymphocytes and raised protein with normal glucose. Anti- TPO Antibody was positive. All relevant investigations like HIV, HBsAg, Anti- HCV Ab, ANA (Hep2 method), ANA profile, P-ANCA, c-ANCA, VGKC (voltage gated potassium channel) Ab, NMDA Receptor/Anti- Glutamate Antibody) Ab, VDRL were negative. She was given pulse doses of methylprednisolone followed by maintenance prednisolone. Then her GCS improved followed by sudden deterioration. Repeat CSF showed marginal decrement of protein and cell count. Then she was given IV Immunoglobulin and patient improved. At discharge her CSF study normalized. Anti-TPO Ab titre came to normal level and EEG normalized. Hashimoto’s encephalopathy(HE) should be suspected in a case of sub-acute encephalopathy with high levels of anti-thyroid antibodies may be with normal thyroid functions. Here the patient did not have improvement on steroids. The patient needed immunoglobulin to improve.

Background and objectives The HIV-associated renal diseases represent a spectrum. Indian data on this is sparse. This study was undertaken to find out the prevalence and clinicopathological spectrum of renal involvement in HIV among antiretroviral therapy (ART) naive patients (Group 1) and among those on ART (Group 2). Methods Systematic random sampling was undertaken to select 109 patients each from virology outpatient department (VOPD) and ART centre of a tertiary care hospital. They were screened and further investigated if renal involvement was found. Results Renal involvement was present in 25/109 (22.94%) and 15/109 (13.76%) patients of Groups 1 and 2, respectively. Among patients of Groups 1 and 2, 9/24 (37.5%) and 2/13 (15.4%), respectively, had clinically significant proteinuria, but none in the nephrotic range. Statistically significant relationships of renal involvement were observed with CD4 count

Dengue fever is an important viral hemorrhagic fever amongst the arthropod borne virus illnesses Dengue suspect patients admitted in the School of Tropical Medicine Kolkata after being screened for inclusion and exclusion criteria and taken as a case Objective of the study was to evaluate the detailed clinical picture laboratory parameters complications of Dengue fever its outcome and epidemiological profile After detailed history clinical examination and necessary investigations patients were managed according to NVBDCP guidelines In this study a total of dengue IgM ELISA positive or Dengue NS Ag ELISA positive or both patients were included and analyzed Amongst clinical manifestations most of the patients had myalgia followed by rash vomiting and arthralgia Bleeding manifestations were noted in of patients of the patients had plasma leakage Only patients had hypotension which was corrected by only volume replacement in patients In LFT patients showed raised SGOT showed raised SGPT and only minority had raised bilirubin level SGOT SGPT were present in patients In analysis of SGOT elevation fold elevation was common But in analysis of SGPT elevation fold elevation and fold elevation were comparable In making a diagnosis cases Dengue IgM was helpful followed by for Dengue NS Ag and only th of patients had both tests reactive Platelet values and days counted from the onset of fever were followed and no specific association was noted of patients had pancreatic involvement and all of them had remarkable significant lipase elevation than amylase In our study some new clinic biochemical parameters were noted in hepatic pancreatic involvement sero diagnosis bleeding patterns platelet count trends and plasma leakage These should always be kept in mind during an epidemic which would help in managing dengue fever and predicting its outcome

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH ) is a rare but potentially life threatening conditioncharacterized by uncontrolled activation of CD8+ T lymphocytes and macrophages that leads to organ damage. HLHcan be primary (familial or genetic) and secondary. Secondary HLH occurs due to infections caused mostly by viruses likeEbstein Barr virus, Cytomegalovirus (CMV), Parvo B19 etc. Early diagnosis and treatment is the key to management ofHLH. We present here a case of a 30 year old female who presented with fever, jaundice, cough and progressive weakness of bothlower limbs. There was no girdle like sensation, no bladder/bowel involvement. She was recently diagnosed to be seropositivefor Human Immuno-deficiency Virus (HIV)-1 and had a CD4 count of 27/μL. She had hepatomegaly, pancytopenia, hyperbilirubinemia, hypoalbuminemia, raised liver enzymes and hypertriglyceridemia. CSF had raised protein, reduced sugarand neutrophils. DNA PCR for CMV was positive and there was evidence of CMV disease on fundoscopy. Her bonemarrow revealed presence of haemophagocytes. She was treated successfully with Ganciclovir, Dexamethasone and antiretroviraldrugs and was discharged. Though often fatal and difficult to diagnose, HLH is potentially treatable disorder.

Cryptococcosis is a common opportunistic pathogen in the setting of advanced human immunodeficiency virus (HIV) infection especially with CD4 count less than 50 cells/micro liter and in other immunodeficient conditions such as hematologic malignancies, transplant recipients or in persons on prolonged glucocorticoid and/or immunosuppressant therapy. Disseminated cryptococcosis is uncommon in immunocompetent person. We detected such a case at our institute presented initially with pulmonary mass lesion and later evolving into chronic non-healing skin ulcer and asymptomatic brain involvement without having any evidence of overt immunosuppression. However the patient developed gall-bladder carcinoma about one and half years after her chest complaints. She underwent surgical resection but neither received radiotherapy nor chemotherapy post-surgery. She was treated successfully with anti-fungal combination therapy as per Infectious Diseases Society of America (IDSA) guideline.

Indian post-kala-azar dermal leishmaniasis (PKDL) is a low-frequency (5–10%) dermal sequela of visceral leishmaniasis (VL) caused by Leishmania donovani ; importantly, affected individuals are speculated to be parasite reservoirs. Insight into its immunopathogenesis could translate into rational immunomodulatory therapeutic approaches against leishmaniases. In patients with PKDL ( n =21), peripheral lymphocytes were analyzed for surface markers, intracellular cytokines, and lymphoproliferative responses using flow cytometry. In lesional tissue biopsies ( n =12), expression of counter-regulatory cytokines (IFN-γ and IL-10) and the T-regulatory transcription factor forkhead box protein 3 (Foxp3) was analyzed using reverse transcriptase-PCR, along with immunohistochemical detection ( n =8) of CD3 and Foxp3 positivity. In patients with PKDL, circulating CD8 + CD28 − and antigen-induced IL-10 + CD3 + lymphocytes were increased and receded with treatment. CD8 + lymphocytes showed impaired proliferative responses to L. donovani antigen (LDA) and phytohemagglutinin, which were reinstated after treatment. At presentation, the upregulated lesional IFN-γ and IL-10 messenger RNA (mRNA), Foxp3 mRNA, and protein were curtailed after treatment. In Indian patients with PKDL, increased frequency of the CD8 + CD28 − phenotype, enhanced antigen-specific IL-10 production, and accompanying anergy of circulating lymphocytes suggest their regulatory nature. Furthermore, the concomitantly elevated lesional expression of Foxp3 suggests their possible recruitment into the lesional site, which would sustain disease pathology.

Background. Post– kala-azar dermal leishmaniasis (PKDL), an established sequela of visceral leishmaniasis (VL), is proposed to facilitate anthroponotic transmission of VL, especially during interepidemic periods. Immunopathological mechanisms responsible for Indian PKDL are still poorly defined. Methods. Our study attempted to characterize the immune profiles of patients with PKDL or VL relative to that of healthy control subjects by immunophenotyping, intracellular cytokine staining of peripheral blood mononuclear cells, and enzyme-linked immunosorbent assay for serum cytokines and immunoglobulin G (IgG) subclasses. Results. Patients with PKDL had significantly raised percentages of peripheral CD3CD8 cells compared with control subjects, a difference that persisted after cure. Patients with PKDL showed an intact response to phytohemagglutinin, with the percentages of lymphocytes expressing interferon (IFN)–, interleukin (IL)–2, IL-4, and IL-10 being comparable to those in control subjects. Patients with VL had decreased IFN- and IL-2 expression, which was restored after cure, and increased IL-10 expression, which persisted after cure. In their response to Leishmania donovani antigen, patients with PKDL showed a 9.6-fold increase in the percentage of IL-10 – expressing CD3CD8 lymphocytes compared with control subjects, and this percentage decreased with treatment. Patients with PKDL had raised levels of IgG3 and IgG1 (surrogate markers for IL-10), concomitant with increased serum levels of IL-10. Conclusions. IL-10 –producing CD3CD8 lymphocytes are important protagonists in the immunopathogenesis of Indian PKDL. Leishmaniasis, comprising a spectrum of diverse clinical

Immune reconstitution inflammatory syndrome describes a collection of inflammatory disorders associated with paradoxical deterioration of various pre-existing processes following start of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients. Leprosy as an opportunistic infection in immune reconstitution syndrome has been rarely reported in literature. A case of a 30-year-old HIV positive man with extrapulmonary tuberculosis of left foot on HAART having developed borderline tuberculoid leprosy as opportunistic infection in immune reconstitution syndrome has been reported.

SummaryHere we report a unique case of tuberculoid leprosy and cytomegalovirus retinitis in a 27-year-old female patient with AIDS, suggestive of highly active antiretroviral therapy (HAART)-induced immune restoration disease. After initiation of HAART, the patient presented with decreased visual acuity, hypoesthetic patch with local nerve thickening, and an increase in her CD4+ T cell count. On further investigations cytomegalovirus retinitis and tuberculoid leprosy were confirmed. To our knowledge no case with such a co-existence has previously been reported.