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   2018| April-June  | Volume 10 | Issue 2  
    Online since May 23, 2018

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Dermatological manifestations of HIV/AIDS individuals in Shiraz, South of Iran
Mohammad Ali Davarpanah, Nasrin Motazedian, Farideh Jowkar
April-June 2018, 10(2):80-83
DOI:10.4103/0974-777X.233000  PMID:29910568
Introduction: HIV infection remains as a major challenge facing medical sciences in the world today. Mucocutaneous manifestation was first observed in patients with HIV/AIDS in the early 1980s. The aim of this study was to identify various skin manifestations based on making careful clinical observations and performing the necessary tests. Materials and Methods: A total of 240 patients whose disease was diagnosed using WB and ELISA tests, with dermatologic manifestations and were older than 18 years, participated in this study. These patients had referred to the voluntary counseling and testing center in Shiraz for routine examinations. Results: From the total of 240 participants, 158 were males (65.8%) and 82 were females (34.2%). The mean age was 40.87 ± 8.04 years. Dermatologic manifestations were of infectious origin in 79 (33%) of the participants. As the most common viral skin infections, herpes simplex was seen in 16 patients (6.7%), with herpes zoster ranking second with 15 patients (6.3%). No relationship was found between CD4 cell count and infectious or noninfectious dermatologic manifestations (P = 0.274). Conclusion: No association was found between CD4 cell counts and dermatologic manifestations. Many skin disorders may appear in HIV/AIDS patients with normal CD4 cell counts.
  5,913 111 5
Diagnostic accuracy of CD64 for sepsis in emergency department
Silvana Teixeira Dal Ponte, Ana Paula Alegretti, Diogo André Pilger, Gabriela Petitot Rezende, Giordanna Andrioli, Helena Cocolichio Ludwig, Luciano Diogo, Luciano Zubaran Goldani, Melina Loreto, Pauline Simas Machado, Renato Seligman
April-June 2018, 10(2):42-46
DOI:10.4103/jgid.jgid_130_16  PMID:29910563
Introduction: Sepsis is a systemic inflammatory response to suspected or confirmed infection. Clinical evaluations are essential for its early detection and treatment. Blood cultures may take as long as 2 days to yield a result and are not always reliable. However, recent studies have suggested that neutrophil CD64 expression may be a sensitive and specific alternative for the diagnosis of systemic infection. Objective: The objective of the study was to analyze the difference in CD64 values between subjects with systemic inflammatory response syndrome (SIRS), suspected or confirmed sepsis, who meet diagnostic criteria for SIRS upon arriving at an emergency department. Materials and Methods: This was a prospective observational cohort study, an accuracy study of CD64 prospectively evaluated. The sample consisted of 109 patients aged 18 years with criteria for SIRS on arrival to emergency department. CD64 expression was measured within 6 h of hospital admission and once again after 48 h. Results: ROC curve analysis suggested that a cutoff of 1.45 for CD64 expression could diagnose sepsis with a sensitivity of 0.85, a specificity of 0.75, an accuracy of 82.08%, a positive predictive value of 0.96, a negative predictive value of 0.38 and a positive likelihood ratio of 3.33. The area under the curve was 0.83. Conclusion: CD64 seems to be a useful, sensitive, and specific biomarker in discriminating between SIRS and sepsis.
  5,254 145 7
Early results of fecal microbial transplantation protocol implementation at a community-based university hospital
Rodrigo Duarte-Chavez, Thomas R Wojda, Thomas B Zanders, Berhanu Geme, Gloria Fioravanti, Stanislaw P Stawicki
April-June 2018, 10(2):47-57
DOI:10.4103/jgid.jgid_145_17  PMID:29910564
Introduction: Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the “last resort” option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital. Methods: After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCap™ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results. Results: A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ≥3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools. Conclusions: This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university hospital. Following FMTP implementation, primary (86%) and overall (94%) nonsurgical cure rates were similar to those reported in other studies. The potential role of opioids as a modulator of CDI warrants further clinical investigation.
  5,052 123 5
State of globe: Neutrophil CD64: Is it a reliable biomarker for sepsis?
Sajal Ajmani, Vikas Agarwal, Mohan Gurjar
April-June 2018, 10(2):33-34
DOI:10.4103/jgid.jgid_95_17  PMID:29910560
  4,845 80 -
Leprosy-associated chronic wound management using biomaterials
Srinivasan Sivasubramanian, Sambasivam Mohana, Paulraj Maheswari, Victor Victoria, Ramar Thangam, Jayashri Mahalingam, Gayathri Chandrasekar-Janebjer, Vincent Savariar, Balaraman Madhan, Palani Gunasekaran, Satish S Kitambi
April-June 2018, 10(2):99-107
DOI:10.4103/jgid.jgid_79_17  PMID:29910571
Background: Deformities and neuropathic chronic ulcers are the common features associated with leprosy-cured individuals that impact their quality of life and impair rehabilitation efforts. The challenging aspects for treatment of chronic wounds are the factors that inhibit healing. We reasoned that limited success of various therapeutic interventions could be due to the fact that leprosy-cured individual's physiology gets acclimatized to having a chronic wound that any therapeutic intervention is counterbalanced to maintain status quo at the wound site. Therefore, an alternative strategy would be to use biomaterials that gradually alter the wound site allowing the individual's physiology to participate in the healing process. Aims: Developing the human amnion (Amn)-derived biomaterial scaffolds and evaluating its use to heal chronic wounds in leprosy-cured but deformed persons (LCDPs). Materials and Methods: Using an enzymatic protocol, we have developed a rapid method to generate biomaterial scaffolds from discarded human Amn. A clinical trial on 26 LCDPs was performed with the biomaterial, and its wound-healing potential was then compared with LCDPs undergoing standard treatment procedure. Results: Biomaterial-based treatment of chronic wounds on LCDP displayed a higher efficiency in healing when compared to standard treatment. Conclusions: This study exemplifies that biomaterial-based treatment of leprosy-wounds offers an excellent affordable alternative for wound management. This study underlines the importance of involving both local wound environment and systemic effects for healing. In addition, we highlight wound healing as a necessity for successful rehabilitation and reintegration of leprosy-cured person into the society.
  4,630 115 2
Hepatitis C infection become a common issue among hemodialysis patients in a hemodialysis center Jakarta, Indonesia, and survival comparison of hemodialysis patients with hepatitis infection between two hemodialysis centers in Jakarta, Indonesia, and Penang, Malaysia
Diana Laila Ramatillah, Syed Azhar Syed Sulaiman, Amer Hayat Khan
April-June 2018, 10(2):37-41
DOI:10.4103/jgid.jgid_85_17  PMID:29910562
Background: According to the Association of Nephrologist in Indonesia (Pernefri) recommendation, isolation and using special hemodialysis machines are not necessary for hemodialysis (HD) patients who have been infected by hepatitis C virus (HCV), while according to the Ministry of Health Malaysia recommendation, hepatitis C patients should be dialyzed in a separate room or a separate area with a fixed partition and dedicated machines. Aim: The aim of this study was to identify the correlation between the recommendation which had been followed by two HD centers in different countries and the impact of that on the hepatitis C infection issue. Methods: A cohort prospective and retrospective study was done in this research. The study included HD patients who were followed up for 9 months and who died in the last 5 years. Universal sampling was used to select the patients based on inclusion criteria. Results: There was a significant relationship between HCV during the first checkup and HCV during the second checkup during the 9-month follow-up of HD patients in a HD center, Jakarta, Indonesia. The total number of patients who had hepatitis C during the first and second checkups was also different in this HD center. Conclusion: Besides providing special HD rooms and machines for HD patients with hepatitis C, minimizing blood transfusion to the patients on HD is also important to reduce the chance for the patients to acquire hepatitis C and to increase the percentage of survival.
  4,631 81 -
Organized medicine: Need for a guild of associations
Sunil Kumar Raina, Sagar C Galwankar, Ramesh Bhat, Udhay Bodhankar, Ram Prabhoo, Shiv K Mishra
April-June 2018, 10(2):35-36
DOI:10.4103/jgid.jgid_160_17  PMID:29910561
  4,187 62 2
Isolation and characterization of novel broad host range bacteriophages of Vibrio cholerae O1 from Bengal
Sounak Sarkar, Mayukh Das, Tushar Suvra Bhowmick, Hemanta Koley, Robert Atterbury, Alok K Chakrabarti, Banwarilal L Sarkar
April-June 2018, 10(2):84-88
DOI:10.4103/jgid.jgid_37_17  PMID:29910569
Objectives: We have isolated a total of five newer cholera phages which are novel broad host range to incorporate with the existing phage typing schemes for an extended typing scheme. Materials and Methods: These newly isolated phages were well characterized including the electron micrograph. A total of 300 Vibrio cholerae strains were isolated from the different endemic region in India were included in phage typing study. Results: These phages were found different from the existing phages. Electron microscopic results showed that the phages belonged to myophage and podophage group. Characterization of the phages based on pH, temperature, and organic solvent sensitivity showed differences among the phages used in this study. All the strains of Vibrio O1 were typeable (100%) with the five set of cholera phages. Of these, 40% strains were clustered under Type-1. Conclusion: The newer Vibrio phages are novel and broad host range and will be useful to incorporate with the existing phage typing system for more precisely discriminate the strains of Vibrio cholerae.
  3,756 65 1
Disseminated histoplasmosis diagnosed on bone marrow aspiration in a case of fever with thrombocytopenia
Shreshtha A Tiwari, Sandeep S Ojha
April-June 2018, 10(2):112-113
DOI:10.4103/jgid.jgid_4_17  PMID:29910573
  3,230 67 -
Clonal lineage diversity, antibiotic resistance, and virulence determinants among methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolated from nurses at a teaching hospital in Ilam, Iran: Successful nares decolonization by mupirocin
Ali Hematian, Aazam Monjezi, Ramin Abiri, Parviz Mohajeri, Abbas Farahani, Setareh Soroush, Morovat Taherikalani
April-June 2018, 10(2):67-73
DOI:10.4103/jgid.jgid_43_17  PMID:29910566
Background: Staphylococcus aureus is known to be responsible for nosocomial infections, and the typing method was useful in managing the reservoir of bacteria. The main aim of this study was to determine the prevalence of S. aureus in the nares and hands of nurses working in Imam Khomeini hospital, Ilam, Iran, as well as to determine the clonal relatedness, antimicrobial susceptibility profiles, different virulence, and resistance determinants among these isolates. The evolution of mupirocin activity in the eradication of methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) colonization in the nares of the healthcare workers in Ilam, Iran, was also determined in this study.Materials and Methods: In this cross-sectional study, 80 nurses, auxiliary nurses, and service workers from Imam Khomeini Hospital were enrolled. MRSA, antibiotic susceptibility, and virulence determinants were evaluated. Then, the isolates were subjected to pulsed field gel electrophoresis (PFGE) and Staphylococcal cassette chromosome mec typing. Results: Our results demonstrated that 23% of isolates were MRSA. PFGE results demonstrated that pulsotypes A (3 out of 30; 10%) and J (3 out of 30; 10%), pulsotypes E (2 out of 30; 6.7%), M (2 out of 30; 6.7%), P(2 out of 30; 6.7%), and V (2 out of 30; 6.7%) were the most predominant pulsotypes, respectively. Conclusion: We cannot give conclusive suggestions about the correlation between nasal carriage and infections, but we suggest the monitoring of all healthcare workers annually, decontamination of their noses by using mupirocin and other antistaphylococcal agents, and also the washing of their hands at least every 2 h.
  3,204 78 1
Proteomic analysis of avian influenza A (H7N9) patients within a family cluster
Yang Zheng, Xiaomin Lou, Peng Yang, Weixian Shi, Yanda Chu, Meishuang Yan, Cuicui Jiang, Di Wu, Yang Pan, Jiachen Zhao, Yang Li, Yusheng Dong, Lijuan Chen, Siqi Liu, Quanyi Wang
April-June 2018, 10(2):58-66
DOI:10.4103/jgid.jgid_159_16  PMID:29910565
Background: To date, there is limited information on the progression of human infections of avian influenza virus A (H7N9). This study investigated differential blood protein profiling of a H7N9-infected family cluster to find a slice of crucial proteins concerning disease attack and virus clearance.Materials and Methods: Plasma samples from one family cluster (including one index case and one asymptomatic case) were collected at four time points. The protein profiles were identified by isobaric tagging for relative and absolute quantification-based quantitative differential LC/MS/MS, and their functional annotations were analyzed by PANTHER and STRING tools. Results: A total of 1257 nonredundant proteins were identified from 3027 unique peptides. Three differential protein profiles for each subject were generated by comparing relative protein abundance between samples of each of the first three time points and the last time point. Gene ontology analysis indicated that differential protein profiles for the two cases were mainly enriched in the biological processes of response to stimulus, immunity, blood coagulation, lipid transport, and cell adhesion. Two groups of proteins with an upward or downward expression change according to the postinfection time points were detected for each case. STRING analysis further indicated that the hubs in the network of these time-dependent proteins were mostly apolipoproteins. Conclusions: Significant perturbation of the response upon viral infection occurred immediately after confirmation of H7N9 virus infection. The differential protein profiles shed further light on distinguishing the index case from the asymptomatic one. Furthermore, apolipoproteins may play an important role in the progression of the disease.
  3,134 86 1
The role of biochemical variations and genotype testing in determining the virological response of patients infected with hepatitis C virus
Abid Shoukat, Mosin S Khan, Syed Mudassar, Zaffar Kawoosa, Altaf H Shah, Showkat Ali Zargar
April-June 2018, 10(2):89-98
DOI:10.4103/jgid.jgid_48_17  PMID:29910570
Background: In hepatitis C virus (HCV), infection viral and IL28B genotype along with many clinical and biochemical factors can influence response rates to pegylated interferon plus ribavirin (Peg-IFN-a/R) therapy and progression to chronic hepatitis C (CHC). Aims: The present study was conducted to determine the effect of biochemical and risk factors on treatment outcome in CHC patients in relation to their viral and host genotype. Settings and Design: The present study was a prospective Pe- IFN efficacy study consisting of Peg-IFN-a/R therapy for 24–48 weeks including 250 HCV infected patients. Materials and Methods: Biochemical parameters were determined by Beckman Coulter AU680 automated analyzer. HCV and Interleukin 28B (IL28B) genotyping were carried out by polymerase chain reaction-restriction fragment length polymorphism and viral load was determined by quantitative real-time PCR. Results: Wild outnumbered the variant genotypes in rs 12979860, rs 12980275, and rs 8099917 SNP of IL28B gene. Sustained virological response (SVR) SVR and viral genotype were significantly associated with age, hepatic steatosis, low-grade varices, and serum aspartate transaminase levels (at the end of treatment) (P < 0.05). In addition, SVR was significantly influenced by body mass index (BMI), insulin resistance, serum low-density lipoprotein , and ferritin levels (P < 0.05). Viral genotype 1 infected patients had higher serum cholesterol and triglyceride levels (P < 0.05). Conclusions: Although the IL28B sequence variation is the major factor that can influence response rates to antiviral therapy, viral and biochemical factors also have a definite role to play in the diagnosis, etiology, and treatment outcome in HCV-infected patients.
  3,157 62 -
Pulmonary nocardiosis and scrub typhus in an immunocompromised host
Isabella Princess, R Ebenezer, Nagarajan Ramakrishnan, S Nandini
April-June 2018, 10(2):108-111
DOI:10.4103/jgid.jgid_105_17  PMID:29910572
Pulmonary infections are not uncommon in patients with an underlying immunocompromised condition. Unusual combination of microorganisms causing concomitant infections among these patients has also been reported. However, certain rare dual occurrences are usually unanticipated as in the case we present here. This case highlights the importance of being aware of the possible coexistence of infections in immunocompromised patients. To the best of our knowledge, this is the first report of coinfection with Nocardia otitidiscaviarum and Orientia tsutsugamushi in a critically ill immunocompromised patient from South India.
  3,115 73 3
Detection of biofilm-associated implant pathogens in cardiac device infections: High sensitivity of sonication fluid culture even in the presence of antimicrobials
Alessandra Oliva, Maria Teresa Mascellino, Bich Lien Nguyen, Massimiliano De Angelis, Alessia Cipolla, Annalisa Di Berardino, Antonio Ciccaglioni, Claudio Maria Mastroianni, Vincenzo Vullo
April-June 2018, 10(2):74-79
DOI:10.4103/jgid.jgid_31_17  PMID:29910567
Introduction: Sonication showed more sensitivity than traditional culture in the diagnosis of device infections. Aims of the study were to assess the role of sonication in the microbiological diagnosis and management of cardiac device infections (CDIs), to evaluate the sensitivity of sonication in patients on antimicrobial therapy at the time of device removal, and to analyze biofilm formation of the isolated strains. Materials and Methods: A total of 90 devices (31 generators and 59 electrodes) collected from 31 patients with infection underwent sonication before culture. Devices were sonicated for 5 min and centrifuged at 3200 rpm for 15 min. Intraoperative traditional cultures were performed in 26 patients. Microorganisms were identified using conventional methods. Staphylococcal strains were tested for slime production. Results: Microbiological diagnosis was achieved in 28 patients (90%). Sonicate fluid was positive in 68/90 (76%) of devices (27/31 [87%] generators and 41/59 [69%] electrodes), whereas intraoperative pocket swabs grew bacteria in 10/26 patients (38%, P= 0.0007). Among leads, 37/59 (62.7%) yielded bacteria even in the absence of vegetation. Coagulase-negative Staphylococci accounted for 83.8% (57/68) of the total; Staphylococcus aureus and Gram-negative bacilli were found in 4.4% (3/68) and 5.8% (4/68), respectively. Biofilm production was present in 15/22 (69%) staphylococcal strains. Overall, patients on therapy (n = 23) had a microbiological diagnosis in 20/23 (86.9%) and 7/22 (30.4%) through sonication and intraoperative cultures, respectively (P = 0.0002). Discussion: Our data showed the high sensitivity of sonication in the diagnosis of CDIs, even in patients under antimicrobial therapy. Conclusion: Sonication represents an essential tool for both diagnosis and management of CDIs.
  2,966 79 3
Oerskovia species bacteremia in a diabetic patient
Katerina G Oikonomou, Carla Sue Mcwilliams, Marwa M Moussa
April-June 2018, 10(2):113-114
DOI:10.4103/jgid.jgid_67_17  PMID:29910574
  2,567 64 1
Travel-acquired scrub typhus infection masked by dengue fever in a patient from nonendemic area
Akanksha Garg, Aditi Jain, Rajesh Kashyap
April-June 2018, 10(2):114-115
DOI:10.4103/jgid.jgid_68_17  PMID:29910575
  2,377 43 2
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008