Open Access Original Research Article

Correlation between Cycle Threshold (Ct) Value and IL-6 and D-Dimer in Chip-based RT-PCR Positive COVID-19 Cases: Study from a Stand-alone Laboratory

Chhavi Gandhi, H. N. Ravikumar, Vani Ravikumar, C. Vani

Asian Journal of Research in Infectious Diseases, Page 1-9
DOI: 10.9734/ajrid/2021/v8i330236

Background: Novel Coronavirus (SARS-COV-2) is a leading cause of morbidity and mortality since the beginning of 2020 leading to range of symptoms from mild flu to respiratory distress, which is called COVID-19. RTPCR being the main diagnostic test can confirm the presence of the virus in the clinical samples, while various studies have defined Interleukin-6 and D-dimer as potent biomarker for severity. In this study, we have attempted to correlate the severity of COVID-19 with the presence of IL-6 and D-dimer and the Cycle threshold (Ct vlue) as determined by chip based RTPCR.

Aim: The study aims to correlate the Cycle threshold value obtained after chip-based RT-PCR with markers such as IL-6 and D-Dimers.                                                     

Methodology: It is a retrospective, observational study done in 799 subjects  in a span of three months (August 2020 to October 2020) at R V Metropolis Diagnostic and Healthcare Pvt Ltd. All symptomatic patients who tested positive in the Laboratory for COVID-19 by chip-based RT-PCR were included. Chip based RTPCR or Truenat test was performed on Nasopharyngeal swabs of the suspected subjects. Interleukin-6 was determined by Electrochemiluminiscence assay while D-dimer was done on the principle of Chemiluminiscence.

Statistical Analysis Used: SPSS 12.0 version.

Results: Total number of subjects enrolled were 799, with mean age of the subjects being 46.80± 17.55 years. In the study, males were found to be affected by COVID-19 more than females with ratio of male to female being 1.65:1. 498 (62.3%) of males presented with COVID-19 while it was observed in 301 (37.6%) females. Out of 799 subjects, 289 (36.2%) were symptomatic and out of 289 subjects, 140 (17.5% of total subjects) required hospitalisation. Cycle threshold values of both screening as well as confirmatory genes were determined separately in the cases of symptomatic and asymptomatic cases and there was no significant difference between the Ct values in cases of symptomatic and asymptomatic patients. Symptomatic patients were subcategorised under hospitalised and non-hospitalised and Again, no significant difference was seen between the two subset of patients in terms of Ct-value and, indirectly, the viral load of their clinical sample. The results convey that IL-6 and D-Dimer was significantly high (p=0.001 and <0.001 respectively) in case of symptomatic patients.D-Dimer was significantly high (p= <0.001) in the patients who needed hospitalisation. IL-6 was significantly raised as well (p=0.02). Screening and confirmatory gene were found to have no significant relationship with IL-6 and D-Dimer, neither any correlation was observed with them.

Conclusion: Biomarkers such as Interleukin-6 and D-dimer can very well help in determining the severity and need for hospitalisation in a COVID-19 affected patient, but they have been found to have no relationship with cycle threshold value of RTPCR in our study.

Open Access Original Research Article

Current Trend in the Antibiogram of Bacterial Pathogens of Adult Lower Respiratory Tract Infections in a Nigerian Tertiary Hospital

Oluwalana T. Oyekale, Bola O. Ojo, Damilola E. Oguntunmbi, Oluwatoyin I. Oyekale

Asian Journal of Research in Infectious Diseases, Page 10-18
DOI: 10.9734/ajrid/2021/v8i330237

Background: Lower respiratory tract infections (LRTIs) are among the commonest infectious diseases requiring hospitalization. There is an increasing resistance development of bacterial pathogens of LRTIs to the commonly prescribed antibiotics necessitating regular surveillance for these bacteria and their antibiogram.

Aim: To identify bacterial pathogens of adult LRTIs, determine their antibiotic susceptibility pattern, and suggest the best empirical treatment of adult LRTIs in the setting.

Study Design: Descriptive cross-sectional study.

Methods: A total of 194 respiratory samples from 194 consecutive consenting adult in-patient of a Federal Teaching Hospital were processed. Identification of isolated bacteria and antibiotic susceptibility testing of the isolates were carried out following the standard protocol.

Results: Bacteria isolation was seen in 52.1% of all specimens, highest isolation rate was from sputum (55.2%). Isolation was higher in males (54.9%) than females (48.1%) but no significant difference was seen (P=0.36). Gram negative bacteria were predominantly isolated (64.4%) and Klebsilla pneumoniae was the most common (33.7%). Eight extended-spectrum beta-lactamase (ESBL) producers and 3 methicillin-resistant Staphylococcus aureus (MRSA) were also detected. All isolates were sensitive to imipenem and meropenem. All MRSAs were sensitive to vancomycin. There was poor sensitivity pattern seen against most antibiotics tested.

Conclusion: Gram negative bacteria were the predominant bacterial pathogen isolated, and isolates were resistant to most antibiotics tested, though, all were sensitive to carbapenems. Levofloxacin plus gentamicin, and carbapenems were the suggested first and second line empirical treatment of choice respectively for adult LRTIs in this and similar settings.

Open Access Original Research Article

Positivity Rate as a Performance Indicator for COVID-19 Response in Edo State, Nigeria

Andrew Ifeanyichukwu Obi, Pius Ononigwe, Faith Ireye, Patrick Okundia, Osamuyi Irowa, Helen Eboreime, Ekaete Tobin, Lauretta Iruobe, Bruce Osa, Uwa Okhuarobo, Kester Okoduwa

Asian Journal of Research in Infectious Diseases, Page 24-30
DOI: 10.9734/ajrid/2021/v8i330240

Background: Positivity rate is a very reliable indicator in determining the effectiveness of public health interventions of infectious disease magnitude.

Aim: To use positivity rate as performance indicator of effectiveness of COVID-19 Control measures in Edo State, Southern Nigeria.

Materials and Methods: Laboratory based record review of 20,220 Polymerase Chain Reaction (PCR) based laboratory results from COVID-19 line-list analysed from the four (4) NCDC accredited molecular laboratory within Edo State. The weekly COVID-19 test positivity was computed in relation to the total samples tested between 23rd March to 30th November, 2020. Data collected were analysed using IBM SPSS version 20.0 software with statistical significance set at p˂0.050 and 95% Confidence Interval.

Results: A total of 20,220 PCR results reviewed with 2696 (13.3%) COVID-19 cases identified while 17,524 (86.7%) were negative. The average weekly sample collection and testing was 552.28 ± 369.98, with average weekly COVID-19 case yield and positivity rate (%) of 77.89 ±106.23 and 12.20±13.75% respectively. A statistically significant positive correlation was identified between sample tested and COVID-19 case yield (R = 0.569; < 0.01). The first wave of the COVID-19 in Edo State witnessed a consistent and progressive decline in test positivity rate till it deepened at 0.6 % by the end of November, 2020.

Conclusion: Increasing sample testing has significant positive correlation with COVID-19 case detection in Edo State. Positivity rate was a good indicator to monitor COVID-19 outbreak response in Edo State.

Targeted surveillance and sample collection for testing can significantly help improve the quality and case yield during epidemic outbreak response. Bridging the gap in sample collection for testing can greatly influence how quickly an epidemic outbreak response and control is achieved.

Open Access Original Research Article

Experience of Perceived Stress and Associated Factors during COVID 19 Lockdown among Hoteliers of Pokhara, Nepal

Akriti Kafle, Maginsh Dahal, Sudip Khanal, Kushalata Baral, Sirjana Pandit Pahari, Pratikshya Gurung, Raj Kumar Sangroula, Kabita Pathak, Suraj Baral, Anil Kafle, Sreya Paudyal, Niru Gurung, Anjali Parajuli

Asian Journal of Research in Infectious Diseases, Page 31-41
DOI: 10.9734/ajrid/2021/v8i330241

It is great time to know the psychological consequences and know how hoteliers are coping to it because of Covid19 lockdown. Thus we tried to access prevalence of perceived stress and associated factors among hoteliers of Nepal. A hotel based quantitative descriptive cross-sectional study was done using a structured questionnaire cum interview schedule. The data was recorded in Microsoft Excel sheet, and was analyzed using Statistical Package for Social Sciences version 23. A descriptive analysis was done using mean, frequency, percentage and standard deviation. Bivariate analysis was done using Mann-whitney U test and Kruskal Wallis test as the data were non-normal. Significance level was observed at p-value less than 0.05. There was significant relation between stress score and variables like age, gender, marital status, smoking, alcohol, bread winner, sound sleep, family conflict, too many responsibilities, pay loans, pay rent of hotel, other source of income, paying salary, happy with government, lockdown only solution, economic problem and social problems. (p -value <0.05) Male had significantly higher stress than female. Similarly married participants showed significantly higher stress than unmarried. Stress level has been increased among the hoteliers of Nepal due to covid19 lockdown and has affected the tourism sector very badly.

Open Access Case Study

Oculogyric Crisis – Atypical Presentation in Patient with Dengue Fever

Saurabh Rajkumar Jain, Jitendra D. Lakhani, Pramod R. Jha, Shivangi V. Gharia

Asian Journal of Research in Infectious Diseases, Page 19-23
DOI: 10.9734/ajrid/2021/v8i330239

Here we are presenting a case of dengue fever presented with an atypical symptom of “oculogyric crisis” with features of multi organ dysfunction syndrome. Increased vascular permeability, plasma leakage, haemorrhagic manifestations, and thrombocytopenia are charecteristics of dengue fever.  A 19 year old male patient, with no co-morbidity came to Dhiraj hospital with chief complaints of  fever which was high grade & intermittent, it is associated with chills & rigours for 5 days. Also complain of abdominal pain over epigastric region, dull aching non radiating associated with decreased appetite since 5 days. Dengue infection has a wide range of clinical features. Neurological complications can occur in any spectrum of dengue infection.  The diagnosis of oculogyric crisis is majorly clinical and it requires a focused detailed history and detailed physical examination to find out possible triggers for the crisis and to rule out other reasons for abnormal eye movements.