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   Table of Contents - Current issue
April-June 2021
Volume 13 | Issue 2
Page Nos. 65-111

Online since Monday, May 31, 2021

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State of the globe: The frenzy of self-medication, cocktail regimens and everchanging guidelines on SARS-CoV-2 p. 65
Vivek Chauhan, Suman Thakur
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Incidence of secondary bacterial infections following utilization of tocilizumab for the treatment of COVID-19 – A matched retrospective cohort study Highly accessed article p. 67
Joanna L Moore, Stephanie J Stroever, Patricia E Rondain, Robyn N Scatena
Introduction: Immunosuppressive agents are theorized to target the cytokine storm syndrome in COVID-19. However, the downstream effects regarding susceptibilities to secondary infection risk remains unknown. This study seeks to determine risk differences for secondary infections among COVID-19 patients who did and did not receive tocilizumab. Methods: We conducted a matched retrospective cohort study from two large, acute care hospitals in Western Connecticut from March 1, to May 31, 2020. We collected variables using manual medical record abstraction. The primary exposure variable was any dose of tocilizumab. The primary outcome was any healthcare-associated bacterial or fungal infection as defined by the National Healthcare Safety Network. We performed a Kaplan–Meier analysis to assess the crude difference in cumulative probability of healthcare-associated infection (HAI) across exposure groups. We also performed a multivariable Cox regression analysis to determine the hazard ratio for HAI by exposure group while controlling for potential confounders. Results: The Kaplan–Meier analysis demonstrated no difference in the cumulative probability of HAI across groups. The adjusted hazard of HAI for patients given tocilizumab was 0.85 times that of patients not given tocilizumab (95% confidence interval = 0.29, 2.52, P = 0.780) after controlling for relevant confounders. Conclusions: Tocilizumab did not increase the incidence of secondary infection among COVID-19 patients. Larger, randomized trials should evaluate infection as a secondary outcome to validate this finding.
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Gaps in the care cascade among human immunodeficiency virus-exposed infants born in 2017 in Mashonaland East Province of Zimbabwe p. 72
Ndaimani Augustine, Owiti Philip, Ajay M V Kumar, Zizhou Simukai, Mugurungi Owen, Mugauri Hamufare Dumisani, Komtenza Brian
Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.
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Impact of an interventional program on improving compliance of hand hygiene and reducing hospital-acquired infection in the critical care unit p. 80
Jeneth Gutierrez, Aladeen Alloubani, Mohammad Alzaatreh, Mohammad Mari, Laila Akhu-Zaheya
Introduction: This study aimed to determine the effect of a hand hygiene (HH) and awareness campaign on knowledge and compliance with HH practices among health-care workers working staff in the main intensive care units and also to evaluate the rates of hospital-acquired infection (HAI) before and after the intervention. Methods: A prospective, interventional, pre–post design was utilized and carried out in three phases: the first stage was a 1-month preintervention stage to develop the foundation of the compliance rate of handwashing; the second stage was the interventional handwashing campaign; the third stage was the postintervention stage to improve the compliance rate of handwashing. Two instruments were used in this study: the HH Knowledge Questionnaire developed by the World Health Organization to assess HH knowledge and the Handwashing Questionnaire developed to evaluate HH washing. Results: HH knowledge has been increased from preintervention (M = 11.84, standard deviation [SD] = 2.41) to postintervention (M = 18.80, SD = 2.93), and the effective compliance with HH practice was as low as 49% in June 2017 to 75% in February 2018. In addition, the HAI rate was dropped from 13.2% in June 2017 to 9% in February 2018. An inverse association was recognized between HH compliance and HAI rates. Conclusions: These results recommend that reasonable approaches can decrease the HAI rate of intensive care units. A nationwide handwashing interventional program can be employed in all hospitals.
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Long turnaround times in viral load monitoring of people living with HIV in resource-limited settings p. 85
Fredrick Mbiva, Hannock Tweya, Srinath Satyanarayana, Kudakwashe Takarinda, Collins Timire, Janet Dzangare, Phoebe Nzombe, Tsitsi M Apollo, Bekezela Khabo, Exevia Mazarura
Introduction: Routine viral load (VL) testing is fraught with challenges in resource-limited settings which lead to longer turnaround times for the return of VL results. We assessed the turnaround times for VL testing and factors associated with long turnaround (>30 days) in Marondera, Zimbabwe, between January and September 2018. Methods: This was an analytical study of routine program data. Data were extracted from electronic records and paper-based reports at two laboratories and at antiretroviral therapy (ART) facilities. The unit of analysis was the VL sample. Duration (in days) between sample collection and sample testing (pre-test turnaround time), duration between sample testing and receipt of VL result at ART the site (post-test turnaround time), and duration between sample collection and receipt of result at the ART site (overall turnaround time) were calculated. Days on which the VL testing machine was not functional, and workload (number of tests done per month) were used to assess associations. We used binomial log models to assess the factors associated with longer turnaround time. Results: A total of 3348 samples were received at the two VL testing laboratories, and 3313 were tested, of these, 1111 were analyzed for overall turnaround time. Pre-test, post-test, and overall turnaround times were 22 days (interquartile range (IQR): 11–41), 51 days (IQR: 30–89), and 67 days (IQR: 46–100), respectively. Laboratory workload (relative risk [RR]: 1.12, 95% confidence interval [CI]: 1.10–1.14) and machine break down (RR: 1.15, 95% CI: 1.14–1.17) were associated with long turnaround time. Conclusions: Routine VL turnaround time was long. Decentralizing VL testing and enhancing laboratory capacity may help shorten the turnaround time.
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Evaluation of COVID-19 antigen fluorescence immunoassay test for rapid detection of SARS-CoV-2 p. 91
Vandana Vijayeta Kiro, Ankesh Gupta, Parul Singh, Neha Sharad, Surbhi Khurana, Prakash S, Lalit Dar, Rajesh Malhotra, Naveet Wig, Arvind Kumar, Anjan Trikha, Purva Mathur
Introduction: Tests detecting SARS-CoV-2-specific antigen have recently been developed, and many of them are now commercially available. However, the real-world performance of these assays is uncertain; therefore, their validation is important. In this study, we have evaluated the performance of STANDARD F COVID-19 antigen fluorescence immunoassay (FIA) kit. Methods: Nasopharyngeal samples collected from patients were subjected to the test as per manufacturer's instructions. The performance of the kit was compared with the gold standard real-time polymerase chain reaction. Results: A total of 354 patients were tested with STANDARD F COVID-19 antigen FIA test kit. The overall sensitivity, specificity, positive predictive value, and negative predictive value of this test were found to be 38%, 99%, 96.2%, and 72%, respectively, with a diagnostic accuracy of 75.7%. Conclusion: STANDARD F COVID-19 antigen FIA showed high specificity and positive predictive value but low sensitivity and negative predictive value.
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Palate tuberculosis with paradoxical lymphadenitis p. 94
Ines Kechaou, Rym Abida, Mohamed Salah Hamdi, Lamia Ben Hassine
Oral cavity involvement in tuberculosis (TB), particularly palatine, is extremely rare and mostly described in case reports. Management of these cases usually responds to classic antitubercular therapy. Some serious complications such as paradoxical reactions (PRs) may however occur, making it more challenging for physicians to treat and to manage. We present a case of a 30-year-old female patient with a history of juvenile idiopathic arthritis and systemic lupus erythematosus who presented a bifocal form of TB involving the palate and the cervical lymph nodes. Follow-up after 2 months of proper antitubercular treatment revealed a PR of the lymph nodes contrasting with a favorable outcome of the oral lesions. It seems useful to raise all clinicians' awareness to suspect TB when they deal with chronic drug-resistant oral erosions and to keep in mind the diagnosis of PR when there is a worsening of one lesion and a favorable outcome of another.
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A rare bug and recurrent bleed p. 97
Yashendu Sarda, Vishak K Acharya, Deepthi Sharma, GV Chaithra, Madhav M Kamath, Santosh P V Rai
Isolated pulmonary actinomycosis is a rare entity. Its clinical features and radiological findings are nonspecific, making early diagnosis difficult for clinicians. We report a case of 40-year-old nonsmoker, immunocompetent male without an underlying structural lung disease who presented to us with recurrent hemoptysis and was diagnosed to have Actinomycosis after multiple readmissions.
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A rare case of Salmonella meningitis and hemophagocytic lymphohistiocytosis p. 100
Nimisha S Dange, Vishal Sawant, Lona Dash, Alpana Santosh Kondekar
Enteric fever is a common infectious disease of the tropical world. Common age group involved is children aged between 5 and 10 years. In addition to diarrhea, it may lead to extraintestinal infections including aseptic meningitis, hepatitis, cholecystitis, acute abdomen, intestinal perforation, pneumonia, psychosis, and ataxia. Hematologic complications leading to hemophagocytosis have a prevalence of < 1%. Salmonella meningitis has an incidence of 6% with poor prognosis neurological sequelae. We report a rare case of enteric fever that presented with hemophagocytic syndrome and S. meningitis. Response to third-generation cephalosporins is dramatic, eventually giving good prognosis.
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Primary bacterial peritonitis caused by Streptococcus pneumoniae p. 103
Sofia Maraki, Panagiotis Moraitis, Sophia Barbagadakis, Ioannis Vlachakis
Primary peritonitis is a rare infection in healthy children, mainly affecting patients with underlying medical disorders. We report a case of primary pneumococcal peritonitis in an immunocompetent 3-year-old boy. Diagnosis was made at laparotomy and cultures of the intra-abdominal pus yielded Streptococcus pneumoniae. Timely antibiotic treatment administered resulted in complete resolution of the infection.
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Mucosal papillary hyperplasia in gallbladder: A clue for infectious etiology in HIV patients p. 105
Juhi Devendra Mahadik, Ramya Prakash Masand, Shilpa Jain
Gallbladder specimens are ditzel in surgical pathology and opportunistic diseases like cryptosporidiosis where they are easy to miss. We describe three cases of gallbladders with mucosal papillary hyperplasia with acute and chronic inflammation, all of which revealed cryptosporidiosis on complete histological evaluation. The patients were found to be HIV positive on further chart review. In the absence of clinical history, which is often the case with gallbladder specimens, the finding of mucosal papillary hyperplasia can be a reactive response to an infectious cause and can serve as a helpful clue to look for organisms with patience at higher magnification.
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The coruscating magnetic resonance imaging features of dumb rabies p. 108
Dinesh Chouksey, Pankaj Rathi, Kapil Telang, Ajoy K Sodani
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Dengue encephalitis: A rare but dreaded complication of dengue fever p. 109
Shalendra Singh, Kiran Kalshetty, Rabi Narayan Hota, Nipun Gupta, Kaminder Bir Kaur
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Immune thrombocytopenia: A rare complication of rabies vaccine p. 110
Sachin Bansal, Rahul Bhargava, Ayush Singh, Meet Kumar, Santosh Raut Kurmi, Prabhat Agrawal
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008