Showing papers in "Journal of Infection in Developing Countries in 2013"
TL;DR: The results suggest that misdiagnosis of arbovirus co-infections as malaria infections, combined with a lack of virus surveillance and underreporting of arBovirus infections, increases the potential for undetected and uncontrolled spread of important vector-borne arbOViruses becoming serious underlying public health concerns in Nigeria.
Abstract: Introduction: Clinical symptoms of malaria and typhoid infections are virtually indistinguishable from those initially seen in many arbovirus infections Here we describe arbovirus co-infection detected in 310 sera samples collected from febrile, clinically suspected malaria/typhoid patients in Borno State, Nigeria Methodology: Tested initially for Plasmodium falciparum by microscopy and for Salmonella Typhi by Widal test, samples were subsequently tested for chikungunya (CHIKV), yellow fever (YFV), dengue (DENV) and West Nile viruses (WNV) by plaque reduction neutralization test Results: While 92% of patients tested positive for malaria, typhoid, an arbovirus infection, or a combination of one or more of these types of infections, less than 1% of the patients tested positive for malaria alone and only 39% tested positive for typhoid alone Approximately half of the patients tested positive for infection with a single arbovirus (48%) regardless of the presence or absence of malaria or typhoid Of those who showed 90% to 95% virus neutralization, 677% had neutralizing antibodies against DENV, 50% against CHIKV, 25% against WNV and 87% against YFV Eight per cent tested negative against all six pathogens, suggesting that other arboviruses not tested for in this study may also be circulating in Nigeria Conclusions: The results suggest that misdiagnosis of arbovirus co-infections as malaria infections, combined with a lack of virus surveillance and underreporting of arbovirus infections, increases the potential for undetected and uncontrolled spread of important vector-borne arboviruses becoming serious underlying public health concerns in Nigeria
120 citations
TL;DR: The prevalence of soil-transmitted helminths and S. mansoni differs by geographical area of the schools and social determinants, and primary school de-worming and health education on proper hygiene are recommended.
Abstract: Introduction: This study aimed to determine the prevalence of intestinal helminths, risk factors and haematocrit values among primary schoolchildren. Methodology: Across-sectional study was conducted in 12 primary schools in March 2011. Stool samples were randomly selected from 778 children and were microscopically examined using Kato-Katz and formal-ether concentration methods. Haematocrit values were measured using heparinized capillary tubes. Results: The overall prevalence of intestinal helminths was 51.5% (rural = 68.3%, urban = 36.2%). Hookworm spp., Schistosoma mansoni and Schistosoma stercoralis were more prevalent in rural schools, whereas Hymenolepis nana was higher in urban schools (p = 0.0001). With regard to haematocrit, 34% of rural and 21.7% of urban schoolchildren had haematocrit values below the median (40.5%) (p=0.001). Hookworm spp. and S. mansoni infected children had lower haematocrit values than non-infected children (p = 0.001). Lack of footwear was positively associated with intestinal helminths infection in rural schools [OR = 2.5 (95% CI: 1.5-4.1)], and having dirty fingernails and untrimmed fingernails were positively associated with the prevalence of intestinal helminths in urban samples [OR = 1.58 (95% CI: 1.032.5)]. Conclusion: The prevalence of soil-transmitted helminths and S. mansoni differs by geographical area of the schools and social determinants. Primary school de-worming and health education on proper hygiene are recommended.
76 citations
TL;DR: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.
Abstract: Introduction: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients. Methodology: In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed. Results: During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole. Conclusion: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.
68 citations
TL;DR: The current concepts in henipavirus pathogenesis in humans are reviewed and it is shown that endothelial cells are an important target during the terminal stage of infection.
Abstract: Hendra virus (HeV) and Nipah virus (NiV) are emerging zoonotic viruses that cause severe and often lethal respiratory illness and encephalitis in humans. Henipaviruses can infect a wide range of species and human-to-human transmission has been observed for NiV. While the exact route of transmission in humans is not known, experimental infection in different animal species suggests that infection can be efficiently initiated after respiratory challenge. The limited data on histopathological changes in fatal human cases of HeV and NiV suggest that endothelial cells are an important target during the terminal stage of infection; however, it is unknown where these viruses initially establish infection and how the virus disseminates from the respiratory tract to the central nervous system and other organs. Here we review the current concepts in henipavirus pathogenesis in humans.
67 citations
TL;DR: Care-related HH compliance among doctors and nurses in this large West African hospital is low; however, the NICU, which had implemented HH interventions, had better HH compliance.
Abstract: Introduction: Nosocomial infections have long been neglected in Sub-Saharan Africa, and hand hygiene (HH) is usually neglected in hospital settings. This study aimed to provide baseline data on HH compliance among health workers and HH resources in a large West African teaching hospital. Methodology: A cross-sectional, unobtrusive observational study assessed personal and care-related HH compliance among doctors and nurses and HH resources in 15 service provision centres of the Korle-Bu Teaching Hospital (KBTH), Ghana, in 2011. Data was collected with an infection prevention checklist and health worker HH compliance form, based on World Health Organization guidelines. Results: Care-related HH compliance of doctors and nurses was low and basic HH resources were deficient in all 15 service centres. Care-related HH compliance among doctors ranged from 9.2% to 57% and 9.6% to 54% among nurses. HH compliance was higher when risk was perceived to be higher ( i.e. , in the emergency and wound dressing/treatment rooms and labour wards). The neonatal intensive care unit (NICU) showed the highest level of compliance among health workers. Facilities for HH, particularly alcohol hand rub and liquid soap dispensers were shown to be deficient. Conclusion: Care-related HH compliance among doctors and nurses in this large West African hospital is low; however, the NICU, which had implemented HH interventions, had better HH compliance. HH intervention programs should be designed and promoted in all service centres. Also, the introduction of alcohol-based hand rubs as an accessible and effective HH alternative in Korle-Bu Teaching Hospital is recommended.
66 citations
TL;DR: Drug abuser inmates in prisons may offer a unique community to bridge prevention and control of human blood-borne virus infection to the general community.
Abstract: Introduction: This study was conducted to determine the current molecular prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and human T lymphotropic virus-1/2 (HTLV-1/2) circulating among drug abuser inmates incarcerated in prisons located in Central Java, Indonesia. Methodology: Socio-epidemiological data and blood specimens were collected from 375 drug abuser inmates in four prisons. The blood samples were analyzed with serological and molecular testing for HIV, HBV, HCV, HDV, and HTLV-1/2. Results: The seroprevalence of HIV, HBsAg, HCV, HDV, and HTLV-1/2 in drug abuser inmates was 4.8% (18/375), 3.2% (12/375), 34.1% (128/375), 0% (0/375), and 3.7% (14/375), respectively. No co-infections of HIV and HBV were found. Co-infections of HIV/HCV, HIV/HTLV-1/2, HBV/HCV, HBV/HTLV-1/2, and HCV/HTLV-1/2 were prevalent at rates of 4% (15/375), 1.3% (5/375), 1.1% (4/375), 0.3% (1/375), and 2.1% (8/375), respectively. The HIV/HCV co-infection rate was significantly higher in injection drug users (IDUs) compared to non-IDUs. Triple co-infection of HIV/HCV/HTLV-1/2 was found only in three IDUs (0.8%). HIV CRF01_AE was found to be circulating in the inmates. HBV genotype B3 predominated, followed by C1. Subtypes adw and adr were found. HCV genotype 1a predominated among HCV-infected inmates, followed by 1c, 3k, 3a, 4a, and 1b. All HTLV-1 isolates shared 100% homology with HTLV-1 isolated in Japan, while all of the HTLV-2 isolates were subtype 2a. Conclusion: Drug abuser inmates in prisons may offer a unique community to bridge prevention and control of human blood-borne virus infection to the general community.
64 citations
TL;DR: The results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.
Abstract: Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles. Methodology: We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010. Results: We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial. Gram-negative bacterial isolates (n = 191; 61.3%) significantly outnumbered Gram-positive isolates (n = 121; 38.7%). The most frequently isolated bacteria were Pseudomonas species (29.8%), Staphylococcus aureus (16.7%), Enterococcus species (11.5%), Escherichia coli (7.1%), and Enterobacter species (7.1%), respectively. While 13.2% of the Gram-negative isolates were inducible beta-lactamase positive, 44.2% of Staphylococcus aureus isolates were methicillin resistant. Conclusions: Our results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.
57 citations
TL;DR: The novel re-assortment A influenza H7n9 (nrH7N9) emerged in humans in the Shanghai and surrounding provinces of China in late February and early March, with elderly patients greater than 60 years of age accounted for 61% of the cases, indicating that the elderly may be at high risk for severe disease.
Abstract: The novel re-assortment A influenza H7N9 (nrH7N9) emerged in humans in the Shanghai and surrounding provinces of China in late February and early March. Three infected index patients developed severe viral pneumonia with acute respiratory distress syndrome (ARDS) and resulted in fatal outcome. As of 15 April 2013 there were reported 60 confirmed nrH7N9 infections with 13 fatalities. Human-to-human transmission has not been observed, but zoonotic infections of nrH7N9 from birds to humans appear to be associated with live poultry markets. Elderly patients greater than 60 years of age accounted for 61% of the cases, indicating that the elderly may be at high risk for severe disease.
46 citations
TL;DR: Sexual contact, perinatal infection, blood and its derivatives, hemodialysis, intravenous and percutaneous drug use, and occupational, habitual, and social behavior have been identified as risk factors for hepatitis transmission in various settings in these countries.
Abstract: Introduction: The epidemiology of viral hepatitis during pregnancy is of paramount importance for health planners and program managers. Data on viral hepatitis during pregnancy are not readily available in many African and Arab countries. Both regions have their own unique geography, and comprise over 59 states with crossover and interaction of different cultures. Methodology: A systematic electronic search of the published literature was conducted and data on epidemiology and risk factors of maternal hepatitis B virus (HBV) infection and hepatitis C (HCV) infection in Arab and African countries were extracted from relevant studies. Results: The serology of hepatitis viruses varies greatly among these countries, with different viral genotype patterns. Such a variation in prevalence could be explained by the different risk factors involved. Sexual contact, perinatal infection, blood and its derivatives, hemodialysis, intravenous and percutaneous drug use, and occupational, habitual, and social behavior have been identified as risk factors for hepatitis transmission in various settings in these countries. Conclusions: Infection from hepatitis B and C viruses imposes major socioeconomic and even political burdens on such young and dynamic societies. Thus strategies and clear policies of intervention are required to combat the consequences of hepatitis B and C at both the regional and national levels.
45 citations
TL;DR: A baseline Candida species identification was undertaken in 267 HIV-infected patients with oropharyngeal candidiasis for future reference to identifyCandida species causing severe infections.
Abstract: Introduction: Oropharyngeal candidiasis is a common occurrence in the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of oropharyngeal candidiasis and type of Candida species profile may be a reflection of immunological changes in patients. The aim of this study was to undertake a baseline Candida species identification for future reference. Methodology: Oral swabs of 267 HIV-infected patients with oropharyngeal candidiasis were cultured and Candida species were identified by API 32 C. Results: A total of 201 (75.3%) Candida species and 10 (3.7%) non candida fungi were identified. Twenty different Candida species were isolated. Candida albicans was the most prevalent species (68.5%) followed by C. tropicalis (7.4%), C. krusei (6.4%), C. parapsilosis (3.0%) and C. sake (2.5%). Other species ranged from 0.5% to 1.5%. Positive culture was independent of whether patients were on anti-retroviral therapy or not. Conclusion: Of all Candida isolates, 68.5% were identified as C. albicans. Since other uncommon species were also isolated, it may be necessary in this group of patients to identify Candida species causing severe infections.
43 citations
TL;DR: The results indicate the urgent need for interventions in order to improve the nutritional status of children and reduce infection rates of enteric parasites in Chiapas.
Abstract: Background: For many years Chiapas, Mexico's poorest state, has had the highest rate of child mortality due to intestinal infections of unknown etiology in the country. To begin identifying the infectious agents, our work determined the prevalence of intestinal parasites as well as malnutrition in children from Chiapas's three most impoverished municipalities: Pantepec, Chanal, and Larrainzar. Methodology: In this cross-sectional study, conducted between January and November 2009, we assessed the prevalence of intestinal parasites by means of coproparasitological analysis in children 40% of children represented varying degrees of malnutrition and a marked constitutional delay in growth. A very high prevalence of stunting was also recorded in children from Chanal and Larrainzar (70% and 55 %, respectively). An association between infection with intestinal parasites and malnutrition was observed in Pantepec. Preschool-age children were more likely to be infected with intestinal parasites. Conclusion: Our results indicate the urgent need for interventions in order to 1) improve the nutritional status of children and 2) reduce infection rates of enteric parasites.
TL;DR: Intestinal parasitic infections should be suspected in HIV/AIDS-infected patients with advanced disease presenting with chronic diarrhea, and patients with low CD4 counts should be examined critically for intestinal parasites, regardless of diarrheal status.
Abstract: Introduction: Intestinal parasitic infectionsare a major public health burden in tropical countries. Although all HIV/AIDS patients are susceptible to parasitic infections, those having lower immune status are at greater risk. The aim of this study was to determine the prevalence of intestinal parasitic infections in patients living with HIV/AIDS. Methodology: This was a facility-based cross-sectional study. A total of 343 consecutively sampled HIV/AIDS patients from the HIV care clinic of Hawassa University Referral Hospital were included. Subjects were interviewed for demographic variables and diarrheal symptoms using structured questionnaires. Stool examinations and CD4 cells counts were also performed. Results: The prevalence of intestinal parasitic infection was 47.8% among HIV/AIDS patients; single helminthic infection prevalence (22.7%) was higher than that the prevalence of protozoal infections (14.6%). About 54% of study participants had chronic diarrhea while 3.4% had acute diarrhea. The prevalence of intestinal parasites in patients with chronic diarrhea was significantly higher than in acute diarrhea (p =500 cells/mm3. Conclusions: Intestinal parasitic infections should be suspected in HIV/AIDS-infected patients with advanced disease presenting with chronic diarrhea. Patients with low CD4 counts should be examined critically for intestinal parasites, regardless of diarrheal status.
TL;DR: The data from this study can help health professionals to treat antenatal patients more effectively and reinforces the need for establishing effective prevention programs, which could lead to a reduction in the prevalence of HBV, HCV, syphilis, and HIV.
Abstract: Introduction: The epidemiology of viral hepatitis during pregnancy is of paramount importance for health planners and program managers. Data on viral hepatitis during pregnancy are not readily available. This study was conducted to assess the extent of seropositivity of hepatitis B, hepatitis C, HIV, and syphilis in pregnant women and to re-evaluate the need for routine antenatal care screening. Methodology: All samples were tested to detect HBsAg by enzyme linked immunosorbent assay (ELISA). Samples were tested to detect anti-HCV by ELISA. Samples were also tested for antibodies to Treponema Pallidum by qualitative rapid plasma reagine (RPR); finally, samples were tested for antibodies to HIV by three different methods as per Strategy III of the National AIDS Control Organization by using different systems of testing to establish a diagnosis of HIV. Results: Seropositivity of hepatitis B was 2.9%, hepatitis C was 0.19%, syphilis was 0.48%, and HIV was 0.38%. Out of the 1038 samples, no co-infection was found between hepatitis B, hepatitis C, syphilis, or HIV. Conclusion: The data from this study can help health professionals to treat antenatal patients more effectively. The data also reinforces the need for establishing effective prevention programs, which could lead to a reduction in the prevalence of HBV, HCV, syphilis, and HIV
TL;DR: These results shed light on some of the resistance patterns of MRSA strains isolated from local health care settings in Cairo, Egypt and identify different mechanisms of fluoroquinolne resistance.
Abstract: Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a persistent problem in community and health care settings. Fluoroquinolones are among the drugs of choice used to treat MRSA infections. This study aims to identify different mechanisms of fluoroquinolne resistance in local MRSA random sampling isolates in Cairo, Egypt. Methodology: A total of 94 clinical isolates of S. aureus were collected from two major University hospitals in Cairo. Identification was confirmed by appropriate morphological, cultural, and biochemical tests. The antibiotic susceptibility pattern was determined for all isolates. The possible involvement of efflux pumps in mediating fluoroquinolone resistance as well as changes in the quinolone resistance determining region (QRDR) of gyrA and gyrB genes were investigated Results: A total of 45 isolates were found to be MRSA, among which 26 isolates were found to be fluoroquinolone-resistant. The MIC values of the tested fluoroquinolones in the presence of the efflux pump inhibitors omeprazole and piperine were reduced. Measuring the uptake of ciprofloxacin upon the addition of the efflux pump inhibitor omeprazole, an increased level of accumulation was observed. Non-synonymous and silent mutations were detected in the QRDR of gyrA and gyrB genes. Conclusions: These results shed light on some of the resistance patterns of MRSA strains isolated from local health care settings in Cairo, Egypt. The resistance of these MRSA towards fluoroquinolones does not depend only on mutation in target genes; other mechanisms of resistance such as the permeability effect, efflux pumps and decreased availability of quinolones at the target site can also be involved.
TL;DR: It is imperative to develop public health policies to prevent toxoplasmosis in Nigeria, especially in HIV-infected patients, as well as in HIV clinical staging and CD4 cell counts.
Abstract: Introduction: We examined the seroprevalence of toxoplasma infection in HIV-negative and -positive adults from Zaria, Northern Nigeria, and assessed its relationship with demographic, clinical, and immunological findings. Methodology: In a six-month cross-sectional study undertaken in 2008, sera of 219 adults, including 111 consecutive HIV-infected adults and 108 healthy HIV-negative adult volunteers from Zaria, Northern Nigeria, were examined for IgG and IgM antibodies to toxoplasma by ELISA. Clinical characteristics of the HIV-infected patients were documented. Differences in toxoplasma seropositivity between HIV-positive and negative adults were sought. The relationship between toxoplasma seropositivity and variables such as age, sex and antiretroviral (ART) status, as well as HIV clinical staging and CD4 cell counts were also determined. P 0.05). The rate of IgM seropositivity was 4.6% in healthy adults and 1.8% in HIV-infected patients, while the rate of IgG seropositivity (without IgM seropositivity) was 28.7% in healthy adults and 37.8% in HIV-infected patients (p>0.05). Toxoplasma seropositivity was not associated with age, sex, ART status, CD4 cell count or HIV clinical staging. Seventy-four percent of the toxoplasma seropositive HIV-infected patients were asymptomatic and no cases of toxoplasma encephalitis were identified. Conclusion: Toxoplasmosis is equally prevalent in HIV-infected patients and healthy adults from similar environments in Northern Nigeria. It is imperative to develop public health policies to prevent toxoplasmosis in Nigeria, especially in HIV-infected patients.
TL;DR: The prevalence of ESBL-producing Enterobacteriaceae in a university hospital in eastern Saudi Arabia was determined and the ESBLs produced by these isolates were characterized at the molecular level.
Abstract: Introduction: Few reports about the prevalence and genetic basis of extended spectrum beta-lactamases (ESBLs) are available from Saudi Arabia. We sought to determine the prevalence of ESBL-producing Enterobacteriaceae in a university hospital in eastern Saudi Arabia and to characterize the ESBLs produced by these isolates at the molecular level. Methodology: All clinical isolates of Escherichia coli, Klebsiella spp ., and Proteus spp . collected over two years were evaluated for susceptibility to a panel of antimicrobials and were analyzed for the ESBL phenotype using screening and confirmatory tests. ESBL-positive isolates were then screened for the presence of genes encoding CTX-M, SHV, and TEM beta-lactamases by PCR. Results and conclusions: The overall prevalence of ESBL-producing isolates was 4.8% (253/5256). Most isolates (80%) were from the inpatient department. The ESBL phenotype was more frequently detected in K. pneumonia . CTX-M genes were the most prevalent ESBL genes, detected in 82% of the studied isolates. The ESBL producers demonstrated a high multidrug resistance rate (96.6%). In transconjugation assay, the same ESBL gene pattern was transmitted from 29.7% of K. pneumoniae donors to the recipient strain, and the latter exhibited concomitant decreased aminoglycosides and co-trimoxazole susceptibility. We observed the presence of ESBL screen-positive but confirmatory-negative isolates (8.9%). Phenotypic tests for the production of AmpC β-lactamase tested positive in 52% of these isolates. Further studies are needed for appropriate detection of concomitant ESBL and AmpC enzyme production among such isolates. Continued surveillance and judicious antibiotic usage together with the implementation of efficient infection control measures are absolutely required.
TL;DR: A high prevalence of faecal carriage of multidrug-resistant Gram-negative bacteria, including ESBLs, in Buenos Aires is revealed, and the use of surveillance cultures will be helpful for tracking and monitoring the spread of ESBL-producing Enterobacteriaceae within community settings.
Abstract: Introduction: The aim of this study was to determine the prevalence of intestinal carriage of extended-spectrum beta-lactamase (ESBL)producing Enterobacteriaceae and carbapenem-resistant Gram-negative bacilli in the community in Buenos Aires, Argentina. Methodology: Faecal samples from 164 non-hospitalized patients were cultured on CHROMagar KPC and CHROMagar ESBL plates. Isolates resistant to third-generation cephalosporins or carbapenems were selected for further study. The minimal inhibitory concentration (MIC) of the isolates was determined using the E-test method. The phenotypic detection of ESBLs and carbapenemases was performed using the double-disc synergy test. Results: The rate of faecal carriage of Enterobacteriaceae resistant to third-generation cephalosporins was 26.8%. Escherichia coli represented a large majority (75%) of the isolates recovered. Thirty-three ESBL-producing isolates were detected from 31 faecal samples (18.9% of the collected specimens). Eight carbapenem-resistant Gram-negative bacilli were recovered from eight specimens (4.9%). Conclusions: This study revealed a high prevalence of faecal carriage of multidrug-resistant Gram-negative bacteria, including ESBLs, in Buenos Aires. Therefore, the use of surveillance cultures will be helpful for tracking and monitoring the spread of ESBL-producing Enterobacteriaceae within community settings.
TL;DR: Targeted educational measures such as online education and counseling via Chinese websites and social media, and the provision of safer sex and STI-related information by health experts to university students are suggested.
Abstract: Introduction: This study investigated the current state of attitudes, behaviors, and knowledge concerning sex and sexually transmitted infections (STIs) among Chinese university students. Methodology: A cross-sectional anonymous university intranet-based survey was given to students attending the Shantou University, Guangdong, China using a 28-item questionnaire. Results: Of 3425 website visitors, 1030 university students completed the survey, of which 80% were between 20 and 25 years of age, 76% considered pre-marital sex acceptable, 21% had had sexual intercourse, and 45% of sexually active students had engaged in oral sex, anal intercourse, or sex with strangers. Students had limited knowledge and awareness about common STIs, symptoms, and complications. Three percent of the sexually active students reported having had STIs and another 8% were not sure whether they had or not. Most students had misconceptions about transmission and prevention of STIs. The internet was the main information resource for 76% of students. Conclusions: Despite having more open attitudes and behaviors towards sex, students’ STI knowledge and awareness of STI risks was considerably limited, raising concerns about a likely rise in STI incidence. Prior knowledge of STIs had no significant influence. Targeted educational measures such as online education and counseling via Chinese websites and social media, and the provision of safer sex and STI-related information by health experts to university students are suggested.
TL;DR: OPC and Candida colonization occur more frequently in HIV-positive patients with CD4+ cell counts ≤ 200 cell/mm3 and ART significantly reduces OPC, suggesting endogenous infection.
Abstract: Introduction: Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection reported in human immunodeficiency virus (HIV) positive patients worldwide. This prospective study was undertaken to investigate OPC and Candida colonization (CC) and their correlation with CD4 + cell counts and antiretroviral therapy (ART) in HIV-positive patients. Methodology: In total, 190 HIV-positive patients were enrolled for study in three groups as follows: Group A, 90 patients without ART; Group B, 100 patients undergoing treatment with ART; and Group C, 75 HIV-negative control patients. All HIV patients underwent clinical examination and were subjected to CD4 + cell counts. Swabs were collected from the oral cavity of all individuals and plated on Sabouraud’s dextrose agar. Identification of Candida species was performed by conventional methods. Results: Candida species were isolated in 84/190 (44.2%) and 20/75 (26.6%) of the HIV-positive subjects and controls respectively (p 500 cell/mm 3 (5/63; 7.9% versus 0/21 0%) respectively. Conclusion: OPC and Candida colonization occur more frequently in HIV-positive patients with CD4 + cell counts ≤200 cell/mm 3 . ART significantly reduces OPC. C. albicans is the most frequently isolated species in both OPC and colonization, suggesting endogenous infection.
TL;DR: It is shown that S. Typhimurium ST313 is a prevalent sequence-type causing gastrointestinal diseases and septicemia in patients from Nigeria and DRC and three distinct phylogenetic clusters based on the origin of isolation suggest some spatial evolution.
Abstract: Introduction: Salmonella enterica serovar Typhimurium ST313 is an invasive and phylogenetically distinct lineage present in sub-Saharan Africa. We report the presence of S. Typhimurium ST313 from patients in the Democratic Republic of Congo and Nigeria. Methodology: Eighteen S. Typhimurium ST313 isolates were characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). Additionally, six of the isolates were characterized by whole genome sequence typing (WGST). The presence of a putative virulence determinant was examined in 177 Salmonella isolates belonging to 57 different serovars. Results: All S. Typhimurium ST313 isolates harbored resistant genes encoded by blaTEM1b, catA1, strA/B, sul1, and dfrA1. Additionally, aac(6’)1aa gene was detected. Phylogenetic analyses revealed close genetic relationships among Congolese and Nigerian isolates from both blood and stool. Comparative genomic analyses identified a putative virulence fragment (ST313-TD) unique to S. Typhimurium ST313 and S. Dublin. Conclusion: We showed in a limited number of isolates that S. Typhimurium ST313 is a prevalent sequence-type causing gastrointestinal diseases and septicemia in patients from Nigeria and DRC. We found three distinct phylogenetic clusters based on the origin of isolation suggesting some spatial evolution. Comparative genomics showed an interesting putative virulence fragment (ST313-TD) unique to S. Typhimurium ST313 and invasive S. Dublin.
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TL;DR: Through foreign aid, China has consolidated friendly relations and economic and trade cooperation with other developing countries, promoted South-South cooperation and contributed to the common development of mankind.
Abstract: In the 1950s, soon after the founding of the People’s Republic of China, although it was short of funds and materials, China began to provide economic aid and technical assistance to other countries, and gradually expanded the scope of such aid. Since China adopted the reform and opening-up policies in the late 1970s, its economy has been developing rapidly, with the overall national strength growing notably. However, China remains a developing country with a low per-capita income and a large poverty-stricken population. In spite of this, China has been doing its best to provide foreign aid, to help recipient countries to strengthen their self-development capacity, enrich and improve their peoples’ livelihood, and promote their economic growth and social progress. Through foreign aid, China has consolidated friendly relations and economic and trade cooperation with other developing countries, promoted South-South cooperation and contributed to the common development of mankind.
TL;DR: Carapenem resistance was observed to be mediated by MBL in a considerable number of isolates, and colistin is an alternative for infections caused by CA-R isolates; however, MIC testing should be performed whenever clinical use of colistsin is considered.
Abstract: Introduction: Pseudomonas aeruginosa and Acinetobcter spp. are important nosocomial pathogens and carbapenem resistance is an emerging threat. Therapeutic options for infections with these isolates include colistin. This study was conducted to determine the prevalence of carbapenem resistance in P. aeruginosa and Acinetobacter spp. bloodstream isolates, phenotypically characterize the resistance mechanisms and evaluate the invitro activity of colistin. Methodology: Consecutive 145 (95 P.aeruginosa and 50 Acinetobacter spp.) non-repeat isolates were included. Antibiotic susceptibility testing was performed per CLSI guidelines. MIC for carbapenems and colistin was performed using Etest. Isolates showing reduced susceptibility or resistance to the carbapenems were tested for metallo-β-lactamase (MBL) production using imipenem-EDTA combined disk and MBL Etest. Results: Carbapenem resistance was observed in 40% P. aeruginosa and 66.0% Acinetobacter spp. Carbapenem-resistant (CA-R) isolates were significantly (p< 0.05) more frequently resistant to the other antibiotics than carbapenem-susceptible isolates. Approximately half of the CA-R strains were multidrug-resistant, and 3.1-5.5% were resistant to all antibiotics tested. MBL was found in 76.3% and 69.7% of the P. aeruginosa and Acinetobacter spp., respectively. Colistin resistance was observed in three (6.0%) Acinetobacter isolates and eight (8.4%) P. aeruginosa. MIC50 for carbapenems were two to four times higher for MBL-positive compared to MBL-negative isolates, but no difference was seen in MIC for colistin. Conclusion: Carbapenem resistance was observed to be mediated by MBL in a considerable number of isolates. Colistin is an alternative for infections caused by CA-R isolates; however, MIC testing should be performed whenever clinical use of colistin is considered.
TL;DR: The findings of the fourth outbreak of AOACD that occurred in Venezuela are reported, in Tachira state, with a high fatality rate among confirmed cases.
Abstract: Acute orally acquired Chagas disease (AOACD) has emerged as a significant threat in some countries
of South America [1,2]. Until March 2013, at least
four have reported outbreaks of acute orally acquired Chagas disease, specifically Brazil [3], Venezuela [4], Colombia [5] and Bolivia [6]. Outbreaks are also likely occurring in Argentina and Ecuador, according to some old reports [2]. In Venezuela, there have been at least three well-known epidemiological reports of AOACD, the first in 2007 at Caracas (Chacao) [4], the second in 2009 at Vargas [7] and the third in 2010 at
Caracas (Antimano) [8]. A common feature of these
outbreaks is that they have affected predominantly
children and have led to a high fatality rate among confirmed cases. Reports describing the investigation of these outbreaks are of high scientific and epidemiological significance; however, information on only the first outbreak has been published [4]. For these reasons we report the findings of the fourth outbreak of AOACD that occurred in Venezuela, in Tachira state.
TL;DR: In this article, the clinical features and demographic information in children visiting the Leishmania clinic of two main teaching hospitals were studied and the most common types were acute cases with a 71% prevalence rate and papules with 37% prevalence.
Abstract: Introduction: Mashhad, located in north-east Iran, is one of the most important regions for cutaneous leishmaniasis (CL) due to Leishmania tropica . Children account for 7-10% of the infected population in the endemic areas. Despite the high sensitivity and susceptibility of this age group, no comprehensive study has yet investigated the clinical characteristics and demographic data in children in our region. Therefore, we aimed to study the clinical features and demographic information in children visiting the Leishmania clinic of two main teaching hospitals. Methodology: In a cross-sectional study all the required data were gathered from the children’s records available at the cutaneous leishmaniasis clinics of Ghaem and Imam Reza hospitals during October 2008 to September 2011. Data included the patient’s age, sex, lesion chronicity and distribution, the clinical features, and the involved body parts. Descriptive statistical tests and SPSS version 11.5 were used for data analyses. Results: Among the 8,801 studied files, 689 (7%) were related to children under the age of 13. Female to male ratio was 0.9 with the highest prevalence in the 6-9 year age group. Regarding disease chronicity, the most common types were acute cases with a 71% prevalence rate. The face was the most involved body part (77.2%) and papules with 37% prevalence were the most common type of lesions seen. Conclusion: Childhood cutaneous leishmaniasis accounts for a major portion of CL in north-east Iran, has no apparent sex preference, and its clinical spectrum does not remarkably differ from that of adult CL.
TL;DR: History of diarrhoea and cough over the four weeks preceding the study and maternal education above secondary level were potential risk factors for ISS and EA and asymptomatic rotavirus infection were detected in higher frequencies among cases than controls; however, association with ISS cannot be confirmed.
Abstract: Introduction: We aimed to identify potential risk factors for intussusception (ISS) among children presenting to two pediatric hospitals in Egypt. Methodology: In this case-control study, enrolled children < 3 years old with ISS (confirmed radiologically and/or surgically) were matched by age and gender to controls admitted with acute non-abdominal surgical illnesses. Stool samples were collected and tested for various enteric bacteria, rotavirus, enteric adenoviruses (EA, 40 and 41) and astroviruses using commercially available ELISA diagnostic kits. Results: From December 2004 to May 2009, 158 cases and 425 matched controls were enrolled. A history of diarrhoea and cough over the preceding four weeks of interview were more common in cases than controls, respectively. Children with mothers who had secondary education and above were 2.2 times more likely to have ISS than those whose mothers had a lower level of education. In spite of the low detection rate of EA infection (regardless of diarrhoea history) and asymptomatic rotavirus infection, they were detected in higher frequencies in cases than controls; however, infection with astrovirus and bacterial pathogens did not appear to be associated with increased risk of ISS. Conclusions: History of diarrhoea and cough over the four weeks preceding the study and maternal education above secondary level were potential risk factors for ISS. EA and asymptomatic rotavirus infection were detected in higher frequencies among cases than controls; however, association with ISS cannot be confirmed. Additional research is needed to confirm these findings and evaluate the pathogenesis which may link such infections with ISS.
TL;DR: The isolation rates and antimicrobial susceptibility of Shigella spp.
Abstract: Background: This study compared the diversity of common diarrhoeal pathogens and antimicrobial susceptibility in four hospitals in Bangladesh. Methodology: A total of 13,959 diarrhoea patients, comprising rural Mirzapur [2,820), rural Matlab (2,865), urban Dhaka (5,287) and urban Mirpur (2,987) were included under the diarrhoeal disease surveillance system of icddr,b during 2010-2011; stool specimens were tested for Shigella spp., Vibrio cholerae , enterotoxigenic Escherichia coli and rotavirus. Results: Rotavirus was highest in Mirzapur (28%) followed by Dhaka (24%), Matlab (19%) and Mirpur (18%). Overall, Shigella was significantly more prevalent in rural sites (Mirzapur 13% and Matlab 7%), than in urban sites (Dhaka 3% and Mirpur 3%). Vibrio cholerae was more common in the urban sites of Dhaka (14%) and Mirpur (12%). 72% of Shigella isolates were susceptible to ciprofloxacin in Mirzapur, and 88% to mecillinam. In Dhaka, the figures for Shigella were 65% and 50%, in Matlab 65% and 85%, and in Mirpur 59% and 92% respectively. Susceptibility of Shigella to azithromycin and ceftriaxone in Dhaka was 74% and 95%, and in Mirpur 88% and 92% respectively. Vibrio cholerae showed the highest resistance to trimethoprim-sulfamethoxazole (100% in Mirpur) and lowest resistance to ciprofloxacin (0% in Dhaka, Matlab and Mirpur) and azithromycin (30% in Dhaka to 7% in Mirzapur). Multidrug resistance (≥ 3 antibiotics) for Shigella were: Mirzapur (50%); Dhaka (36%); Matlab (23%) and Mirpur (37%); and for V. cholerae it was 26%, 37%, 49% and 23% respectively. Conclusion: The isolation rates and antimicrobial susceptibility of Shigella spp. and V. cholerae along with rotavirus differed significantly in certain geographical sites.
TL;DR: This mini-review summarises what is currently known about non-typhoidal Salmonella in sub-Saharan Africa and discusses some of the issues which remain.
Abstract: The publication of studies using next generation sequencing to analyse large numbers of bacterial isolates from global epidemics is transforming microbiology, epidemiology and public health. The emergence of multidrug resistant Salmonella Typhimurium ST313 is one example. While the epidemiology in Africa appears to be human-to-human spread and the association with invasive disease almost absolute, more needs to be done to exclude the possibility of animal reservoirs and to transfer the ability to track all Salmonella infections to the laboratories in the front line. In this mini-review we summarise what is currently known about non-typhoidal Salmonella in sub-Saharan Africa and discuss some of the issues which remain.
TL;DR: This prospective study aimed to investigate species prevalence and extent of antimicrobial resistance among clinical isolates of enterococci in a tertiary care hospital in India.
Abstract: Introduction Enterococci are one of the major causes of nosocomial and community-acquired infections. In recent years, the evolution of antimicrobial resistance in enterococci has posed enormous challenges for clinicians. The antimicrobial therapy of enterococcal infections is complicated because of the inherent resistance shown by enterococci to several commonly used antibiotics such as cephalosporins, low-level aminoglycosides, and low-level clindamycin and perhaps more importantly, because of their acquired resistance to all currently available antibiotics, that leaves limited medicative options and results in the selection and spreading of multidrug-resistant (MDR) strains in hospitals [1,2]. Empirical use of antibiotics, absence of national guidelines for screening patients for MDR bacteria and lack of sufficient information and programs to control rapid spread of enterococci has led to increased mortality caused by enterococcal infections [3-5]. Knowledge of the antibiogram is essential to formulate therapeutic strategies for treating enterococcal infections [1]. This prospective study aimed to investigate species prevalence and extent of antimicrobial resistance among clinical isolates of enterococci in a tertiary care hospital in India.
TL;DR: The results favour use of cefexime or possibly chloramphenicol as first choice for uncomplicated enteric fever and MICs for third-generation cephalosporins and susceptibility pattern must be closely monitored in view of its emerging resistance among Salmonella enterica.
Abstract: Introduction: Enteric fever is a global public health problem, especially in developing countries. Antimicrobial resistance is a major issue enteric fever management. This study examined current pattern of antimicrobial susceptibility among Salmonella enterica isolates from enteric fever cases at a tertiary care centre in New Delhi, India. Methodology: Blood cultures from patients with enteric fever during January 2010- July 2012 were processed using the BACTEC automated system. Antimicrobial susceptibility was tested using Kirby Bauer’s disc diffusion method and/or Phoenix 100 automated system. Results: Of 344 isolates of Salmonella enterica, 266 (77.3%) were S. Typhi, 77 (22.4%) were S. Paratyphi A, and one (0.3%) was S. Paratyphi B. Resistance to nalidixic acid (NA R ) (96.7%) was most common, followed by ciprofloxacin (37.9%), and azithromycin (7.3%). Multi-drug resistance was observed only in S. Typhi (3.4%). Among NA R strains, 61.8% were sensitive, 11.1% were moderately sensitive, and 23.9% were resistant to ciprofloxacin (0.8%, 57.4%, and 37.9% respectively according to revised CLSI breakpoint criteria for ciprofloxacin). Resistance to third-generation cephalosporin was found in seven (2%) strains of S. enterica. Conclusion: Increasing rates of nalidixic acid, fluoroquinolone and azithromycin resistance among S. enterica, particularly in S. Paratyphi A strains, is of concern, as S. Paratyphi A infection is becoming increasingly common and is not prevented by current vaccinations. Our results favour use of cefexime or possibly chloramphenicol as first choice for uncomplicated enteric fever. MICs for third-generation cephalosporins and susceptibility pattern must be closely monitored in view of its emerging resistance among Salmonella enterica.