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Coverpage
January-March 2020
Volume 12 | Issue 1
Page Nos. 1-38

Online since Wednesday, February 19, 2020

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EDITORIAL  

State of the globe: Human Nipah virus infection needs “One Health” p. 1
Sunil Kumar Raina
DOI:10.4103/jgid.jgid_155_19  
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EXPERT COMMENTARY Top

Active case finding in tuberculosis: Need for a cautious approach p. 3
Sunil Kumar Raina
DOI:10.4103/jgid.jgid_139_19  
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ORIGINAL ARTICLES Top

A study of multidrug-resistant, colistin-only-sensitive infections in intubated and mechanically ventilated patients over 2 years p. 5
Ipe Jacob, Pradeep Rangappa, Lakshman C Thimmegowda, Karthik Rao
DOI:10.4103/jgid.jgid_179_18  
Background and Aims: Multidrug-resistant, Gram-negative infections are increasingly common in the intensive care unit (ICU). This study compares the occurrence and outcome of colistin-only-sensitive (COS) infections among mechanically ventilated patients at a tertiary hospital ICU. Methods: The study included adult patients admitted over a period of 2 years, who were intubated and mechanically ventilated for more than 48 h. They were divided into two groups, those with COS infections and those without, and their GCS and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, ICU length of stay, leukocyte count, and mortality were compared. COS patients were divided into neurosurgery, neurology, respiratory, and sepsis with bacteremia groups. The COS organisms in each group, their sources, ICU length of stay, ventilator-free days, and mortality were analyzed. Results: Three hundred and one patients were selected, of whom 41 (13.6%) had COS infections. COS patients had a longer ICU length of stay than non-COS patients (P = 0.001) but comparable APACHE II and GCS scores, leukocyte count, and mortality. The sepsis group accounted for 8 out of 15 (53%) deaths among COS patients (P = 0.03). Acinetobacter baumannii accounted for 61% of the COS infections, Klebsiella pneumonia: 24.4%, Pseudomonas aeruginosa: 12.2%, and Escherichia coli: 2.4%. Endotracheal secretion cultures accounted for 65.8% of COS isolates, urine cultures 17%, pus cultures 7.3%, and blood cultures 4.9%. ICU length of stay, ventilator-free days, and mortality were similar between each COS organism. Conclusion: Intubated patients with multidrug-resistant, COS infections have a longer stay in ICU than non-COS patients. COS infections associated with bacteremia have high mortality.
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Isolation of a novel phage and targeting biofilms of drug-resistant oral enterococci p. 11
Sonia Bhonchal Bhardwaj, Manjula Mehta, Shaveta Sood, Jyoti Sharma
DOI:10.4103/jgid.jgid_110_19  
Introduction: Enterococci are now recognized as the second most cause of nosocomial infections worldwide. The emergence of multidrug-resistant strains in the organism has given rise to alternative strategies such as phage therapy. In this study, an Enterococcus faecalis infecting phage was isolated and its efficiency against biofilms formed by drug-resistant enterococci obtained from chronic periodontitis was evaluated. Materials and Methods: Bacteriophage against E. faecalis was isolated from sewage sample. The phage was propagated and identified using transmission electron microscope (TEM).In vitro biofilm formation was assessed. Results: TEM microscopy showed that the phage belonged to Siphoviridae family. In the presence of the novel phage, the metabolic activity of enterococci biofilm was reduced at 48 h of contact. A difference of at least 5 log CFU/ml was seen in the live cells of the control biofilm, and the phage treated biofilm of enterococci isolates. Conclusion: The study shows that the novel phage inhibits biofilm production in oral enterococci isolates from periodontitis patients but has a narrow host range. The role of bacteriophages as strong biotechnological and natural therapeutic agents for E. faecalis in chronic periodontitis can be considered.
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Persistence of clonal azole-resistant isolates of Candida albicans from a patient with chronic mucocutaneous candidiasis in Colombia p. 16
Andrés Ceballos-Garzon, Luz M Wintaco-Martínez, Norida Velez, Catalina Hernandez-Padilla, Alejandro De la Hoz, Sandra Liliana Valderrama-Beltrán, Carlos A Alvarez-Moreno, Patrice Le Pape, Juan David Ramírez, Claudia M Parra-Giraldo
DOI:10.4103/jgid.jgid_74_19  
Purpose: The present article describes retrospectively a case of a patient with chronic mucocutaneous candidiasis (CMC) who presented recurrent Candida albicans infection since he was 6 months old. We obtained 16 isolates recovered during a 4-year period. Our purpose was to determinate the susceptibility, genotyping, and the pathogenicity profile in all the isolates. Methods: Sixteen C. albicans were isolated from a 25-year-old male with several recurrent fungal infections admitted to Hospital. The isolates were recovered during 4 years from a different anatomical origin. We typified them by multilocus sequence typing, also we evaluated susceptibility to fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole, caspofungin, and amphotericin B by microdilution method and we also test the pathogenic capacity in the Galleria mellonella model. Results: Genotyping of all clinical isolates showed the persistence of the same diploid sequence type (DST). Isolates changed their susceptibility profile over time, but there were no significant statistical differences in pathogenicity. Conclusion: Herein, a persistent clonal isolates of C. albicans (DST 918) in a patient with CMC, showed changes in its susceptibility profile after several antifungal treatments acquiring gradual resistance to the azole drugs, which did not affect their pathogenicity.
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Dissecting an outbreak: A clinico-epidemiological study of Nipah virus infection in Kerala, India, 2018 Highly accessed article p. 21
Bhargavan Pallivalappil, Althaf Ali, NK Thulaseedharan, Ummer Karadan, Jayakrishnan Chellenton, KP Dipu, AS Anoop Kumar, KG Sajeeth Kumar, TP Rajagopal, KP Suraj, GR Santosh Kumar, RN Supreeth, Mounika Yelisetti, Prathap Reddy Muthyala, KS Aryasree, K S Apurva Rao
DOI:10.4103/jgid.jgid_4_19  
Background: An outbreak of Nipah virus infection was confirmed in Kerala, India in May 2018. Five out of 23 cases including the first laboratory-confirmed case were treated at Baby Memorial Hospital (BMH), Kozhikode. The study describes the clinical characteristics and epidemiology of the Nipah virus outbreak at Kozhikode during May 2018. Objective: To study the clinical and epidemiological profile of Nipah virus epidemic that occurred in Kerala in May 2018. Methods: A collaborative team of physicians and epidemiologists from BMH, Medical College Hospital (MCH) Kozhikode and from the Indian Medical Association (IMA) conducted this study. The clinical and exposure history and the data on outbreak response were gathered from hospital medical records and through interviewing patient relatives and health workers using questionnaires. Results: It was identified that out of the 23 patients with Nipah virus infection, 21 (91.3%) expired. Out of the 21 patients, 18 tested positive for Nipah virus by Real Time polymerase chain reaction (RT-PCR). It has been found that only the index case was infected in the community from fruit bats. Rest of the cases were due to transmission of the virus at three public hospitals. Median age was 45 years. 65% of them were males. Median incubation period was 9.5 days. Fever (100%), altered sensorium (84.2%), tachycardia (63.1%), hypertension (36.8%), segmental myoclonus (15.7%), segmental sweating (15.7%) and shortness of breath (73.6%) were common features. Mean duration of illness was 6.4 days. Conclusion: The rapid spread of infection uncovered the miserable state of health care system in implementing infection control measures. The case fatality and the socio-economic burden warrant developing appropriate treatments, vaccines and diagnostics.
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Are treatment outcomes of patients with tuberculosis detected by active case finding different from those detected by passive case finding? p. 28
Mahendra Singh, Karuna D Sagili, Jaya P Tripathy, Surekha Kishore, Yogesh A Bahurupi, Ajay Kumar, Vagish Kala, Vikas Yadav, Shikha Murmu
DOI:10.4103/jgid.jgid_66_19  
Context: India has adopted active case finding (ACF) as an additional strategy to find its missing tuberculosis (TB) cases since 2017. Treatment outcomes of patients identified through ACF may be similar or different from those detected through routine passive case finding (PCF); currently, there are limited studies on this in India. Aim: The aim of this study was to assess differences in treatment outcomes of patients detected through ACF and PCF under the national TB program. Study Design: A study was conducted in six TB units of Haridwar district where ACF campaigns were conducted in 2017–2018. Methods: Data from patients detected by ACF (n = 72) and PCF (n = 184) were extracted from program records. Results: Of 72 patients detected by ACF, only 54 (75%) were initiated on treatment. A high proportion of initial loss to follow-up (25% vs. 0%) and delay in treatment initiation (4 days vs. 0 days) was observed in ACF patients as compared to PCF. The proportion of unsuccessful treatment outcome was 33% (n = 18) among ACF patients compared to 14% (n = 25) among PCF patients (adjusted relative risk: 2.6, 95% confidence interval: 1.7–4.0). Conclusion: High initial loss to follow-up, delay in treatment initiation, and poor treatment outcome among ACF patients are a major concern. The study results call for active follow-up after diagnosis and close monitoring during treatment for patients detected by ACF.
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CASE REPORT Top

Unusual presentation of methicillin-resistant Staphylococcus aureus colitis complicated with acute appendicitis p. 34
Elias Estifan, Sushant M Nanavati, Vinod Kumar, Aarohi Vora, Moayyad Alziadat, Ahmed Sharaan, Mourad Ismail
DOI:10.4103/jgid.jgid_117_19  
Clostridium difficile colitis has been the most recognized bacterial enterocolitis for years and other bacteria such as Staphylococcus colitis has been relegated. Staphylococcus enterocolitis following antibiotics had been one of the most frequent complications in surgical patients in the 1950s and 1960s and now reappear with more resistance such as methicillin-resistantStaphylococcus aureus(MRSA) colitis which brings a new challenge. A 32-year-old Hispanic female with a history of type I diabetes mellitus presenting with altered sensorium and a 2-day history of watery, nonbloody diarrhea, intractable emesis, and diffuse crampy abdominal pain. About a month before the presentation, the patient had a soft-tissue laceration on the left foot requiring a 7-day course of cephalexin and clindamycin that healed appropriately. On physical examination, she was tachycardic with heart rate of 110 bpm and tachypneic with respiratory rate of 28, somnolent but arousable with the Glasgow Coma Scale >12. The abdomen was soft, tender diffusely to palpation without rebound or guarding. On the biochemical analysis, her blood glucose was 968 mg/dL with anion gap metabolic acidosis (AG 46). In the intensive care unit, she initiated on intravenous (IV) fluids, insulin, and IV antibiotics for suspicion of colitis. Clostridium difficile testing was negative, but stool cultures grew MRSA for which she was started on vancomycin and TMP-SMX. Due to continued abdominal pain on antibiotics, computed tomography of the abdomen with contrast showed acute appendicitis with inflammatory debris and without perforation or abscess requiring laparoscopic appendectomy. Our case presented with diabetic ketoacidosis (DKA), which complicates the etiology of abdominal pain on admission for the clinician masking-MRSA colitis associated with a rare complication of appendicitis double challenge and difficult to diagnose as most DKA patients present with abdominal pain. This is the first case report describing MRSA enterocolitis in patient with DKA complicated by acute appendicitis.
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LETTER TO EDITOR Top

Frequency of panton–valentine leukocidin gene among clinical isolates of methicillin-resistant staphylococcus aureus in Eastern Province of Saudi Arabia p. 37
Sayed A Quadri, Abdulrahman A Al-Sultan, Ameen Mohammad Al-Ramdan, Lorina I Badger-Emeka, Sayed Ibrahim Ali
DOI:10.4103/jgid.jgid_27_19  
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008