Journal of Infection in Developing Countries最新文献

Introduction: Mediastinitis remains one of the most serious complications of cardiac surgery. The reported incidence is 1-4%, while the related mortality varies from 10-47%.

Case presentation: A patient with triple vessel disease (TVD) was hospitalized at our clinic for coronary artery bypass graft (CABG) surgery. The preoperative examination results were normal. We performed standard CABG under extracorporeal circulation. The patient had a favorable postoperative course. On the fifth postoperative day, the wound showed seropurulent drainage. The treatment of the patient's wound continued with open dressing, negative wound pressure device, debridement, minimal muscle plasticity, and total bilateral muscle pectoral flap plasticity. The infecting microorganism was identified as multidrug-resistant Acinetobacter baumani, and systemic antibiotic therapy was initiated. The patient had "per secundum closure" of the wound after all these efforts. The wound healed completely 2 months after discharge, and the patient was in good health.

Conclusions: Mediastinitis is associated with high mortality and high financial and human costs. The occurrence of this high-risk complication can be prevented through constant vigilance at every step from admission to discharge.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) expresses the Panton-Valentine leukocidin (PVL) virulence gene, which is associated with community and hospital-acquired severe MRSA infections. The objective of this study was to determine the prevalence and antibiotic susceptibility profile with a focus on the presence of the PVL gene among MRSA isolates in healthcare settings.

Methodology: A total of 1,207 clinical specimens and 304 hospital environment swabs were collected in a tertiary care hospital in Nepal, and investigated following basic microbiological techniques. S. aureus was confirmed with the coagulase test. An antibiotic susceptibility test (AST) was performed by the Kirby-Bauer method and screening for MRSA was carried out by the cefoxitin disc diffusion method guided by the Clinical and Laboratory Standards Institute (CLSI), 2020. DNA was extracted and used in a polymerase chain reaction (PCR) to detect mecA and PVL genes.

Results: Of the 1,511 samples, 45 (2.9%) S. aureus (23 clinical and 22 environmental) were isolated. Among them, 69.6% (16/23) and 27.3% (6/22) were MRSA in clinical and environmental isolates, respectively. Twelve (52.2%) clinical isolates and seven (31.8%) environmental isolates were multidrug resistant. The majority of isolates were susceptible to vancomycin and linezolid. The PVL gene was detected in 18.2% (n = 4/22) of the MRSA isolates, of which three were from clinical sources and one was from an environmental swab.

Conclusions: The prevalence of MRSA, and PVL-producing S. aureus were higher in the hospital setting. Hence, immediate and urgent implementation of infection control and sanitation measures are needed in the hospital.

Introduction: Rabies is a dreadful zoonotic viral disease that affects animals and humans with a fatality rate of 100%. This report aims to create awareness among the veterinarians and general public about the paralytic form of rabies in order to understand the antemortem clinical diagnosis implications in limited resource settings, so as to follow the post-exposure prophylaxis at the golden hour period of rabies transmission.

Case presentation: A one-year-old female dog was presented to the Ambulatory Clinic Unit, Veterinary Clinical Complex, Veterinary College and Research Institute, Theni, Tamil Nadu, India with the ailment of a dropped jaw and was unable to swallow food and water for the past three days. Epidemiological investigations revealed that the animal had dog-bitten wounds from a week ago. On clinical examination, facial distortion, changes in the vocal cord, and paralysis of the throat muscle were noticed. Based on the anamnesis, clinical, and epidemiological investigations, the animal was diagnosed to be a probable case of paralytic form of canine rabies. In the limited resource settings, antemortem clinical diagnosis was practiced to suspect rabies-infected dogs. Further, the owner was advised to implement preventive measures to safeguard against rabies infection. The dog was kept under isolation and succumbed on day two with evidence of progressive paralytic signs.

Conclusions: This report emphasizes the importance of paralytic rabies, alongside of furious form of rabies, further creating awareness among the general public about the antemortem clinical diagnosis under limited resource settings.

Introduction: Alcohol and substance use disorders are important public health problems with an increased risk for bloodborne and sexually transmitted infections.

Objectives: To determine the frequency and risk factors of hepatitis B, hepatitis C and HIV in individuals with drug and alcohol addiction.

Methodology: This prospective study was conducted in the outpatient clinic of Alcohol and Substance Abuse Treatment and Education Center (ASATEC), Izmir, Turkey. Detailed anamneses were taken from alcohol and/or drug addicts who applied to the outpatient clinic; HBV, HCV, HIV serology results in the last 6 months were examined.

Results: The study group consisted of 478 persons, including 112 (23.4%) alcohol addicts, 322 (67.4%) substance addicts, and 44 (9.2%) combined alcohol and substance addicts. The mean age of the cases was 32 ± 11 years and 432 (90.4%) were male. Drug injection and needle sharing was recorded in 16.5% and 9.8% of participants, respectively. Hepatitis B surface antigen (HBsAg) positivity was found in 2.7%, anti-HCV positivity in 9.6% and HIV Ag/Ab positivity in 1.9% of the cases. Among patients using intravenous drugs, HBsAg positivity was found in 2%, anti-HCV positivity in 55%, while HIV Ag/Ab positivity was not detected. A history of sexually transmitted disease was a risk factor for HBsAg, HIV Ag/Ab positivity. Intravenous drug use, needle sharing and ecstasy use were determined as risk factors for anti-HCV positivity.

Conclusions: Risky behaviors for HBV, HCV and HIV transmission are high in alcohol and substance addicts. The use of ecstasy is a novel risk factor for HCV transmission.

Introduction: Cytokeratins (CKs) have been associated with precancerous and cancerous gastric lesions in patients with Helicobacter pylori-associated chronic gastritis, making them useful for diagnosing epithelial tumors.

Methodology: A retrospective study was conducted utilizing 200 formalin-fixed paraffin-embedded gastric biopsy samples collected from the lesser curvature of the stomach. Samples from the control group, patients with H. pylori infection, and patients with H. pylori-associated gastritis, with complete and incomplete intestinal metaplasia (IM) were immunostained. Monoclonal antibodies were utilized to determine the expression of CK7, CK20, and Ki-67.

Results: Patients infected with H. pylori had strong CK20 expression on the surface, and weak CK7 expression on the surface and deep glands; while non-specific chronic gastritis patients had weak focal CK7 expression and strong CK20 expression. The normal gastric mucosa of patients in the control group had relatively weak CK7 expression, restricted to a few cells in the neck and deep glands. CK20 showed diffuse strong reactivity on the surface. On the other hand, patients with complete IM showed a CK7 staining pattern that was either negative or weakly focal on the surface and crypts associated with diffuse surface CK20 and focal crypt staining corresponding to gastric type IM. The Ki67 proliferating index was low (≤ 15%) in H. pylori infected patients, high (> 30%) in patients with incomplete IM, and intermediate (16-30%) in patients with complete IM.

Conclusions: These results indicate a significant link between the expressions of CK7/CK20 and Ki67 in patients afflicted with H. pylori and IM.

Introduction: The 2022 mpox global outbreak underscores the need for an improved understanding of mpox epidemiology, co-morbidities, and clinical management/outcome. We report a case of a 30-year-old Nigerian antiretroviral treatment-experienced person living with human immunodeficiency virus (PLHIV) who had PCR-confirmed mpox and chickenpox co-infection.

Case presentation: The patient presented with a generalized itchy rash of three weeks and antecedent low-grade fever. He had no recent travel, animal exposure, or same-sex relationship. Examination revealed generalized pustular and nodular eruptions without peripheral lymphadenopathy.

Results: CD4 count was 78 cells/mm3, wound swab microscopy revealed Gram-positive cocci in clusters and Gram-negative bacilli while culture yielded Pseudomonas aeruginosa. Despite supportive care and definitive antimicrobial therapy, his clinical condition deteriorated with sepsis-related multi-organ dysfunction and ultimately death.

Conclusions: Mpox and chickenpox co-infection may occur, with potentially fatal complications in the setting of advanced HIV disease. Increased surveillance for co-viral infections in PLHIV with febrile exanthema and aggressive management to improve outcome are recommended.

Introduction: We report the case of a 76-year-old male who was hospitalized with severe dehydration, pain in the hepatic region, and weakness in the limbs.

Methodology: A contrast-enhanced abdomen CT and a contrast-enhanced ultrasound identified a large liver abscess. The patient underwent percutaneous drainage of the abscess.

Results: The culture examination, analyzed by multiplex polymerase chain reaction test, showed the presence of Klebsiella oxytoca. The laboratory report identified a resistance mechanism involving a plasmid-mediated SHV-1 extended-spectrum-beta-lactamase (ESBL).

Conclusions: K. oxytoca is a Gram-negative bacterium and is potentially associated with a large variety of infections. The association between the liver abscess by K. oxytoca and rhabdomyolysis had not yet been described in the literature.

Introduction: Human pegivirus-1 (HPgV-1) influences the pathogenesis and outcome of viral infections. We investigated the prevalence and impact of HPgV-1 due to the paucity of studies on Indian people living with HIV (PLHIV).

Methodology: Samples were collected from 347 treatment-naïve PLHIV; and 100 blood donors negative for HIV, HBV, and HCV. CD4+ T-cell and HIV-1 viral load were measured using flow-cytometry and quantitative polymerase chain reaction (qPCR), respectively. HPgV-1 was quantified and genotyped by qPCR and Sanger sequencing, respectively.

Results: HPgV-1 viremia in PLHIV and controls was 11% (38/347) and 1% (1/100), respectively. We found HPgV-1 genotype-2a in PLHIV and genotype-2b in controls. Male preponderance was seen in HIV-1 mono-infection and co-infection groups (166 vs. 143 and 33 vs. 5; p < 0.0001). The peak prevalence of HPgV-1 was at 31-50 years (p = 0.02). CD4+ T-cell count (245.5 vs. 240; p = 0.59) and HIV-1 log viral load (4.7 vs. 4.9; p = 0.50) were not significantly different between the HIV-1 mono-infected and coinfected individuals. However, a direct correlation existed between HpgV-1 viral load and CD4+ T-cell count (r = 0.27, p = 0.05) and an inverse correlation with HIV-1 viral load (r = -0.21, p = 0.10).

Conclusions: This is the first study in India to estimate the HPgV-1 prevalence in PLHIV with the predominance of genotype-2a. HPgV-1 viremia had a moderate impact on CD4+ T-cells and HIV-1 viral load, which requires a longitudinal study to identify the beneficial influence on HIV-1 disease progression and outcome.

Introduction: Breast tuberculosis (TB) is a rare extra-pulmonary presentation of tuberculosis. In the western world, this accounts for less than 0.1% of breast conditions (all breast conditions, not limited to TB or extra-pulmonary TB), but can be up to 3-4% in regions endemic for TB such as in Africa and Asia.

Case presentation: We report a case of a 54-year- old human immunodeficiency virus (HIV)-positive lady who presented with six months history of multiple masses on the left breast which were initially suspected to be cancer of the breast. However, histology report of the mass confirmed TB of the breast.

Conclusions: Presentation of TB can be non-specific and atypical in patients with HIV infection, especially when it presents in extra-pulmonary forms.

Introduction: To ensure the appropriate usage of ceftazidime-avibactam (CAZ-AVI), recently introduced in our hospital, we aimed to determine susceptibility rates, enzyme analysis, and clonal relationship among strains, together with clinical data.

Methodology: Between June 1 and September 30, 2021, demographic and microbiological data of the patients were recorded. In the obtained samples, meropenem and colistin minimal inhibitory concentration (MIC) levels, carbapenem resistance genes, and the clonal relationship were studied by molecular methods. CAZ-AVI was not used in any of the patients.

Results: 140 carbapenem-resistant Klebsiella pneumoniae were isolated from 57 patients. Resistance to CAZ-AVI was found in 76 (54.3%) strains. Out of 57 patients, 31 (54.4%) isolates could be reached. Meropenem MIC level was ≥ 32 µg/mL in 26 (83.9%), and colistin MIC level was ≥ 4 µg/mL in 17 (54.8%) isolates. Enzyme analysis revealed NDM in 20 (64.5%), OXA-48 in 17 (54.8%), and KPC in seven (22.6%). NDM + OXA-48 was determined in 10 (32.2%) strains. NDM was determined in all CAZ-AVI resistant strains, OXA-48 in 16.1% (2/5) strains. Seven genotypes were detected. The largest cluster was genotype 3 clusters (11 isolates). Of 31 patients, 22 (71.0%) died. CAZ-AVI was susceptible in one of the patients who survived and four who died.

Conclusions: Before using a new antibiotic, each center should determine the basal data and phenotypic/genotypic resistance ratios specific to that antibiotic. While a high NDM rate and low CAZ-AVI sensitivity limit the use of the drug in our center, it is clear that CAZ-AVI use in sensitive strains will decrease mortality.