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October-December 2022
Volume 14 | Issue 4
Page Nos. 129-175

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EDITORIAL  

State of the globe: Candida auris-a global healthcare threat p. 129
Suman Thakur
DOI:10.4103/jgid.jgid_215_22  
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ORIGINAL ARTICLES Top

Identification and antifungal drug susceptibility pattern of Candida auris in India p. 131
Smita Deshkar, Niranjan Patil, Shraddha Amberkar, Ashish Lad, Farozan Siddiqui, Swati Sharan
DOI:10.4103/jgid.jgid_44_22  
Introduction: Candida auris has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of C. auris. Methods: Isolates of C. auris were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method. Results: Out of 50 isolates C. auris, 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% (n = 42) isolates were found to be resistant and 16% (n = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5–16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% (n = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% (n = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin. Conclusion: Correct identification of C. auris can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of C. auris are on rise.
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Evaluation of immunohistochemistry technique for diagnosis of extrapulmonary tuberculosis in biopsy tissue specimen as compared to composite diagnostic criteria p. 136
Pragati D Rao, D R Gayathri Devi, S R Mangala Gouri, AS Arjun, Lalitha Krishnappa, Abdul Azeem
DOI:10.4103/jgid.jgid_112_22  
Introduction: Diagnosis of extrapulmonary tuberculosis (EPTB) has been challenging owing to its paucibacillary nature and diverse clinical manifestations. Immunohistochemistry (IHC) on biopsy specimens has presented a new perspective toward improving tuberculosis diagnosis. MPT64 is a unique antigen that has shown high sensitivity and specificity compared to other conventional techniques in its ability to diagnose tuberculosis as well as differentiate it from nontubercular mycobacteria. In this study, we aimed to analyze the utility of anti-MPT64 in the diagnosis of EPTB. Methods: In this cross-sectional study, conducted over a period of 1 year, 52 nonrepetitive samples from 52 participants with a presumptive diagnosis of EPTB were collected and processed. The specimens were subjected to Ziehl–Neelsen staining, GeneXpert, tissue culture by mycobacterium growth indicator tube, H and E staining, and IHC with anti-MPT64. The sensitivity and specificity of anti-MPT64 was computed against a composite diagnostic criterion. Results: Fifty-two consecutive participants satisfying the study criteria were recruited. The mean age of the study population was 37.35 ± 18.71 years. Lymph node specimen accounted for majority of the specimen processed (n = 20, 38.5%). The sensitivity of anti-MPT64 in the diagnosis of EPTB was 68.29%, specificity was 90.90%, positive predictive value was 96.55%, and negative predictive value was 43.47%, when composite criteria were considered standard for diagnosis. Conclusion: Immunohistochemical staining by anti-MPT64 is useful in establishing microbiological diagnosis of EPTB on biopsy specimens.
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Genotype profiles of rotavirus strains in children under 5-year-old outpatients with diarrhea in Bandung, West Java, Indonesia p. 142
Dwi Prasetyo, Yudith Setiati Ermaya, Iesje Martiza Sabaroedin, Dyah Widhiastuti, Novilia Sjafri Bachtiar, Cissy Bana Kartasasmita
DOI:10.4103/jgid.jgid_101_22  
Introduction: Diarrhea is a global leading cause of morbidity and mortality among children under five, with rotaviruses being the most common cause. This study aimed to determine the genotypes of rotavirus in children under 5 years with diarrhea in Bandung, Indonesia. Methods: This cross-sectional study was conducted from 2014 to 2018 on 450 children under five with acute diarrhea in primary health centers in Bandung, Indonesia. Fecal samples were examined for rotavirus antigen using an enzyme-linked immunosorbent assay method, and genotype was determined through sequencing using polymerase chain reaction. Results were statistically analyzed using Pearson Chi-square in Epi Info version 3.5.4, with P < 0.05 considered statistically significant. Results: Rotavirus was identified in 8.9% of the subjects, slightly higher in boys (n = 24, 9.8%) than girls (n = 16, 7.8%). We found that the most rotavirus positive in age group is >12–24 months and >24–59 months, while the highest percentage is at the age of ≤6 months (11.8%). Moderate malnutrition was observed in more subjects (12.8%). Vomiting was more frequent in patients positive (55%, P = 0.013) and fever was seen in 32.5% (P = 0.645). No signs of dehydration were seen in most subjects (75%), P = 0.227. Rotavirus genotypes identified were G1P[8] (18, 45%), G3P[8] (14, 35%), G3P[6] (4, 10%), G3P[9] (2, 5%), G2P[4] (1, 2.5%), and nontypeable (NT) (1, 2.5%). Conclusions: The dominant rotavirus genotype is G1P[8], followed by G3P[8], G3P[6], G3P[9], G2P[4], and NT. The most common rotavirus positive in age group is >12–24 months and >24–59 months, while the highest percentage is at the age of ≤6 months.
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Peripheral blood mononuclear cell cytokine mRNA profiles in acute respiratory infection patients p. 147
Marina Alexandrovna Plotnikova, Sergey A Klotchenko, Alexey A Lozhkov, Kirill I Lebedev, Alexander S Taraskin, Irina L Baranovskaya, Maria A Egorova, Edward S Ramsay, Vitaly N Chebotkevich, Andrey V Vasin
DOI:10.4103/jgid.jgid_301_21  
Introduction: Respiratory infections, collectively, are one of the World's most common and serious illness groups. As recent observations have shown, the most severe courses of acute respiratory infection, often leading to death, are due to uncontrolled cytokine production (hypercytokinemia). Methods: The study involved 364 patients with respiratory illness being treated in clinics in St. Petersburg (Russia) in 2018–2019 and 30 healthy controls. Cytokine analysis was carried out in the acute phase of illness (2–3 days from onset of initial symptoms) and in the stage of recovery (days 9–10). The research presented is devoted to the assessment of mRNA expression of specific cytokines (interleukin [IL]-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α [TNF-α], and interferon-λ) and MxA in whole blood leukocytes, by means of real-time polymerase chain reaction. Results: In 70% of patients, bacterial or viral pathogens were identified, with influenza viral infections (types A and B) prevailing. Significant increases in the expression of IL-18, TNF, and IL-10 were observed, relative to controls, only with influenza viral infections. We have shown a difference in IL-6 mRNA expression in patients with bacterial or viral pathogens. No statistically significant difference was found in white blood cells IL-4 expression levels between patients and healthy controls. Conclusion: Investigation of the nuances of systemic cytokine production, in response to specific viral and bacterial pathogens, makes it possible to assess the risks of developing hypercytokinemia during respiratory infection with agents circulating in the human population and to predict the pathogenicity and virulence of circulating threats.
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High prevalence of fungal and NDM-OXA producing Gram-negative bacterial superinfections in the second wave of coronavirus disease 2019 in India: Experience from a dedicated coronavirus disease 2019 hospital in North India p. 154
Omika Katoch, Neha Sharad, Parul Singh, Sharad Srivastav, Richa Aggrawal, Rajesh Malhotra, Purva Mathur
DOI:10.4103/jgid.jgid_238_21  
Introduction: During the second wave of coronavirus disease 2019 (COVID-19), superinfection caused by fungus and multidrug-resistant bacteria worsened the severity of illness in COVID-19 patients. Limited studies from India reported the antimicrobial resistance pattern of secondary infections. In this study, we aim to study the epidemiology of pathogens causing superinfections and genotyping of Gram-negative isolates in COVID-19 patients. Methods: This retrospective study was conducted at a dedicated COVID-19 center, India. The identification of bacteria/fungi was done by Vitek2® and matrix-assisted laser desorption/ionization-time of flight mass spectrometry system. Identification of beta-lactamase genes was done using thermal cycler. The diagnosis of mucormycosis was based on 10% potassium hydroxide direct microscopy. Statistical analyses were performed using STATA version 15.1 (StataCorp., College Station, TX, USA). For continuous variables, mean and standard deviation were computed. For comparing proportions of secondary infections across admission location and outcomes, the Chi-squared test of independence was used. To compare the mean and median between intensive care units and outcomes, an independent t-test and a Mann–Whitney test were used. Results: Of all the clinical samples, 45.4% of samples were cultured positive for secondary infections. Acinetobacter baumannii (35%) was the most common Gram-negative pathogen, while among Gram positive, it was Enterococcus faecium (40%). Among fungus, Candida spp. (61%) predominates followed by molds. Colistin and tigecycline proved effective against these pathogens. blaNDM was the most prevalent gene followed by the blaOX among the carbapenemase genes. Conclusions: The mortality rate among COVID-19 patients with secondary infection was significantly higher compared to the overall mortality rate in COVID-19 patients.
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CASE SERIES Top

Purpura fulminans and spotted fever: A case series from South India p. 162
Karthik Gunasekaran, Divyaa Elangovan, Susmitha Perumalla, Kundavaram Paul Prabhakar Abhilash, John Antony Jude Prakash
DOI:10.4103/jgid.jgid_297_21  
Purpura fulminans (PF) is associated with acute infections such as meningococcal, staphylococcal, streptococcal, and rickettsial infections. However, there are only a few reports of association of PF with rickettsial fever from India. In this case series of seven adults with PF, four were definitive cases of spotted fever as the ompA real-time polymerase chain reaction was positive. The other three adults were probable cases of spotted fever, as they were positive by immunoglobulin M enzyme-linked immunosorbent assay, and their fever subsided within 72 h of rickettsia-specific therapy. Three of the seven patients had peripheral gangrene. These patients, despite presenting with severe spotted fever, had a favorable outcome. This is attributed to the high index of suspicion and early treatment supported by diagnostic assays.
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CASE REPORTS Top

Capsule-deficient cryptococcal meningitis: A diagnostic conundrum p. 165
Trupti Shende, Gagandeep Singh, Immaculata Xess, Swati Khullar, Renu Kumari Yadav, Reshu Agarwal, M Vasantha Padma Srivastava
DOI:10.4103/jgid.jgid_255_21  
Cryptococcosis is a serious systemic mycosis. Its incidence has escalated in the past four decades. Cryptococcus neoformans causes localized or disseminated infection in immunocompromised and immunocompetent patients. The capsulated form is commonly encountered which can be diagnosed on an India ink preparation or antigen detection. However, the noncapsulated forms are very rare and require a high index of suspicion for correct diagnosis. Herein, we present a case of cryptococcal meningitis due to a noncapsulated strain in an apparently immunocompetent patient with no proven immunodeficiencies along with review of world literature. Such cases are a diagnostic challenge for the clinician as well as microbiologist.
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Disseminated cytomegalovirus infection in a child with langerhans cell histiocytosis p. 170
Polina Siri Iswarya, Dhaarani Jayaraman, X Joshua Rajan, Krithika Prabaharan
DOI:10.4103/jgid.jgid_15_22  
Cytomegalovirus (CMV) reactivation is well known in post-transplant immunocompromised children. However, the incidence in non-transplant patients is significantly less, and only scarce case reports are available in the literature regarding CMV disease in children with solid tumors. We present a 3-year-old male child with multisystem refractory Langerhans cell histiocytosis, who had very high CMV viremia and disseminated CMV infection with secondary hemophagocytic lymphohistiocytosis and was successfully treated without organ damage and sequelae. Although routine screening is not recommended, CMV viremia/disease needs to be considered in non-transplant immunocompromised children with multisystem involvement with unexplained cytopenia.
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LETTERS TO EDITOR Top

Post-COVID-19 cerebral pheohyphomycosis due to Rhinocladiella mackenziei: A Middle Eastern replica of Post-COVID-19 mucormycosis? p. 173
Bhushan Sudhakar Wankhade, Ammar Mohamed Abdel Hadi, Ghaya Zeyad Alrais, Zeyad Faoor Alrais, Ahmad Elzayyat
DOI:10.4103/jgid.jgid_105_22  
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A rare cause of nonhealing ulcer in an immunocompetent person p. 174
Subodh Kumar Mahto, Kritika Gupta, Ankita Sheoran, Nitasha Pasricha
DOI:10.4103/jgid.jgid_133_22  
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008