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SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Extended-spectrum ß-lactamases in gram negative bacteria
Deepti Rawat, Deepthi Nair
September-December 2010, 2(3):263-274
DOI
:10.4103/0974-777X.68531
PMID
:20927289
Extended-spectrum ß-lactamases (ESBLs) are a group of plasmid-mediated, diverse, complex and rapidly evolving enzymes that are posing a major therapeutic challenge today in the treatment of hospitalized and community-based patients. Infections due to ESBL producers range from uncomplicated urinary tract infections to life-threatening sepsis. Derived from the older TEM is derived from Temoniera, a patient from whom the strain was first isolated in Greece. ß-lactamases, these enzymes share the ability to hydrolyze third-generation cephalosporins and aztreonam and yet are inhibited by clavulanic acid. In addition, ESBL-producing organisms exhibit co-resistance to many other classes of antibiotics, resulting in limitation of therapeutic option. Because of inoculum effect and substrate specificity, their detection is also a major challenge. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in
Klebsiella pneumoniae, K. oxytoca, Escherichia coli
and
Proteus
mirabilis.
In common to all ESBL-detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic-resistance mechanisms in the face of the introduction of new antimicrobial agents. Thus there is need for efficient infection-control practices for containment of outbreaks; and intervention strategies, e.g., antibiotic rotation to reduce further selection and spread of these increasingly resistant pathogens.
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147
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3,004
CONSENSUS PAPER
The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper
Stanislaw P Stawicki, Rebecca Jeanmonod, Andrew C Miller, Lorenzo Paladino, David F Gaieski, Anna Q Yaffee, Annelies De Wulf, Joydeep Grover, Thomas J Papadimos, Christina Bloem, Sagar C Galwankar, Vivek Chauhan, Michael S Firstenberg, Salvatore Di Somma, Donald Jeanmonod, Sona M Garg, Veronica Tucci, Harry L Anderson, Lateef Fatimah, Tamara J Worlton, Siddharth P Dubhashi, Krystal S Glaze, Sagar Sinha, Ijeoma Nnodim Opara, Vikas Yellapu, Dhanashree Kelkar, Ayman El-Menyar, Vimal Krishnan, S Venkataramanaiah, Yan Leyfman, Hassan Ali Saoud Al Thani, Prabath W B Nanayakkara, Sudip Nanda, Eric Cioè-Peña, Indrani Sardesai, Shruti Chandra, Aruna Munasinghe, Vibha Dutta, Silvana Teixeira Dal Ponte, Ricardo Izurieta, Juan A Asensio, Manish Garg
April-June 2020, 12(2):47-93
DOI
:10.4103/jgid.jgid_86_20
What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel
Betacoronavirus
, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article.
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ORIGINAL ARTICLES
Global contributors to antibiotic resistance
Aastha Chokshi, Ziad Sifri, David Cennimo, Helen Horng
January-March 2019, 11(1):36-42
DOI
:10.4103/jgid.jgid_110_18
PMID
:30814834
Introduction:
Antibiotic-resistant infections have become increasingly prevalent nowadays. As a result, it is essential to examine the key socioeconomic and political factors which contribute to the rise in the prevalence of antibiotic resistance in developing and developed nations. This study aims to identify the various contributors to the development of antibiotic resistance in each type of nation.
Methods:
PUBMED was used to identify primary research, systematic reviews, and narrative reviews published before Jan 2017. Search terms included antibiotic resistance, antimicrobial resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries. Publications from different countries were included to ensure generalizability. Publications were excluded if they didn't mention factors causing resistance, focused on the molecular basis of resistance, or if they were case reports. Publicly available reports from national and international health agencies were used.
Results:
In developing countries, key contributors identified included: (1) Lack of surveillance of resistance development, (2) poor quality of available antibiotics, (3) clinical misuse, and (4) ease of availability of antibiotics. In developed countries, poor hospital-level regulation and excessive antibiotic use in food-producing animals play a major role in leading to antibiotic resistance. Finally, research on novel antibiotics is slow ing down due to the lack of economic incentives for antibiotic research.
Conclusion:
Overall, multiple factors, which are distinct for developing and developed countries, contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the need to improve the regulatory framework for antibiotic use and research globally.
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SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Multidrug resistant
Acinetobacter
Vikas Manchanda, Sinha Sanchaita, NP Singh
September-December 2010, 2(3):291-304
DOI
:10.4103/0974-777X.68538
PMID
:20927292
Emergence and spread of
Acinetobacter
species, resistant to most of the available antimicrobial agents, is an area of great concern. It is now being frequently associated with healthcare associated infections. Literature was searched at PUBMED, Google Scholar, and Cochrane Library, using the terms '
Acinetobacter
Resistance, multidrug resistant (MDR), Antimicrobial Therapy, Outbreak, Colistin, Tigecycline, AmpC enzymes, and carbapenemases in various combinations. The terms such as MDR, Extensively Drug Resistant (XDR), and Pan Drug Resistant (PDR) have been used in published literature with varied definitions, leading to confusion in the correlation of data from various studies. In this review various mechanisms of resistance in the
Acinetobacter
species have been discussed. The review also probes upon the current therapeutic options, including combination therapies available to treat infections due to resistant
Acinetobacter
species in adults as well as children. There is an urgent need to enforce infection control measures and antimicrobial stewardship programs to prevent the further spread of these resistant
Acinetobacter
species and to delay the emergence of increased resistance in the bacteria.
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136
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1,107
SYMPOSIUM
Fundamentals of vaccine immunology
Angela S Clem
January-March 2011, 3(1):73-78
DOI
:10.4103/0974-777X.77299
PMID
:21572612
From a literature review of the current literature, this article provides an introduction to vaccine immunology including a primer on the components of the immune system, passive vs. active immunization, the mechanism(s) by which immunizations stimulate(s) immunity, and the types of vaccines available. Both the innate and adaptive immune subsystems are necessary to provide an effective immune response to an immunization. Further, effective immunizations must induce long-term stimulation of both the humoral and cell-mediated arms of the adaptive system by the production of effector cells and memory cells. At least seven different types of vaccines are currently in use or in development that produce this effective immunity and have contributed greatly to the prevention of infectious disease around the world.
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3,141
REVIEW ARTICLE
The forgotten plague: Psychiatric manifestations of ebola, zika, and emerging infectious diseases
Veronica Tucci, Nidal Moukaddam, Jonathan Meadows, Suhal Shah, Sagar C Galwankar, G Bobby Kapur
October-December 2017, 9(4):151-156
DOI
:10.4103/jgid.jgid_66_17
PMID
:29302150
The media and public health generally focus on the biological and physical ramifications of epidemics. Mental health issues that coincide with emerging diseases and epidemics are rarely examined and sometimes, even eschewed due to cultural considerations. Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Virus disease (EVD) and Zika Virus, are discussed in this commentary to illustrate the continued need of care after the resolution of the actual illness. Various infectious diseases have associations with mental illness, such as an increased risk of obsessive-compulsive disorders and Tourette syndrome in children with Group B streptococcal infection. Current EVD literature does not demonstrate a strong association of mental illness symptoms or diseases but there is a necessity of care that extends beyond the illness. Patients and their families experience depression, anxiety, trauma, suicidal ideation, panic and other manifestations. Zika virus has been associated neuronal injury, genetic alteration that affects fetal development and detrimental maternal mental health symptoms are being documented. While funding calls from the international community are present, there are no specific epidemiological data or fiscal estimates solely for mental health during or after infectious diseases epidemics or disasters that support health care providers and strengthen policies and procedures for responding to such situations. Therefore, those on the frontlines of epidemics including emergency physicians, primary care providers and infectious disease specialists should serve communicate this need and advocate for sustained and increased funding for mental health programs to heighten public awareness regarding acute psychiatric events during infectious diseases outbreaks and offer treatment and support when necessary.
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SYMPOSIUM - LIESHMANIASIS
Drug resistance in leishmaniasis
Jaya Chakravarty, Shyam Sundar
May-August 2010, 2(2):167-176
DOI
:10.4103/0974-777X.62887
PMID
:20606973
The treatment options of leishmaniasis are limited and far from satisfactory. For more than 60 years, treatment of leishmaniasis has centered around pentavalent antimonials (Sb
v
). Widespread misuse has led to the emergence of Sb
v
resistance in the hyperendemic areas of North Bihar. Other antileishmanials could also face the same fate, especially in the anthroponotic cycle. The HIV/ visceral leishmaniasis (VL) coinfected patients are another potential source for the emergence of drug resistance. At present no molecular markers of resistance are available and the only reliable method for monitoring resistance of isolates is the technically demanding
in vitro
amastigote-macrophage model. As the armametrium of drugs for leishmaniasis is limited, it is important that effective monitoring of drug use and response should be done to prevent the spread of resistance. Regimens of simultaneous or sequential combinations should be seriously considered to limit the emergence of resistance.
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REVIEW ARTICLE
Tuberculosis: Current situation, challenges and overview of its control programs in India
Gursimrat K Sandhu
April-June 2011, 3(2):143-150
DOI
:10.4103/0974-777X.81691
PMID
:21731301
Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000 years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India, historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place. Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second largest, in terms of population coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lack of political will; and, above all, corrupt administration. Multidrug-resistant TB (MDR-TB) is another emerging threat to TB eradication and is a result of deficient or deteriorating TB control program. WHO with its "STOP TB" strategy has given a vision to eliminate TB as a public health problem from the face of this earth by 2050. For this review article, data available at the official websites of WHO; and from the Ministry of Health, Government of India, were consulted, and search engines PubMed
;
and Google Scholar
;
were used.
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704
SYMPOSIUM ON DIAGNOSIS, DRUGS AND DISEASES
Toxoplasmosis: A global threat
Joćo M Furtado, Justine R Smith, Rubens Belfort, Devin Gattey, Kevin L Winthrop
July-September 2011, 3(3):281-284
DOI
:10.4103/0974-777X.83536
PMID
:21887062
Toxoplasmosis, a disease described worldwide, which is caused by the protozoan
Toxoplasma gondii,
commonly involves the retina. The disease has a higher impact in immunocompromised individuals and in congenital infection because of the severity of central nervous system involvement. Although simple prophylactic measures could reduce transmission,
T. gondii
seroprevalence is still high, especially in South America. Educational campaigns and the development of new drugs to prevent primary infection could potentially reduce the burden of the disease.
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SYMPOSIUM - LIESHMANIASIS
Leishmaniasis vaccine: Where are we today?
Lukasz Kedzierski
May-August 2010, 2(2):177-185
DOI
:10.4103/0974-777X.62881
PMID
:20606974
Leishmaniasis is a disease that ranges in severity from skin lesions to serious disfigurement and fatal systemic infection. WHO has classified the disease as emerging and uncontrolled and estimates that the infection results in two million new cases a year. There are 12 million people currently infected worldwide, and leishmaniasis threatens 350 million people in 88 countries. Current treatment is based on chemotherapy, which relies on a handful of drugs with serious limitations such as high cost, toxicity, difficult route of administration and lack of efficacy in endemic areas. Vaccination remains the best hope for control of all forms of the disease, and the development of a safe, effective and affordable antileishmanial vaccine is a critical global public-health priority. Extensive evidence from studies in animal models indicates that solid protection can be achieved by immunization with defined subunit vaccines or live-attenuated strains of
Leishmania
. However, to date, no such vaccine is available despite substantial efforts by many laboratories. The major impediment in vaccine design is the translation of data from animal models to human disease, and the transition from the laboratory to the field. Furthermore, a thorough understanding of protective immune responses and generation and maintenance of the immunological memory, the most important and least-studied aspect of antiparasitic vaccine development, during
Leishmania
infection is needed. This review focuses on recent findings in antileishmania vaccine field and highlights current difficulties facing vaccine development and implementation.
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MICROBIOLOGY REPORTS
Study of antibiotic resistance pattern in methicillin resistant staphylococcus aureus with special reference to newer antibiotic
Dardi Charan Kaur, Sadhana Sanjay Chate
April-June 2015, 7(2):78-84
DOI
:10.4103/0974-777X.157245
PMID
:26069428
The worldwide epidemic of antibiotic resistance is in danger of ending the golden age of antibiotic therapy. Resistance impacts on all areas of medicine, and is making successful empirical therapy much more difficult to achieve.
Staphylococcus aureus
demonstrates a unique ability to quickly respond to each new antibiotic with the development of a resistance mechanism, starting with penicillin,until the most recent, linezolid and daptomycin. Methicillin resistant
S. aureus
(MRSA) has become endemic today in hospitals worldwide. Resistance to the newer antimicrobial-agents - linezolid, vancomycin, teicoplanin, and daptomycin are been reported and also the fear of pandrug-resistance. This study was carried out to know the antimicrobial resistant pattern of MRSA to newer antibiotic, to know any isolates are extensively-drug resistant (XDR)/pandrug resistant (PDR), inducible macrolide-lincosamide streptogramin B (iMLSB), and mupirocin resistance. Thirty-six MRSA isolates resistant to the routinely tested antibiotic were further tested for list of antibiotic by a group of international experts. Isolates were tested for iMLSB and mupirocin resistance by the disk diffusion method. Of 385 MRSA, 36 (9.35%) isolates of MRSA were resistant to the routinely tested antibiotic. Among these 36 MRSA isolates, none of our isolates were XDR/PDR or showed resistant to anti-MRSA cephalosporins (ceftaroline), phosphonic acids, glycopeptides, glycylcyclines, and fucidanes. Lower resistance was seen in oxazolidinones (2.78%), streptogramins (5.56%), lipopeptide (5.56%). Thirty-four (94.44%) isolates showed constitutive MLSB (cMLSB) resistance and two (5.56%) iMLSB phenotypes. High- and low-level mupirocin resistance were seen in 13 (36.11%) and six (16.67%), respectively. In our study, none of our isolates were XDR or PDR. No resistance was observed to ceftaroline, telavancin, teicoplanin, and vancomycin; but the presence of linezolid resistance (1, 2.28%) and daptomycin resistance (2, 5.56%) in our rural set-up is a cause of concern.
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436
SYMPOSIUM - LIESHMANIASIS
Liposomal amphotericin B and leishmaniasis: Dose and response
Shyam Sundar, Jaya Chakravarty
May-August 2010, 2(2):159-166
DOI
:10.4103/0974-777X.62886
PMID
:20606972
Liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). It is the treatment of choice for immunocompetent patients in the Mediterranean region and the preferred drug for HIV/VL co-infection. Although there is a regional variation in the susceptibility of the parasite a total dose of 20 mg/kg is effective in immunocompetent patients. Randomized clinical trials of liposomal amphotericin B in the treatment and secondary prophylaxis of HIV-VL coinfected patients is urgently needed to optimize treatment in this subset. With the availability of Liposomal amphotericin B at a preferential pricing in the endemic areas, short course combination therapy can become a viable alternative.
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8,189
472
ELECTRONIC EPIDEMIOLOGY
Seasonality of tuberculosis
Auda Fares
January-March 2011, 3(1):46-55
DOI
:10.4103/0974-777X.77296
PMID
:21572609
Objectives:
This study was designed to review previous studies and analyse the current knowledge and controversies related to seasonal variability of tuberculosis (TB) to examine whether TB has an annual seasonal pattern.
Study Design and Methods:
Systematic review of peer reviewed studies identified through literature searches using online databases belonging to PubMed and the Cochrane library with key words "Tuberculosis, Seasonal influence" and " Tuberculosis, Seasonal variation". The search was restricted to articles published in English. The references of the identified papers for further relevant publications were also reviewed.
Results:
Twelve studies conducted between the period 1971 and 2006 from 11 countries/regions around the world (South Western Cameroon, South Africa, India, Hong Kong, Japan, Kuwait, Spain, UK, Ireland, Russia, and Mongolia) were reviewed. A seasonal pattern of tuberculosis with a mostly predominant peak is seen during the spring and summer seasons in all of the countries (except South Western Cameroon and Russia).
Conclusions:
The observation of seasonality leads to assume that the risk of transmission of
M. tuberculosis
does appear to be the greatest during winter months. Vitamin D level variability, indoor activities, seasonal change in immune function, and delays in the diagnosis and treatment of tuberculosis are potential stimuli of seasonal tuberculosis disease. Additionally, seasonal variation in food availability and food intake, age, and sex are important factors which can play a role in the tuberculosis notification variability. Prospective studies regarding this topic and other related subjects are highly recommended.
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SYMPOSIUM - LIESHMANIASIS
Immunological perspectives of leishmaniasis
Susanne Nylen, Shalini Gautam
May-August 2010, 2(2):135-146
DOI
:10.4103/0974-777X.62876
PMID
:20606969
Leishmania
parasites have been widely used in experimental models to understand generation, maintenance and failure of immune responses underlying resistance and susceptibility to infection. The clinical outcomes of
Leishmania
infection depend on the infecting species and the immune status of the host. Noticeably most people exposed
Leishmania
never develop overt disease. Understanding the immunological events that result in failure or successful control of the parasites is fundamental to both design and evaluation of vaccines and therapies against the leishmaniases. Recent studies visualizing immune response to
Leishmania major
in the skin have given new insights into the different immune cells acting as hosts the parasite during different stage of infection. Control of
Leishmania
infection and disease progression has been associated with generation of T-helper (Th) 1 and Th2 responses respectively. Though still valid in several aspects, the Th1/Th2 paradigm is an oversimplification in need of revision. Th2 polarization has never explained severity of human leishmanial disease and a number of other T-cell subsets, including regulatory T- and Th17- cells, have important roles in susceptibility and resistance of both experimental and human leishmanial disease. This review gives an updated overview of immunological response considered to be of importance in protection, susceptibility, disease progression and cure of leishmaniasis, with a special emphasis on human diseases.
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SYMPOSIUM ON DIAGNOSIS, DRUGS AND DISEASES
An update on crimean congo hemorrhagic fever
Suma B Appannanavar, Baijayantimala Mishra
July-September 2011, 3(3):285-292
DOI
:10.4103/0974-777X.83537
PMID
:21887063
Crimean Congo hemorrhagic fever (CCHF) is one of the deadly hemorrhagic fevers that are endemic in Africa, Asia, Eastern Europe, and the Middle East. It is a tick-borne zoonotic viral disease caused by CCHF virus of genus
Nairovirus
(family Bunyaviridae). CCHF not only forms an important public health threat but has a significant effect on the healthcare personnel, especially in resource-poor countries. India was always a potentially endemic area until an outbreak hit parts of Gujarat, taking four lives including the treating medical team. The current review is an attempt to summarize the updated knowledge on the disease particularly in modern era, with special emphasis on nosocomial infections. The knowledge about the disease may help answer certain questions regarding entry of virus in India and future threat to community.
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208
SYMPOSIUM ON INFECTIOUS AGENTS IN A MULTIDRUG RESISTANT GLOBE
Methicillin and vancomycin resistant
S. aureus
in hospitalized patients
Poonam Sood Loomba, Juhi Taneja, Bibhabati Mishra
September-December 2010, 2(3):275-283
DOI
:10.4103/0974-777X.68535
PMID
:20927290
S. aureus
is the major bacterial cause of skin, soft tissue and bone infections, and one of the commonest causes of healthcare-associated bacteremia. Hospital-associated methicillin-resistant
S. aureus
(MRSA) carriage is associated with an increased risk of infection, morbidity and mortality. Screening of high-risk patients at the time of hospital admission and decolonization has proved to be an important factor in an effort to reduce nosocomial transmission. The electronic database Pub Med was searched for all the articles on "Establishment of MRSA and the emergence of vancomycin-resistant
S. aureus
(VRSA)." The search included case reports, case series and reviews. All the articles were cross-referenced to search for any more available articles. A total of 88 references were obtained. The studies showed a steady increase in the number of vancomycin-intermediate and vancomycin-resistant
S. aureus.
Extensive use of vancomycin creates a selective pressure that favors the outgrowth of rare, vancomycin-resistant clones leading to heterogenous vancomycin intermediate
S. aureus
hVISA clones, and eventually, with continued exposure, to a uniform population of vancomycin-intermediate
S. aureus
(VISA) clones. However, the criteria for identifying hVISA strains have not been standardized, complicating any determination of their clinical significance and role in treatment failures. The spread of MRSA from the hospital to the community, coupled with the emergence of VISA and VRSA, has become major concern among healthcare providers. Infection-control measures, reliable laboratory screening for resistance, appropriate antibiotic prescribing practices and avoidance of blanket treatment can prevent long-term emergence of resistance.
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SPECIAL ARTICLE
The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG)
Veronica Sikka, Vijay Kumar Chattu, Raaj K Popli, Sagar C Galwankar, Dhanashree Kelkar, Stanley G Sawicki, Stanislaw P Stawicki, Thomas J Papadimos
January-March 2016, 8(1):3-15
DOI
:10.4103/0974-777X.176140
PMID
:27013839
The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding
in
utero
fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed to generate sufficient resources and political traction to effectively halt and contain further expansion of the current outbreak.
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SYMPOSIUM - LIESHMANIASIS
Treatment of visceral leishmaniasis
EM Moore, DN Lockwood
May-August 2010, 2(2):151-158
DOI
:10.4103/0974-777X.62883
PMID
:20606971
The available treatment options for visceral leishmaniasis (VL) have problems relating to efficacy, adverse effects and cost, making treatment a complex issue. We review the evidence relating to the different methods of treatment in relation to - efficacy and toxicity of the drugs in different areas of the world; ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give intramuscular, intravenous or oral therapy; the sex and child-bearing potential of the patient and the immune status of the patient. The high mortality of untreated/ poorly treated VL infection makes the decisions paramount, but a unified and coordinated response by each area is likely to be more effective and informative to future policies than an
ad hoc
response. For patients in resource-rich countries, liposomal amphotericin B appears to be the optimal treatment. In South Asia, miltefosine is being used; the combination of single dose liposomal amphotericin B and short course miltefosine looks encouraging but has the problem of potential reproductive toxicities in females. In Africa, the evidence to switch from SSG is not yet compelling. The need to monitor and plan for evolving drug failure, secondary to leishmania parasite resistance, is paramount. With a few drugs the options may be limited; however, we await key ongoing trials in both Africa and India to explore the effects of combination treatment. If safe and reliable combinations are revealed by the ongoing studies, it is far from clear as to whether this will avoid leishmania parasite resistance. The development of new drugs to add to the armamentarium is paramount. Lessons can be learnt from the management of diseases such as tuberculosis and malaria in terms of planning the switch to combination treatment. As important as establishing the best choice for specific antileishmanial agent is ensuring treatment centers, which can best manage the problems encountered during treatment, specifically malnutrition, bleeding, intercurrent infections, drug side effects and detecting and treating underlying immunosuppression.
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EXPERT COMMENTARY
Association between hepatitis C and hepatocellular carcinoma
Luis Jesuino de Oliveira Andrade, Argemiro D'Oliveira, Rosangela Carvalho Melo, Emmanuel Conrado De Souza, Carolina Alves Costa Silva, Raymundo Parana
January-June 2009, 1(1):33-37
DOI
:10.4103/0974-777X.52979
PMID
:20300384
Hepatocellular carcinoma (HCC) is the fifth most common cancer, the third most common cause for cancer death in the world, a major cause of death in patients with chronic hepatitis C virus infection,
and responsible for approximately one million deaths each year. Overwhelming lines of epidemiological evidence have indicated that persistent infection with hepatitis C virus (HCV) is a major risk for the development of HCC. The incidence of HCC is expected to increase in the next two decades, largely due to hepatitis C infection and secondary cirrhosis, and detection of HCC at an early stage is critical for a favorable clinical outcome. Potential preventive strategies in the development of HCC are being recognized. The natural history of HCC is highly variable and the clinical management choices for HCC can be complex, hence patient assessment and treatment planning have to take the severity of the nonmalignant liver disease into account. This review summarizes the inter-relationship between HCV and liver carcinogenesis.
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383
ORIGINAL ARTICLES
Distribution of
Candida
Species in different clinical samples and their virulence: Biofilm formation, proteinase and phospholipase production: A study on hospitalized patients in Southern India
Vinitha Mohandas, Mamatha Ballal
January-March 2011, 3(1):4-8
DOI
:10.4103/0974-777X.77288
PMID
:21572601
Introduction:
Candida
species are normal inhabitants of the skin and mucosa. The importance of epidemiological monitoring of yeasts involved in pathogenic processes is unquestionable due to the increase of these infections over the last decade;
Materials and Methods:
The clinical samples from the respiratory tract (sputum, bronchial wash, tracheal secretions), saliva, blood, urine, middle ear discharge, vitreous fluid, corneal ulcer, and plastic devices (endotracheal tube, catheter tip, suction tip) were collected and cultured. The species of
Candida
isolated were identified.
Results:
A total of 111 isolates of
Candida
species were recovered from 250 diverse clinical sources.
C. albicans
(39.64%) was the most isolated species, although the
Candida non albicans
species with 60.36% showed the major prevalence. In blood cultures,
C. krusei
(38.23%) and
C. albicans
(20.58%) were isolated frequently.
C. albicans
(63.27%) was the predominant species in mucosal surface. Urinary tract infections caused by yeasts were more frequent in hospitalized patients,
C. krusei
(50.0%) being commonly isolated, followed by
C. albicans
(25.0%).
Discussion:
Several virulence factors like, biofilm, proteinase, phospholipase, etc. contribute to the pathogenecity. Early detection of virulence factors by
Candida
is useful in clinical decision making. We therefore have aimed at demonstrating the formation of biofilm using the method proposed by Branchini
et al
, (1994). The proteinase produced by
Candida
was estimated as per the method of Staib
et al
, (1965). Phospholipase assay was carried out as per the method of Samaranayake
et al
, (2005).
Conclusions
: The data suggests that the capacity of
Candida
species to produce biofilm may be a reflection of the pathogenic potential of the isolates.
C. krusei
and
C. tropicalis
showed strong slime production. The non-
Candida
albicans produced more proteinase than
C. albicans. C. albicans
produced higher levels of phospholipase than non
Candida
albicans in this study.
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156
PRACTITIONER SECTION
Approach to a patient with urosepsis
Om Prakash Kalra, Alpana Raizada
January-June 2009, 1(1):57-63
DOI
:10.4103/0974-777X.52984
PMID
:20300389
Urinary tract infections can occur in all age groups and produce an exceptionally broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with Gram negative sepsis to septic shock. In approximately one-quarter of all patients with sepsis, the focus of infection is localized to the urogenital tract. This may lead to substantial morbidity and significant economic implications. We present a review of the current approaches to managing urospesis.
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REVIEW ARTICLE
Laboratory detection and clinical implication of oxacillinase-48 like carbapenemase: The hidden threat
Yamuna Devi Bakthavatchalam, Shalini Anandan, Balaji Veeraraghavan
January-March 2016, 8(1):41-50
DOI
:10.4103/0974-777X.176149
PMID
:27013843
Carbapenemase producing Gram-negative pathogen is of great concern for physician. The challenging aspects are treatment option and infection control. Monitoring of respective carbapenemase resistance mechanism is necessary to prevent the outbreaks. Currently, the rapid emergence of oxacillinase (OXA-48) like is alarming. Increasing frequency of OXA-48 is seen than the classical carbapenemase (KPC, NDM, IMP, and VIM) across the world. The
bla
OXA-48
gene is commonly identified in
Escherichia coli
and
Klebsiella pneumoniae.
The transferrable plasmid of OXA-48 is associated with rapid spread and inter-species dissemination. In general, OXA-48-like enzymes weakly hydrolyzes both carbapenem and broad spectrum cephalosporins. Except OXA-163, which effectively hydrolyze cephalosporin. This poor hydrolytic profile obscures the detection of OXA-48-like. It may go undetected in routine diagnosis and complicates the treatment option. Co-production of OXA-48-like with CTX-M-15 and other carbapenemase (NDM, VIM) leads to the emergence of multidrug resistant strains.
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196
SYMPOSIUM ON INFECTIONS AND TRAVEL
Prevention of soil-transmitted helminth infection
Luciene Mascarini-Serra
April-June 2011, 3(2):175-182
DOI
:10.4103/0974-777X.81696
PMID
:21731306
Soil-transmitted helminths (STHs) form one of the most important groups of infectious agents and are the cause of serious global health problems. The most important STHs are roundworms
(Ascaris lumbricoides),
whipworms
(Trichuris trichiura)
and hookworms (
Necator americanus
or
Ancylostoma duodenale
); on a global level, more than a billion people have been infected by at least one species of this group of pathogens. This review explores the general concepts of transmission dynamics and the environment and intensity of infection and morbidity of STHs. The global strategy for the control of soil-transmitted helminthiasis is based on (i) regular anthelminthic treatment, (ii) health education, (iii) sanitation and personal hygiene and (iv) other means of prevention with vaccines and remote sensoring. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are discussed, as well as the costs of the prevention of STHs, although these cannot always be calculated because interventions in health education are difficult to measure. An efficient sanitation infrastructure can reduce the morbidity of STHs and eliminates the underlying cause of most poverty-related diseases and thus supports the economic development of a country.
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SYMPOSIUM
Combination vaccines
David AG Skibinski, Barbara C Baudner, Manmohan Singh, Derek T O'Hagan
January-March 2011, 3(1):63-72
DOI
:10.4103/0974-777X.77298
PMID
:21572611
The combination of diphtheria, tetanus, and pertussis vaccines into a single product has been central to the protection of the pediatric population over the past 50 years. The addition of inactivated polio,
Haemophilus influenzae
, and hepatitis B vaccines into the combination has facilitated the introduction of these vaccines into recommended immunization schedules by reducing the number of injections required and has therefore increased immunization compliance. However, the development of these combinations encountered numerous challenges, including the reduced response to
Haemophilus influenzae
vaccine when given in combination; the need to consolidate the differences in the immunization schedule (hepatitis B); and the need to improve the safety profile of the diphtheria, tetanus, and pertussis combination. Here, we review these challenges and also discuss future prospects for combination vaccines.
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EXPERT COMMENTARY
Reflections on the ebola public health emergency of international concern, part 2: The unseen epidemic of posttraumatic stress among health-care personnel and survivors of the 2014–2016 Ebola outbreak
Lorenzo Paladino, Richard P Sharpe, Sagar C Galwankar, Farhad Sholevar, Christine Marchionni, Thomas J Papadimos, Elisabeth Paul, Bhakti Hansoti, Michael Firstenberg, Manish Garg, Mindy Watson, Ric A Baxter, Stanislaw P Stawicki, On behalf of The American College of Academic International Medicine (ACAIM)
April-June 2017, 9(2):45-50
DOI
:10.4103/jgid.jgid_24_17
PMID
:28584454
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© 2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer -
Medknow
Online since 10
th
December, 2008