Recent International Journal of Infectious Diseases Articles
Don’t forget how severe varicella can be—complications of varicella in children in a defined Polish population
Ewelina Gowin | Jacek Wysocki | Michał Michalak
Summary: BackgroundThis study aimed to analyze the causes of hospitalization in children with varicella, based on a defined Polish population.MethodsThis was a retrospective analysis of causes of hospitalization in children under 18 years of age with varicella, treated on the Infectious Diseases Ward of the Children's Hospital in Poznan, Poland from January 2007 to June 2012. The ward serves almost the entire child population of the Greater Poland region (10% of the Polish population – almost 600 000 children). The analysis was based on hospital records. Patients were identified using the International Classification of Diseases Tenth Revision (ICD-10) codes. The case definition consisted of physical evidence of varicella.ResultsA total of 224 children were hospitalized for varicella complications. The median age of admitted patients was 37.5 months (range 6 days to 17 years). Rates of hospitalization decreased with age. The highest rates were among children during their first year. Ninety-two percent of children were healthy prior to hospitalization (no chronic diseases). The most common complications were respiratory tract infections (26%), followed by skin infections (21%) and neurological symptoms (18%). Twenty-five patients (11%) had more than one complication. The most common coexisting conditions were dehydration and otitis media.ConclusionsThe results presented here serve to remind us that varicella may to lead to severe complications in unvaccinated children and adolescents, and demonstrate the benefits of varicella vaccination. Most children hospitalized with varicella were immunologically healthy. Meningitis was more common in older children (>6 years of age). Streptococcus pyogenes was the most commonly identified bacterial pathogen.
Xuhui Tan | Lingling Yuan | Jingjing Zhou | Yinan Zheng | Fen Yang
Summary: BackgroundThe novel influenza A H1N1 (2009) virus, identified in mid-2009, spread rapidly in Guangdong Province. The accurate estimation of epidemiological parameters is of vital significance in decision-making for coping with pandemic influenza.MethodsWe used influenza A H1N1 epidemic data from local cases in Guangdong Province, China, in conjunction with a complex SEIR model (susceptible, exposed, infectious, recovered) to estimate the basic reproduction number. The transmission rate was obtained by fitting the model to the cumulative number of local daily infected cases using the nonlinear ordinary least squares method. The latent period and duration of infectiousness were obtained from the published literature, and the proportion of symptomatic infected cases was obtained from the serological survey conducted by the Center for Disease Control and Prevention of Guangdong Province. We determined the variance of model parameters via a simulation study.ResultsThe model was in keeping with the observed epidemic data (coefficient of determination=0.982). The basic reproduction number was estimated preliminarily to be R0=1.525 (95% confidence interval 1.448–1.602), with the possible range of true R0 being 1.30–1.85. We estimated the transmission rate β to be between 0.390 and 0.432.ConclusionsWith the help of the serological survey, useful estimates of key epidemiological parameters for the influenza A H1N1 outbreak in Guangdong Province were obtained. The sensitivity analysis suggests that different latent periods and infectious periods, which specify different mean durations of generation time, have a significant impact on R0. Our proposed model and findings provide a relevant contribution towards understanding the characteristics of influenza A H1N1 in Guangdong Province.
Y. Zhu | X. Cao | G. Tao | W. Xie | Z. Hu | D. Xu
Summary: ObjectiveAn LH750 hematology analyzer with VCS (volume, conductivity, and light scatter) technology can determine morphologic properties of peripheral leukocytes, known as cell population data (CPD). We have previously demonstrated that the lymphocyte CPD exhibit significant changes in acute hepatitis B virus infection. A simplified lymphocyte CPD, the lymph index, was proposed. We conducted the current study to further evaluate the clinical usefulness of the lymph index, and included patients with various viral infections, as well as those with acute bacterial infections.MethodsPeripheral blood was collected from 72 patients with viral infections, 46 patients with acute bacterial infections, and 204 controls. The lymphocyte CPD included the mean volume (LV) with its standard deviation (LV-SD) and the conductivity (LC). The lymph index was calculated as LV×LV-SD ÷ LC.ResultsThe lymph index was significantly increased in viral infections and only mildly increased in acute bacterial infections compared to controls. Using a lymph index cutoff value of ≥12.92, we achieved 91.67% sensitivity and 97.2% specificity for diagnosing viral infection.ConclusionsThe findings may be clinically useful since these morphological parameters are readily obtained by hematology analyzer during automated leukocyte differentials. They are quantitative, objective, and fast. The lymph index could be a potential hematological parameter for viral infection.
Afroditi Anastasiadou | Ioannis Kakoulidis | Dimitrios Butel | Emmanuilia Kehagia | Anna Papa
Summary: ObjectivesTo investigate the extent to which Greek patients with West Nile virus neuroinvasive disease (WNND) recovered from the initial infection in 2010, when a West Nile virus (WNV) lineage 2 outbreak took place.MethodsTwenty-two patients with WNND were examined 16 months after the onset of symptoms. The physical and mental function of the 22 survivors was evaluated.ResultsA considerable persistent morbidity and long length of time to recovery was observed. The most common symptoms were anorexia (77.3%) and muscle weakness (72.7%), followed by memory impairment (36.4%) and depression (22.7%). Older age was correlated with memory impairment, muscle weakness, and permanent damage. A complete recovery was seen in 7/22 (31.8%) patients, while three patients presented permanent damage. The critical time-point was 1 year after the onset of symptoms; at that time the patient's health status was either highly improved or had deteriorated irreversibly.ConclusionsWNND is associated with considerable short- and long-term morbidity and mortality. Lineage 2 strains need further scientific attention. Public health measures are needed to prevent the infection, especially in the elderly with underlying diseases.
Molecular characterization of the envelope gene of dengue virus type 3 newly isolated in Guangzhou, China, during 2009–2010
Lei Luo | Hui-ying Liang | Qin-long Jing | Peng He | Jun Yuan | Biao Di | Zhi-jun Bai | Yu-lin Wang | Xue-li Zheng | Zhi-cong Yang
Summary: BackgroundAfter an absence of 29 years, dengue virus type 3 (DENV-3) re-emerged in Guangzhou in 2009 and again in 2010. However, the geographical route by which the virus entered the city, and how it has changed genetically, remain unclear. Therefore, we carried out a comprehensive investigation into the molecular characteristics of the DENV-3 involved.MethodsThe envelope (E) genes of viruses isolated from dengue patients during the 2009–2010 epidemics were sequenced and compared with previously published E gene sequences of global representative DENV-3 strains available in GenBank, including isolates circulating in other provinces of China.ResultsA total of 13 isolates (seven from 2009 and six from 2010) were obtained from human serum samples. Phylogenetic analysis revealed that the isolates were grouped into three genotypes (I, III, and V) and then two clades within genotype III (genotype I from Indonesia, genotype III clade A from Côte d’Ivoire, genotype III clade B from Tanzania, and genotype V from Philippines). In addition, there were 1.3–9.0% and 0.5–3.9% differences in the nucleic and deduced amino acid sequences between the 2009 and 2010 strains, respectively.ConclusionsThe DENV-3 viruses from the period 2009–2010 were not from the continuous spread of an epidemic strain or the re-emergence of the 2009 strains in the 2-year period. The introduction of different DENV-3 genotypes following more than one geographical route was an important contributing factor to the 2009–2010 dengue epidemics in Guangzhou.
Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue
R. Premaratna | A. Ragupathy | J.K.N.D. Miththinda | H.J. de Silva
Summary: BackgroundFluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children.MethodsOne hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage.ResultsIn the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness.ConclusionsClinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation.
Clinical characteristics and outcomes of influenza and other influenza-like illnesses in Mexico City
Arturo Galindo-Fraga | Ana A. Ortiz-Hernández | Alejandra Ramírez-Venegas | Rafael Valdez Vázquez | Sarbelio Moreno-Espinosa | Beatriz Llamosas-Gallardo | Santiago Pérez-Patrigeon | Maggie Salinger | Laura Freimanis | Chiung-yu Huang | Wenjuan Gu | M. Lourdes Guerrero | John Beigel | Guillermo M. Ruiz-Palacios
Summary: BackgroundInfluenza-like illnesses (ILI) are estimated to cause millions of deaths annually. Despite this disease burden, the etiologic causes of ILI are poorly described for many geographical regions.MethodsBeginning in April 2010, we conducted an observational cohort study at five hospitals in Mexico City, enrolling subjects who met the criteria for ILI. Evaluations were conducted at enrollment and on day 28, with the collection of clinical data and a nasopharyngeal swab (or nasal aspirate in children). Swabs were tested by multiplex PCR for 15 viral pathogens and real-time PCR for influenza.ResultsDuring the first year, 1065 subjects were enrolled in this study, 55% of whom were hospitalized; 24% of all subjects were children. One or more pathogens were detected by PCR in 64% of subjects, most commonly rhinovirus (25% of all isolates) and influenza (24% of isolates). Six percent of subjects died, and of those, 54% had no pathogen identified. Rhinovirus was the most common pathogen among those who died, although it did not have the highest case fatality rate.ConclusionsMultiple respiratory viruses beyond influenza are associated with significant morbidity and mortality among adults and children in Mexico City. Detection of these agents could be useful for the adjustment of antibiotic treatment in severe cases.
Amjad Ali | Habib ur Rehman | Muhammad Nisar | Shazia Rafique | Sadia Ali | Abrar Hussain | Nausheen | Muhammad Idrees | Sabeen Sabri | Hakeem Zada | Shah Hussain
Summary: BackgroundDengue is the most important vector-borne disease in many different parts of the world and is expanding into other areas of the globe without hindrance. The morbidity and mortality due to dengue complications are increasing globally at an alarming rate. Although transmission of the dengue virus has been documented in well-characterized areas of Pakistan, its incidence in Khyber Pakhtunkhawa has not been characterized. To address this issue we aimed to determine the seroprevalence of dengue (IgM and IgG) antibodies and the disease symptoms in the population of Khyber Pakhtunkhawa, and to investigate the incidence of dengue fever in different seasons and in urban as well as in rural areas.MethodsFrom August to October 2011, data of suspected dengue patients were collected from different primary, secondary, and tertiary collection centers situated in Khyber Pakhtunkhawa in order to determine the actual seroprevalence of dengue antibodies (IgM and IgG) in Khyber Pakhtunkhawa.ResultsA total 612 subjects with a suspected infection were enrolled in our study. Of the 612 suspected cases, 319 were found positive for dengue IgG, IgM, or both IgG and IgM. The overall weighted prevalence of dengue-specific antibodies (IgM and/or IgG) was 52.12%. Overall, of the 52.12%, 31.86% (95% confidence interval (CI) 28.17–35.55) were positive for dengue IgM and 20.26% (95% CI 17.03–23.39) were positive for dengue IgG. Only 23 (3.75%) samples showed both IgG and IgM antibodies. A higher prevalence of IgM (39.35%, 95% CI 32.84–45.86) and IgG (22.42%, 95% CI 16.86–27.98) antibodies was found in the age group 21–30 years as compared to the children age group (≤10 years) and the oldest age group (≥51 years). The mean age of the febrile cohort was 53.16±44.22 years, ranging from 4 to 85 years. Age group was not statistically associated with IgM (p=0.64) or IgG (p=0.49) positivity. A higher seroprevalence of IgM (37.24%, 95%CI 32.84–45.86) was observed in males as compared to females (IgM 17.88%, 95% CI 11.11–24.65) while higher seroprevalnce of IgG (22.76%, 95% CI 15.35–30.17) was seen in females as compared to males (IgG 17.58%, 95% CI 14.21–20.95). Gender was not significantly associated with IgM (p=0.06) or IgG (p=0.53) positivity. Dengue IgM (35.38%, 95% CI 38.61–62.91) and IgG (50.76%, 95% CI 38.61–62.91) were higher in patients who had a history of travel to a dengue endemic area as compared to those who did not (IgM 33%, 95% CI 29.06–36.94, and IgG 15%, 95% CI 12.01–17.99). History of travel to an endemic area was significantly associated with IgM (p=0.023) and IgG (p=0.041) positivity. A higher incidence of IgM (41.13%, 95% CI 35.55–46.71) and IgG (27.42%, 95% CI 22.36–32.48) was observed in urban areas than in rural areas (IgM 23%, 95% CI 18.34– 27.66, and IgG 13.41%, 95% CI 9.63–17.19). IgM (p=0.0005) and IgG (p=0.0007) positivity was significantly associated with area of residence. Symptoms including fever (p=0.007), headache (p=0.001), Skin rash (0.005), joint pain (0.004) and Fatigue were significantly linked to dengue fever. IgM and IgG antibodies were more frequently seen in the post-monsoon season (68.33%) than in the monsoon period (31.68%). The death ratio in the overall weighted prevalence was 2.19%.ConclusionThe results of the present cohort study of febrile subjects show that young people and males are more susceptible to dengue fever. Dengue infection was most prominent in the post-monsoon season, in urban areas, and in patients with a history of travel to an endemic locality. Furthermore seven deaths were found in our cohort study.
Ehsan Mostafavi | Sadegh Chinikar | Saeid Bokaei | AliAkbar Haghdoost
Summary: ObjectivesThis study was conducted to determine the predicting factors of Crimean Congo hemorrhagic fever (CCHF) in Zabol and Zahedan, from where more than 60% of all national cases are reported, in order to improve CCHF disease surveillance and to target control efforts.MethodsData were collected from the National Reference Laboratory on Arboviruses and Viral Hemorrhagic Fevers, the national meteorology organization, the veterinary organization, and the national statistics center of Iran. A Poisson regression analysis was applied for the temporal modeling of human samples between 2000 and 2006. The modeling fitness was checked with data from 2007.ResultsThis modeling revealed that the disease occurrence followed a seasonal pattern. The maximum temperature and relative humidity in previous months was found to positively affect the occurrence of the disease. Variables such as the level of livestock imports and the number of slaughtered animals were also found to be influential in the occurrence of the disease. The pseudo R2 was 0.51 in the final model.ConclusionsThe model predicted the number of cases 1 month in advance with more or less acceptable accuracy. Therefore, it appears that the model might be useful as part of an early warning system.
Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study
Juan Carlos Lozano Becerra | Robert Sieber | Gladys Martinetti | Silvia Tschuor Costa | Pascal Meylan | Enos Bernasconi
Summary: BackgroundRecent data suggest that varicella zoster virus (VZV)-associated complications of the central nervous system (CNS) are more common and diverse than previously thought. The main purpose of this article is to describe the clinical characteristics and the outcome of patients suffering from meningitis and encephalitis caused by VZV reactivation.MethodsA retrospective case study of adult patients (≥16 years old) diagnosed with a VZV reactivation in the CNS was performed. The cases were identified by a qualitative PCR DNA assay of the cerebrospinal fluid (CSF) at the Regional Hospital of Lugano between January 1, 2003 and July 31, 2010.ResultsEleven out of 519 CSF samples (2.1%), submitted from patients with a clinical diagnosis of viral meningitis or encephalitis, were positive for VZV. A vesiculo-pustular skin eruption was observed in only five patients (45%). In six cases (55%), a systemic inflammatory syndrome was absent. The clinical outcome was favorable in eight patients (73%). Only one out of 11 patients (9%) died. The four patients with encephalitis had a less favorable prognosis: one patient recovered without residual neurological sequelae; two had a chronic neuropsychological handicap, speech difficulties, facial nerve palsy, and focal seizures; one patient died. We estimated an annual incidence rate of VZV infection of the CNS of 1.02/100 000 inhabitants for southern Switzerland.ConclusionsScreening of CSF for VZV by PCR is recommended for all patients with encephalitis and for those with viral meningitis of unclear origin in order to better target antiviral treatment.
Hepatitis C virus core protein induces hepatic metabolism disorders through down-regulation of the SIRT1–AMPK signaling pathway
Jian-Wu Yu | Li-Jie Sun | Wei Liu | Yong-Hua Zhao | Peng Kang | Bing-Zhu Yan
Summary: BackgroundSteatosis and insulin resistance induced by hepatitis C virus (HCV) infection are, at least in part, critical factors for the progression of chronic hepatitis C (CHC) and can influence the outcome of antiviral treatment. Silent information regulator 1 (SIRT1) and adenosine monophosphate-activated protein kinase (AMPK) play a key role in the regulation of hepatic glucose and lipid metabolism. The aim of this study was to investigate the possible effect of HCV core protein on energy, glucose, and lipid metabolism of hepatocytes and expression of SIRT1 and AMPK.MethodsHCV core protein expression plasmid was transfected into HepG2 cells. The level of reactive oxygen species (ROS) and values of NAD+/NADH and ATP/ADP were detected. Intracellular levels of triacylglycerol (TG), cholesterol, glucose uptake by hepatocytes, and glucose production were measured. The expression levels of mRNA and protein of SIRT1 and AMPK were detected. The mRNA levels of SIRT1 and AMPK downstream glucose and lipid metabolism genes were measured.ResultsIn HepG2 cells expressing HCV core protein, the level of ROS increased, the value of NAD+/NADH decreased, the activity and expression levels of mRNA and protein of SIRT1 and AMPK decreased, glucose uptake and its regulator gene GLUT2 mRNA levels decreased, glucose production and its regulator genes PEPCK and G6Pase mRNA levels increased, intracellular TG and cholesterol contents and their regulator gene (SREBP-1c, FAS, ACC, HMGR, and HMGS) mRNA levels increased, the glycolytic gene GK and fatty acid oxidation genes PPARα and CPT1A mRNA levels decreased.ConclusionsHCV core protein induces alterations in cellular redox state (decrease in the NAD+/NADH ratio), which could influence the activity of SIRT1 and secondarily AMPK, then change the expression profile of glucose and lipid metabolism-related genes, thereby causing metabolism disorders of hepatocytes.
Detection of viral antigens in renal tissue of glomerulonephritis patients without serological evidence of hepatitis B virus and hepatitis C virus infection
Dan Kong | Di Wu | Tianzhen Wang | Tianzhu Li | Shengjie Xu | Fulai Chen | Xiaoming Jin | Ge Lou
Summary: ObjectivesGlomerulonephritis is an important extrahepatic manifestation of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HBV and HCV infection may be occult, and they are often overlooked by both patients and doctors. The aim of this study was to assess the importance of HBV and HCV infection in glomerulonephritis patients with undetectable HBV surface antigen (HBsAg) and HCV antibody in serum.MethodsThe HBsAg, the HBV core antigen (HBcAg), and the HCV antigen were detected using immunohistochemistry in frozen renal tissues of 500 glomerulonephritis patients without serological evidence of HBV and HCV infection. Electron microscopy was used to trace the virus particles, and clinicopathological features were also reviewed.ResultsHBsAg or HBcAg was positive in nine out of 500 cases (9/500, 1.8%). Three cases were HBsAg-positive and another six cases were HBcAg-positive. The HCV antigen was found in eight cases (8/500, 1.6%). There was one case of HBV and HCV co-infection (1/500, 0.2%). Under electron microscopy, virus particles were found in the base membrane and cytoplasm of endotheliocytes in the glomerulus. The most common clinical manifestation was nephrotic syndrome (9/18), followed by nephritic syndrome (7/18). Membranous nephropathy was the most common pathological diagnosis (5/18), followed by mesangioproliferative glomerulonephritis (4/18) and IgA nephropathy (4/18).ConclusionsOccult HBV and HCV infection might be implicated in HBV- or HCV-associated glomerulonephritis. More attention should be focused on the underlying cause.
Concurrent occurrence of human and equine West Nile virus infections in Central Anatolia, Turkey: the first evidence for circulation of lineage 1 viruses
Aykut Ozkul | Koray Ergunay | Aydan Koysuren | Feray Alkan | Ethem M. Arsava | Seda Tezcan | Gurol Emekdas | Sabri Hacioglu | Mahur Turan | Durdal Us
Summary: BackgroundWest Nile fever is an important zoonotic infection caused by West Nile virus (WNV), a member of the Flaviviridae. Previous serological data from Turkey suggest widespread WNV circulation. This report includes cases of human and equine WNV infections occurring concurrently, and manifesting as central nervous system infections, in two neighboring provinces of Central Anatolia, Turkey. A partial phylogenetic analysis of the causative virus is given for the first time.MethodsThe cases were reported in February (horses) and March (human). Symptoms of the disease were similar in the two species, characterized by neurological manifestations suggesting meningoencephalitis. Real-time/nested PCRs and commercial immunoassays and a plaque reduction neutralization assay were employed for the detection of viral RNA and specific antibodies, respectively.ResultsWNV RNAs were detected in buffy coat (horses) and cerebrospinal fluid (human) samples. Partial nucleotide sequences of the E-gene coding region revealed that the strains are closely related to viruses of lineage 1, clade 1a. Accompanying equine serosurveillance demonstrated WNV-specific antibodies in 31.6% of the samples.ConclusionsThis is the first report of acute WNV infections caused by lineage 1 strains from Turkey, in concordance with previous reports from some European and North African countries.
Kinetics of measles antibody by hemagglutination inhibition assay in children in south-west and north-central Nigeria
Anyebe Bernard Onoja | Adekunle Johnson Adeniji
Summary: ObjectivesWe investigated the antibody level of children against wild measles virus in view of recurrent measles epidemics, in order to provide information on immunization status for health policies and for the global measles mortality reduction initiative.MethodsTwo hundred and seventy-three children between the ages of 10 months and 13 years were recruited for this study from three hospital facilities in south-west and north-central Nigeria. Serum samples were collected from February to July 2009, and laboratory examination commenced in August of the same year. Measles hemagglutinin (HA) antigen was prepared by culturing the measles vaccine virus strain (Edmonston-Zagreb) in a vero/hSLAM cell line. Serum samples were treated to get rid of potentiating factors, non-specific inhibitors, and agglutinins before the HA/hemagglutination inhibition (HI) procedure.ResultsOut of the 175 children vaccinated in Ibadan, 60 (34.3%) had an antibody level not sufficient to protect against measles infection. Likewise, 12 (25.0%) vaccinated children from Ilorin had an antibody level not sufficient to protect against measles infection. There was no significant difference in the level of protection between the children in Ibadan and Ilorin (p>0.05). The geometric mean titer (GMT) was 53.83 for males and 48.64 for females. There was no significant difference between the GMTs of females and males in both locations (p>0.05). Also, no significant difference was observed in the GMTs of children in both locations (p>0.05).ConclusionsOf the vaccinated children, 157 (57.5%) developed protective measles virus HI antibody, which is not enough to maintain protective herd immunity. Hence there is a need for catch-up and follow-up vaccination programs, especially in rural areas and places with difficult terrains, in order to reduce measles mortality.
Wei Li | Yong-Wen He
Summary: BackgroundPatients have been identified with hemorrhagic fever (HF) caused by Huaiyangshan virus (HYSV) infection since 2009. This study aimed to investigate the characteristics of clinical symptoms, laboratory examinations, epidemiological factors, and therapeutic responses in patients with Huaiyangshan hemorrhagic fever (HYSHF).MethodsA total of 57 patients with a suspected HF were admitted to the Department of Infectious Diseases, the Affiliated Union Hospital of Tongji Medical College between June 2009 and October 2010. A potential infection with HYSV was determined by indirect immunofluorescent assay and reverse-transcription (RT)-PCR. The clinical symptoms, epidemiological characteristics, laboratory examinations, and therapeutic responses of these patients were evaluated.ResultsForty-eight out of 57 patients were diagnosed with HYSHF. They displayed diverse clinical symptoms, such as an acute febrile ﬂu-like illness, and progressed to proteinuria, hemorrhagic manifestations, and encephalopathy. Some patients exhibited progressive leukopenia, thrombocytopenia, liver and kidney dysfunction, and systemic cell injury. Following symptom-specific treatment, 35 patients recovered completely and 13 patients died from severe complications, including central nervous system manifestations.ConclusionsPatients with HYSHF displayed diverse clinical symptoms and laboratory findings. Such patients should be treated immediately and closely monitored to prevent severe complications.
Cecília Lameirinhas Longo | Patricia Brasil | Otávio de Melo Espíndola | Ana Claudia Celestino Bezerra Leite | Rita Maria Ribeiro Nogueira | Otília Lupi | Elizabeth de Souza Neves
Summary: Globalization has increased both the number of emergent diseases and the diversity of co-infections, which could in turn mutually influence the pathogenesis of well-known infectious diseases. Here, we report the first series of chronic human T-cell lymphotropic virus type 1 (HTLV-1) patients co-infected with the dengue fever virus. As both of these diseases are immuno-mediated, we anticipated interference in the development of both diseases, with atypical clinical and laboratory parameter results. All the patients had classic dengue fever, and the main outstanding abnormality was leukopenia associated with lymphopenia. Although a mutual influence was expected, dengue fever did not affect the clinical course of HTLV-1 infection, and HTLV-1 proviral loads revealed unpredictable patterns of change.
Molecular and phylogenetic analysis of influenza A H1N1 pandemic viruses in Cuba, May 2009 to August 2010
Alexander Piñón Ramos | Belsy Acosta Herrera | Odalys Valdés Ramírez | Amely Arencibia García | Mayra Muné Jiménez | Clara Savón Valdés | Angel Goyenechea Fernández | Grehete González | Suset I. Oropesa Fernández | Guelsys González Báez | Bárbara Hernández Espinosa
Summary: The influenza A(H1N1)pdm09 virus was detected in Cuba in May 2009. The introduction of a new virus with increased transmissibility into a population makes surveillance of the pandemic strain to the molecular level necessary. The aim of the present study was the molecular and phylogenetic analysis of pandemic influenza A(H1N1)pdm09 strains that circulated in Cuba between May 2009 and August 2010. Seventy clinical samples were included in the study. Nucleotide sequences from the hemagglutinin HA1 region segment were obtained directly from clinical samples. Genetic distances were calculated using MEGA v.5.05. A phylogenetic tree was constructed using MrBayes v.3.1.2 software. Potential N-glycosylation sites were predicted using NetNGlyc server 1.0. The 48 Cuban sequences of influenza A(H1N1)pdm09 obtained were similar to the A/California/07/2009 (H1N1) vaccine strain. Most of the Cuban strains belonged to clade 7. Cuban viruses showed amino acid changes, some of them located at three antigenic sites: Ca, Sa, and Sb. Two dominant mutations were detected: P83S (100%) and S203T (85.7%). Glycosylation site analysis revealed the gain of one site at position 162 in 13 sequences. The findings in this study contribute to our understanding of the progress of the influenza A(H1N1)pdm09 virus, since this virus is at the starting point of its evolution in humans.
Immunity against varicella zoster virus based on history of previous chickenpox: a study in premarital Iranian women
Ali Hosseininasab | Ali-Mohamad Arabzadeh | Ali Akbar Haghdoost | Zahra Helmi
Thomas M. Yuill | John P. Woodall | Susan Baekeland
Summary: The recent yellow fever outbreak in Darfur has been the worst in Africa in 20 years. It began on 2 September 2012. However, it was not until 30 October that samples were sent to a reference laboratory in Senegal for confirmation of the disease. On 9 November 2012, the World Health Organization (WHO) Sudan reported 266 suspected cases and 85 fatalities in 20 localities for a case fatality rate of 32%, with Central Darfur state the area hardest hit. The yellow fever vaccination plan to cover 3.5 million persons was finalized. On 13 November 2012 the WHO reported laboratory confirmation of yellow fever in two samples. Mass vaccination began in the region on 20 November. On 10 January 2013 a report was jointly released by the Ministry of Health and the WHO that stated that 171 people had died of the disease as of 9 January 2013 and that there had been 849 suspected cases in Darfur since 2 September 2012. It was estimated that 35 out of the 64 localities of Darfur had been affected by the disease. On 14 February 2013, the WHO reported two confirmed yellow fever cases in Chad in December 2012, an apparent spill-over from Darfur. The Ministry of Health of Chad launched an emergency mass vaccination campaign against yellow fever starting 22 February 2013.
Regional epidemiology of invasive pneumococcal disease in Asian adults: epidemiology, disease burden, serotype distribution, and antimicrobial resistance patterns and prevention
Ivan Fan-Ngai Hung | Terapong Tantawichien | Ying Huang Tsai | Shilpa Patil | Ricardo Zotomayor
Summary: ObjectivesTo summarize published data on the clinical and economic burden, epidemiology, antimicrobial resistance levels, serotype prevalence, and prevention strategies for pneumococcal disease among adults in Asia.MethodsWe performed a systematic search of the PubMed database for relevant, peer-reviewed articles published between January 1995 and December 2011, covering China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam.ResultsTaiwan and Thailand had the most comprehensive epidemiological data on adult pneumococcal disease. Very little relevant data were found for Indonesia, Pakistan, the Philippines, and Vietnam; surveillance is urgently needed in these countries. The emergence and spread of resistance emphasize the importance of vaccination to prevent infection in adults at increased risk for serious pneumococcal disease. Vaccination policies and opinions on the efficacy of vaccination vary widely in Asian countries, although a new option in the form of a pneumococcal conjugate vaccine is now available.ConclusionsIncreased awareness of the public health and economic benefits of pneumococcal vaccination is critically needed to help both the public and policymakers in making changes to vaccination policies in the region. Maximizing access to pneumococcal vaccines will decrease the number of hospitalizations, complications, and deaths associated with pneumococcal disease.
Andrés F. Henao-Martínez | Guido R. González-Fontal | José R. Castillo-Mancilla | Ivana V. Yang
Summary: BackgroundEnterobacteriaceae bacteremia is a common complication in patients with neoplasm. The cancer itself, chemotherapy-induced immunosuppression, and other cancer-related procedures play a role as predisposing factors for this condition. However, despite the clear association between cancer and Enterobacteriaceae bacteremia, the distinctive clinical characteristics of patients with cancer presenting with Enterobacteriaceae bacteremia have not been well established.MethodsThe population studied was a prospective cohort of adult hospitalized patients with Enterobacteriaceae bacteremia in a tertiary care hospital. We compared the clinical variables and microbiological features between patients with an underlying neoplasm (n=203) and those without (n=259). STATA software was used for statistical association analysis.ResultsIn a bivariate analysis, older age, prior exposure to aminopenicillins, fewer days of symptoms, biliary source of bacteremia, greater severity of APACHE II score, lower white blood cell and platelet counts, and the presence of Klebsiella pneumoniae were more common in the neoplasm group. In a multivariable analysis, K. pneumoniae bacteremia (odds ratio (OR) 6.13, 95% confidence interval (CI) 1.65–22.71; p=0.007), APACHE II score (OR 1.18, 95% CI 1.05–1.34; p=0.007), and exposure to aminopenicillins (OR 28.84, 95% CI 1.94–429.3; p=0.015) were associated with neoplasm. K. pneumoniae bacteremia was more commonly present in patients with lung and gastrointestinal cancers.ConclusionsWe have confirmed the association of K. pneumoniae bacteremia with underlying neoplastic disease, especially with gastrointestinal malignancies, which may allow stratification for initial empiric antibiotic therapy in this subset of patients. Prior exposure to aminopenicillins in the neoplasm group might contribute to this finding.
Early-onset and late-onset group B streptococcal disease in Japan: a nationwide surveillance study, 2004–2010
Kousaku Matsubara | Kiyoshi Hoshina | Yoko Suzuki
Summary: ObjectivesTo clarify the incidence and prognosis of early-onset (EOD) and late-onset (LOD) GBS disease in Japan. To evaluate the influence of national guidelines issued in 2008 on the epidemiology of GBS disease.MethodsRetrospective nationwide questionnaire surveillance on culture-confirmed GBS infections between 2004 and 2010.ResultsEighty-eight EOD and 162 LOD cases were reported from 152 participating hospitals. The case fatality of EOD was 13.6% and of LOD was 8.0%. Premature birth <37 weeks (p<0.001) and low birth weight <2500g (p<0.001) were significantly associated with EOD mortality. A high rate of neurological sequelae was noted in meningitis in EOD (8/24) and LOD (29/85) cases. Based on a live-birth number of 438 359 and inborn case numbers of 36 EOD and 42 LOD, the incidence of EOD and LOD were estimated to be 0.08 (95% confidence interval (CI) 0.06–0.11)/1000 and 0.10 (95% CI 0.07–0.12)/1000 live-births, respectively. Before (2004–2008) and after (2009–2010) the issue of guidelines, the mortality of EOD (from 14.8% to 11.8%) and LOD (from 9.8% to 2.5%) improved, but the incidence was unchanged.ConclusionsThe incidence of EOD and LOD is apparently low in Japan, but the mortality and morbidity rates remain substantial. The issue of national guidelines did not affect the incidence.
Randomized controlled trial comparing ciprofloxacin and cefepime in febrile neutropenic patients with hematological malignancies
Takahiko Yasuda | Ritsuro Suzuki | Yuichi Ishikawa | Seitaro Terakura | Yoshihiro Inamoto | Masamitsu Yanada | Hirokazu Nagai | Yukiyasu Ozawa | Kazutaka Ozeki | Yoshiko Atsuta | Nobuhiko Emi | Tomoki Naoe
Summary: BackgroundCiprofloxacin (CPFX) is a potential alternative in patients with febrile neutropenia (FN) because of its activity against Gram-negative organisms. We conducted a non-inferiority, open-label, randomized controlled trial comparing intravenous CPFX and cefepime (CFPM) for FN patients with hematological malignancies.MethodsPatients aged from 15 to 79 years with an absolute neutrophil count of <0.500×109/l were eligible, and were randomized to receive 300mg of CPFX or 2g of CFPM every 12h. Initial treatment efficacy, overall response, and early toxicity were evaluated.ResultsFifty-one episodes were included in this trial, and 49 episodes (CPFX vs. CFPM: 24 vs. 25) were evaluated. Treatment efficacy at day 7 was significantly higher in the CFPM group (successful clinical response: nine with CPFX and 19 with CFPM; p=0.007). The response was better in high-risk patients with neutrophil counts of ≤0.100×109/l (p=0.003). The overall response during the study period was similar between the CPFX and CFPM groups (p=0.64). Adverse events were minimal, and all patients could continue the treatment.ConclusionsWe could not prove the non-inferiority of CPFX in comparison with CFPM for the initial treatment of FN. CFPM remains the standard treatment of choice for FN.
The risk for bacterial endocarditis in cirrhotic patients: a population-based 3-year follow-up study
Tsung-Hsing Hung | Yu-Hsi Hsieh | Kuo-Chih Tseng | Chih-Chun Tsai | Chen-Chi Tsai
Summary: BackgroundWe noted only rare reports of cirrhotic patients with bacterial endocarditis (BE). There is insufficient data on the risk of BE in liver cirrhosis. This is the first national population-based study evaluating the risk of BE in cirrhotic patients.MethodsWe used the National Health Insurance Database, which is derived from the Taiwan National Health Insurance Program. The study cohort comprised 40 803 patients with cirrhosis and the comparison cohort consisted of 40 841 randomly selected subjects with a similar age and sex distribution.ResultsOf the total 81 644 patients, 192 (0.24%) experienced BE during the 3-year follow-up period, 121 patients from the study cohort (0.30% of the cirrhotic patients) and 71 patients from the comparison group (0.17% of non-cirrhotic patients) (p<0.001). After adjusting for patient age, sex, and comorbid disorders, the Cox regression analysis showed that cirrhotic patients had a high risk of BE compared to non-cirrhotic patients during the 3-year follow-up period (hazard ratio 2.04, 95% confidence interval 1.61–2.44, p<0.001).ConclusionWe conclude that liver cirrhosis is a risk factor for the occurrence of BE.
A hospital-based study on seroprevalence of leptospirosis among febrile cases in northeastern Malaysia
A.A. Noor Rafizah | B.D. Aziah | Y.N. Azwany | M. Kamarul Imran | A. Mohamed Rusli | S. Mohd Nazri | A. Mohd Nikman | I. Nabilah | H. Siti Asma’ | W.M. Zahiruddin | I. Zaliha
Summary: ObjectiveTo determine the seroprevalence of leptospirosis among febrile inpatient cases in northeastern Malaysia.MethodsA hospital-based cross-sectional study was conducted among 999 febrile cases admitted to 10 hospitals in northeastern Malaysia. A survey using a proforma sheet was used to obtain sociodemographic and occupational information. Serum samples were screened for leptospirosis by IgM enzyme-linked immunosorbent assay test (IgM ELISA) and confirmed by microscopic agglutination test (MAT).ResultsThere was an equivalent distribution of males and females in the 999 respondents enrolled in the study. The majority were Malay (94.7%) and their mean age was 39.4 (standard deviation 17.6) years. The overall seroprevalence of leptospirosis was 8.4% (95% confidence interval (CI) 6.8–10.3) (n=84). The high-risk occupational group was found to have a higher seroprevalence, which was 56% (95% CI 45.3–66.1) (n=47). The predominant serogroup was Sejroe (82.1%, 95% CI 72.6–88.8) (n=69).ConclusionsThis study revealed a possible high seroprevalence of leptospirosis among febrile cases, indicating the need to review the importance of adding leptospirosis to the case investigation of febrile illness, especially among high-risk occupational groups in Malaysia, as well as in other endemic countries.
Emergence of methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of late-onset nosocomial pneumonia in intensive care patients in the USA
Timothy R. Pasquale | Bonnie Jabrocki | Sara-Jane Salstrom | Timothy L. Wiemken | Paula Peyrani | Nadia Z. Haque | Ernesto G. Scerpella | Kimbal D. Ford | Marcus J. Zervos | Julio A. Ramirez | Thomas M. File Jr
Summary: ObjectiveTo compare demographic and clinical characteristics, and methicillin-resistant Staphylococcus aureus (MRSA) strain characteristics, in patients with early-onset (EO) and late-onset (LO) MRSA nosocomial pneumonia.MethodsThis was a retrospective analysis of data from a multicenter observational study of nosocomial pneumonia patients admitted between November 2008 and July 2010. Laboratory analyses performed on MRSA isolates included confirmation of antimicrobial susceptibility and heteroresistance to vancomycin, USA typing, staphylococcal cassette chromosome (SCC) mec typing, and detection of Panton–Valentine leukocidin (PVL) genes.ResultsWe identified 134 patients; 42 (31%) had EO MRSA pneumonia and 92 (69%) had LO MRSA pneumonia. The patients in the LO group were more likely to have risk factors for multidrug-resistant pathogens (98% vs. 76%, p<0.001). The MRSA USA300 strain was found with equal frequency in the EO and LO groups. Likewise, both groups had similar frequencies of isolates exhibiting PVL and SCCmec type IV.ConclusionsOur findings provide further evidence of the continued migration of community-associated MRSA into the healthcare setting in the USA. MRSA USA300 genotype has emerged as a significant cause of LO nosocomial pneumonia in intensive care units. Appropriate anti-MRSA antimicrobial therapy should be considered for both EO and LO hospital-acquired pneumonia and ventilator-associated pneumonia.
Michelle Shuel | Frances B. Jamieson | Patrick Tang | Shirley Brown | David Farrell | Irene Martin | Jan Stoltz | Raymond S.W. Tsang
Summary: ObjectiveTo characterize Bordetella pertussis isolates in Ontario, Canada in order to understand the clonal diversity of strains present in this province.MethodsA total of 521 isolates from the period 1998–2006 were analyzed by serotyping, pulsed-field gel electrophoresis (PFGE), and DNA sequencing of their virulence factors of pertactin, fimbriae 3, pertussis toxin subunit 1, and pertussis toxin gene promoter. Characteristics of the Ontario isolates were compared to those described for isolates from Europe and Australia.ResultsA single predominant clone was identified in Ontario, Canada, represented by 83.5% of the 521 isolates analyzed. This clone was characterized by the genotype fim3B, prn2, ptxS1A, and ptxP3 (sequence type (ST)-1), and 72.9% of this clone displayed three closely related PFGE profiles of BpSR11, BpSR5, and BpSR12. Pertussis isolates in Europe with these PFGE profiles and virulence factor genotype are reported as common. The Australian epidemic clone was previously reported to have the genotype prn2 and ptxP3.ConclusionThe finding of one predominant B. pertussis clone in Ontario, Canada, with characteristics identical to strains involved in epidemics in Europe and Australia, suggests a potential link of this strain to the resurgence of pertussis in this province.
Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru
M.J. Magee | E. Bloss | S.S. Shin | C. Contreras | H. Arbanil Huaman | J. Calderon Ticona | J. Bayona | C. Bonilla | M. Yagui | O. Jave | J.P. Cegielski
Summary: ObjectivesDiabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB–DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes.MethodsDuring 2005–2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan–Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes.ResultsOf 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB–DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5kg/m2 (p<0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB–DM patients. Among 149 TB–DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB–DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome.ConclusionsDiabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB–DM patients, the majority had a favorable TB treatment outcome.
Secular trends in the epidemiology of Clostridium difficile infection (CDI): relationship with alcohol gel and antimicrobial usage in a hospital
Moacyr Silva Jr | Alexandre Rodrigues Marra | Thiago Zinsly Sampaio Camargo | Silvana Maria de Almeida | Itacy Siqueira | Luci Correa | Julia Yaeko Kawagoe | Oscar Fernando Pavão dos Santos | Michael B. Edmond
Summary: BackgroundClostridium difficile-associated diarrhea (CDAD) has shown increasing incidence, morbidity, and mortality in recent years. We assessed the number of CDAD tests requested, CDAD positivity rates, the use of alcohol-based hand rubs, and antimicrobial utilization.MethodsWe collected information on every adult patient (>18 years) who developed diarrhea and had a positive stool test for C. difficile toxin from June 2005 to December 2009 at a tertiary care hospital. A time-series analysis was performed using monthly data on the incidence of C. difficile infection (CDI) (i.e., cases of infection per 1000 patient-days), as well as the consumption of alcohol-based hand rubs (in liters/1000-patient days) and antibiotics (in defined daily doses per 1000 patient-days).ResultsThe mean number of annual requests for C. difficile tests was 1031, and the rates per 1000 patient-days for each year from 2005 to 2009 were 0.30, 0.46, 0.39, 0.31, and 0.40 overall in the hospital, and 0.18, 0.10, 0.53, 0.38, and 0.37 in the intensive care unit (ICU). The use of alcohol-based hand rubs per 1000 patient-days increased from 37.4 to 73.0, and from 41.5 to 129.4 in the hospital and in the ICU, respectively.ConclusionsThe incidence of CDI in the hospital and ICU remained low, despite the increased use of alcohol-based hand rubs and antimicrobials.
Polyclonal endemicity of Acinetobacter baumannii in ventilated patients in an intensive care unit in Uruguay
Julio Cesar Medina-Presentado | Verónica Seija | Rafael Vignoli | Julio Pontet | Luciana Robino | Nicolás F. Cordeiro | Inés Bado | Virginia García-Fulgueiras | Maximiliano Berro | Cristina Bazet | Eduardo Savio | Gloria Rieppi
Summary: ObjectivesTo identify the mechanisms responsible for respiratory infections by Acinetobacter baumannii in intubated patients and risk factors for digestive colonization and infection by A. baumannii.MethodsWe conducted a prospective study in an intensive care unit (ICU) between May 2005 and November 2006, including 175 consecutive patients at the beginning of invasive ventilation (day 1). We performed pharyngeal and rectal swabs on days 1, 4, 7, 10, 13, and 16. Respiratory samples were taken on days 1 and 7, or on suspicion of ventilator-associated pneumonia (VAP).ResultsWe detected 62 patients with A. baumannii digestive colonization and 20 cases of A. baumannii lower respiratory infection (14 VAP and six purulent tracheobronchitis (PTB)). Digestive colonization by A. baumannii was an independent risk factor for lower respiratory tract infections with that microorganism (p<0.0001; relative risk 8.71, 95% confidence interval 2.73–27.77). Respiratory and rectal A. baumannii isolates from the same patients were compared by enterobacterial repetitive intergenic consensus (ERIC)-PCR; in 9/11 cases (eight VAP and one PTB) results suggested events of exogenous pneumonia with previous colonization, whereas the remaining two cases (two PTB) were suggestive of exogenous infection without previous colonization.ConclusionsIn our unit the pathogenesis of VAP by A. baumannii is mixed, most cases corresponding to exogenous pneumonia with previous colonization.
Safak Kaya | Ahmet Emre Eskazan | Nazif Elaldi
Summary: BackgroundBrucellosis, a disease endemic in many countries including Turkey, is a systemic infectious disease. Cardiovascular complications are not frequent, and endocarditis is the main cardiac manifestation of brucellosis. Pericarditis in the absence of concomitant endocarditis is extremely rare.MethodsIn this report, we present four patients with pericarditis caused by brucellosis in the absence of concomitant endocarditis, along with a review of the published literature on brucellar pericarditis. We also searched for clinically silent pericardial effusion among patients with brucellosis. We performed routine transthoracic echocardiography (TTE) on 72 consecutive patients with newly diagnosed brucellosis in the absence of any signs and symptoms of pericarditis over a period of 6 months.ResultsThree of our patients with brucellar pericarditis recovered fully after antibiotics. The other patient received 6 days of antibiotic treatment, and her signs and symptoms regressed, but after this the patient was lost to follow-up. We did not detect pericarditis among the 72 newly diagnosed patients.ConclusionsBrucellar pericarditis is a rare clinical entity, and the morbidity and mortality in patients with brucellar pericarditis is low. Pericardiocentesis should only be performed in patients with cardiac tamponade. Moreover, the choice of antibiotics and the duration of treatment do not differ between brucellosis cases with or without isolated pericarditis. Although the prevalence of pericarditis in brucellosis is low, brucellar pericarditis should always be kept in mind in patients with acute or chronic pericarditis, especially in areas where brucellosis is endemic.
Functional polymorphisms in the CYP1A1, ACE, and IL-6 genes contribute to susceptibility to community-acquired and nosocomial pneumonia
Lyubov E. Salnikova | Tamara V. Smelaya | Viktor V. Moroz | Arkadiy M. Golubev | Alexander V. Rubanovich
Summary: ObjectivesTo establish the contribution of genetic host factors to the risk of community-acquired pneumonia (CAP) and nosocomial pneumonia (NP) in the population of the Russian Federation.MethodsA total of 796 subjects (CAP: 334 patients, 134 controls; NP: 216 critically ill patients with NP, 105 critically ill patients without NP) were included in two case–control studies. We analyzed 13 polymorphisms in 11 genes (IL-6, TNF-α, MBL2, CCR5, NOS3, CYP1A1 (three sites), GSTM1, GSTT1, ABCB1, ACE, and MTHFR) using a tetra-primer allele-specific PCR method.ResultsIndividual single nucleotide polymorphism (SNP) analysis revealed a strong association between CYP1A1 rs2606345 and CAP (p=3.9×10−5, odds ratio (OR) 0.42, 95% confidence interval (CI) 0.27–0.63). Three genes (CYP1A1, ACE, and IL-6) were identified that account for part of the increase in vulnerability to both diseases, CAP and NP. The carriage of three predisposing genotypes versus protective genotypes increased the CAP risk (p=0.001, OR 7.01, 95% CI 1.99–24.70) and NP risk (p=0.028, OR 4.34, 95% CI 1.15–16.45).ConclusionsGenetic predisposition to CAP and NP is attributed to the cumulative contribution of polymorphisms at the CYP1A1, IL-6, and ACE genes, independently of age, gender, causative pathogen, and the use of mechanical ventilation, in patients in the Russian Federation.
Distribution of uropathogenic virulence genes in Escherichia coli isolated from patients with urinary tract infection
Mouna Tarchouna | Asma Ferjani | Walid Ben-Selma | Jalel Boukadida
Summary: BackgroundEscherichia coli is the predominant pathogen causing urinary tract infection (UTI), the most common bacterial infectious disease encountered in clinical practice, accounting for significant morbidity and high medical costs. The severity of UTI produced by E. coli is due to the expression of a wide spectrum of virulence factors. In this study we evaluated the role of E. coli virulence determinants in the pathogenesis of UTI.MethodsA total of 90 uropathogenic E. coli strains were screened by PCR for the prevalence of seven virulence genes encoding type 1 fimbriae (fimH), pili associated with pyelonephritis (pap), S and F1C fimbriae (sfa and foc), afimbrial adhesins (afa), cytotoxic necrotizing factor (cnf), hemolysin (hly), and aerobactin (aer).ResultsThe prevalence of genes coding for fimbrial adhesive systems was 68% for fimH, 41% for pap, and 34% for sfa/foc. The operons coding for afa afimbrial adhesins were identified in 20% of strains. The hly and cnf genes coding for toxins were amplified in 19% and 3% of strains, respectively. A prevalence of 52% was found for the aer gene. The various combinations of detected genes were designated as virulence patterns. The strains isolated from hospitalized patients displayed a great diversity of gene associations compared to those isolated from ambulatory patients.ConclusionsOur study showed that investigation of the bacterial pathogenicity associated with UTI may contribute to a better medical intervention.
John N. Aucott | Lauren A. Crowder | Kathleen B. Kortte
Summary: ObjectivesThe study objective is to demonstrate the clinical and research utility of an operationalized definition of post-treatment Lyme disease syndrome (PTLDS), as proposed by the Infectious Diseases Society of America.MethodsSeventy-four patients with confirmed erythema migrans and 14 controls were enrolled. Patient-reported symptoms and health function (SF-36) were collected pre-treatment and at follow-up visits over 6 months post-treatment.ResultsEight (11%) patients met our operationalized definition of PTLDS, which included self-reported symptoms of fatigue, widespread musculoskeletal pain or cognitive complaints, and functional impact as measured by a T score of <45 on the composite SF-36. No controls met the functional impact criteria. Forty-three (60% patients returned to their previous health status when measured at 6 months post-treatment. Twenty (28%) patients had either residual symptoms or functional impact, but not both, and did not meet criteria for PTLDS.ConclusionsThis operationalized definition of PTLDS allows for identification of those patients who are treated for early Lyme disease and have significant post-treatment illness, as they have both residual symptoms and impact on daily life functioning. With further refinement and improvement of this operationalized definition, the true incidence of PTLDS can be determined and future studies can be designed to examine its pathophysiology and treatment.
Acid aspiration provokes the pneumonia caused by multidrug-resistant Acinetobacter baumannii in BALB/c mice
Shyh-Ren Chiang | Hung-Jen Tang | Chung-Hua Chen | Chi-Chung Chen | Wen-Ying Lee | Ping-Chin Chang | Yu-Hsin Chiu | Yin-Ching Chuang
Summary: ObjectiveTo determine whether acid aspiration provokes the development of multidrug-resistant Acinetobacter baumannii (MDRAB) pneumonia in its host.MethodsGroups of mice were inoculated intratracheally (IT) with 50μl of 0.1N HCl and 1×108 colony-forming units (CFU) Ab396 (A+Ab group), or 50μl of 0.1N HCl and 20μl of 0.9% saline (A+S group), or 20μl of 0.9% saline and 1×108 CFU of Ab396 (S+Ab group), or 50μl of 0.9% saline and 20μl of 0.9% saline (S+S group). Cytokines, bacterial loads in the bronchoalveolar lavage fluid (BALF), lung permeability, histopathology of the lungs, and survival rates were evaluated.ResultsOnly the A+Ab mice developed extensive Ab396 pneumonia and had significantly elevated bacterial loads, increased lung leakage, and lower levels of tumor necrosis factor alpha (TNF-α) compared with the other three groups (p<0.05, Mann–Whitney U-test). Moreover, a strong synergistic effect (p<0.05, two-way analysis of variance) was observed between the acid induction and Ab396 infection, resulting in lung injury and an unfavorable survival outcome.ConclusionsLung injury caused by acid aspiration provoked secondary MDRAB pneumonia; also synergistic effects between acid aspiration and Ab396 infection resulted in a detrimental outcome in the infected mice.
A simple diagnostic aid for tuberculous meningitis in adults in Morocco by use of clinical and laboratory features
Tarek Dendane | Naoufel Madani | Aicha Zekraoui | Jihane Belayachi | Khalid Abidi | Amine Ali Zeggwagh | Redouane Abouqal
Summary: BackgroundThe delay in diagnosis and treatment of tuberculous meningitis (TBM) is a major factor in the high mortality observed with this pathology. The distinction between bacterial meningitis (BM) and TBM by clinical features alone is often impossible, and the available biological resources remain inadequate or inaccessible, especially in developing countries. We attempted to develop a simple diagnostic algorithm on the basis of clinical and laboratory findings that could be used as an early predictor of TBM in adult patients in Morocco.MethodsWe compared the clinical and laboratory features on admission of 508 adults in a medical intensive care unit in Morocco who satisfied diagnostic criteria for tuberculous (n=274) or bacterial (n=234) meningitis. Features independently predictive of TBM were modeled by multivariate logistic regression to create a diagnostic rule, and by a classification and regression tree (CART).ResultsSix features were predictive of a diagnosis of TBM: female gender, duration of symptoms, the presence of localizing signs, white blood cell (WBC) count, the level of serum sodium, and the total cerebrospinal fluid WBC count. The sensitivity for CART was 87% and for a score >7 was 88%; specificity was 96% and 95%, respectively. The internal validation was excellent for both diagnostic methods, with a receiver operating characteristic (ROC) area of 0.906 bootstrap samples for a score >7 and 0.910 for CART.ConclusionsThe clinical and laboratory parameters identified in this study may help the clinician with the empiric diagnosis of TBM and could be used in settings with limited microbiological diagnostic support.
Severe sepsis caused by a linezolid-resistant Enterococcus faecium in a 10-year-old girl after multiple trauma
M. Mutschler | S. Trojan | J.M. Defosse | A. Helmers | C. Probst | B. Bouillon | F. Wappler | S.G. Sakka
Summary: While infections caused by Enterococcus faecium resistant to vancomycin (VRE) are increasing, linezolid-resistant strains are still rare. We present the case of a 10-year-old girl with severe sepsis caused by a linezolid-resistant E. faecium (Van-B VRE) after multiple trauma and right-sided hemipelvectomy. The off-label use of a targeted antimicrobial therapy with daptomycin (350mg/day; approximately 8mg/kg) for 17 days resulted in rapid normalization of infection parameters and improved clinical status. No side effects were observed and the patient was successfully discharged from the intensive care unit.
Providing outpatient parenteral antibiotic therapy (OPAT) to facilitate effective treatment of melioidosis
Theresa Seetoh | David C. Lye | Sophia Archuleta | Dale Fisher
Abiola Olumuyiwa Olaitan | Meryem Berrazeg | Obasola Ezekiel Fagade | Olawale Olufemi Adelowo | John Adeolu Alli | Jean Marc Rolain
A probable food-borne outbreak of pharyngitis after a massive rainstorm in Beijing, caused by emm89 group A Streptococcus rarely found in China
Peng Yang | Xiaomin Peng | Junyong Yang | Xiaogen Dong | Man Zhang | Quanyi Wang
Eric R. Cox | Seema U. Nayak | Janaki C. Kuruppu
Available online 22 May 2013
A.G. Vos | M.W.M. Wassenberg | J. de Hoog | J.J. Oosterheert
Summary: ObjectiveTo determine factors associated with the diagnosis of tuberculous uveitis and the response to anti-tuberculous treatment (ATT).MethodsA retrospective case study was performed at the University Medical Centre Utrecht between October 2007 and December 2009. Patients with possible tuberculous uveitis (TBU) were selected from all patients with an unexplained uveitis. Demographics, ethnicity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tuberculin skin test (TST), QuantiFERON (QFT) test, and ocular findings were evaluated. An interdisciplinary panel discussed if there was a presumed TBU and decided to start treatment. When there was a decrease in intraocular cell count and/or improvement in visual acuity after ATT, the confirmation of presumed TBU was made.ResultsOf 585 patients with unexplained uveitis, 66 (11.3%) fulfilled the definition of possible TBU. Ten (15.4%) patients were regarded as having presumed TBU and received ATT. All of them had latent tuberculosis (LTB). The ocular situation improved in seven patients (70%). A history of TB contact, abnormalities on chest radiology, and extraocular manifestations of TB were associated with a good response to ATT in the case of presumed tuberculous uveitis.ConclusionsTuberculous uveitis remains difficult to diagnose. No clearly correlating factors that predicted the response to ATT, including ocular parameters, could be identified.
Molecular characterization of the first community-acquired methicillin-resistant Staphylococcus aureus strains from Central Iran
Available online 21 May 2013
Alireza Japoni-Nejad | Mohsen Rezazadeh | Hamid Kazemian | Nasimeh Fardmousavi | Alex van Belkum | Ehsanollah Ghaznavi-Rad
Summary: BackgroundCommunity-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has spread throughout the world with varying regional incidences and different staphylococcal cassette chromosome mec (SCCmec) elements in different genetic backgrounds. No information is available on CA-MRSA in Iran. A cross-sectional study was carried out among healthy students to investigate: (1) the prevalence of CA-MRSA in Central Iran, (2) the molecular epidemiology of such CA-MRSA strains, (3) the antimicrobial resistance patterns of the strains, and (4) the distribution of virulence genes in these CA-MRSA strains.MethodsA total of 700 nasal swabs were collected and subjected to S. aureus and MRSA-specific isolation procedures. Antimicrobial resistance patterns were determined using the disk diffusion method, and molecular typing was carried out by multi-locus sequence typing (MLST), SCCmec typing, and Staphylococcus protein A (spa) typing for all CA-MRSA isolates. PCR was used to detect various virulence genes.ResultsOne hundred fifty-four S. aureus strains were isolated from the anterior nares of 700 healthy students. According to the US Centers for Disease Control and Prevention definitions for CA-MRSA, seven (4.5%) isolates were confirmed as CA-MRSA. CA-MRSA isolates belonged to SCCmec types IV (n = 6) and V (n = 1). The predominant spa-type among the CA-MRSA isolates was t790 (n = 3), with single t660, t084, and t325 isolates; one isolate was not typeable. The predominant sequence type was ST22, t790, SCCmec IV in three isolates, and the four other sequence types were ST25, ST859, ST14, and ST15.ConclusionsIranian CA-MRSA strains are genetically diverse with an elevated prevalence of t790/ST22 SCCmec IV isolates. These findings support the need for more effective infection control measures to reduce nasal carriage and prevent dissemination of CA-MRSA in Iran.
Available online 18 May 2013
Keshavamurthy Vinay | Amrinder Jit Kanwar | Tarun Narang | Uma Nahar Saikia
Deworming of intestinal helminths reduces HIV-1 subtype C viremia in chronically co-infected individuals
Available online 18 May 2013
Andargachew Mulu | Melanie Maier | Uwe Gerd Liebert
Summary: ObjectiveTo define the impact of helminthic infestations and their treatment on viral load and T cell subsets in chronic HIV-1-infected patients.MethodsTwo hundred twenty chronic HIV-1-infected Ethiopian patients with (N = 87) and without (N = 133) helminthic infestations were included. To determine the impact of deworming on viral load and T cell subsets, a subset of these patients with (n = 23) and without (n = 20) helminthic infestations were followed longitudinally. Helminth egg loads, plasma HIV RNA levels, and peripheral blood CD4+ and CD8+ T cells were determined at baseline and at 12 weeks after antihelminthic treatment.ResultsAt baseline, plasma viral load was significantly higher in individuals with (n = 220) than without (n = 87) a helminthic infestation (5.01 log10 vs. 3.41 log10, p < 0.001). Twelve weeks after antihelminthic treatment, plasma HIV RNA levels were reduced in the successfully treated group (p < 0.001). Twelve weeks after antihelminthic treatment, helminth infestations and their treatment had no significant effect on CD4+ T cell counts. However, helminth-infested individuals had a higher level of CD8+ T cells at baseline (p < 0.001), which was significantly reduced (p < 0.01) at 12 weeks after antihelminthic treatment.ConclusionsHelminths were found to be associated with an increased HIV RNA level. Successful treatment of intestinal helminths reduced plasma HIV RNA levels in chronic HIV-1 subtype C infection. Considering the high endemicity of helminths in tropical settings, the management of chronically HIV-infected individuals must include deworming.
Available online 17 May 2013
Rosario Rivera | Kristen Forney | Maria René Castro | Paulina A. Rebolledo | Nataniel Mamani | Maritza Patzi | Percy Halkyer | Juan S. Leon | Volga Iñiguez
Summary: ObjectivesRotavirus is the most important etiology of severe diarrhea in Bolivia. The monovalent attenuated human oral rotavirus vaccine Rotarix® was introduced in Bolivia in 2008. We describe the molecular epidemiology of circulating rotavirus strains before vaccine introduction.MethodsTwo thousand one hundred thirty-five diarrheal samples were collected from hospitals in four Bolivian cities during 2007–2008. Forty-three percent (445 of 1030 rotavirus-positive samples) were analyzed for G and P genotypes. Among those, 331 were electropherotyped by polyacrylamide gel electrophoresis. Disease severity was quantified using a modified Vesikari scale.ResultsAmong the 445 samples, five genotypes were found to be prevalent: G9P (33%), G1P (17%), G2P (13%), G9P (12%), and G1P (4%). Co-infections with two or more strains accounted for 14% of samples. The most prevalent strain, G9, showed greater electropherotype diversity compared to other serogroups. Strain G1P generally infected younger children and peaked later in the year than other strains. No particular genotype was associated with a higher severity score, though there was a significant difference in the duration of diarrhea between genotypes.ConclusionsDuring the 2-year pre-vaccine period, substantial diversity of rotavirus co-circulating strains was observed. These data constitute a baseline against which changes in circulating strains post-vaccine introduction can be monitored.
Available online 16 May 2013
Yasuhiro Tsuji | Wataru Hashimoto | Shinichiro Taniguchi | Yoichi Hiraki | Akiko Mizoguchi | Eiji Yukawa | Hideto To
Summary: The purpose of this study was to investigate the penetration of linezolid into the mediastinum and pleural space by comparing its concentration in the serum, mediastinum, and pleural space. The linezolid area under the concentration-versus-time curve from zero to 12h (AUC)mediastinumfluid/serum and AUCpleuralfluid/serum ratio were 1.32 and 1.64, respectively. The results suggest that the linezolid concentration in the mediastinum varies as in the serum, and that the concentration in the mediastinum is the same as or greater than that in the serum.