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Coverpage
July-September 2021
Volume 13 | Issue 3
Page Nos. 113-156

Online since Tuesday, August 31, 2021

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EDITORIAL  

State of the globe: Revisiting cholera – The larger ongoing pandemic p. 113
Suman Thakur, Vivek Chauhan
DOI:10.4103/jgid.jgid_234_21  
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ORIGINAL ARTICLES Top

Association between cholera outbreak and traditional gold mining in Northern State, Sudan 2017 p. 115
Mohamed Ali Alzain, Mogahid Hassan Haruwn, Mohamed Osman Abdelaziz, Mohamed Elsheikh, Collins Otieno Asweto, Fahad D Algahtani, Adeniyi Abolaji Adeboye, Najm Eldinn Elsser Elhassan, Ramaiah Itumalla
DOI:10.4103/jgid.jgid_47_20  
Introduction: Cholera is one of the health problems causing considerable morbidity and mortality. The Northern State of Sudan experienced a recent cholera outbreak, however, there are limited data on the outbreak. Methods: The objective of this study was to assess the magnitude and risk factors associated with the cholera outbreak in the Northern State of Sudan. A retrospective case series study was conducted in the Northern State of Sudan, which involved tracing cases of cholera outbreak of 2017. Data were collected through reports and interviews. A geographical information system was used to map all cases during the outbreak. Chi-square test and logistic regression were used to identify associated factors. Results: There were 957 cholera cases reported in the state with an attack rate of 14.2/10,000 persons. Dalgo locality had the highest number (415) of cases reported with an attack rate of 167.2/10,000 persons. About 78% of cases were adult males, while 56.2% of cases were immigrants from other states. Immigrants in Halfa and Dalgo localities were four times (odds ratio [OR] = 4.031, 95% confidence interval [CI]: 2.482–6.547) and eight times (OR = 8.318, 95% CI: 5.674–12.193), respectively, at risk of cholera infection compared to immigrants in Dongola locality. The overall case-fatality rate was 1.9%. This was significantly higher in younger (5.8%) and older (22.7%) age groups (P < 0.05). Conclusions: The study revealed that the cholera outbreak spread highly along with traditional gold mining areas due to poor sanitation. Therefore, improving sanitation services and establishing an effective surveillance system in these areas are essential to prevent future occurrence of outbreaks.
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A cross-sectional study on molecular detection of Helicobacter pylori cytotoxin-associated gene A and 16SrRNA gene from gastric biopsy specimens p. 120
Manjula A Vagarali, Sharada C Metgud, Hema Bannur, Suneel S Dodamani
DOI:10.4103/jgid.jgid_60_20  
Introduction: The aim of the study is relative proportion of cytotoxin-associated gene A (cagA) virulence marker in Helicobacter pylori isolates and gastric biopsy samples by polymerase chain reaction (PCR). Methods: This cross-sectional study was conducted at a tertiary care hospital setting. Gastric biopsy tissues from 200 patients, suffering from upper gastrointestinal tract disorders, were examined for H. pylori infection using methods, such as hematoxylin and eosin (H and E) staining, 16S rRNA (Ribosomal ribonucleic acid), and cagA gene PCR. Chi-square and kappa statistics were used to find the association and agreement between the tests, respectively; P ≤ 0.05 was considered statistically significant. Screening tests' accuracy was calculated in terms of sensitivity and specificity along with positive and negative predictive values. Results: Out of 200 patients, H. pylori was detected in 14.5%, 48.5%, and 31% patients by H and E staining, 16S rRNA, and cagA PCR, respectively. Sensitivity and specificity of cagA PCR as compared to H and E staining were 89.6% and 78.9%, respectively. Conclusions: CagA detection directly from biopsy specimen by PCR can potentially and rapidly determine the patient's status, especially when at a higher risk of peptic ulcer.
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Economic evaluation of implementing a rapid point-of-care screening test for the identification of hepatitis C virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India p. 126
Muniyandi Malaisamy, Karikalan Nagarajan, Tyagi Kirti, Singh Malkeet, Prakash Venkatesan, S Senthilkumar, Karthikeyan Sananthya, Krishnan Rajendran, Rajsekar Kavitha, Shanmugam Vivekanandan, TS Selvavinayagam
DOI:10.4103/jgid.jgid_394_20  
Introduction: Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis. Methods: To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. Results: When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy. Conclusions: The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
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Diagnostic accuracy and agreement between four phenotypic carbapenemase detection tests among enterobacterales p. 133
Fizza Farooqui, Seema Irfan, Sidra M Laiq
DOI:10.4103/jgid.jgid_106_19  
Introduction: Carbapenem-resistant Enterobacterales (CREs) are becoming increasingly popular as a cause of hospital-acquired infections that are difficult to treat and are frequently reported as causes of outbreaks in various hospitals. Conventional culturing techniques take at least 2 days to report a case as carbapenem resistant, and it is therefore important to detect such resistance mechanisms as early as possible. Methods: This study aimed to compare the diagnostic performance of Carba NP, modified Hodge test (MHT), ethylenediaminetetraacetic acid (EDTA) disk synergy test (DST), and the modified carbapenem inactivation method (mCIM). This study was done at Microbiology Laboratory, Aga Khan University Hospital, Karachi. It was an observational study. Carba NP, MHT, EDTA DST, and the mCIM were performed on consecutive isolates of Enterobacterales. Sensitivity, specificity, and agreement between the four tests were calculated. Results: Of 207 Enterobacterales isolated, 127 were resistant to carbapenems. One hundred and fourteen of these were tested by a polymerase chain reaction, and the sensitivities of the Carba NP, MHT, EDTA DST, and the mCIM were found to be 94.34%, 75.47%, 79.25%, and 98.11%, respectively. Conclusions: Due to increased rates of carbapenem resistance, there is a need to employ mechanisms in hospitals that can identify such organisms as early as possible, both from clinical and epidemiological standpoints. The Carba NP test is a rapid, cost–effective, and reliable method and mCIM is more accurate but time consuming and both can be safely used for the screening of CREs.
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CASE SERIES Top

Cryptococcosis with tuberculosis: Overlooked coinfections p. 139
Christina S Suresh, Marilyn M Ninan, Anand Zachariah, Joy S Michael
DOI:10.4103/jgid.jgid_330_20  
Tuberculosis and cryptococcosis are important opportunistic pathogens causing significant morbidity and mortality in immunocompromised individuals. Concurrent infections of these two agents are rarely reported. We report five cases of culture-proven coinfection of Mycobacterium tuberculosis and Cryptococcus neoformans during inpatient admission at a tertiary care hospital in southern India between 2007 and 2019. Four patients were persons living with HIV infection and one was on immune suppression for chronic renal disease. Maintaining a high degree of clinical suspicion will ensure early diagnosis and appropriate management of coinfections in the immunocompromised individual.
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CASE REPORTS Top

Varicella infection in an immunized pediatric living donor liver-transplant recipient p. 142
Vibha Mehta, Krithiga Ramachandran, Reshu Agarwal, Seema Alam, Viniyendra Pamecha, Ekta Gupta
DOI:10.4103/jgid.jgid_233_20  
Varicella-zoster virus (VZV) is a DNA virus belonging to the Herpesviridae family. Primary infection causes chickenpox followed by latency in the sensory ganglia, which can sometimes reactivate leading to herpes zoster. Chicken pox is generally a mild disease of childhood with a secondary attack rate of >85%, but disseminated VZV infection with visceral involvement and fatal outcome may occur in immunocompromised individuals. Indian Academy of Pediatrics recommends two doses of live-attenuated varicella vaccine in healthy unexposed children at 15–18 months and then at 4–6 years of age. The effectiveness of a single dose of vaccine is around 85% and with a two-dose schedule is as high as 92%. Despite the vaccine-induced protection, community-acquired VZV infections still remain a problem in immunocompromised population. We hereby report a case of a previously immunized pediatric liver-transplant recipient who acquired VZV infection. This case report clearly highlights the importance of strict environmental infection control practices, early suspicion, diagnosis, and management in such cases.
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Splenic artery embolization in subcapsular splenic hematoma secondary to dengue hemorrhagic fever p. 145
Sameera S Dronamraju, Shilpa Abhay Gaidhane, Khatib Nazli Mahalaqqa, Abhay M Gaidhane, Amol G Andhale, Zahiruddin Syed Quazi
DOI:10.4103/jgid.jgid_140_20  
Dengue hemorrhagic fever (DHF) is a common syndrome of dengue viral infection but complications such as sub-capsular splenic hematoma leading to capsular rupture in dengue are rare. We report a case of a young male who presented with fever, breathlessness, and acute abdomen. His CT of the abdomen revealed subcapsular splenic hematoma measuring 16.7 cm × 13.0 cm × 11 cm. His laboratory parameters were suggestive of anemia, thrombocytopenia, acute kidney injury, coagulopathy, and hepatopathy because of which instead of splenectomy, splenic artery embolization with ultrasound-guided splenic hemorrhage drainage was performed for his management as his clinical condition deteriorated. This case report sensitizes newer modalities of treatment of subcapsular splenic hematoma with splenic arterial embolization.
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Isolated rectal tuberculosis in immunocompetent host p. 148
Piyush Manoria, Abhishek Singhai, Hanni V Gulwani
DOI:10.4103/jgid.jgid_318_20  
Abdominal tuberculosis (TB) is the sixth most common site for extrapulmonary TB. Ileocecal region is the most common site for it, and its incidence reduces as we move proximally and distally from it. Isolated rectal TB in an immunocompetent person is very rare, and it usually mimics as rectal carcinoma. The yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions, and mostly, they are diagnosed after surgical intervention. We report a case of isolated rectal TB in a middle-aged female who present with chronic diarrhea and was diagnosed by the presence of epithelioid cells forming granulomas and acid-fast bacilli in rectal biopsy.
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Cardiac tamponade associated with human immunodeficiency virus-associated immune complex kidney disease p. 151
Iyad Farouji, Ahmad Damati, Kok Hoe Chan, Amr Ramahi, Kara Chenitz, Jihad Slim, Fayez Shamoon
DOI:10.4103/jgid.jgid_226_20  
Cardiac tamponade is a life-threatening emergency, characterized by rapid accumulation of pericardial fluid. There are multiple risk factors for cardiac tamponade, nephrotic syndrome is an uncommon one, especially in adults. Herein, we are reporting a 35-year-old African American woman with membranoproliferative glomerulonephritis secondary to human immunodeficiency virus-associated immune complex kidney disease (HIVICK), who presented with cardiac tamponade. The patient had pericardiocentesis and was discharged, with outpatient follow-up with cardiology, nephrology, and infectious disease. To the best of our knowledge, this is the first report of HIVICK nephrotic syndrome associated with cardiac tamponade.
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LETTERS TO EDITOR Top

Streptococcal pharyngitis in children: A tertiary pediatric hospital in Bucharest, Romania Highly accessed article p. 154
Victor Daniel Miron, Gabriela Bar, Claudiu Filimon, Vlad Alexandru Gaidamut, Mihai Craiu
DOI:10.4103/jgid.jgid_59_21  
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Role of face masks in the rise of mucormycosis cases in India during the COVID-19 pandemic p. 155
SN Chandan
DOI:10.4103/jgid.jgid_453_20  
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008