Tinea nigra is a rare superficial fungal infection characterized by asymptomatic, unilateral, well-defined brown to black macules predominantly affecting the palms and soles. Diagnosis is often challenging due to its rarity and resemblance to other pigmented lesions. This report presents a clinical case, a diagnostic algorithm, and treatment recommendations, emphasizing the role of thorough examination and questioning. We describe the case of a 64-year-old woman of Amerindian (Maya) heritage from Yucatan, Mexico, who presented with a three-month history of a slowly growing dark spot on her left palm. The lesion was asymptomatic, non-scaling, and non-palpable. Palmar skin scrapings, prepared with KOH, revealed pigmented yeast and hyphae, leading to a diagnosis of tinea nigra. Following treatment with topical ketoconazole, the patient\'s lesions completely resolved at the one-month follow-up. The cultivation of scales confirmed the presence of Hortaea werneckii. Our findings highlight the importance of considering tinea nigra in the differential diagnosis of pigmented lesions on acral surfaces. We propose a diagnostic algorithm to aid healthcare professionals in recognizing this uncommon condition and recommend treatment protocols that effectively resolve the infection within two weeks. This case underscores the necessity for increased awareness and accurate diagnosis of tinea nigra, particularly in non-endemic regions.

UNASSIGNED: Newer coexisting conditions should be identified in order to modify newer risk factors. Aim was to identify patients with non-classical or less common coexisting conditions in patients infected of COVID 19.
UNASSIGNED: Single centred study from June 2020 to May 2021 at a tertiary centre in North India. A preformed questionnaire was used to record clinical and laboratory parameters and to identify cases which are in addition to CDC list and Indian data.
UNASSIGNED: 0.67% (46) cases out of 6832 patients were identified to have non-classical coexisting illness. It was divided into 2 groups-infections A (60.1%) and non-infections B (39.9%). Group A included-tuberculosis- pulmonary (14.3%) & extra pulmonary (32.9%), bacterial (25.0%) viral infections [dengue, hepatitis B & C] (14.3%), HIV disease (10.7%) and malaria (3.6%). Group B included- organ transplant (27.8%), autoimmune [myasthenia gravis, polymyositis, psoriasis] (22.6%), haematologic [Haemophilia, ITP, Aplastic anaemia, APML, CML] (27.8%), uncommon malignancies [disseminated sacral chordoma and GTN] (11.1%) and snakebite (11.1%). Serum Procalcitonin was not helpful for diagnosis of bacterial infection in COVID-19 disease. Group A had significantly longer duration of illness, hepatitis and elevated CRP. The mortality in group A & B were 32.1% and 43.8% respectively. Death in non-severe COVID cases was in tetanus and snakebite. 30.7% death among tuberculosis patients. More than 70% of deaths were attributable to COVID 19 in both the groups.
UNASSIGNED: In Indian settings, comorbidities like tuberculosis and bacterial infections can precipitate severe COVID 19 unlike other parts of the world where tuberculosis is relatively uncommon.

The coronavirus disease 2019 (COVID-19) pandemic has changed the way we manage patients, especially those with respiratory illnesses. Clinical manifestations, chest imaging, and reverse-transcription polymerase chain reaction (RT-PCR) play major roles in diagnosing respiratory infections during a pandemic. However, several infections can mimic COVID-19 regarding its clinical signs, symptoms, and imaging appearance. Diagnosing pneumonia other than COVID-19 is a big challenge in developing countries, given the limited resources available. We presented a case of a 25-year-old female with clinical symptoms and radiological characteristics typical of COVID-19 but a repeated negative RT-PCR test. Further workups found lung tuberculosis as her primary diagnosis. Our patient continued treatment with an antituberculosis agent and a short course of steroids, with a remission of symptoms.

Dirofilariasis is a zoonotic infection transmitted by several species of mosquitoes. A 16-year-old boy presented with forearm swelling of two months duration. Imaging studies revealed a parasitic cyst. Surgical excision of the lesion was performed, and pharmacotherapy with diethylcarbamazine was given. A histopathological examination confirmed a diagnosis of human subcutaneous dirofilariasis caused by Dirofilaria repens. Clinicians should consider similar infections, especially in light of current climate changes and the emergence of various zoonoses. The epidemiological impact of diagnosing and preventing similar zoonotic infections is invaluable.

Extrapulmonary tuberculosis (ETB) involving skin with multiple lesions is an uncommon presentation of mycobacterial infection. Cutaneous tuberculosis (TB) having multiple lesions with Poncet\'s disease (tuberculous Rheumatism) is rarely reported. We hereby report a multifocal cutaneous tuberculosis with Poncet\'s disease in a 19-year-old immunocompetent female.

Pulmonary involvement in leptospirosis is common. Severe pulmonary forms of leptospirosis (SPFL) carry high mortality. We report two cases of an otherwise healthy adult male from the western suburbs of India, admitted with severe pulmonary hemorrhage with extremely poor oxygenation. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used as the last-rescue life-saving measure. Both the patients showed good pulmonary recovery within 2 weeks. Despite having thrombocytopenia, we experienced lesser bleeding complications requiring transfusions during the extracorporeal membrane oxygenation (ECMO) period.
UNASSIGNED: Sen S, Goyal A, Lokhande V. Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases. Indian J Crit Care Med 2022;26(8):966-969.

Leptospirosis is a rodent-borne acute febrile illness, classically seen after heavy rainfall and floods. This study aimed to describe the clinical profile, management strategies and outcome of patients with leptospirosis amidst the Coronavirus disease-2019 outbreak. A prospective study of adult patients with undifferentiated fever (5-15 days) was conducted in South India between October 2020 and February 2021. The demographic, clinical details, laboratory details, treatment and outcome of leptospirosis positive (based on serology) and negative patients were compared. A chisquare test was used for qualitative variables, while an independent t-test or Mann Whitney U test was used for continuous variables. Of the 206 patients with suspected acute febrile illness, a total of 63 patients were diagnosed with leptospirosis based on serology results. The median sequential organ failure assessment score was higher in those with leptospirosis (p<0.001). Myalgia, abdominal pain, jaundice, decreased urine output, myocarditis, and dialysis requirement were more common in patients with leptospirosis. Leucocytosis and raised procalcitonin/C-reactive protein were more common in patients with leptospirosis. The duration of stay and antibiotic consumption was higher in patients with leptospirosis. Acute febrile illness such as leptospirosis should be suspected in tropical areas with significant risk factors. The presence of conjunctival suffusion, hepatic and renal dysfunction should warrant a serology test for leptospirosis.

A large majority of neurological infections remain undiagnosed worldwide. Emerging and re-emerging infections are likely to be responsible for a significant proportion of these. Over the last two decades, several new organisms producing neurological infection and the neurotropic potential of many other known pathogens have been identified. Large outbreaks caused by re-emerging pathogens such as Chikungunya virus, Zika virus and Ebola virus have led to better delineation of their neurological manifestations. Recognition of the pandemic potential of emerging pathogens and an improved understanding of their host-vector-environment interactions would help us be better prepared to meet these emerging threats.

Tetanus is caused by an exotoxin, tetanospasmin, produced by Clostridium tetani, an anaerobic gram-positive bacillus.Tetanospasmin prevents the release of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the spinal cord, brainstem motor nuclei, and the brain, producing muscle rigidity and tonic spasms.Trismus (lockjaw), dysphagia, laryngeal spasms, rigidity of limbs and paraspinal muscles, and opisthotonic posture are common.Frequent severe spasms triggered by touch, pain, bright light, or sounds may produce apnea and rhabdomyolysis.Autonomic overactivity occurs in severe tetanus causing labile hypertension, tachycardia, increased secretions, sweating, and urinary retention. Dysautonomia is difficult to manage and is a common cause of mortality; magnesium sulfate infusion is often used.Antibiotics (penicillin or metronidazole) and wound care reduce toxin production and human tetanus immune globulin neutralizes the circulating toxin.Nasogastric tube placement for feeding and medications is needed.Early elective tracheostomy is performed in moderate or severe tetanus to prevent aspiration and laryngeal stridor.Benzodiazepines help reduce rigidity, spasms, and autonomic dysfunction. Large doses of diazepam (0.2-1 mg/kg/h) are administered via nasogastric tube.Neuromuscular blocking agents and mechanical ventilation are used for refractory spasms.Mortality ranges from 5% to 50%. How to cite this article: Karnad DR, Gupta V. Intensive Care Management of Severe Tetanus. Indian J Crit Care Med 2021; 25(Suppl 2):S155-S160.

UNASSIGNED: (1) Blood culture is the gold standard for the diagnosis of bacterial infections. (2) Bone marrow culture is more sensitive than blood culture even in patients with enteric fever receiving antibiotics. (3) Microscopic agglutination test is considered the gold standard for diagnosing leptospirosis; however, now IgM ELISA and polymerase chain reaction (PCR) are more frequently used for diagnosis. (4) Tuberculosis is diagnosed with the help of nucleic acid amplification tests like Xpert MTB/RIF Ultra which also detects rifampicin resistance. Other tests include microscopy, Lowenstein-Jensen and mycobacteria growth indicator tube culture, line probe assay. (5) Tropical rickettsial infections are diagnosed by serological reactions (Weil-Felix, ELISA for antibodies) and PCR. (6) For Brucellosis culture from blood, bone marrow or tissue specimens remain the mainstay in diagnosis. (7) Dengue, Zika, Crimean-Congo hemorrhagic fever, Ebola, hantavirus, rabies are diagnosed with reverse transcriptase-polymerase chain reaction. Serological tests like IgM ELISA or paired sera samples for IgG are also used for diagnosis.
UNASSIGNED: Basu S, Shetty A. Laboratory Diagnosis of Tropical Infections. Indian J Crit Care Med 2021;25(Suppl 2):S122-S126.