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Background Evaluating the burden of respiratory syncytial virus (RSV) and influenza among young children in LMICs is crucial to inform implementation policies, given the importance of maternal influenza and RSV vaccination, which may not yet be widely available. Methods This study established a one-year surveillance of severe acute respiratory infection (SARI) from June 2022–2023 in hospitalized children 1–24 months from rural West Bengal India. We tested nasopharyngeal swabs collected from children admitted with SARI using multiplex real-time PCR for influenza, RSV, SARS-CoV-2, with a subset ( N  = 81) tested for additional respiratory pathogens and analyzed clinical features, factors influencing infections, and hospitalization duration. Results Of 1842 children admitted with SARI, 77% (1419) were between 1 and 24 months. Of 191 sampled, 21 required intensive care, and 3 died. The majority of mothers (83.7%) were vaccinated against COVID-19, but none against influenza, pertussis, or RSV. Viruses were detected in 44% (84/191), with RSV being the most common 60/190 (31.6%), followed by influenza 12/190 (6.3%), and SARS-CoV-2 2/191 (1%). Influenza subtypes included influenza A/H3 (6/16), A/H1N1pdm (5/16), Influenza B (4/16), and Influenza C (1/16). RSV peaked during autumn, influenza during winter and monsoon. Influenza was more common in infants < 6 months (13.4%, p  = 0.03). RSV affected both infants under 6 months and over similarly (34% vs. 29.6%, p  = 0.5). Infants < 6 months frequently required oxygen support ( p  = 0.02), though ICU admissions were similar ( p  = 0.98). RSV was associated with 19% of ICU admissions and influenza with 14%. Additional pathogens included Haemophilus influenzae (23.45%), Streptococcus pneumoniae (22%), rhinovirus (13.6%), parainfluenza virus group (6.1%), Staphylococcus aureus (8.6%), Moraxella catarrhalis (5%), bocavirus (3.7%), adenovirus (3.7%), Chlamydia pneumoniae (1%), and Bordetella (1%). Viral-bacterial co-detection occurred in 34%, especially in infants < 6 months. Children with RSV had increased risk of having S. pneumoniae [Odds Ratio OR 6.2, 95% CI 1.8–21.3]. Rhinovirus cases were associated with ICU admission, mechanical ventilation, and longer length of stay, regardless of age. Conclusion RSV and influenza were the key contributors to SARI in children under-2. Findings highlight the need for diagnostics to guide vaccination, reduce antibiotic use, and improve indoor air quality for alleviating the SARI burden in rural settings.

Background Microscopy of peripheral blood thin and thick films remains the reference for malaria diagnosis. Although Giemsa staining is most commonly used, the Leishman staining method provides better visualization of the nuclear chromatin pattern of cells. It is less well known whether accuracy of parasitaemia assessment is equally accurate with the latter method. Methods Peripheral blood thin and thick smears from consecutive febrile patients admitted to Ispat General hospital, Rourkela, Odhisa, India, were stained with Giemsa and Leishman stain. Methods were compared for species identification, parasite quantification, and ability for identification of alternative diagnoses. Results Blood films from 1,180 fever patients were compared according to staining method, of which 111 were identified as parasitaemic using Giemsa and 110 with Leishman staining. The Kappa value as a measure of agreement between methods was 0.995 (p < 0.001), and the log 10 parasitaemia between methods were strongly correlated (r 2  = 0.9981). In parasite negative patients, thin smear assessment contributed to making a diagnosis in 276/1,180 (23%) of cases. These assessments were better made in Leishman-stained preparations, especially for the assessment of morphological changes in red and white cells. Conclusion Leishman’s staining method for thin and thick smears is a good alternative to Giemsa’s stain for identifying Plasmodium parasites. The Leishman method is superior for visualization of red and white blood cell morphology.

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Artemisinin and partner-drug resistance in Plasmodium falciparum are major threats to malaria control and elimination. Triple artemisinin-based combination therapies (TACTs), which combine existing co-formulated ACTs with a second partner drug that is slowly eliminated, might provide effective treatment and delay emergence of antimalarial drug resistance. In this multicentre, open-label, randomised trial, we recruited patients with uncomplicated P falciparum malaria at 18 hospitals and health clinics in eight countries. Eligible patients were aged 2–65 years, with acute, uncomplicated P falciparum malaria alone or mixed with non-falciparum species, and a temperature of 37·5°C or higher, or a history of fever in the past 24 h. Patients were randomly assigned (1:1) to one of two treatments using block randomisation, depending on their location: in Thailand, Cambodia, Vietnam, and Myanmar patients were assigned to either dihydroartemisinin–piperaquine or dihydroartemisinin–piperaquine plus mefloquine; at three sites in Cambodia they were assigned to either artesunate–mefloquine or dihydroartemisinin–piperaquine plus mefloquine; and in Laos, Myanmar, Bangladesh, India, and the Democratic Republic of the Congo they were assigned to either artemether–lumefantrine or artemether–lumefantrine plus amodiaquine. All drugs were administered orally and doses varied by drug combination and site. Patients were followed-up weekly for 42 days. The primary endpoint was efficacy, defined by 42-day PCR-corrected adequate clinical and parasitological response. Primary analysis was by intention to treat. A detailed assessment of safety and tolerability of the study drugs was done in all patients randomly assigned to treatment. This study is registered at ClinicalTrials.gov, NCT02453308, and is complete. Between Aug 7, 2015, and Feb 8, 2018, 1100 patients were given either dihydroartemisinin–piperaquine (183 [17%]), dihydroartemisinin–piperaquine plus mefloquine (269 [24%]), artesunate–mefloquine (73 [7%]), artemether–lumefantrine (289 [26%]), or artemether–lumefantrine plus amodiaquine (286 [26%]). The median age was 23 years (IQR 13 to 34) and 854 (78%) of 1100 patients were male. In Cambodia, Thailand, and Vietnam the 42-day PCR-corrected efficacy after dihydroartemisinin–piperaquine plus mefloquine was 98% (149 of 152; 95% CI 94 to 100) and after dihydroartemisinin–piperaquine was 48% (67 of 141; 95% CI 39 to 56; risk difference 51%, 95% CI 42 to 59; p<0·0001). Efficacy of dihydroartemisinin–piperaquine plus mefloquine in the three sites in Myanmar was 91% (42 of 46; 95% CI 79 to 98) versus 100% (42 of 42; 95% CI 92 to 100) after dihydroartemisinin–piperaquine (risk difference 9%, 95% CI 1 to 17; p=0·12). The 42-day PCR corrected efficacy of dihydroartemisinin–piperaquine plus mefloquine (96% [68 of 71; 95% CI 88 to 99]) was non-inferior to that of artesunate–mefloquine (95% [69 of 73; 95% CI 87 to 99]) in three sites in Cambodia (risk difference 1%; 95% CI −6 to 8; p=1·00). The overall 42-day PCR-corrected efficacy of artemether–lumefantrine plus amodiaquine (98% [281 of 286; 95% CI 97 to 99]) was similar to that of artemether–lumefantrine (97% [279 of 289; 95% CI 94 to 98]; risk difference 2%, 95% CI −1 to 4; p=0·30). Both TACTs were well tolerated, although early vomiting (within 1 h) was more frequent after dihydroartemisinin–piperaquine plus mefloquine (30 [3·8%] of 794) than after dihydroartemisinin–piperaquine (eight [1·5%] of 543; p=0·012). Vomiting after artemether–lumefantrine plus amodiaquine (22 [1·3%] of 1703) and artemether–lumefantrine (11 [0·6%] of 1721) was infrequent. Adding amodiaquine to artemether–lumefantrine extended the electrocardiogram corrected QT interval (mean increase at 52 h compared with baseline of 8·8 ms [SD 18·6] vs 0·9 ms [16·1]; p<0·01) but adding mefloquine to dihydroartemisinin–piperaquine did not (mean increase of 22·1 ms [SD 19·2] for dihydroartemisinin–piperaquine vs 20·8 ms [SD 17·8] for dihydroartemisinin–piperaquine plus mefloquine; p=0·50). Dihydroartemisinin–piperaquine plus mefloquine and artemether–lumefantrine plus amodiaquine TACTs are efficacious, well tolerated, and safe treatments of uncomplicated P falciparum malaria, including in areas with artemisinin and ACT partner-drug resistance. UK Department for International Development, Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and US National Institutes of Health.

Context: Pseudomonas aeruginosa is an obsessive invader in the hospitals worldwide. It has powerful antibiotic resistance mechanisms, one of such being metallo beta lactamase, which is taking away from our hands our last resort, carbapenem group of antibiotics, to fight them. Not only they possess this metallic gun, they are exceptionally good gun dealers also, as the genes producing this metallo beta lactamase resides on plasmids and hence, are easily and efficiently transferrable among other bacteria, Thus it becomes a present day concern to detect the presence of MBL positive Pseudomonas aeruginosa in every hospital to have a powerful and effective antibiotic regimen in the future also. Aims: To determine the presence and extent of MBL positive Pseudomonas aeruginosa in a Midnapore Medical College, West Midnapore district, West Bengal, India. Materials and Methods: A total of 630 samples were processed, out of which 112 isolates of Pseudomonas aeruginosa were found. Among these, 20, were found to be imipenem resistant and these were subjected to EDTA impregnated imipenem disc potentiation test. Discussion: Out of 112 P. aeruginosa, 8 isolates (7%) turned out to be MBL producers. Also, a high susceptibility pattern was found for aminoglycosides. Conclusion: Although we found a low prevalence of MBL producing P. aeruginosa, still it is worrisome. Constant vigilance and careful selection of antibiotics are necessary.