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Coverpage
October-December 2020
Volume 12 | Issue 4
Page Nos. 165-239

Online since Monday, November 30, 2020

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EDITORIAL  

State of the globe: “Hansen's disease – Down but not out in the SARS-CoV-2 era” p. 165
Suman Thakur, Vivek Chauhan
DOI:10.4103/jgid.jgid_396_20  
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CONSENSUS PAPER Top

COVID-19 blind spots: A consensus statement on the importance of competent political leadership and the need for public health cognizance Highly accessed article p. 167
Thomas J Papadimos, Samara E Soghoian, Prabath Nanayakkara, Sarman Singh, Andrew C Miller, Venkataramanaiah Saddikuti, Achala Upendra Jayatilleke, Siddharth P Dubhashi, Michael S Firstenberg, Vibha Dutta, Vivek Chauhan, Pushpa Sharma, Sagar C Galwankar, Manish Garg, Nicholas Taylor, Stanislaw P Stawicki
DOI:10.4103/jgid.jgid_397_20  
As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health “blind spotting,” promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such “blind spots” identified during an expert group intense analysis of “missed opportunities” during the initial wave of the pandemic.
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ORIGINAL ARTICLES Top

A clinicohistopathological correlation of Hansen's disease in a rural tertiary care hospital of Central India p. 191
Manisha A Atram, Pravinkumar V Ghongade, Nitin M Gangane
DOI:10.4103/jgid.jgid_58_20  
Background: Leprosy is an ancient, chronic granulomatous infectious disease caused by Mycobacterium leprae, principally affecting the skin and peripheral nerves. The clinical manifestations of leprosy are variable and can mimic a variety of other skin diseases. Thus, histopathological examination plays an important role in early diagnosis and management. Aim: The aim was to study the clinicohistopathological correlation of all suspected cases of Hansen's disease. Materials and Methods: A retrospective study was conducted on 207 skin biopsies obtained from patients clinically diagnosed as new lesion of leprosy in the department of pathology from 2016 to 2019. Demographic, clinical details of the patients were retrieved from hospital information system. Hematoxylin–eosin- and Fite–Faraco-stained sections were evaluated for features confirming leprosy and further categorized as per Ridley–Jopling system. Sensitivity, specificity, and concordance rates were studied. Results: The male-to-female ratio was 1.5:1. The agreement between histopathological and clinical diagnoses was more than 90% in all the subclasses except for borderline tuberculoid leprosy (BT) and tuberculoid leprosy (TT) which showed an agreement of 86.5% and 88.4%, respectively. The sensitivity of clinical diagnosis ranged from 69.70% for indeterminate to 100% for histoid and neuritic types. The specificity ranged from 90% for BT and TT to 100% for neuritic leprosy. Conclusion: Clinical diagnosis of early leprosy lesions offers difficulties even to experienced dermatologists as a patient presents in different clinicopathological forms, depending on host immune status. Thus, the correlation between clinical, histopathological, and bacteriological features is required for diagnosis and classification of leprosy. Nerve damage is irreversible; therefore, early detection and treatment is important to prevent Grade 2 disabilities.
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Prevalence of hepatitis delta virus infection among hepatitis B virus-infected and exposed patients p. 197
Krithiga Ramachandran, Reshu Agarwal, Manoj Kumar Sharma, Vikram Bhatia, Ekta Gupta
DOI:10.4103/jgid.jgid_137_19  
Background: Hepatitis delta virus (HDV) infection is a cause of coinfection and superinfection among hepatitis B virus (HBV)-infected patients. The global prevalence of HDV may vary drastically depending on the geographical location. In India, serological techniques form the basis for the determination of HDV prevalence in majority of the studies with very limited literature based on molecular techniques. In addition, sparse data on HDV infection among HBV-exposed group, i.e., patients with total antibodies to core antigen (anti-hepatitis B core [HBc]) positive and negative hepatitis B surface antigen (HBsAg), are available. Objective: This study was aimed to determine the prevalence of HDV in both HBV-infected and HBV-exposed groups, utilizing both serological and molecular methods. Settings and Design: This was a retrospective cross-sectional study conducted from January till June 2018 where samples of 142 patients were retrieved and were categorized into two groups: Group A included patients with both HBsAg and anti-HBc positivity (n = 120/142 [85%]), i.e., confirmed HBV infection, and Group B included patients with anti-HBc positivity and HBsAg negativity (n = 22/142 [15%]), i.e., exposed to HBV. Materials and Methods: All the specimens were retrieved from −80°C and were tested for anti-HDV immunoglobulin (Ig) M (IgM), anti-HDV IgG, and HDV RNA. Results: HDV infection was observed in only one patient in Group A and none in Group B, making an overall prevalence of 0.78% (95% confidence interval = 0.02%–3.9%). The infected patient was reactive for both IgM and IgG with a viral load of 2log10IU/ml. Conclusion: The present study provides evidence that HDV infection is very low(0.78%) in this part of India. However further prospective studies with larger sample size are warranted.
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Incidence, risk factors and clinical outcomes of patients with hypermucoviscoid Klebsiella in a tertiary intensive care unit p. 202
Vimal Bhardwaj, Vellaichamy Muthupandi Annapandian, Annie Rofeena Sinazer, Arjun Alva, Shiva Prasad
DOI:10.4103/jgid.jgid_145_19  
Background and Objectives: Hypermucoviscoid Klebsiella(hvKP), a dreaded variant of Klebsiella, so far, fewer cases were reported from the community. This study was designed to evaluate the incidence of hvKP isolates, risk factors for hvKP infections, antibiotic sensitivity pattern and clinical outcome including morbidity and mortality. Patients and Setting: Patients who have got admitted under medical intensive care unit (MICU) and had positive culture of Klebsiella infections. Materials and Methods: This study was conducted at department of MICU at a tertiary care hospital between January 2018 and December 2018. A standardized proforma was prepared and data was collected, which includes basic demographics of the patients, co-morbidities, clinical details and mortality. This study was approved by the Institutional Review Board and Ethics Committee. Results: A total of 165 patients (males, 123; 74.5%) had Klebsiella pneumoniae infection during the study period, out of whom 32 was hvKP (19.4%). The mean age was 53.1 ± 16.8 years. Among the 32 hvKP patients, 22 (68.8%) were hospital acquired infection (HAI) and 10 were (31.2%) community acquired infection. The overall mortality rate of hvKP infection was 56.2% (18/32). The incidence of mortality rate was similar in patients having pan-drug sensitive and in patients with extreme drug-resistance (61.9% vs. 66.7%; P = 0.831). HAI is significantly associated with multi drug resistance of hvKP (odds ratio [OR], 7.917; P < 0.05) and diabetes is associated with increased risk of hvKP related mortality (OR, 5.250; P = 0.054). Conclusions: Our study results showed, increased incidence of HAI with hvKP predominantly associated with pneumonia and increase in trend of drug resistance with two cases being pan resistant. More number of studies are required to evaluate the existing antibiotics strategy and steps to curb the spread of this dreaded infection.
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A hospital-based nonconcurrent cohort study on factors associated with in-hospital mortality in patients with laboratory confirmed influenza p. 208
Vijay Alexander, G Jackwin Sam Paul, Anand Zachariah, Alice Joan Mathuram
DOI:10.4103/jgid.jgid_45_20  
Background and Aim: Influenza is a disease with varied clinical presentation and varied mortality reported in existing literature. The study aimed to determine the factors associated with mortality in patients hospitalized with influenza infection. Materials and Methods: This was a 5-year nonconcurrent cohort study done in a tertiary care center in Southern India. Patients with laboratory confirmed influenza infection diagnosed between January 2013 and October 2018 were recruited into the study. Results: A total of 130 patients were recruited. Diabetes (45.4%) and chronic obstructive pulmonary disease (COPD) (26.1%) were the most common comorbid illnesses. Thirty-one patients (23.8%) required admission to the intensive care unit (ICU) and 58 patients required ventilation (noninvasive/mechanical ventilation [MV] – 44.6%). Influenza A was the most common isolated strain (46.9%). Univariate analysis demonstrated that a high pneumonia severity index (P < 0.0001), CURB 65 > 2 (P < 0.0001), MV dependency (P < 0.0001), need for ICU stay (P < 0.0001), low PF ratio (P < 0.0001), COPD (P = 0.021), secondary bacterial pneumonia (P < 0.0001), acute respiratory distress syndrome (P = 0.0004), and acute kidney injury (P = 0.0006) were the significant factors associated with in-hospital mortality. Multivariate analysis demonstrated that new onset/worsening renal dysfunction was the only factor significantly associated with in-hospital mortality in patients admitted with influenza. Conclusions: Our study showed a mortality of 12.3% (n= 16) and new onset/worsening renal dysfunction was the only patient factor associated with mortality. Early recognition of complications and appropriate treatment may reduce mortality in patients admitted with severe influenza. We recommend influenza vaccination for at-risk populations to reduce severity and mortality.
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MICROBIOLOGY REPORTS Top

Hepatitis E virus infection among asymptomatic pregnant women at the University College Hospital, Ibadan p. 214
Adeola Fowotade, Gloria Chinenye Anaedobe, Olubukola A Adesina
DOI:10.4103/jgid.jgid_124_19  
Introduction: The high mortality associated with fulminant Hepatitis E infection in pregnancy justifies the need to assess the epidemiologic proportion of this underestimated virus. Objectives: This study aimed to determine the burden of HEV infection among pregnant women attending antenatal Clinic in Ibadan. Methodology: HEV IgG and IgM serological surveys were carried out among 230 pregnant women attending antenatal clinic in Ibadan, Nigeria. Serum and stool samples from HEV IgM positive women were further analysed using two independent reverse transcriptase polymerase chain reactions (RT-PCR) assays, targeting ORF1 region of HEV genome. Socio-demographic variables associated with HEV in these women, were analyzed to estimate statistical significance (p < 0.05). Results: Eleven (4.8%) women had HEV IgM, while 39 (17.0%) women had HEV IgG. Three (27.3%) of the 11 anti-HEV IgM positive samples were positive for HEV RNA while all stool samples tested negative for HEV RNA. HEV infection among pregnant women was statistically associated with age (p = 0.044), and educational status (p = 0.005). Conclusion: Recent HEV infection among this pregnant population is on the lower part of the scale, compared with other Sub-Saharan African countries. However, the HEV IgG seroprevalence rate suggests indirect evidence of past contact with HEV.
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Inhibitory effect of zinc sulfate on clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii p. 217
Ishaan Ramdas, C Sheela Devi
DOI:10.4103/jgid.jgid_57_20  
This objective of the study was to determine the inhibitory effect of zinc sulfate against the clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii. The inhibitory effect of zinc sulfate was determined against the 120 clinical isolates (60 isolates of P. aeruginosa and 60 isolates of A. baumannii) by agar dilution method. The findings indicate that zinc has an inhibitory effect on the clinical isolates of P. aeruginosa and A. baumannii at a concentration ranging from 0.25to 1mg/ml of zinc sulfate by agar dilution method.
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PICTORIAL EDUCATION Top

Nontyphoid Salmonella empyema in a patient with type 2 diabetes mellitus p. 219
Dipesh Solanky, Brian Kwan
DOI:10.4103/jgid.jgid_190_20  
Pleuropulmonary infections caused by nontyphoid Salmonella(NTS) are rare, but may develop in immunocompromised hosts. We report the case of a 56-year-old male with uncontrolled diabetes mellitus presenting with a multiloculated empyema due to NTS involving the left oblique pulmonary fissure.
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CASE REPORTS Top

Colchicine, aspirin, and montelukast – A case of successful combined pharmacotherapy for adult multisystem inflammatory syndrome in COVID-19 p. 221
Sean Downing, Vivek Chauhan, Irshad H Chaudry, Sagar Galwankar, Pushpa Sharma, Stanislaw P Stawicki
DOI:10.4103/jgid.jgid_296_20  
Since the beginning of the COVID-19 pandemic, many therapeutic strategies have been tried, with mixed results, to prevent and treat adult multisystem inflammatory syndrome in COVID-19 (AMIS-COVID-19). The reason behind this may the complex web of highly intertwined pathophysiologic mechanisms involved in the SARS-CoV-2 infection and the corresponding human systemic response, leading to end-organ damage, disability, and death. Colchicine, high-dose aspirin, and montelukast are being investigated currently as potential modulators of AMIS-COVID-19 in patients who fail to improve with traditional therapeutic approaches. Here, we present a patient who presented with high fevers, extreme fatigue and dyspnea, and ongoing deterioration. As part of our clinical approach, we used the simultaneous combination of the three agents listed above, capitalizing on their different respective mechanisms of action against AMIS-COVID-19. Following the initiation of therapy, the patient showed symptomatic improvement within 24 h, with the ability to return to daily activities after 72 h of continued triple-agent approach. Based on this experience, we have reviewed the immunomodulatory basis of this regimen, including potential avenues in which it may prevent the development of cytokine release syndrome (CRS) and its clinical manifestation, AMIS-COVID-19. By blocking the early stages of an inflammatory response, via diverse mechanistic pathways, the regimen in question may prove effective in halting the escalation of CRS and AMIS-COVID-19 in acutely symptomatic, nonimproving COVID-19 patients.
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Neonatal meningitis and septicemia caused by multidrug-resistant Elizabethkingia anophelis identified by 16s ribosomal RNA: An emerging threat p. 225
Frincy K Baruah, Biswajyoti Borkakoty, Abid Ahmed, Prakritish Bora
DOI:10.4103/jgid.jgid_126_19  
Elizabethkingia anophelis infections are emerging, especially among premature newborns, immunocompromised, and critically ill patients. The importance of correctly identifying this Gram-negative organism lies in the fact that it is associated with fatal complications such as meningitis, acute pulmonary edema, congestive cardiac failure, septic shock, and death. In addition, it is inherently resistant to multiple antibiotics which are used to treat Gram-negative bacilli. Here, we report a case of E. anophelis related meningitis and septicemia in a preterm neonate along with a brief review of literature.
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An unusual cause of adult ileoileal intussusception p. 228
Mohamed Javid, Shanthi Ponnandai Swaminathan, Rajeswari Mani, Arun Victor Jebasingh
DOI:10.4103/jgid.jgid_115_20  
Intestinal intussusception in adults is not considered to be common. Clinical presentations may range from an acute presentation to a chronic one and such wide variations make it challenging to establish the diagnosis on time. Adult intussusceptions usually have an identifiable pathological lead point: commonly a polyp, submucosal lipoma, or other tumors. Our patient, a 42-year-old male, presented to us with features of acute intestinal obstruction. He underwent an emergency laparotomy when intussusception of the ileum was noted; the involved bowel segment was resected. Histopathology showed that the lead point was due to tuberculous lesion. Further investigations showed that the patient had pulmonary tuberculosis (TB), which was not identified till then. The patient was started on antituberculous treatment thereafter and the patient recovered well. We intend to present this case to sensitize the readers to the unusual presentation of intestinal TB as intussusception which should be considered especially in countries with high TB endemicity.
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Recurrent Staphylococcus lugdunensis osteomyelitis of the lumbar spine in a patient on chronic hemodialysis p. 231
Yamil E Michelen, Zeena Lobo, Daniel Walshon-Dipillo, George Psevdos
DOI:10.4103/jgid.jgid_17_20  
Staphylococcus lugdunensis is an emerging coagulase-negative Staphylococcus regarded as a formidable pathogen capable of causing significant infections at various body sites including bone and joints. We report the case of a Caucasian elderly male with recurrent lumbar osteomyelitis due to S. lugdunensis. He had a history of chronic low back pain. Besides chronic kidney failure and need for hemodialysis, he had no other history of immunosuppression. He did not have fever or leukocytosis; however, the erythrocyte sedimentation rate was elevated, and repeated blood cultures from the periphery and the hemodialysis access (tunneled catheter) were continuously positive for S. lugdunensis. The diagnosis was made by bone biopsy and culture. The bacteremia cleared after removing of the dialysis catheter. The patient received 8 weeks of antibiotic therapy for the osteomyelitis.
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LETTERS TO EDITOR Top

Peptide targets to SARS-CoV-2 p. 234
Santi M Mandal
DOI:10.4103/jgid.jgid_208_20  
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Comparison of conventional versus molecular semi-quantitative assay in presumptive pulmonary tuberculosis cases: A study from eastern India p. 235
Geetarani Purohit, Baijayantimala Mishra, Prasanta Raghab Mohapatra
DOI:10.4103/jgid.jgid_179_20  
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Detection of Mycobacterium Tuberculosis and rifampicin-resistant gene among hemodialysis patients in Khartoum, Sudan: Using GeneXpert assay p. 236
Balsam Adil Mohamed, Mohammed H Ahmed, Nadir Abuzeid
DOI:10.4103/jgid.jgid_16_20  
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Splenic infarction complicating scrub typhus p. 238
Ashwini Tayade, Sourya Acharya, Nikhil Balankhe, Aishwarya Ghule, Swapnil Lahole
DOI:10.4103/jgid.jgid_27_20  
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008