Browsing by Author "Rayamajhi, Sulav"
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Publication ARDS as a presenting feature in sarcoidosis: an uncommon occurrence(Nepalese Respiratory Society, 2022) Shrestha, Sanjeet K; Malla, Jonas; Bhusal, Yuvaraj; Bhattarai, Sanjeet; Lama, Rakesh; Rayamajhi, Sulav; Gurung, Naresh; Shrestha, Ashish; Karthik, Ashish; Pradhan, Pratistha; Rana, Reena; Khetan, KhusbooAbstract: Sarcoidosis though a chronic multi-system granulomatous disease, predominantly involves respiratory system. Often asymptomatic, patients can present with lymphadenopathy, prolonged fever and shortness of breath. Acute respiratory distress syndrome (ARDS) is relatively uncommon presenting feature of the disease. Here we present a case of a 19 years old female presenting in acute respiratory distress syndrome, eventually being diagnosed as Sarcoidosis. Although different diagnostic criteria have been developed for early diagnosis of sarcoidosis, atypical presentations can always pose significant challenge and lag for the diagnosis.Publication Pulmonary Mucormycosis secondary to Severe Acute Respiratory Illness due to Covid 19 Infection: A Case Report Authors(Nepalese Respiratory Society, 2022) Karthak, Ashish; Shrestha, Ashish; Gurung, Naresh; Bhusal, Yuvaraj; Lama, Rakesh; Rayamajhi, Sulav; Bhattarai, Sanjeet; Regmi, Asim; Ghimire, Anup; Khanal, Kishor; Shrestha, Sanjeet KAbstract: Patients diagnosed and hospitalized with SARS COV-2 are managed with corticosteroids due to its known benefits for the prevention of airway inflammation secondary to acute respiratory distress syndrome seen commonly in viral pneumonia. However, these patients carry a high risk of developing secondary bacterial and fungal infection. We present a case of 60-year-old male with COVID-19 pneumonia. The patient was diagnosed with pulmonary mucormycosis 18 days following admission. The patient was treated with broad-spectrum antibiotics, remdesivir and corticosteroids along with antifungals including voriconazole and amphotericin B with no significant improvement. However, even after extensive medical management patient was eventually intubated and succumbed to its complications. Mucormycosis although an uncommon infection should be considered due to extensive use of glucocorticoid therapy and concurrent comorbidities present among COVID-19 patients.Publication Respiratory Fungal Co-Infections in Covid-19 Patients(Nepalese Respiratory Society, 2024) Guragain, Ankita; Bhusal, Yuvaraj; Rayamajhi, Sulav; Bhattarai, Sanjeet; Shrestha, Sanjeet KrishnaAbstract: Background: Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), has been known to cause mild respiratory illness to severe pneumonia. During its pandemic, an increase in viral, bacterial, and fungal coinfections was observed. With Candida, Aspergillus, and Mucor species being the primary fungal pathogens causing secondary pulmonary infections. Risk factors such as prolonged immunosuppressive drug use and comorbidities such as diabetes mellitus and solid organ transplantation increase susceptibility to these coinfections. Objective: The study aimed to determine the incidence of pulmonary candidiasis, invasive aspergillosis, and pulmonary mucormycosis in COVID-19 patients and evaluate various risk factors. Methods: Lower respiratory samples from COVID-19 patients with suspected fungal coinfections were analyzed microbiologically. Macroscopic features such as the morphology of colonies and microscopic characters such as the presence or absence of septations in hyphae, the arrangement of hyphae, the arrangement of conidiophores and conidia, and the presence or absence of rhizoids on lactophenol cotton blue (LPCB) mounts were used for the identification of molds. Morphology of colony, Gram stain, and germ tube test were used for identification of Candida spp. Results: Of 1789 suspected cases, 216 (12.1%) showed positive fungal culture, predominantly in males (67.9%). Candida spp. accounted for 62.9% of cases, followed by Aspergillus spp. (22.2%) and Mucor spp. (7.4%), with 7% showing mixed Aspergillus and Candida infections. Non-albicans Candida spp. were the most common Candida spp., followed by Aspergillus flavus, fumigatus, and nidulans, and Rhizopus among Mucorales. All of the COVID-19 patients were under steroid therapy, and 89.8% of patients had immunocompromising conditions, primarily diabetes mellitus (76.2%), followed by hypertension (14%), both diabetes and hypertension (9.3%), and organ transplantation (0.5%). Conclusion: COVID-19 is associated with a high number of respiratory fungal coinfections, driven by prolonged hospitalization, steroid use, and comorbidities. Careful measures should be adopted by healthcare professionals to minimize the risk of respiratory fungal coinfections and associated fatality.