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Coverpage
October-December 2018
Volume 10 | Issue 4
Page Nos. 173-229

Online since Thursday, November 29, 2018

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EDITORIAL  

State of the globe: Ensuring effective communication in public health emergencies p. 173
Sunil Kumar Raina
DOI:10.4103/jgid.jgid_60_18  
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EXPERT COMMENTARY Top

A novel scoring system for Lyme's disease; A spirochetal infection p. 175
Vivek Chauhan, Suman Thakur
DOI:10.4103/jgid.jgid_116_17  
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ORIGINAL ARTICLES Top

Studying communication problems for emergency management of SARS and H7N9 in China p. 177
Wuqi Qiu, Cordia Chu, Ayan Mao, Jing Wu
DOI:10.4103/jgid.jgid_168_17  
Background: Severe Acute Respiratory Syndrome (SARS) and Influenza A virus Subtype H7N9 (H7N9) have both had a great impact on China in the 21st century, causing significant negative impacts on health, the economy, and even global security. The control efforts for SARS were heavily criticized, the H7N9 response, 10 years later was acknowledged to be much better. Aims: This article explores communication for emergency management of SARS in 2003 and H7N9 in 2013 in China, to provide useful evidence for government and practitioner on management improvement for infectious disease outbreaks response in China and international community in the future. Methods: This study uses a qualitative case study approach, including in-depth interviews, literature review, and document, to analysis the emergency management of SARS in 2003 and H7N9 in 2013 in China, identified the problems of communication with the emergency management process for SARS and H7N9. Results: The control efforts for SARS were slow to be mobilized and were heavily criticized and generally considered to be suboptimal, as the poor handling of SARS exposed serious communication problems in the then emergency management system processes. The H7N9 response, 10 years later, was acknowledged to be much better. Conclusion: Communication is very important in the prevention and control of infectious diseases. From SARS to H7N9, the progress had been made in information disclosure.
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Prediction of cardiovascular disease risk using framingham and data on adverse effect of antiretroviral drugs risk equation in relation to lipodystrophy in HIV patients on highly active antiretroviral therapy p. 182
Deepak Kumar, Gopal Krishna Bohra, Madhulata Agarwal, Sayendra Khichar, Shyama Choudhary, Naresh Midha
DOI:10.4103/jgid.jgid_89_17  
Background: In the era of high active antiretroviral therapy (HAART), with increasing survival of HIV patients, cardiovascular risk has emerged as a leading health issue. Aims: This study aims to predict the 10-year cardiovascular disease risk in HIV patients using the Framingham risk score and its modification for HIV-infected patients on HAART, that is, the data on adverse effect of antiretroviral drugs (DAD) prediction equation. Setting and Design: This is a case control study. Materials and Methods: The present study included 320 subjects (220 HIV infected cases and 100 age, sex and body mass index matched HIV noninfected healthy controls) and was conducted in a tertiary care centre in western Rajasthan. All the patients were subjected to a detailed clinical history, complete physical examination and evaluation of laboratory parameters. We calculated Framingham risk score and DAD prediction equation for these patients and compared these scores between patients on HAART with lipodystrophy, those without lipodystrophy, HAART naive and healthy controls. Statistical Analysis: Unpaired t-test was used and statistical analysis was performed using SPSS version 20. Results: In our study, 46.67% patients on HAART developed lipodystrophy, of which 17.72% had moderate-to-high risk of cardiovascular risk according to Framingham risk score, which is significantly higher than in patients without lipodystrophy and controls (3.3% and 6%, respectively). Similar high risk was also seen with DAD score. The various risk factors also showed a positive correlation with duration of HAART. Conclusion: Our study emphasizes the need for early recognition of cardiovascular risk in HIV-infected patients on HAART, especially in those with lipodystrophy and advocates effective use of risk calculators in these patients.
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CSE-1034 versus ceftriaxone: Efficacy and safety analysis from a randomized, open-labeled phase III study in complicated urinary tract infections p. 188
Manu Chaudhary, Shiekh Gazalla Ayub, Mohd Amin Mir, Members of Study Group*
DOI:10.4103/jgid.jgid_98_17  
Objective: The aim of this study was to determine the clinical outcome, microbiological outcome and safety profile of CSE-1034, a novel combination of Ceftriaxone, Sulbactam and EDTA in patients with complicated urinary tract infections (cUTI). Materials and Methods: This was a randomized, controlled, open-labeled Phase-3 trial with the primary objective of assessing the efficacy and safety of CSE-1034 versus Ceftriaxone for the empirical treatment of cUTI. Adult cUTI patients were randomized to receive either intravenous dose of CSE-1034 or Ceftriaxone. The primary end point was composite cure rate (clinical response and bacterial eradication) in mMITT population at test of cure (TOC) visit. Secondary measures included verification of primary endpoint across other visits in different population sets, safety of patients and treatment duration. Results: Overall, 204 patients were enrolled in the study and received one of the two treatments. At primary endpoint (TOC visit), the composite cure rate was much higher in CSE-1034 treatment arm compared to Ceftriaxone arm i.e. 97% (68/70) vs 83% (58/71) (treatment difference 12.6%; 95% CI: 5.9% to 26.4%). The adverse events (AEs) rates reported in two treatment arms were 21% in CSE-1034 and 36% in Ceftriaxone groups. Additionally, the treatment duration in CSE-1034 arm was significantly less (P < 0.05). Conclusions: CSE-1034 3 g every 24 h showed a high favorable clinical and bacteriological response, and 95% CI around the treatment difference prove the superiority of CSE-1034 vs. Ceftriaxone for the treatment of cUTI. Therefore, CSE-1034 provides an effective alternative in the treatment of patients with cUTI.
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Comparative proteomic profiling of Mycobacterium tuberculosis and the Thai vaccine strain Mycobacterium bovis Bacille Calmette–Guerin Tokyo172: Diverse biomarker candidates for species differentiation p. 196
Songsri Kasempimolporn, Pornpimol Premchaiporn, Wichit Thaveekarn, Supatsorn Boonchang, Visith Sitprija
DOI:10.4103/jgid.jgid_149_17  
Background: Bacille Calmette–Guerin (BCG)-related complications can occur in vaccinated children. Comparison of the composition of cellular proteins of virulent Mycobacterium tuberculosis (MTB) H37Rv with of attenuated Mycobacterium bovis BCG Tokyo172 vaccine strain used in Thailand and identify protein candidates of value for differentiation between the two mycobacterial species may facilitate the diagnosis of etiologic agent of mycobacterial disease in vaccinated children, as most cases have been believed to have originated from BCG vaccine. Materials and Methods: The two-dimensional electrophoresis (2DE) proteomic profiles of cellular proteins from the Thai vaccine strain M. bovis BCG Tokyo172 and MTB were compared and the matched spots in 2DE gels were submitted to mass spectrometry analysis. Results: There were a number of similar protein contents with different intensity or position between MTB and M. bovis BCG Tokyo172. A higher expression of some immunogenic proteins was shown in BGG Tokyo172 when compared to MTB, while some were shown the opposite pattern. Conclusions: Proteomic approach reveals key proteins participating in different species of Mycobacteria, and may be useful for discrimination between MTB and the BCG Tokyo172 infection.
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Hospital-based surveillance: Accuracy, adequacy, and timeliness of dengue case report in Bandung, West Java, Indonesia of 2015 p. 201
Riyadi Adrizain, Djatnika Setiabudi, Alex Chairulfatah
DOI:10.4103/jgid.jgid_108_17  
Context: Dengue fever (DF) altogether with its severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome, has become public health concerns. Indonesia belongs to category A of endemicity for DF/DHF. One of the several efforts to control dengue virus infection in Indonesia is a passive surveillance called “Dengue Case Surveillance.” Timeliness report defined as a report sent within 24 h after the clinical diagnosis is needed to have a proper surveillance. The study on the evaluation of dengue case report in terms of accuracy, adequacy, and timeliness in Indonesia is still limited. Aims: The aim of this study was to identify the accuracy, adequacy, and timeliness from the reports of dengue viral infection (DVI) cases admitted from January 1 to December 31, 2015 to 7 major hospitals in Bandung, West Java, Indonesia. Settings and Design: This was a retrospective analysis study. Materials and Methods: To evaluate the accuracy, all medical records of DVI patients were reviewed epidemiologically, clinically, and laboratory using a standardized questionnaire. To evaluate the adequacy, hospital data were compared with reported data in Bandung Municipality Health Authority. To evaluate the timeliness of report, interview to the person in charge for dengue reporting cases in each hospital and in Bandung Municipality Health Authority were performed. Statistical Analysis Used: Univariate analysis was used for statistical analysis. Results: A total of 4096 (72%) of 5712 hospitalized DVI cases lived in Bandung Municipality. The accuracy of the clinical diagnosis was 3397 out of 4096 cases (82.9%). The adequacy of the accurate cases was 1553 out of 3397 cases (45.7%). Conclusions: The timeliness of report was varied, ranging from days to month. The accuracy of dengue cases was good, but the adequacy and timely reporting should be strengthened.
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Action of colloidal bismuth hydroxide gel and its commercial cream on enteropathogens and colonizers of the gastrointestinal tract p. 206
Tomás Subils, Cecilia Casabonne, Agustina González, Virginia Aquili, Claudia E Balagué
DOI:10.4103/jgid.jgid_102_17  
Background: Acute diarrheal diseases constitute a world public health problem because they are the second cause of death in children under 5 years of age. Colloidal bismuth hydroxide gel (CBHG) is an active ingredient in low-cost, antidiarrhetic drugs for oral use; it does not inhibit intestinal motility, and it features very low intestinal absorption of <1%. Materials and Methods: We analyzed the sensitivity by determining the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC); the effect on bacterial growth by studying the specific growth velocity and the generation time in growth curves; and bacterial attachment by counting viable plaques, of enteropathogenic Escherichia coli, shigatoxigenic E. coli O157:H7, Klebsiella pneumoniae, Salmonella spp., and Shigella flexneri in the commercial cream (Chobet® bismuth cream with pectin [CBCHP]), its active ingredient (CBHG), and its excipients (E) separately. Results: CBCHP: MIC 6–10 mg/ml and MBC 7.5–15 mg/ml of bismuth; CBHG: MIC 6–10 mg/ml of bismuth. E: No inhibition was observed at the concentration studied in this study. At very low subinhibitory concentrations of CBCHP and CBHG, there was already evidence of a significant decrease in growth, which could not be recorded for E. CBCHP and CBHG presented an elevated capacity for bacterial displacement, significantly greater than E. Conclusions: We believed that the results obtained in this study are very promising from the treatment standpoint, as a possible treatment for cases of diagnosis or suspicion of bacterial gastroenteritis. The antimicrobial and attachment effects of CBCHP are exclusively due to its active ingredient CBHG; these effects are promoted in the presence of E.
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Multidrug resistant Pseudomonas aeruginosa in Iran: A systematic review and metaanalysis p. 212
Hamid Vaez, Amin Salehi-Abargouei, Zahra Rashki Ghalehnoo, Farzad Khademi
DOI:10.4103/jgid.jgid_113_17  
Background: Multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR P. aeruginosa in Iran. The aim of the present study was to investigate the relative frequency of MDR P. aeruginosa in different parts of Iran. Materials and Methods: Using appropriate keywords and well-known English and Persian database, available data about MDR P. aeruginosa in Iran were retrieved. After applying predefined criteria, relevant studies were selected. Results: By using random-effect models, the pooled incidence of MDR P. aeruginosa was estimated 58% (95% confidence interval [CI]; 0.54–0.61). The highest and lowest prevalence of MDR P. aeruginosa were observed in Tehran (100%) (95% CI; 0.94–1.00) and Zahedan (16%) (95% CI; 0.10–0.24), respectively. The highest resistance rate was against ceftazidime (50%) (95% CI; 0.46–0.54) and amikacin (50%) (95% CI; 0.46–0.54). Conclusion: Our findings are of concern since they demonstrate the high prevalence rate of MDR P. aeruginosa in the majority of Iranian hospitals.
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Rectal carriage of carbapenem-resistant enterobacteriaceae: A menace to highly vulnerable patients p. 218
Amarjeet Kumar, Sarita Mohapatra, Sameer Bakhshi, Manoranjan Mahapatra, V Sreenivas, Bimal K Das, Seema Sood, Arti Kapil
DOI:10.4103/jgid.jgid_101_17  
Background: Bloodstream infection (BSI) due to carbapenem-resistant enterobacteriaceae (CRE) is the leading cause of morbidity and mortality in patients with hematological malignancy. These patients receive chemotherapy during treatment, which lead to severe mucositis of gastrointestinal tract and myelosuppression. It was hypothesized that the gut colonizer translocate into the blood circulation causing BSI. Colonization rate with CRE among these patients in India is unknown. Aim: This study aims to determine the carriage rate of CRE in cancer patients. Setting and Design: A prospective study was conducted in a tertiary care hospital of India. Materials and Methods: Rectal swab of 93 patients were collected and processed as per the Center for Disease Control and Prevention protocol for detection of CRE. The isolate CREs were identified by standard phenotypic tests and confirmed for carbapenem resistance by disk diffusion test using carbapenem disk (imipenem, meropenem, doripenem, and ertapenem), Carba-NP test and modified Hodge test. Resistant to any of the carbapenem disc is considered as CRE. Results: A total of 86 isolates were detected from 93 patients. Seventy-six isolates were identified as CRE, and 10 isolates were Gram-positive cocci and other Gram-negative bacilli. Acute myeloid leukemia was the most common clinical presentation followed by acute lymphoid leukemia. Thirty-nine out of 93 patients were on chemotherapy. Sixty-seven out of 76 isolates of CRE were observed positive for carbapenemase production by Carba-NP test. Conclusion: This study highlights very high rate of CRE carriage among the hematological malignancy patients; who are highly vulnerable to infection. This confirms the need of infection control prevention activities among the hematological malignancy patients.
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Extended-spectrum beta-lactamase-producing community-acquired urinary tract infections in children: Chart review of risk factors p. 222
Sundaram Balasubramanian, Dhanalakshmi Kuppuswamy, Swathi Padmanabhan, Vaishnavi Chandramohan, Sumanth Amperayani
DOI:10.4103/0974-777X.246391  
Background: Community acquired urinary tract infections (CA-UTI) caused by extended spectrum beta lactamase (ESBL) producing organisms is on the rise throughout the world. There are known risk factors such as age <1 year, children on uroprophylaxis, recurrent UTI, recent antibiotic usage etc which can predict the occurrence of these ESBL producers. Objectives: To correlate known risk factors with occurrence of ESBL UTI and antibiotic susceptibility of uropathogens isolated. Materials and Methods: Clinical and microbiological data were collected from 100 children 1month to 12 years with CA-UTI. The risk factors were compared in the ESBL and non-ESBL group and analysed. Results and Conclusion: The antimicrobial sensitivity pattern in our study showed increased resistance to cephalosporins, cotrimoxazole, fluoroquinolones and amoxicillin-clavulanic acid which are frequently used in the treatment of UTI, with most isolates being sensitive to aminoglycosides, piperacillin-tazobactam and carbapenems. Statistical analysis did not identify any significant risk factor that predisposes to ESBL UTI.
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PICTORIAL EDUCATION Top

Lung cancer screening reveals a nonspiculated nodule: Histoplasmosis p. 226
Teresa Khoo, Gary Clarke, George Psevdos
DOI:10.4103/jgid.jgid_92_18  
We report the case of a middle aged man, 43-pack-years active smoker, who upon radiographic screening for lung cancer found to have a non-spiculated lung nodule concerning for malignancy. Histologic evaluation of this lesion turned out to be a nodule due to Histoplasma capsulatum.
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CASE REPORT Top

Disseminated protothecosis caused by Prototheca zopfii in a liver transplant recipient p. 228
Polati Vishnu Rao, Nandini Sethuraman, Yamunadevi Ramanathan, Ram Gopalakrishnan
DOI:10.4103/jgid.jgid_55_17  
Prototheca is a genus of achlorophyllic algae present ubiquitously in the environment. Human infections are rare affecting immunocompromised individuals. We report a case of fatal algaemia caused by Prototheca zopfii in a patient who underwent liver transplant. Tissue diagnosis is mandatory for diagnosing rare entities in seriously ill, immunocompromised individuals.
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008