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   2013| October-December  | Volume 5 | Issue 4  
    Online since November 22, 2013

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Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Causing Respiratory Tract Infections in a Tertiary Care Center
Kisumu Chawla, Shashidhar Vishwanath, Frenil C Munim
October-December 2013, 5(4):144-148
DOI:10.4103/0974-777X.121996  PMID:24672175
Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. Results: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. Conclusion: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage.
  21 6,131 208
Infection control and practice of standard precautions among healthcare workers in northern Nigeria
OE Amoran, OO Onwube
October-December 2013, 5(4):156-163
DOI:10.4103/0974-777X.122010  PMID:24672178
Background: Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids. Aims: This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria. Settings and Design: Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common. Materials and Methods: This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009. Statistical analysis used: To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors. Results: A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients' care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (c2 = 3.96, P = 0.03), public healthcare providers when compared to private health workers (c2 = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (c2 = 14.64, P = 0.001) and urban areas when compared to rural areas (c2 = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28). Conclusions: This study implies that inadequate workers' knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.
  13 20,473 410
Prevalence and risk factors associated with pediculosis capitis in an impoverished urban community in Lima, Peru
Hannah Lesshafft, Andreas Baier, Humberto Guerra, Angelica Terashima, Hermann Feldmeier
October-December 2013, 5(4):138-143
DOI:10.4103/0974-777X.121994  PMID:24672174
Background: Pediculosis capitis is a ubiquitous parasitic skin disease associated with intense pruritus of the scalp. In developing countries it frequently affects children and adults, but epidemiological data at the community level are rare. Objectives: To assess prevalence and risk factors associated with pediculosis capitis in a resource-poor community in Lima, Peru. Materials and Methods: In total, 736 persons living in 199 households in a circumscribed neighbourhood were examined for head lice and nits by visual inspection. At the same time, socio-demographic data were collected using a structured questionnaire. Variables associated with pediculosis were identified by performing a bivariate analysis, followed by a multivariate logistic regression analysis. Results: Prevalence of pediculosis capitis was 9.1% (95% confidence interval (CI): 7.0-11.2 %) in the general population and 19.9% (CI: 15.4-24.4%) in children ≤15 years of age. Multivariate analysis showed that pediculosis capitis was significantly associated with age ≤ 15 years (OR: 16.85; CI:7.42-38.24), female sex (OR: 2.84; CI: 1.58-5.12), household size of >4 persons (OR: 1.98; CI: 1.11-3.55), low quality of house construction material (OR:2.22; CI: 1.20-4.12), and presence of animals in the household (OR: 1.94; CI: 1.11-3.39). Conclusion: Pediculosis capitis was a very common disease in the studied community in Lima, Peru. Our logistic regression analysis affirms that young age is the most important risk factor for pediculosis capitis. Moreover, female sex, large household size, living in wooden houses and the presence of animals were identified as being significantly associated with head lice infestation.
  9 5,080 74
Atypical dengue meningitis in Makkah, Saudi Arabia with slow resolving, prominent migraine like headache, phobia, and arrhythmia
Kalakatawi H Mamdouh, Kalakatawi M Mroog, Nasser H Hani, Elrefae M Nabil
October-December 2013, 5(4):183-186
DOI:10.4103/0974-777X.122021  PMID:24672183
Although dengue meningitis is a rare presentation of dengue infection, our aim is to focus on atypical presentation of dengue meningitis that may appear in dengue endemic area like the Makkah region. We report two cases of clinical meningitis with positive dengue virus (DENV) IgM in cerebrospinal fluid, followed for minimal 3 months for their prominent attacks of migraine like headache, phobia, and arrhythmia. With special consideration to attack time, type, severity, and respond to classical therapy, using regular ECG monitoring, visual analog pain score and neuropsychological assessments were done. Both cases showed resistant migraine like headaches to classic anti-migraine therapy except for strong NSAID and narcotics with tendency to have severe to extreme severe daily migraine like headache on early to late afternoon time, associated with non-fatal arrhythmias and extreme death phobia, that resolve slowly in a minimal 3 month period. In conclusion, dengue meningitis in the endemic area may present atypically.
  7 3,280 43
Study of opportunistic intestinal parasitic infections in human immunodeficiency virus/acquired immunodeficiency syndrome patients
Manish Kumar Mathur, Ajoy Kumar Verma, Gopee E Makwana, Mala Sinha
October-December 2013, 5(4):164-167
DOI:10.4103/0974-777X.122012  PMID:24672179
Introduction: Intestinal parasites predominantly coccidian parasites are a common cause for diarrhea in human immunodeficiency virus (HIV)-positive patients. Materials and Methods: The study was conducted during January 2009-December 2010. A total of 1,088 stool samples from 544 seropositive HIV positive cases were examined microscopically for ova and cyst using wet mount preparations and stained smears. Out of 544 patients, 343 had prolonged diarrhea for more than 4 weeks, 57 had acute diarrhea of lesser than 7 days and 144 were asymptomatic cases who attended out-patient department; included in this study after taking consent from patients. Enteric pathogens were detected in 274 (50.36%) of the 544 patients. Results and Conclusions: The parasites identified were Cryptosporidium (135), Isospora belli (42), Cyclospora (12), Microsporidia (02), Entamoeba histolytica (49), Hookworm (34). Intestinal parasites in chronic diarrhea were significantly higher than the acute diarrhea (63.05% vs. 7.35%; P < 0.05). Parasitic pathogens were frequently associated with HIV-positive patients with diarrhea in Western India. Stools of all HIV-positive patients with diarrhea should thoroughly be investigated to identify etiologic agents for proper management.
  7 4,734 69
Prevalence and distribution of schistosomiasis in Afder and Gode zone of Somali region, Ethiopia
Nebiyu Negussu, Mohamed Wali, Milion Ejigu, Fikiru Debebe, Sirage Aden, Rashid Abdi, Yusuf Mohamed, Amare Deribew, Kebede Deribe
October-December 2013, 5(4):149-152
DOI:10.4103/0974-777X.122007  PMID:24672176
Background: There is no recent information about the prevalence and distribution of schistosomiasis in the Somali national regional state of Ethiopia. Ethiopia launched the national integrated neglected tropical diseases (NTDs) Master Plan in June 2013. The Master Plan identified mapping NTDs as a prerequisite for launching control programs. Therefore it is important to understand the prevalence and distribution of schistosomiasis in respective regions. Materials and Methods: From February to March 2011, a cross-sectional survey was done in school-aged children from six districts of Afder Gode zone. Urine samples were collected and examined for ova of Schistosoma haematobium using the sedimentation technique and stool samples were collected and examined for S. mansoni using the Kato-Katz technique. A semistructured questionnaire was used to collect sociodemographic characteristics of the participants. Results: Of the 523 children, 513 (98%) of them participated in the study. The prevalence of S. haematobium was 16.0% (95% confidence interval (CI); 12.8-19.2). The rate of the disease was not uniform across the various six communities studied (x2 = 208.8, P < 0.0001). Musthail district had the highest prevalence with 64.2% (95% CI; 60.0-68.3) followed by Kelafo with 11.8% (95% CI; 9.0-14.6). No infections of S. mansoni were found in these settings. There was no difference in the prevalence of infection across age groups. Boys were more likely to be infected by S. haematobium than girls (odds ratio = 1.68; 95% CI: 1.1-2.7). Conclusion: S. haematobium infection is prevalent in the region with varying distribution across the districts. According to the World Health Organization, mass drug administration should be considered in some of the districts.
  7 4,032 57
West Nile virus and its theories, a big puzzle in Mexico and Latin America
Darwin Elizondo-Quiroga, Armando Elizondo-Quiroga
October-December 2013, 5(4):168-175
DOI:10.4103/0974-777X.122014  PMID:24672180
It has been 13 years since the first outbreak of West Nile Virus (WNV) occurred in the Americas. Since then, thousands of human cases have been reported in the United States. In contrast, there has not yet been an outbreak of WNV in any Latin American countries, including Mexico where <20 cases have been reported. We aimed to review publications to gather the main theories related to the fact that not all the countries of the continent reported human cases or that they have reported few cases since the introduction of WNV in the Western Hemisphere. We identified relevant publications using the PubMed database. Furthermore, we present on-line published information from Mexico. We found that researchers have tried to explain this phenomenon using several theories, like pre-existing antibodies against a heterotypical virus that have conferred cross protection in the population. Another explanation is that the strains circulating in Latin America are attenuated or that they came from a different origin of introduction in the continent. Another theory is that a conclusive diagnostic in regions where more than one Flavivirus is circulating results in cross-reaction in serological tests. Probably the sum of factors described by researchers in these theories in order to explain the behavior of the virus has resulted in the low number of reported cases in Latin America.
  7 4,097 82
Non-zoonotic Pasteurella multocida infection as a cause of septic shock in a patient with liver cirrhosis: A case report and review of the literature
Jose Orsini, Ruben Perez, Alfonso Llosa, Nyale Araguez
October-December 2013, 5(4):176-178
DOI:10.4103/0974-777X.122016  PMID:24672181
Pasteurella multocida is a Gram-negative organism characterized morphologically as coccobacillus. It is the commonest organism infecting pet bites. However, severe infections may occur in the absence of animal bites or scratches. Pasteurella multocida serves as an opportunistic pathogen in humans, especially in patients with depressed immune system. Few cases in the literature identify Pasteurella multocida as the causative agent of septic shock, especially in cirrhotic patients. We report a patient who presented with septic shock as a result of Pasteurella multocida bacteremia, without prior history of animal exposure.
  4 5,441 35
Spontaneous pneumorrhachis and transverse myelitis complicating purulent meningitis
Bouchra Amara, Sad Boujraf, Mohammed Benzagmout, Smael Labib, Mustapha Harandou
October-December 2013, 5(4):179-182
DOI:10.4103/0974-777X.122019  PMID:24672182
Pneumorrhachis is the presence of air in the spinal canal; mostly, it has an iatrogenic origin. The association of this entity with spontaneous pneumomediastinum without any pneumothorax is rarely reported in the literature. The spontaneous resorption is the usual evolution. The association to acute transverse myelitis is discussed by the authors. The patient is a 21-year-old male with pneumorrhachis associated to a spontaneous pneumomediastinum was admitted at the emergency department for bacterial meningitis. The antibiotherapy has marked the clinical profile by disappearance of the meningeal signs in the 48 h after admission. In contrast, the neurological symptoms were of marked aggravation by appearance of a tetraparesis with a respiratory distress syndrome having required artificial ventilation. The computed tomography (CT) scan showed a typical hypodensity corresponding to paramedullary air extending to several thoracic segments. The spinal magnetic resonance imaging (MRI) showed a high cervical medullary edema without signs of compression. The patient died within 15 days with a profile of vasoparalysis resistant to vasoactive drugs. Pneumomediastinum associated to pneumorrhachis and transverse myelitis complicating purulent meningitis is a rare entity. Although the usual evolution is favorable, the occurrence of serious complications is possible.
  2 3,218 52
State of the globe: Non-fermenting gram-negative bacilli challenges and potential solutions
Durgesh G Deshmukh, Amol M Zade, Kishor V Ingole, Jolhf K Mathai
October-December 2013, 5(4):125-126
DOI:10.4103/0974-777X.121983  PMID:24672171
  1 3,063 58
The importance of accuracy in diagnosis of positive malaria cases in a country progressing towards malaria elimination
Sumadhya Deepika Fernando, Chathuri J Navaratne, Gawrie NL Galappaththy, Rabindra R Abeyasinghe, Nilupa Silva, Renu Wickermasinghe
October-December 2013, 5(4):127-130
DOI:10.4103/0974-777X.121992  PMID:24672172
Background: With Sri Lanka aiming towards malaria elimination by 2015, the National Anti Malaria Campaign has stressed on the importance of identification of the species of Plasmodium either by examination of stained blood smears for malaria parasites or by Rapid Diagnostic Tests for malaria antigens before the initiation of treatment. This study aims at confirmation of the accuracy of clinical and/or microscopical malaria diagnosis using serology. Materials and Methods: Study population comprised 51 individuals diagnosed with malaria either microscopically or clinically during the first half of 2011. ELISA for detection of the two significant blood antigens (AMA-1 and MSP1-19) was carried out in these individuals, 14-28 days after being diagnosed as being positive for malaria microscopically. Results: ELISA confirmed the microscopic diagnosis in all 47 of the patients including two mixed infections which flagged positive for both parasite antigens. However, four individuals diagnosed clinically as being positive for P. vivax by Health Care Providers were negative for malaria antibodies by ELISA. Conclusions: With 175 cases of malaria reported in 2011, a formidable challenge exists to diagnose malaria positive blood smears due to the large number of negative blood smears being seen daily. After routine cross checking of positive slides, it is heartening to note that there were no false positives detected through serological assays amongst patients who were diagnosed as malaria positive by microscopy. Presumptive treatment of febrile patients with anti-malarials can lead to waste of resources and adversely impact the condition of the patient if the fever is not due to malaria.
  1 3,793 88
The Plasmodium falciparum Antigen MB2 Induces Interferon-γ and Interleukin-10 Responses in Adults in Malaria Endemic Areas of Western Kenya
Lyticia A Ochola, Gideon M Ng'wena, Gregory S Noland, Bartholomew N Ondigo, George Ayodo, Chandy C John
October-December 2013, 5(4):131-137
DOI:10.4103/0974-777X.122001  PMID:24672173
Background: MB2 is a novel Plasmodium falciparum antigen of unknown function expressed in pre-erythrocytic and blood stages of infection in the human host. Interferon-gamma (IFN-γ) and interleukin (IL)-10 responses to other P. falciparum antigens have been associated with protection from clinical malaria, but these responses have not been studied for MB2. The present study was undertaken to characterize IFN-γ and IL-10 responses to P. falciparum MB2 antigen in adults living in areas of differing malaria transmission in Western Kenya. Materials and Methods: Cytokine responses to two 9-mer MB2 peptides predicted to be human leukocyte antigen (HLA) class I restricted T-cell epitopes were measured by enzyme-linked immunosorbent assay (ELISA) (IFN-γ and IL-10) and enzyme-linked immunosorbent spot (ELISPOT) (IFN-γ) in adults (n = 228) in areas of unstable and stable malaria transmission. HLA class I restriction of responses was assessed in a sub-group of the study population. Results: IFN-γ and IL-10 responses to MB2 peptides by ELISA were observed in both sites with no significant difference in prevalence (IFN-γ, unstable transmission area, 18.8%, stable transmission area, 27.5%, P = 0.33; IL-10, unstable transmission area, 22.5%, stable transmission area, 25.0%, P = 0.78). Prevalence of IFN-γ responses by ELISPOT was also similar in both areas (unstable, 10.8%, stable, 10.9%, P = 0.98). Neither IFN-γ nor IL-10 responses showed evidence of HLA class I restriction. Conclusions: MB2 induces IFN-γ and IL-10 responses in adults living in both stable and unstable malaria transmission areas. Future studies should assess if these responses are associated with protection from clinical malaria.
  1 3,068 54
Rapid detection of malaria parasite by toluidine blue method: A new staining method
Vamseedhar Annam, Chakkirala Nalini Mohan, Vazhayil Ramunny Mrinalini
October-December 2013, 5(4):153-155
DOI:10.4103/0974-777X.122008  PMID:24672177
Background: Malaria is a commonest mosquito-borne infectious disease worldwide. Early identification and management of malaria prevents complications and mortality. Identification of the malaria mainly relies on detection of the parasite on blood smears. The present study was conducted to compare Toluidine blue method with Leishman method for detection of malaria parasite and also to study the efficacy and advantages of using Toluidine blue method. Materials and Methods: In 540 consecutive patients with clinical suspicion of malaria, peripheral smears were prepared. Smears were processed for both conventional Leishman method and Toluidine blue method simultaneously. The significance of Toluidine blue method over Leishman method was analyzed using Chi-square (χ2 ) test. Results: Out of 540 smears, 28.3% (153/540) were positive for malaria parasite on conventional Leishman method, while the smear positivity was more by Toluidine blue method to 33.3% (180/540) [P value < 0.01]. The remaining 66.67% (360/540) were negative by both Toluidine blue method and conventional Leishman method. Conclusion: The Toluidine blue method is simple, rapid, inexpensive, and easily available. The implementation of Toluidine blue method clearly improves microscopic detection of malaria parasite and can be a useful contribution to routine hematology even at rural health sectors.
  - 3,775 60
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008