Journal of Infection in Developing Countries最新文献

Introduction: Coronavirus disease 2019 (COVID-19) patients are predisposed to thrombotic events. COVID-19 coagulopathy can be associated with ADAMTS-13 (a disintegrin-like and metalloprotease with thrombospondin type I repeats 13) levels. ADAMTS-13, the cleaving protease of highly thrombogenic ultra-large von Willebrand Factor (vWF) multimers, was rarely investigated in COVID-19 patients and inconsistent results were obtained. We measured ADAMTS-13 levels of patients admitted to emergency department.

Methodology: A prospective study was carried out with 180 individuals at the Emergency Department of Uşak Training and Research Hospital. The patients were divided into three groups: mild COVID-19 (group 2), severe COVID-19 with oxygen saturation below 94% (group 3), and control group (group 1). ADAMTS-13 levels were analyzed with an enzyme linked immunosorbent assay (ELISA) kit (SunRed, Shanghai, China). Demographic data, clinical findings, and routine laboratory test results (alanine aminotransferase (ALT), aspartate aminotransferase (AST), white blood cell, lymphocyte, platelet, C-reactive protein (CRP), lactate dehydrogenase (LDH), prothrombin time, international normalized ratio (INR), partial thromboplastin time, D-dimer, creatinine, urea) were evaluated.

Results: ADAMTS-13 serum levels were slightly lower in groups 2 and 3 compared to the control group, with no significant difference between the ADAMTS-13 median values (p > 0.05). Groups 1 and 2 exhibited comparable outcomes. Group 3 demonstrated notably elevated levels of CRP, LDH, D-dimer, AST, ALT, creatinine; and decreased platelet counts and INR levels (p < 0.05).

Conclusions: COVID-19-associated coagulopathy is still unclear. Based on our data, ADAMTS-13 levels cannot be used as a biomarker to help stratify patients' risks at the time of admission.

Introduction: We investigated the effect of two preanalytical variables, temperature change and freezing-thawing of serum samples, on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG levels.

Methodology: Serum samples were collected from patients who had coronavirus disease 2019 (COVID-19) prior to vaccination. Six serum samples were included, two each with high positivity (HP), low positivity (LP), and a level of close-to-detection limit (CDL) for SARS-CoV-2 IgG. Each of these six samples was divided into three tubes and placed in refrigerators at 4-8 °C, -20 °C, and -70 °C; removed from the storage temperature once per day for 20 consecutive days; and assayed for SARS-CoV-2 IgG level.

Results: The coefficient of variation of all the remaining serum samples were within 95% except for CDL-1 serum at -70 °C, HP-2 serum at 4-8 °C, HP-2 serum at -20 °C, and HP-2 serum at -70 °C. The levels increased significantly when the temperature in the samples with CDL was reduced. The values in samples with LP at -20 °C and -70 °C were significantly higher than those at 4-8°C. In the case of samples with HP, the values of samples at -20 °C were higher than those in samples at 4-8 °C. There was no positive-negative change during any of the freeze-thaw cycles.

Conclusions: Antibody value in the samples at 4-8 °C remained stable throughout the 20 freeze-thaw cycles. The antibody value of the samples at -20 °C and -70 °C tended to elevate.

Introduction: The study aimed to compare the outcomes of nirmatrelvir and ritonavir drug combination (Paxlovid) therapy in patients who received treatment within or after five days of COVID-19 confirmed in the elderly.

Methodology: This was a single-center, retrospective cohort study of older COVID-19 patients (≥ 60 years) admitted from April 7 to May 30, 2022. Patients were categorized into the EP group (starting Paxlovid within five days) and the LP group (starting Paxlovid after five days) following symptoms onset. Length of stay and positive SARS-CoV-2 duration were compared between the two groups. Severe case conversion from mild and moderate COVID-19 patients were also analyzed.

Results: In total, 273 patients were included: 137 in the EP group and 136 in the LP group. Compared to the LP group, the EP group had a significantly shorter length of stay (12.4 vs. 14.7 days, p = 0.001) and positive SARS-CoV-2 duration (11.7 vs. 15.8 days, p < 0.001). The EP group had lower severe case conversion (4.4% vs. 15.4%, p = 0.002). Additionally, abnormal IL-6 and lower lymphocyte count indicated increased length of stay. Older age was associated with a decreased risk in SARS-CoV-2 negative test (HR = 0.98) and an increased risk in severe case conversion (OR = 1.11).

Conclusions: Starting Paxlovid within five days of COVID-19 symptoms onset reduced the length of stay and SARS-CoV-2 duration compared to initiating treatment after five days. While severe case conversion among mild COVID-19 patients might be comparable whether starting Paxlovid within or after five days.

Introduction: This study aimed to determine the prevalence and risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Jordan during the prevaccination period.

Methodology: Between December 2020 and February 2021, nasopharyngeal and oropharyngeal swabs of 2,460 participants were tested by reverse transcription-polymerase chain reaction (RT-PCR). To assess the risk factors, a questionnaire was applied during sample collection.

Results: Of the participants, 1,463 (59.5%) individuals were found positive for SARS-CoV-2. In multivariate analysis, male gender, younger age, lower educational level, being single, middle and higher socioeconomic status, having symptoms, presence of underlying conditions and smoking were significantly associated with SARS-CoV-2 positivity. On the contrary, washing hands routinely with soap and water, and use of alcohol-based disinfectants significantly reduced possibility of SARS-CoV-2 infection.

Conclusions: The study findings showed that determination of risk factors is of great importance to maintain disease monitoring, prevention and control, particularly in settings with high infection rates.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic proved challenging for the healthcare systems. This study is an analysis of the epidemiological situation of COVID-19 in the Kingdom of Saudi Arabia (KSA), and the impact of the control measures on the epidemiological trends of the disease.

Methodology: A retrospective study was conducted on COVID-19 cases confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in KSA from March 2020 to December 2021. The numbers of confirmed, recovered, and death cases was analyzed and classified by age, gender, and nationality. Descriptive statistics and bivariate analysis for the disease trends and some of the control measures were conducted. All statistical analysis was carried out using the IBM SPSS version 26.

Results: There were 549,810 confirmed cases from March 2, 2020, to December 1, 2021. The highest number of cases was during the summer months. Men accounted for 70% of all reported cases. 65% of incidents involved people aged 20-50 years. Saudi nationals represented 63% of the total cases. There was a decline in both confirmed and fatality cases in 2021 compared to 2020 (OR = 2.1, p < 0.001; and OR = 2.53, p < 0.001 respectively). Furthermore, the precautionary measures implemented to curb the spread of COVID-19 had a positive effect in reducing disease incidences (correlation 0.75, p < 0.001).

Conclusions: The Saudi government has had exceptional success in controlling COVID-19 by expanding screening tests, launching immunization campaigns, and training physicians.

Introduction: Hypodermosis is a subcutaneous infestation in cattle that is caused by larvae of Hypoderma spp. and it is an economically important disease in the cattle industry. This study aimed to find the prevalence rate of hypodermosis and identify variations in the COX1 gene among isolates present in Sulaymaniyah, in the Kurdistan region of Iraq.

Methodology: The study was conducted in a Sulaymaniyah slaughterhouse from March to July 2021. The carcasses of 867 cattle were carefully checked before and after skinning them to record the presence of boils containing the larvae of Hypoderma spp. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using TaqI enzyme, and sequencing of the COX1 gene were used for diagnosis and molecular characterization of Hypoderma spp.

Results: The rate of infestation with Hypoderma bovis was 1.61% and the highest rate (3.57%) was detected in April. The disease was significantly (p < 0.05) higher in local breeds at 2.79%. PCR-RFLP confirmed that all recorded species were H. bovis. The result was further confirmed by Sanger sequencing of the COX1 gene of the isolated species. Comparison of the sequences of the conserved COX1 gene of the parasite led to identification of six different haplotypes in the research area. Two of the haplotypes were previously recorded internationally, while four new haplotypes associated with four novel mutations were recorded for the first time in the study region.

Conclusions: Based on these results we can conclude that H. bovis is a widespread species in the research region.

Introduction: Multi-drug-resistant (MDR) Pseudomonas aeruginosa is a dangerous pathogen causing nosocomial infection, particularly in low- and middle-income countries like Brazil. This retrospective study at a Brazilian university hospital examined the relationship between antimicrobial use and MDR-P. aeruginosa.

Methodology: Data was collected from 358 patients with non-repetitive P. aeruginosa infections from 2009 to 2019. Antibiotic use was measured in grams and expressed as defined daily dose (DDD) per 1000 patient-days for meropenem, imipenem, polymyxin, and tigecycline.

Results: Extensively drug-resistant (XDR) P. aeruginosa occurred in 36.1%, and MDR in 32.6% of cases. Risk factors for XDR infection were hospitalization prior to infection (OR = 0.9901), intensive care unit (ICU) admission (OR = 0.4766), previous antibiotic use (OR = 1.4417), and use of cefepime (OR = 0.3883). Over the ten-year period, utilization of the monitored antibiotics increased, and there was a positive correlation between the rise in MDR-P. aeruginosa and the consumption of ceftriaxone, imipenem, meropenem, and polymyxin B. The 30-day mortality rate was 40.0% for all patients and 41.0% for those infected with XDR-P. aeruginosa.

Conclusions: This study highlights the negative impact of the indiscriminate use of antimicrobials, which has led to a significant increase in multidrug-resistant P. aeruginosa strains in hospitals.

Introduction: Congenital rubella syndrome (CRS) is associated with severe birth defects, that lead to disability in later life. Hence, early detection and intervention are needed to prevent permanent disability and mortality in children with CRS. We evaluated the time to diagnosis or correction intervention related to survival rate using survival analysis.

Methodology: A retrospective cohort study was conducted to evaluate the follow-up of CRS-confirmed cases from 2011-2018 at a national referral hospital in Jakarta, Indonesia. Parents of eligible children who registered in the national CRS registry as laboratory-confirmed CRS cases were contacted through phone calls or home visits and interviewed about the current situation of their child's health. We also obtained clinical data from the medical records.

Results: Fifty children, age 4 to 14 years, identified with laboratory-confirmed CRS were included in this study. Half (54%) of these children were female. All were born from mothers with no previous rubella vaccination history. Ophthalmic abnormalities such as congenital cataracts (88%) were the most common birth defect. Multiple congenital abnormalities including congenital heart disease, ocular abnormalities, and auditory defects were identified in 52% of the children. Based on Kaplan-Meier analysis, 50% of children were diagnosed at four months. Ophthalmic corrections such as cataract surgery were performed earlier than heart or auditory correction, with 50% of children undergoing eye correction one month after the diagnosis.

Conclusions: There is a vital need to implement CRS surveillance in Indonesia to know the burden of CRS and reinforce the preventive actions, including vaccination against rubella.

Introduction: Whipple disease is a rare infectious disease caused by the bacterium Tropheryma whipplei. The classic form affects gastrointestinal and musculoskeletal systems; but other forms may damage the heart, brain, or lungs. Due to non-specific and diverse clinical symptoms, diagnosis of Whipple disease is challenging and often late. Adequate and timely antibiotic treatment is essential for favorable outcome.

Case presentation: Here we present a case of a young woman admitted to the gynecological clinic for diagnostic laparoscopy for suspected haemato-/hydro- salpinx and peritoneal endometriosis. Macroscopic findings during laparoscopy revealed miliary whitish lesions in the pelvis and histopathology reported granulomatous salpingitis and peritonitis. She was complaining of intermittent abdominal pain, bloating and weight loss. Subsequently, the laparoscopy symptoms worsened and her general condition deteriorated. Differential diagnosis included infective agents such as Mycobacterium tuberculosis; in addition to sarcoidosis, granulomatosis with polyangiitis, and malignancies; all of which were excluded. Finally, Tropheryma whipplei was suspected, and after esophagogastroduodenoscopy with duodenal biopsy, long-term antibiotic treatment was initiated and the patient fully recovered.

Conclusions: Although Whipple disease is rare, it is important to have a high level of awareness for Tropheryma whipplei infection. The localization and course of Whipple's disease may be unpredictable, but a favorable outcome is expected with adequate antibiotic treatment.

Introduction: COVID-19, an emerging infectious disease caused by SARS-CoV-2, continues to be a global public health threat. The development of a colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) can extend the availability of simple, reliable molecular tests for the rapid detection of COVID-19.

Methodology: The RT-LAMP assay was developed using a new primer set targeting a portion of SARS-CoV-2 orf8. The method was validated at 63 ºC for 60 minutes with naked-eye visualization of the color change. The clinical performance was compared to a real-time reverse transcription-polymerase chain reaction (rtRT-PCR) using 273 RNA samples extracted from nasopharyngeal swab specimens.

Results: The developed RT-LAMP was specific to SARS-CoV-2 with a limit of detection at 15 RNA copies per reaction. The assay demonstrated diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 90.48% (95% CI: 86.36-93.68%), 87.00% (95% CI: 81.53-91.33%), 100% (95% CI: 95.07-100%), 100% (95% CI: not available), and 73.74% (95% CI: 66.22-80.07%), respectively, compared to the rtRT-PCR. The greatest sensitivity of 98.03% (95% CI: 94.34-99.59%) was demonstrated in samples with the cycle threshold (Ct) values < 30 cycles.

Conclusions: The RT-LAMP method in this study showed good performance. The assay can increase the scope of laboratory testing for rapidly detecting SARS-CoV-2 in Thailand. Due to a decrease in COVID-19 cases, its application is beneficial when commercial alternatives are unavailable.