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   2014| October-December  | Volume 6 | Issue 4  
    Online since November 21, 2014

 
 
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SPECIAL ARTICLE
The emergence of Ebola as a global health security threat: From 'lessons learned' to coordinated multilateral containment efforts
Sarathi Kalra, Dhanashree Kelkar, Sagar C Galwankar, Thomas J Papadimos, Stanislaw P Stawicki, Bonnie Arquilla, Brian A Hoey, Richard P Sharpe, Donna Sabol, Jeffrey A Jahre
October-December 2014, 6(4):164-177
DOI:10.4103/0974-777X.145247  PMID:25538455
First reported in remote villages of Africa in the 1970s, the Ebolavirus was originally believed to be transmitted to people from wild animals. Ebolavirus (EBOV) causes a severe, frequently fatal hemorrhagic syndrome in humans. Each outbreak of the Ebolavirus over the last three decades has perpetuated fear and economic turmoil among the local and regional populations in Africa. Until now it has been considered a tragic malady confined largely to the isolated regions of the African continent, but it is no longer so. The frequency of outbreaks has increased since the 1970s. The 2014 Ebola outbreak in Western Africa has been the most severe in history and was declared a public health emergency by the World Health Organization. Given the widespread use of modern transportation and global travel, the EBOV is now a risk to the entire Global Village, with intercontinental transmission only an airplane flight away. Clinically, symptoms typically appear after an incubation period of approximately 11 days. A flu-like syndrome can progress to full hemorrhagic fever with multiorgan failure, and frequently, death. Diagnosis is confirmed by detection of viral antigens or Ribonucleic acid (RNA) in the blood or other body fluids. Although historically the mortality of this infection exceeded 80%, modern medicine and public health measures have been able to lower this figure and reduce the impact of EBOV on individuals and communities. The treatment involves early, aggressive supportive care with rehydration. Core interventions, including contact tracing, preventive initiatives, active surveillance, effective isolation and quarantine procedures, and timely response to patients, are essential for a successful outbreak control. These measures, combined with public health education, point-of-care diagnostics, promising new vaccine and pharmaceutical efforts, and coordinated efforts of the international community, give new hope to the Global effort to eliminate Ebola as a public health threat. Here we present a review of EBOV infection in an effort to further educate medical and political communities on what the Ebolavirus disease entails, and what efforts are recommended to treat, isolate, and eventually eliminate it.
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ORIGINAL ARTICLES
Resazurin tube method: Rapid, simple, and inexpensive method for detection of drug resistance in the clinical isolates of Mycobacterium Tuberculosis
Santosh S Patil, Shivajirao T Mohite, Sunanda A Kulkarni, Usha S Udgaonkar
October-December 2014, 6(4):151-156
DOI:10.4103/0974-777X.145239  PMID:25538453
Background: Tuberculosis (TB) remains a serious public health problem worldwide. The emergence of drug resistance and multidrug resistance (MDR) has become the main threat to TB treatment and control programs. Rapid detection is critical for the effective treatment of patients. In recent times, a new method using the colorimetric indicator resazurin has been proposed for drug susceptibility of Mycobacterium tuberculosis. Materials and Methods: In this study, the resazurin reduction assay was adapted to screw cap tubes. Using the Resazurin Tube Method (RTM), a total of 100 clinical isolates were tested against Rifampicin (RIF) and Isoniazide (INH). By visual reading, the minimum inhibitory concentrations (MICs) were obtained after eight days. The results obtained were compared with the gold standard proportion method. Results: Excellent results were obtained for RTM with a sensitivity of 100% for both RIF and INH, with a specificity of 98.7 and 95.3%, respectively. Kappa is the measure of agreement between the RTM and proportion method (PM) for RIF and INH, which was found to be 0.972 and 0.935 for RIF and INH, respectively. Conclusion: The RTM appears to be a reliable method for the rapid and simultaneous detection of MDR-TB and drug susceptibility testing (DST) of M. tuberculosis. It is simple, inexpensive, and with no biohazard risk involved.
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Virulence markers of vancomycin resistant enterococci isolated from infected and colonized patients
Priyanka Paul Biswas, Sangeeta Dey, Luna Adhikari, Aninda Sen
October-December 2014, 6(4):157-163
DOI:10.4103/0974-777X.145242  PMID:25538454
Background: The aim of study was to find out the potential pathogenic role of virulence factors elaborated by strains of vancomycin resistant enterococci (VRE) isolated from clinical samples and VRE colonizing the gastrointestinal tract of hospitalized patients. Materials and Methods: Enterococci were isolated from various clinical samples and also from fecal specimens of colonized patients at the time of admission, after 48 h and after 5 days of admission. Various virulence determinants were detected by phenotypic tests. Vancomycin susceptibility in enterococci was detected by disc diffusion and agar screen method. Minimum inhibitory concentration was determined by agar dilution method. Results: Out of all the clinical and fecal samples processed, 12.0% isolates were either vancomycin resistant or vancomycin intermediate. Hemagglutinating activity against rabbit red blood cells was seen with 27.8% and 25.0% of clinical and fecal strains, respectively. Slime layer formation was seen with fecal VRE strains (37.5%) when compared to clinical VRE (27.8%). Among the clinical VRE strains the most prolific biofilm producers were Enterococcus. fecalis (92.9%) when compared to Enterococcus. faecium (52.9%). Biofilm formation/(presence of adhesions) was also seen in (29.2%) of the fecal VREs. In wound infection production of gelatinase, deoxyribonuclease (DNase), and caseinase (70.0% each) were the major virulence factors. The predominant virulence factors seen in the blood stream infection were adhesin, and hemolysin (44.4% each) and in catheter induced infection were DNase and adhesins (75.0% each). Adhesin (29.2%), slime layer (37.6%), DNAse (33.3%), gelatinase (25.0%), lipase (20.8%) and caseinase (16.6%) and hemolysin (8.3%) were produced the fecal isolates. Conclusion: An association between adhesin (as detected by biofilm formation) and urinary tract infection, adhesion and hemolysin with BSI, as also between DNase gelatinase & caseinase with wound infection was noted.
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Kikuchi-Fujimoto disease: Clinical and laboratory characteristics and outcome
PS Rakesh, Reginald G Alex, George M Varghese, Prasad Mathew, Thambu David, Marie Therese Manipadam, Sheila Nair, Ooriapadickal Cherian Abraham
October-December 2014, 6(4):147-150
DOI:10.4103/0974-777X.145234  PMID:25538452
Introduction: Kikuchi-Fujimoto disease is an uncommon disorder with worldwide distribution, characterized by fever and benign enlargement of the lymph nodes, primarily affecting young adults. Awareness about this disorder may help prevent misdiagnosis and inappropriate investigations and treatment. The objective of the study was to evaluate the clinical and laboratory characteristics of histopathologically confirmed cases of Kikuchi's disease from a tertiary care center in southern India. Materials and Methods: Retrospective analysis of all adult patients with histopathologically confirmed Kikuchi's disease from January 2007 to December 2011 in a 2700-bed teaching hospital in South India was done. The clinical and laboratory characteristics and outcome were analyzed. Results: There were 22 histopathologically confirmed cases of Kikuchi's disease over the 5-year period of this study. The mean age of the subjects' was 29.7 years (SD 8.11) and majority were women (Male: female- 1:3.4). Apart from enlarged cervical lymph nodes, prolonged fever was the most common presenting complaint (77.3%). The major laboratory features included anemia (54.5%), increased erythrocyte sedimentation rate (31.8%), elevated alanine aminotransferase (27.2%) and elevated lactate dehydrogenase (LDH) (31.8%). Conclusion: Even though rare, Kikuchi's disease should be considered in the differential diagnosis of young individuals, especially women, presenting with lymphadenopathy and prolonged fever. Establishing the diagnosis histopathologically is essential to avoid inappropriate investigations and therapy.
  2,323 16 -
CASE REPORT
Toxoplasmosis of spinal cord in acquired immunodeficiency syndrome patient presenting as paraparesis: A rare entity
Sachin R Agrawal, Vinita Singh, Sheetal Ingale, Ajeet Prasad Jain
October-December 2014, 6(4):178-181
DOI:10.4103/0974-777X.145248  PMID:25538456
Although brain has been the most common site for toxoplasma infection in acquired immunodeficiency syndrome patients, involvement of spinal cord by toxoplasma has been rarely found. Spinal cord toxoplasmosis can present as acute onset weakness in both lower limbs associated with sensory and bladder dysfunction. A presumptive diagnosis can be made in patients with CD4 count <100/mm 3 based on a positive serum Toxoplasma gondii IgG antibodies, no recent prophylaxis against toxoplasmosis, intramedullary ring enhancing lesion in spinal cord supported by similar lesions in brain parenchyma. Institutions of antitoxoplasma treatment in such patients result in prompt clinical response and therefore avoiding the need of unnecessary invasive diagnostic tests. Here, we report a case of toxoplasmic myelitis in immunocompromised patient presenting as myelopathy who showed significant clinical improvement after starting antitoxoplasma treatment. Hence toxoplasmic myelitis should be considered in toxoplasma seropositive immunocompromised patients presenting as myelopathy and imaging studies showing ring enhancing intramedullary lesion.
  2,092 13 -
ORIGINAL ARTICLES
Antimicrobial susceptibility patterns of leading bacterial pathogens isolated from laboratory confirmed blood stream infections in a multi-specialty Sanatorium
Nishat H Ahmed, Tabish Hussain
October-December 2014, 6(4):141-146
DOI:10.4103/0974-777X.145231  PMID:25538451
Objective: Dealing with severe blood stream infections (BSI) is one of the intractable conditions in hospitals. The empirical treatment given remains pertinent in determining patient outcome, which becomes evidence based when substantiated by knowledge of susceptibility patterns of prevalent pathogenic organisms in the set up. This study was undertaken to determine the occurrence, species prevalence, and antibiotic susceptibility pattern of laboratory confirmed BSI (LCBSI) in patients admitted to our multi-specialty sanatorium. Materials and Methods : Eight hundred and forty-six blood samples from 829 patients suspected of having BSI were cultured as per standard microbiological procedures. Antimicrobial susceptibility testing was done for bacterial isolates from positive blood cultures. Results: Sixty (7.2%) cases were established as LCBSI. A total of eight pathogenic bacterial genera were identified and their antimicrobial susceptibility pattern was noted. Staphylococcus spp. were most prevalent (33%), followed by Klebsiella pneumoniae (20%), Escherichia coli (13%), Acinetobacter spp. (13%), Enterococcus spp. (12%), Pseudomonas aeruginosa (3%), Proteus spp. (2%), and Citrobacter spp. (2%). Conclusions: The study shows the prevalence of common bacterial pathogens causing BSI and their susceptibility patterns. Such studies provide benefit of instantaneous choice of antibiotic therapy aiming at improved patient management and reduced drug resistance.
  2,047 14 -
MICROBIOLOGY REPORTS
Antimicrobial resistance in Pseudomonas sp. causing infections in trauma patients: A 6 year experience from a south asian country
Nonika Rajkumari, Nibu Varghese John, Purva Mathur, Mahesh Chandra Misra
October-December 2014, 6(4):182-185
DOI:10.4103/0974-777X.145250  PMID:25538457
Drug resistance to Pseudomonas sp. has spread to such a level irrespective of the type of patients, that its pattern of distribution and antibiotic resistance needs to be studied in detail, especially in trauma patients and hence the study. A 6 year study was carried out among trauma patients to see the trend and type of resistance prevalent in the apex hospital for trauma care in India among nonduplicate isolates where multidrug-resistance (MDR), cross-resistance and pan-drug resistance in Pseudomonas sp. were analyzed. Of the total 2,269 isolates obtained, the species, which was maximally isolated was Pseudomonas aeruginosa (2,224, 98%). The highest level of resistance was seen in tetracycline (2,166, 95.5%, P < 0.001) and chloramphenicol (2,160, 95.2%, P < 0.001) and least in meropenem (1,739, 76.7%, P < 0.003). Of the total, 1,692 (74.6%) isolates were MDR in which P. aeruginosa (75%) were maximum. MDR Pseudomonas is slowing increasing since the beginning of the study period. Of 1,797 imipenem-resistant P. aeruginosa isolated during the study period, 1,763 (98%) showed resistance to ciprofloxacin or levofloxacin, suggesting that cross-resistance may have developed for imipenem due to prior use of fluoroquinolones. Antibiotic resistance in Pseudomonas sp. is fast becoming a problem in trauma patients, especially in those who requires prolong hospital stay, which calls for proper antimicrobial stewardship.
  1,907 14 -
Changing bacteriological profile and mortality trends in community acquired pneumonia
Sagar Khadanga, Tadepalli Karuna, Pravat Kumar Thatoi, Sarat Kumar Behera
October-December 2014, 6(4):186-188
DOI:10.4103/0974-777X.145251  PMID:25538458
There are very few and conflicting Indian data regarding the bacteriological etiology of community acquired pneumonia (CAP). Adding to this agony, there is no credible data from the eastern part of India. This is a cross-sectional study and descriptive in nature over a period of 1-year. Of the 464 cases of the study population, we could isolate aerobic bacteria in 149 patients (32.1%). Streptococcus pneumoniae has been identified as the most common organism causing CAP (68/149). Gram-negative bacilli (GNB) as a group exceeded marginally over S. pneumoniae (69/149). Among GNB, Pseudomonas aeruginosa was the most common organism (31/69), followed by Klebsiella pneumoniae (29/69). Staphylococcus aureus was identified in (12/149) cases. Co-amoxyclav is still the most sensitive drug for S. pneumoniae. P. aeruginosa was most sensitive to imipenam followed by piperacillin-tazobactam.
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Soft tissue and wound infections due to Enterococcus spp. among hospitalized trauma patients in a developing country
Nonika Rajkumari, Purva Mathur, Mahesh Chandra Misra
October-December 2014, 6(4):189-193
DOI:10.4103/0974-777X.145253  PMID:25538459
Soft tissue and wound infections due to Enterococcus spp. are increasing worldwide with current need to understand the epidemiology of the Enterococcal infections of wounds. Hence, we have looked into the distribution of Enterococcus spp. responsible for causing wound and soft tissue infections among trauma patients, its antibiotic resistance pattern and how it affects the length of hospital stay and mortality. A laboratory cum clinical-based study was performed over a period of 3 years at a level I trauma center in New Delhi, India. Patients with Enterococcal wound and soft tissue infections were identified using the hospital data base, their incidence of soft tissue/wound infections calculated, drug resistance pattern and their possible risk factors as well as outcomes analyzed. A total of 86 non-repetitive Enterococcus spp. was isolated of which E. faecium were maximally isolated 48 (56%). High level of resistance was seen to gentamicin HLAR in all the species of Enterococcus causing infections whereas a low level resistance to vancomycin and teicoplanin was observed among the isolates. Longer hospital stay, repeated surgical procedure, prior antibiotic therapy and ICU stay were observed to associate with increased morbidity (P < 0.05) and hence, more chances of infections with VRE among the trauma patients. The overall rate of wound and soft tissue infections with Enterococcus sp. was 8.6 per 1,000 admissions during the study period. Enterococcal wound infection is much prevalent in trauma care facilities especially in the ICUs. Here, a microbiologist can act as a sentinel, help in empirical therapeutic decisions and also in preventing such infections.
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EDITORIAL
State of the globe: Time to revisit kikuchi Fujimoto disease
Sarah Bezek, Veronica Tucci, Sarathi Kalra, Angela Fisher
October-December 2014, 6(4):139-140
DOI:10.4103/0974-777X.145228  PMID:25538450
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LETTERS TO EDITOR
Fecal carriage of Escherichia coli from pediatric patients with diarrhea and asymptomatic healthy individuals
Rumpa Saha, Shukla Das, Kaustuv De, Taru Singh, Ankita Kumari
October-December 2014, 6(4):194-195
DOI:10.4103/0974-777X.145256  PMID:25538460
  1,456 14 -
Fever and cervical lymphadenopathy in a young female; Thinking beyond tuberculosis
Sagar Khadanga, Rajdip Sen, Pravat Kumar Thatoi, Rina Mohanty, Kailash Bihari Mishra, T Karuna
October-December 2014, 6(4):197-198
DOI:10.4103/0974-777X.145265  PMID:25538463
  1,433 13 -
Anti-nuclear antibody expression in severe scrub typhus infection: Preliminary observations
John Victor Peter, Mathew F Griffith, John Antony Jude Prakash, Anugragh Chrispal, Kishore Pichamuthu, George M Varghese
October-December 2014, 6(4):195-196
DOI:10.4103/0974-777X.145260  PMID:25538461
  1,302 14 -
The HIV associated type 2 diabetes
A Kasthuri, K Mohanakrishnan, SK Amsavathani, G Sumathi
October-December 2014, 6(4):196-197
DOI:10.4103/0974-777X.145262  PMID:25538462
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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008