Showing papers in "Journal of Global Infectious Diseases in 2011"
TL;DR: An introduction to vaccine immunology is provided including a primer on the components of the immune system, passive vs. active immunization, the mechanism by which immunizations stimulate(s) immunity, and the types of vaccines available.
Abstract: From a literature review of the current literature, this article provides an introduction to vaccine immunology including a primer on the components of the immune system, passive vs. active immunization, the mechanism(s) by which immunizations stimulate(s) immunity, and the types of vaccines available. Both the innate and adaptive immune subsystems are necessary to provide an effective immune response to an immunization. Further, effective immunizations must induce long-term stimulation of both the humoral and cell-mediated arms of the adaptive system by the production of effector cells and memory cells. At least seven different types of vaccines are currently in use or in development that produce this effective immunity and have contributed greatly to the prevention of infectious disease around the world.
275 citations
TL;DR: Although simple prophylactic measures could reduce transmission, T. gondii seroprevalence is still high, especially in South America.
Abstract: Toxoplasmosis, a disease described worldwide, which is caused by the protozoan Toxoplasma gondii, commonly involves the retina. The disease has a higher impact in immunocompromised individuals and in congenital infection because of the severity of central nervous system involvement. Although simple prophylactic measures could reduce transmission, T. gondii seroprevalence is still high, especially in South America. Educational campaigns and the development of new drugs to prevent primary infection could potentially reduce the burden of the disease.
197 citations
TL;DR: Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lack of political will; and, above all, corrupt administration.
Abstract: Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000 years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India, historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place. Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second largest, in terms of population coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lack of political will; and, above all, corrupt administration. Multidrug-resistant TB (MDR-TB) is another emerging threat to TB eradication and is a result of deficient or deteriorating TB control program. WHO with its "STOP TB" strategy has given a vision to eliminate TB as a public health problem from the face of this earth by 2050. For this review article, data available at the official websites of WHO; and from the Ministry of Health, Government of India, were consulted, and search engines PubMed(®) and Google Scholar(®) were used.
181 citations
TL;DR: The observation of seasonality leads to assume that the risk of transmission of M. tuberculosis does appear to be the greatest during winter months, and seasonal variation in food availability and food intake, age, and sex are important factors which can play a role in the tuberculosis notification variability.
Abstract: Objectives: This study was designed to review previous studies and analyse the current knowledge and controversies related to seasonal variability of tuberculosis (TB) to examine whether TB has an annual seasonal pattern. Study Design and Methods: Systematic review of peer reviewed studies identified through literature searches using online databases belonging to PubMed and the Cochrane library with key words Tuberculosis, Seasonal influence and Tuberculosis, Seasonal variation. The search was restricted to articles published in English. The references of the identified papers for further relevant publications were also reviewed. Results: Twelve studies conducted between the period 1971 and 2006 from 11 countries/regions around the world (South Western Cameroon, South Africa, India, Hong Kong, Japan, Kuwait, Spain, UK, Ireland, Russia, and Mongolia) were reviewed. A seasonal pattern of tuberculosis with a mostly predominant peak is seen during the spring and summer seasons in all of the countries (except South Western Cameroon and Russia). Conclusions: The observation of seasonality leads to assume that the risk of transmission of M. tuberculosis does appear to be the greatest during winter months. Vitamin D level variability, indoor activities, seasonal change in immune function, and delays in the diagnosis and treatment of tuberculosis are potential stimuli of seasonal tuberculosis disease. Additionally, seasonal variation in food availability and food intake, age, and sex are important factors which can play a role in the tuberculosis notification variability. Prospective studies regarding this topic and other related subjects are highly recommended.
149 citations
TL;DR: The data suggests that the capacity of Candida species to produce biofilm may be a reflection of the pathogenic potential of the isolates, and C. albicans produced higher levels of phospholipase than non CandidaAlbicans in this study.
Abstract: Introduction: Candida species are normal inhabitants of the skin and mucosa The importance of epidemiological monitoring of yeasts involved in pathogenic processes is unquestionable due to the increase of these infections over the last decade; Materials and Methods: The clinical samples from the respiratory tract (sputum, bronchial wash, tracheal secretions), saliva, blood, urine, middle ear discharge, vitreous fluid, corneal ulcer, and plastic devices (endotracheal tube, catheter tip, suction tip) were collected and cultured The species of Candida isolated were identified Results: A total of 111 isolates of Candida species were recovered from 250 diverse clinical sources C albicans (3964%) was the most isolated species, although the Candida non albicans species with 6036% showed the major prevalence In blood cultures, C krusei (3823%) and C albicans (2058%) were isolated frequently C albicans (6327%) was the predominant species in mucosal surface Urinary tract infections caused by yeasts were more frequent in hospitalized patients, C krusei (500%) being commonly isolated, followed by C albicans (250%) Discussion: Several virulence factors like, biofilm, proteinase, phospholipase, etc contribute to the pathogenecity Early detection of virulence factors by Candida is useful in clinical decision making We therefore have aimed at demonstrating the formation of biofilm using the method proposed by Branchini et al, (1994) The proteinase produced by Candida was estimated as per the method of Staib et al, (1965) Phospholipase assay was carried out as per the method of Samaranayake et al, (2005) Conclusions : The data suggests that the capacity of Candida species to produce biofilm may be a reflection of the pathogenic potential of the isolates C krusei and C tropicalis showed strong slime production The non-Candida albicans produced more proteinase than C albicans C albicans produced higher levels of phospholipase than non Candida albicans in this study
144 citations
TL;DR: The current review is an attempt to summarize the updated knowledge on the disease particularly in modern era, with special emphasis on nosocomial infections, to answer certain questions regarding entry of virus in India and future threat to community.
Abstract: Crimean Congo hemorrhagic fever (CCHF) is one of the deadly hemorrhagic fevers that are endemic in Africa, Asia, Eastern Europe, and the Middle East. It is a tick-borne zoonotic viral disease caused by CCHF virus of genus Nairovirus (family Bunyaviridae). CCHF not only forms an important public health threat but has a significant effect on the healthcare personnel, especially in resource-poor countries. India was always a potentially endemic area until an outbreak hit parts of Gujarat, taking four lives including the treating medical team. The current review is an attempt to summarize the updated knowledge on the disease particularly in modern era, with special emphasis on nosocomial infections. The knowledge about the disease may help answer certain questions regarding entry of virus in India and future threat to community.
140 citations
TL;DR: The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed, as well as the costs of the prevention of STHs, although these cannot always be calculated because interventions in health education are difficult to measure.
Abstract: Soil-transmitted helminths (STHs) form one of the most important groups of infectious agents and are the cause of serious global health problems. The most important STHs are roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura) and hookworms (Necator americanus or Ancylostoma duodenale); on a global level, more than a billion people have been infected by at least one species of this group of pathogens. This review explores the general concepts of transmission dynamics and the environment and intensity of infection and morbidity of STHs. The global strategy for the control of soil-transmitted helminthiasis is based on (i) regular anthelminthic treatment, (ii) health education, (iii) sanitation and personal hygiene and (iv) other means of prevention with vaccines and remote sensoring. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed, as well as the costs of the prevention of STHs, although these cannot always be calculated because interventions in health education are difficult to measure. An efficient sanitation infrastructure can reduce the morbidity of STHs and eliminates the underlying cause of most poverty-related diseases and thus supports the economic development of a country.
125 citations
TL;DR: Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis and is also a good indicator of the efficacy of treatment of bacterialMeningitis.
Abstract: Background: In children with meningitis, there is a difficulty to verify the etiology as viral or bacterial. Therefore, intensive research has been carried out to find new and rapid diagnostic methods for differentiating bacterial from viral meningitis. Objectives: The aim of this work was to study the behavior of procalcitonin (PCT) and whether it can be used to differentiate children with bacterial from those with viral meningitis. We also compared PCT to C-reactive protein (CRP) and white blood cell count. Patients and Methods: Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days. Results: PCT levels were significantly higher in patients with bacterial meningitis (mean, 24.8 ng/ml) compared to patients with viral meningitis (mean, 0.3 ng/ml) (P 2 ng/ml showed sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66%, 68%, and 100%, respectively, for the diagnosis of bacterial meningitis. Conclusion: Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis. It is also a good indicator of the efficacy of treatment of bacterial meningitis.
69 citations
TL;DR: The leprosy patients were more aware about the infectious nature of the disease, symptoms, transmission, and curability than the control group and a negative attitude was seen towards the leProsy patients in the society.
Abstract: Background: Leprosy a chronic infectious affliction, is a communicable disease that posses a risk of permanent and progressive disability. The associated visible deformities and disabilities have contributed to the stigma and discrimination experienced by leprosy patients, even among those who have been cured. Aims and Objectives: 1) To assess the knowledge, attitude and belief about leprosy in leprosy patients compared with community members. 2) To find the perceived stigma among leprosy patients. 3). To evaluate the quality of life in leprosy patients as compared to community members using WHO Quality of Life assessment questionaire (WHOQOL- BREF). Materials and Methods: A cross sectional study was conducted at Leprosy Rehabilitation Centre, Shantivan, Nere in Panvel Taluka, district Raigad from October - December 2009. A pre-designed and pre-structured questionaire was used to evaluate knowledge, attitude and perceived stigma among leprosy patients and community members. WHO Quality of life questionaire (WHOQOL-BREF) was used to assess quality of life in leprosy patients and controls. Data analysis was done with the help of SPSS package. Result: Among the cases and control, 43.13% of cases were aware that leprosy is an infectious disease compared to 20.69% of control. 68.62% of cases had knowledge of hypopigmented patches being a symptom of leprosy compared to the 25.86% in control. There was overall high level of awareness about disease, symptoms, transmission and curability in leprosy patients as compared to control. Among control group, 43.10% of population said that they would not like food to be served by leprosy patients as compared to 13.73% in study group. It was seen that the discrimination was much higher in female leprosy patients as compared to male leprosy patients. The mean quality of life scores for cases was significantly lower than those for control group in physical and psychological domain but not in the social relationship and environmental domain. The mean quality of life scores for male cases were lower in each domain as compared to male control group but the difference was not significant except in the physical and enviornmental domain. The mean quality of life scores for female cases were lower in each domain as compared to female control group and the difference was not significant except in the psychological domain. Conclusions: There was a significant difference in physical domain in male leprosy patients and psychological domain in female leprosy patients as compared with their respective gender controls. The leprosy patients were more aware about the infectious nature of the disease, symptoms, transmission, and curability than the control group. A negative attitude was seen towards the leprosy patients in the society.
66 citations
TL;DR: The most important risk factors of sepsis in the study population were preterm birth, followed by respiratory distress and low birth weight, and culture and sensitivity test should be performed in all cases of septicemia.
Abstract: Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. Aim: The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. Setting and design: This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. Materials and Methods: Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. Risk factors for sepsis in the children were registered. Results: Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). Conclusion: As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.
60 citations
TL;DR: There is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007, and a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model.
Abstract: Background: The association of the present Chikungunya pandemic with a mutation in the Chik virus is already established in many parts of the world, including Kerala. Kerala was one of the worst-affected states of India in the Chikungunya epidemic of 2006-2007. It is important to discuss the clinical features of patients affected by Chikungunya fever in the context of this change in the epidemiology of the disease. Aim: This study tries to analyze the clinical picture of the Chikungunya patients in Kerala during the epidemic of 2007. Setting and Design: A cross-sectional survey was carried out in five of the most affected districts in Kerala, India. Materials and Methods: A two-stage cluster sampling technique was used to collect the information. Ten clusters each were selected from all the five districts, and the size of the clusters were 18 houses each. A structured interview schedule was used for data collection. Diagnosis based on clinical signs and symptoms was the major case-finding strategy. Results and Conclusion: Of the 3623 residents in the surveyed households, 1913 (52.8%) had Chikungunya clinically. Most of the affected were in the adult age group (73.4%). Swelling of the joints was seen in 69.9% of the patients, followed by headache (64.1%) and itching (50.3%). The knee joint was the most common joint affected (52%). The number of patients with persistence of any of the symptoms even after 1 month of illness was 1388 (72.6%). Taking bed rest till the relief of joint pain was found to be a protective factor for the persistence of the symptoms. Recurrence of symptoms with a period of disease-free interval was complained by 669 (35.0%) people. Older age (>40 years), a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model. In conclusion, we found that there is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007.
TL;DR: There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.
Abstract: Background: In India, a large segment of the population seeks health care services from individual or institutional private health-care providers for health care. We analyzed a nationally representative data to identify the role of private providers in delivering health care for patients with tuberculosis. Materials and Methods: The primary data source for the present analysis was the 60 th round of the National Sample Survey. Distribution frequencies were used to analyze the distribution of key sociodemographic variables and multiple logistic regression was used to analyze the association between these variables and healthcare seeking behavior. Results: A sample of 2203 respondents who had received ambulatory care for tuberculosis, and 4568 respondents who had received inpatient treatment were analyzed. About half of the respondents had attended private facilities for TB care. Sociodemographic variables such as paediatric age group, females, higher level of education, and economic groups were associated with attendance at private sector. Dissatisfaction with services in government facilities was cited as the main reason for preferring private facilities. Conclusions: Private providers play an important role in providing health care services to a large proportion of patients with tuberculosis. There is a need for innovative measures to increase participation of the private sector in the national TB control program and to improve the quality of services in government facilities.
TL;DR: Novelties on human infection and the disease that can help the general physician from both endemic and non-endemic countries in their medical practice, particularly, now that emigration is undoubtedly a global phenomenon that is modifying the previous geography of infectious diseases worldwide.
Abstract: In accordance with the 1997 documents of the World Health Organization (WHO), amoebiasis is defined as the infection by the protozoan parasite Entamoeba histolytica with or without clinical manifestations. The only known natural host of E. histolytica is the human with the large intestine as major target organ. This parasite has a very simple life cycle in which the infective form is the cyst, considered a resistant form of parasite: The asymptomatic cyst passers and the intestinal amoebiasis patients are the transmitters; they excrete cysts in their feces, which can contaminate food and water sources. E. histolytica sensu stricto is the potentially pathogenic species and E. dispar is a commensal non-pathogenic Entamoeba. Both species are biochemical, immunological and genetically distinct. The knowledge of both species with different pathogenic phenotypes comes from a large scientific debate during the second half of the 20(th) century, which gave place to the rapid development of diagnostics technology based on molecular and immunological strategies. During the last ten years, knowledge of the new epidemiology of amoebiasis in different geographic endemic and non-endemic areas has been obtained by applying mostly molecular techniques. In the present work we highlight novelties on human infection and the disease that can help the general physician from both endemic and non-endemic countries in their medical practice, particularly, now that emigration is undoubtedly a global phenomenon that is modifying the previous geography of infectious diseases worldwide.
TL;DR: MRSA is prevalent in a referral tertiary care teaching hospital of Sikkim, India and strains resistant to methicillin and vancomycin were quite high.
Abstract: Background: Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains is reported to be increasing globally. Objectives: The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India. Materials and Methods: In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI). Results: Methicillin resistance was seen in 152 isolates of S. aureus - 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem. Conclusion: MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.
TL;DR: The identification of H. pylori as the causative agent in the majority of peptic ulcer disease has revolutionized the understanding and management of the disease and significantly decreased medical conditions and surgical procedures associated with end-stage peptic Ulcer disease.
Abstract: Background: Peptic ulcer disease can lead to serious complications including massive hemorrhage or bowel perforation. The modern treatment of peptic ulcer disease has transitioned from the control of gastric acid secretion to include antibiotic therapy in light of the identification of Helicobacter pylori as a causative infectious organism. We sought to determine trends related to this discovery by using a national database. Materials and Methods: Patient discharges with peptic ulcer disease and associated sequelae were queried from the Nationwide Inpatient Sample, 1993 to 2007, under the auspices of a data user agreement. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. Standard error was calculated using SUDAAN software (Research Triangle International, NC, USA). Results: Decreases in the incidences of gastrointestinal perforation, gastrointestinal hemorrhage, and surgical procedures most specific to peptic ulcer disease were statistically significant over the study period [range of P value (two tailed) = 0.000 - 0.00353; significant at P < 0.001 to < 0.01]. The incidence of H. pylori rose dramatically, peaking at an estimated 97,823 cases in 1998 [SE = 3155; 95% CI = 6,184]. Since that time it has decreased and then stabilized. Conclusions: The identification of H. pylori as the causative agent in the majority of peptic ulcer disease has revolutionized the understanding and management of the disease. Medical conditions and surgical procedures associated with end-stage peptic ulcer disease have significantly decreased according to analysis of selected index categories. Resident physician education objectives may need to be modified in light of these trends. Review Criteria: We reviewed patients with peptic ulcer disease. The database used was the Nationwide Inpatient Sample, 1993 to 2007. Message for the Clinic: Medical therapy has resulted in decreased morbidity from H. pylori infection as it is the causative agent in the majority of peptic ulcer disease. Aggressive screening and treatment of this infection will lead to further reduction in morbidity.
TL;DR: It is suggested that Mayaro virus is endemic and enzootic in the rainforest, with sporadic outbreaks that determine differences in risk between birth cohorts of natives, and deep forest hunting may selectively expose native men, descendants of the Shuar and Huaronai ethnic groups, to the arthropod vectors ofMayaro virus in areas close to primate reservoirs.
Abstract: Objectives: The objectives of this report were to document the potential presence of Mayaro virus infection in Ecuador and to examine potential risk factors for Mayaro virus infection among the personnel of a military garrison in the Amazonian rainforest. Materials and Methods: The study population consisted of the personnel of a garrison located in the Ecuadorian Amazonian rainforest. The cross-sectional study employed interviews and seroepidemiological methods. Humoral immune response to Mayaro virus infection was assessed by evaluating IgM- and IgG-specific antibodies using ELISA. Results: Of 338 subjects studied, 174 were from the Coastal zone of Ecuador, 73 from Andean zone, and 91 were native to the Amazonian rainforest. Seroprevalence of Mayaro virus infection was more than 20 times higher among Amazonian natives (46%) than among subjects born in other areas (2%). Conclusions: Age and hunting in the rainforest were significant predictors of Mayaro virus infection overall and among Amazonian natives. The results provide the first demonstration of the potential presence of Mayaro virus infection in Ecuador and a systematic evaluation of risk factors for the transmission of this alphavirus. The large difference in prevalence rates between Amazonian natives and other groups and between older and younger natives suggest that Mayaro virus is endemic and enzootic in the rainforest, with sporadic outbreaks that determine differences in risk between birth cohorts of natives. Deep forest hunting may selectively expose native men, descendants of the Shuar and Huaronai ethnic groups, to the arthropod vectors of Mayaro virus in areas close to primate reservoirs.
TL;DR: HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility in Lusaka, Zambia and routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.
Abstract: Objectives : Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART). Materials and Methods: We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection. Results: Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7-13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03-2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be 200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; P=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease. Conclusions: HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.
TL;DR: A case of liver abscess in which the source was confounding but eventually was traced to Sigmoid Diverticulitis on laparotomy is reported.
Abstract: Pyogenic liver abscess secondary to dissemination from Sigmoid Diverticulitis is rare. Streptococcus Anginosus has been linked to abscesses but has been rarely reported from a Sigmoid Diverticulitis source. We report a case of liver abscess in which the source was confounding but eventually was traced to Sigmoid Diverticulitis on laparotomy.
TL;DR: The nucleic acid amplification methods and their applications in molecular biology are reviewed and the best-known isothermal techniques for DNA/RNA amplification are reviewed.
Abstract: Polymerase chain reaction is the most widely used method for DNA amplification for the detection and identification of infectious diseases, genetic disorders and for other research purposes. However, it requires a thermocycling machine to separate the two DNA strands and then amplify the required fragment. Novel developments in molecular biology of DNA synthesis in vivo demonstrate the possibility of amplifying DNA in isothermal temperature without the need of a thermocycling apparatus. DNA polymerase replicates DNA with various accessory proteins. Therefore, with identification of these proteins, we are able to develop new in vitro isothermal DNA amplification methods by mimicking these in vivo mechanisms. There are several isothermal nucleic acid amplifications, such as transcription-mediated amplification or self-sustained sequence replication, nucleic acid sequence-based amplification, signal-mediated amplification of RNA technology, strand displacement amplification, rolling circle amplification, loop-mediated isothermal amplification of DNA, isothermal multiple displacement amplification, helicase-dependent amplification, single-primer isothermal amplification and circular helicase-dependent amplification. In this paper, we reviewed the nucleic acid amplification methods and their applications in molecular biology. We reviewed the best-known isothermal techniques for DNA/RNA amplification. The above information can be used for the application of valuable molecular diagnostic techniques for the detection of infectious agents in small-scale hospital laboratories in the field. With regards to the properties of isothermal DNA/RNA amplification techniques, the design and development of novel rapid molecular tests for application in field may be possible. ABSTRACT Address for correspondence:
TL;DR: The high number of petite mutation in the isolated yeasts should be seriously considered since it may be one of the reasons of antifungal treatment failure.
Abstract: Context: Candida species are opportunistic yeasts that cause infections ranging from simple dermatosis to potentially life-threatening fungemia. The emergence of resistance to antifungal drugs has been increased in the past two decades. Aim: the present study we determined to find out the susceptibility profiles of clinical isolates of Candida species against four antifungal drugs, including amphotericin B, ketoconazole, fluconazole and itraconazole. Materials and Methods: Antifungal susceptibility testing of the yeasts was done in accordance with the proposed guidelines for antifungal disk diffusion susceptibility testing of yeasts based on the CLSI document M44-A. Results: A total of 206 yeast isolates were assessed. Among the evaluated Candida species, the highest rates of resistance to ketoconazole were seen in Candida glabrata (16.6%) and Candida albicans (3.2%). Susceptibility and intermediate response to fluconazole were seen in 96.6% and 3.4% of the Candida isolates, respectively. A total of 19 (9.2%) yeast isolates showed petite phenomenon including 11 C. glabrata, 3 C. albicans, 2 Candida dubliniensis and one isolate of each Candida krusei and Candida parapsilosis. Conclusion: The high number of petite mutation in the isolated yeasts should be seriously considered since it may be one of the reasons of antifungal treatment failure.
TL;DR: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy; for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern.
Abstract: Background: In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO), which often evade diagnosis. Objective: The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India. Materials and Methods: This is a prospective study of inpatients, with regard to both clinical signs and investigations. Results: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern. Interpretation: In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO. Conclusion: Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.
TL;DR: Existing and newly-developed treatment strategies offer the chance to eliminate onchocercal ocular morbidity in some parts of the world and the next steps toward elimination are reviewed.
Abstract: For decades, onchocerciasis (or river blindness) was one of the most common infectious causes of blindness in the world. Primarily an infection of Africa, with limited distribution in the new world, disease due to the nematode Onchocerca volvulus is rapidly diminishing as a result of large public health campaigns targeting at risk populations in Africa and the Americas. Existing and newly-developed treatment strategies offer the chance to eliminate onchocercal ocular morbidity in some parts of the world. This article reviews these treatment strategies, current clinical and epidemiologic aspects of onchocerciasis, and the next steps toward elimination.
TL;DR: Caffeine and aminophylline had the ability to inhibit many strains of pathogenic bacteria.
Abstract: Background: Purine compounds are special types of alkaloids. Caffeine and aminophylline are considered the most important members of purines due to their wide use in therapeutics. Aims: To detect any potential antibacterial effects on pathogenic bacteria of the widely prescribed members of purines caffeine and aminophylline. Materials and Methods: Two species of gram-positive bacteria and five species of gram-negative bacteria were exposed to these purine agents. Antibacterial effects of the tested purines were determined using the spectrophotometer method to assess the minimum inhibition concentrations (MIC). Results: Among the strains of bacteria tested, Bacillus subtilis showed the most susceptibility to purine agents. Staphylococcus aureus and Bacillus subtilis were found to be more susceptible to caffeine than the other strains. Aminophylline showed inhibitory action on many isolates, especially at the concentration of 10mg/ml. Paracoccus yeei demonstrated resistance to all tested purine compounds up to a concentration of 10.5mg/ml. Conclusions: Caffeine and aminophylline had the ability to inhibit many strains of pathogenic bacteria.
TL;DR: The screening and treatment of urinary tract infection and asymptomatic bacteriuria in renal transplant recipients is discussed and guidelines are evaluated on the basis of a review of published evidence.
Abstract: Asymptomatic bacteriuria and urinary tract infection are common complications after kidney transplantation. In this population, if urinary tract infection occurred in the first six months post procedure, it carries a grave impact on both graft and patient survival. Renal transplant recipients with urinary tract infection are often clinically asymptomatic as a consequence of immunosuppression. Urinary tract infection, however, may progress to acute pyelonephritis, bacteremia and the full blown picture of urosepsis. PubMed and Cochrane databases were searched. The purpose of this review is to discuss the screening and treatment of urinary tract infection and asymptomatic bacteriuria in renal transplant recipients and to evaluate the guidelines on the basis of a review of published evidence.
TL;DR: Two cases of subcutaneous human dirofilariasis due to D. repens with varied clinical presentations are reported in India.
Abstract: Zoonotic filariasis due to Dirofilaria repens (D. repens) is prevalent in several regions of the world. In view of recent rise of human D. repens infections in Europe, Africa and Asia, it is considered an emerging zoonosis in these continents. Most of the documented cases of human dirofilariasis recorded in India had ocular infections, but very few subcutaneous dirofilariasis have been reported. We hereby report two cases of subcutaneous human dirofilariasis due to D.repens with varied clinical presentations.
TL;DR: This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome, and contributes an additional case to the existing literature on this topic.
Abstract: A 24-year-old previously healthy girl presented with persistent fever, headache, and jaundice. Rapid-test anti-dengue virus IgM antibody was positive but anti-dengue IgG was nonreactive, which is suggestive of primary dengue infection. There was clinical deterioration during empiric antibiotic and symptomatic therapy. Bone marrow examination demonstrated the presence of hemophagocytosis. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was made according to the diagnostic criteria of the HLH 2004 protocol of the Histiocyte Society. The patient recovered with corticosteroid therapy. A review of literature revealed only a handful of case reports that showed the evidence that this syndrome is caused by dengue virus. Our patient is an interesting case of hemophagocytic syndrome associated with classic dengue fever and contributes an additional case to the existing literature on this topic. This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome.
TL;DR: FAFLP can be successfully applied to assess the genetic relationship of S. aureus isolates from different hosts and the complete absence of PVL genes in all the bovine strains in the study appears to be significant.
Abstract: Aim and Background: Staphylococcus aureus is a major human pathogen that also causes important infections in cattle and sheep. The present study aimed to test genetic diversity among strains of S. aureus isolated from cattle (n=34) and humans (n=22) by DNA typing. Materials and Methods: Fluorescent amplified fragment length polymorphism (FAFLP) is the genotyping tool used in the study. The presence of the mecA and Panton-Valentine leukocidin (PVL) genes among these strain groups was also checked. Results: A dendrogram deduced from FAFLP showed that all the strains clustered into 10 groups (A-J) with a relative genetic divergence of less than 8%. Sixty-seven percent of the isolates from bovine sources clustered together in two clades (A and H), while another major cluster with 13 isolates (59%) (Cluster G) had all strains from a human host. The remaining strains from both the hosts clustered independently into smaller clusters with the exception of two strains of human origin, which clustered along with a bovine cluster. Thirteen strains belonging to cluster G were highly clonal. About 77% of strains obtained from human infections were methicillin-resistant S. aureus (MRSA), whereas only 29% of strains from bovine origin were MRSA. Only three strains from human origin showed PVL positive, while no strain from cattle had PVL genes. The complete absence of PVL genes in all the bovine strains in the study appears to be significant. Conclusions: FAFLP can be successfully applied to assess the genetic relationship of S. aureus isolates from different hosts. The study also provided the valuable epidemiological data on S. aureus from bovine sources in India, which is lacking.
TL;DR: Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholERA-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks.
Abstract: Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL-Sweden to Crucell-Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E coli) which is of added benefit for travelers It is available in more than 60 countries (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech-Viet Nam to Shantha Biotechnics-India It is available in India and Indonesia A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished Inclusion criteria were defined according to reports quality and relevance
TL;DR: The development and spread of ESBL among Gram-negative bacteria and possible horizontal transfer calls for concern, especially in view of treatment failure, high treatment cost, and consequent discomfort to patients.
Abstract: Background: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are emerging and impacting significantly on the management of patients and hospital costs. Besides, they are not being routinely sought after in diagnostic laboratories thus contributing to treatment failure. Materials and Methods: Bacterial isolates from wounds of 45 patients were identified using commercial identification kits and antibiotic susceptibility was evaluated by the Bauer-Kirby method. Screening and phenotypic confirmation of ESBL production were done as prescribed by the Clinical and Laboratory Standards Institute. The conjugation experiment was performed by the mating assay in broth between the ESBL producers and E. coli ATCC 25922 as the recipient. Results: Out of 102 Gram-negative bacteria isolated, 36 were positive for ESBL mainly of the Enterobacteriaceae family (33) and the rest were oxidase-positive bacilli (3). The predominant bacteria were Klebsiella spp. and E. coli. Others were Serratia rubidae, Citrobacter freundii, Morganella morgannii, Proteus spp., Providencia stuartii, and Enterobacter spp. There was a significant association between treatment with third-generation cephalosporins (3GCs) and isolation of ESBLs ( p=0.0020 ). The ESBL producers were multiply resistant and moderately sensitive to colistin. The conjugation experiment showed that the ESBL gene was transferred horizontally and tetracycline, cotrimoxazole, nitrofurantoin, gentamicin, and aztreonam resistance genes were co-transferred. No mortality was recorded but the mean length of stay in the hospital was 82 days. Conclusion: The development and spread of ESBL among Gram-negative bacteria and possible horizontal transfer calls for concern, especially in view of treatment failure, high treatment cost, and consequent discomfort to patients.
TL;DR: The burden of skin disease in Africa, how it relates to HIV/AIDS and global infectious disease, current educational strategies in Africa to address this need, and potential solutions to move these efforts forward are reviewed.
Abstract: Human immunodeficiency virus and the acquired immunodeficiency syndrome (HIV/AIDS) have greatly complicated dermatologic disease and the required care in most regions of Africa. Opportunistic infections, ectoparasites, Kaposi sarcoma, and skin manifestations of systemic infections are exceedingly common in patients with HIV/AIDS. Dermatologists have contributed significantly to our knowledge base about HIV/AIDS and have played an important educational role regarding the clinical manifestations historically. Because of the increased burden of skin disease in Africa due to the HIV/AIDS epidemic we must redouble our efforts to provide dermatology education to care providers in Africa. We review the burden of skin disease in Africa, how it relates to HIV/AIDS and global infectious disease, current educational strategies in Africa to address this need, and suggest potential solutions to move these efforts forward.