http://www.hindawi.comThe latest articles from Hindawi Publishing Corporation© 2012, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/journals/ipid/2011/462767/Background. Absence of acquired protective immunity in endemic areas children leads to higher susceptibility to severe malaria. To investigate the involvement of regulatory process related to self-reactivity, we evaluated potent changes in auto-antibody reactivity profiles in children and older subjects living in malaria-endemic zones comparatively to none-exposed healthy controls. Methods. Analysis of IgG self-reactive footprints was performed using Western blotting against healthy brain antigens. Plasmas of 102 malaria exposed individuals (MEIs) from endemic zone, with or without cerebral malaria (CM) were compared to plasmas from non-endemic controls (NECs). Using linear discriminant and principal component analysis, immune footprints were compared by counting the number, the presence or absence of reactive bands. We identified the most discriminant bands with respect to age and clinical status. Results. A higher number of bands were recognized by IgG auto-antibodies in MEI than in NEC. Characteristic changes in systemic self-IgG-reactive repertoire were found with antigenic bands that discriminate Plasmodium falciparum infections with or without CM according to age. 8 antigenic bands distributed in MEI compared with NEC were identified while 6 other antigenic bands were distributed within MEI according to the age and clinical status. Such distortion might be due to evolutionary processes leading to pathogenic/protective events.Romuald Dassé, Didier Lefranc, Sylvain Dubucquoi, Patricia Dussart, Virginie Dutoit-Lefevre, Boualem Sendid, François Sombo Mambo, Patrick Vermersch, and Lionel PrinCopyright © 2011 Romuald Dassé et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/571340/The main objective of this study was to detect fatigue-induced clinical symptoms of immune suppression in medical residents. Samples were collected from the subjects at rest, following the first night (low-stress), and the last night (high-stress) of night float. Computerized reaction tests, Epworth Sleepiness Scale, and Wellness Profile questionnaires were used to quantify fatigue level. DNA of human herpes viruses HSV-1, VZV, EBV, as well as cortisol and melatonin concentrations, were measured in saliva. Residents at the high-stress interval reported being sleepier compared to the rest interval. EBV DNA level increased significantly at both stress intervals, while VZV DNA level increased only at low-stress. DNA levels of HSV-1 decreased at low-stress but increased at high-stress. Combined assessment of the viral DNA showed significant effect of stress on herpes virus reactivation at both stress intervals. Cortisol concentrations at both stress intervals were significantly higher than those at rest.Peter N. Uchakin, David C. Parish, Francis C. Dane, Olga N. Uchakina, Allison P. Scheetz, Neal K. Agarwal, and Betsy E. SmithCopyright © 2011 Peter N. Uchakin et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/341065/In February, 2008, the South Eastern Sydney Illawarra Public Health Unit investigated an outbreak of cryptosporidiosis within the south east region of Sydney, Australia. Thirty-one cases with laboratory-confirmed cryptosporidiosis and 97 age- and geographically matched controls selected by random digit dialling were recruited into a case-control study and interviewed for infection risk factors. Cryptosporidiosis was associated with swimming at Facility A (matched odds ratio = 19.4, 95% confidence interval: 3.7–100.8) and exposure to household contacts with diarrhoea (matched odds ratio = 7.7, 95% confidence interval: 1.9–31.4) in multivariable conditional logistic regression models. A protective effect for any animal contact was also found (matched odds ratio = 0.2, 95% confidence interval: 0.1–0.7). Cryptosporidium hominis subtype IbA10G2 was identified in 8 of 11 diagnostic stool samples available for cases. This investigation reaffirms the importance of public swimming pools as potential sources of Cryptosporidium infection and ensuring their compliance with water-quality guidelines. The protective effect of animal contact may be suggestive of past exposure leading to immunity.Darren J. Mayne, Kelly-Anne Ressler, Diane Smith, Gareth Hockey, Susan J. Botham, and Mark J. FersonCopyright © 2011 Darren J. Mayne et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/968031/Street-vended ready-to-eat food sold in Egypt, including sandwiches and dishes of traditional food, was examined for the presence of Listeria species. Out of 576 samples, 24% were found to contain Listeria species. L. monocytogenes and L. innocua were isolated from 57% and 39% of the contaminated samples, respectively. Other Listeria spp. were detected with lower frequency. L. monocytogenes of ≥103 CFU/g were detected in 7% of the total examined samples, which represent 49% of the contaminated food samples (meat, poultry, seafood, dairy products, and products of plant origin). Most of the samples contaminated by L. monocytogenes had high levels of total viable bacterial counts. The results obtained may help to clarify the epidemiology of listeriosis in the country and draw the attention of the decision makers to issue hygienic regulations for food processing industries as well as street vendors in order to ensure safe street-vended ready-to-eat food.Moustafa El-Shenawy, Mohamed El-Shenawy, Jordi Mañes, and Jose M. SorianoCopyright © 2011 Moustafa El-Shenawy et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/604372/This study uses social network and spatial analytical methods simultaneously to understand cholera transmission in rural Bangladesh. Both have been used separately to incorporate context into health studies, but using them together is a new and recent approach. Data include a spatially referenced longitudinal demographic database consisting of approximately 200,000 people and a database of all laboratory-confirmed cholera cases from 1983 to 2003. A complete kinship-based network linking households is created, and distance matrices are also constructed to model spatial relationships. A spatial error-social effects model tested for cholera clustering in socially linked households while accounting for spatial factors. Results show that there was social clustering in five out of twenty-one years while accounting for both known and unknown environmental variables. This suggests that environmental cholera transmission is significant and social networks also influence transmission, but not as consistently. Simultaneous spatial and social network analysis may improve understanding of disease transmission.Sophia Giebultowicz, Mohammad Ali, Mohammad Yunus, and Michael EmchCopyright © 2011 Sophia Giebultowicz et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/219859/This cross-sectional study used Geographic Information System methods to compare sociodemographic and clinical characteristics of children enrolled and not enrolled in a primary care network to determine the suitability of the network to estimate population-based disease rates. We validated the network surveillance system by comparing invasive pneumococcal disease rates between network and nonnetwork children using population-based surveillance data. Among the study population of 130300 children, network children were more likely to be female, Black, non-Hispanic, younger, and receive Medicaid. These differences varied across neighborhoods, however, adjusting for neighborhood characteristics did not significantly change observed differences. Rates of invasive pneumococcal disease were not significantly different between network and non-network children. Significant demographic and clinical differences existed between network and non-network children and varied over small areas. Observed population rates of an infectious disease did not significantly differ suggesting that the network can potentially provide valid disease estimates for the community population.Kristen A. Feemster, Yimei Li, Robert Grundmeier, A. Russell Localio, and Joshua P. MetlayCopyright © 2011 Kristen A. Feemster et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/741406/By definition, zoonotic pathogens are not strict host-species specialists in that they infect humans and at least one nonhuman reservoir species. The majority of zoonotic pathogens infect and are amplified by multiple vertebrate species in nature, each of which has a quantitatively different impact on the distribution and abundance of the pathogen and thus on disease risk. Unfortunately, when new zoonotic pathogens emerge, the dominant response by public health scientists is to search for a few, or even the single, most important reservoirs and to ignore other species that might strongly influence transmission. This focus on the single “primary” reservoir host species can delay biological understanding, and potentially public health interventions as species important in either amplifying or regulating the pathogen are overlooked. Investigating the evolutionary and ecological strategy of newly discovered or emerging pathogens within the community of potential and actual host species will be fruitful to both biological understanding and public health.Dustin Brisson, Catherine Brinkley, Parris T. Humphrey, Brian D. Kemps, and Richard S. OstfeldCopyright © 2011 Dustin Brisson et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/847835/In the 1980s the outlook for patients with the acquired immunodeficiency syndrome (AIDS) and critical illness was poor. Since then several studies of outcome of HIV+ patients on ICU have shown improving prognosis, with anti-retroviral therapy playing a large part. We retrospectively examined intensive care (ICU) admissions in a large HIV unit in London. Between April 2001 and April 2006 43 patients were admitted to the ICU. The mean age of patients was 44 years and 74% were male. Fifty-six percent of admissions were receiving anti-retroviral therapy and 44% had an AIDS defining diagnosis. The median CD4 count was 128 cells/mL and the median APACHE II score was 21. The commonest diagnostic ICU admission category was respiratory disease. This group experienced higher mortality despite slightly lower APACHE II scores, though this did not achieve statistical significance. The follow up period was one year or until April 2007, when data were censored. ICU mortality was 33%, in hospital mortality was 51% and overall mortality at the end of the study period was 67%. Median survival was 1008 days. The CD4 count did not predict long-term survival, although the sample size was too small for this to be conclusive.L. Turtle, R. Vyakernam, A. Menon-Johansson, M. R. Nelson, and N. SoniCopyright © 2011 L. Turtle et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/291513/Biofilm is a common bacterial lifestyle, and it plays a crucial role in human health, causing biofilm-mediated infections. Recently, to counteract biofilm development, new nano-structured biomaterials have been proposed. However, data about the antibacterial properties of nano-structured surfaces are fragmentary and controversial, and, in particular, the susceptibility of nano-structured materials to colonization and biofilm formation by bacterial pathogens has not been yet thoroughly considered. Here, the ability of the pathogenic Streptococcus mutans and Pseudomonas aeruginosa to adhere and form biofilm on surfaces coated with single-wall carbon nanotubes (SWCNTs) was analyzed. Our results showed that the surfaces of SWCNTs-coated glass beads (SWCNTs-GBs) were colonized at the same extent of uncoated GBs both by S. mutans and P. aeruginosa. In conclusion, our results demonstrate that single wall SWCNTs-coated surfaces are not suitable to counteract bacterial adhesion and biofilm development.Fabrizio Pantanella, Francesca Berlutti, Daniele Passeri, Daniela Sordi, Alessandra Frioni, Tiziana Natalizi, Maria Letizia Terranova, Marco Rossi, and Piera ValentiCopyright © 2011 Fabrizio Pantanella et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/197683/In Norway, methicillin-resistant Staphylococcus aureus (MRSA) is increasing in primary healthcare, associated with imported cases and outbreaks in long-term care. According to Norwegian national guidelines, MRSA-exposed healthcare workers (HCWs) and patients are tested. Carriage of MRSA leads to exclusion from work in healthcare institutions. In this study, 388 staff members in 42 nursing homes in Oslo County responded to questions about personal experience with MRSA and of own attitudes to challenges associated with the control and treatment of MRSA patients. Half (52%) of the nursing staff were concerned of becoming infected with MRSA and the consequences of this would be for own social life, family, economy, and work restriction. The concern was associated with risk factors like old buildings not suitable for modern infection control work, low staffing rate (70% without specific training in healthcare and 32% without formal healthcare education), defective cleaning and decolonization, and lack of formal routines and capacity for isolation of MRSA patients. Since the Norwegian MRSA guideline permits patients with persistent MRSA infections to move freely around in nursing homes, the anxiety of the staff to become infected and excluded from job was real.M. Thorstad, I. Sie, and B. M. AndersenCopyright © 2011 M. Thorstad et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/918038/Pneumocystis is an opportunistic fungal respiratory pathogen that causes life-threatening pneumonia (Pcp) in patients suffering from defects in cell-mediated immunity, including those with acquired immunodeficiency syndrome (AIDS) and immunosuppression secondary to chemotherapy or organ transplantation. Despite major advances in health care, the mortality associated with Pcp has changed little over the past 25  years. Pcp remains a leading cause of death among HIV infected patients, with mortality rates of 50% or higher for patients developing severe Pcp. In addition, as more potent immunosuppressive therapies are developed for chronic inflammatory diseases, more cases of Pcp are occurring in non-HIV patients and in previously unreported clinical settings. These features highlight the importance of developing a better understanding of the pathogenesis of this disease, and the need to search for new therapeutic strategies to improve the outcome of Pcp patients. Immune-mediated inflammatory responses play an important role in the pathogenesis of Pcp, and may be even more significant in determining the outcome of Pcp than direct damage due to the organism itself. In this review we will summarize the immunopathogenic mechanisms that contribute to Pcp-associated lung injury, and discuss the potential to target these pathways for adjunctive immune modulation therapy for Pcp.Jing Wang, Terry W. Wright, and Francis GigliottiCopyright © 2011 Jing Wang et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/357121/Background. Healthcare-associated infections (HAIs) are an important patient safety issue, and safety climate is an important organizational factor. This study explores perceptions of infection preventionists (IPs) and quality directors (QDs) regarding two safety microclimates, Senior Management Engagement (SME) and Leadership on Patient Safety (LOPS), across California hospitals. Methods. This was an analysis of two cross-sectional surveys. We conducted Wilcoxon signed-rank test, univariate analyses, and a multivariate ordinary least square regression. Results. There were 322 eligible hospitals; 149 hospitals (46.3%) responded to both surveys. The IP response rate was 59%, and the QD response rate was 79.5%. We found IPs perceived SME more positively than did QDs (21.4 vs. 20.4, P<0.01). No setting characteristics predicted variation in perceptions. Presence of an independent budget predicted more positive perceptions of microclimates across personnel types (P<0.01). Conclusions. Differences in perceptions continue to exist between essential leaders in acute health care settings which could have critical effects on outcomes such as HAIs. Having an independent budget for the infection prevention and control department may enhance the overall safety climate and in turn patient care.Shanelle Nelson, Patricia W. Stone, Sarah Jordan, Monika Pogorzelska, Helen Halpin, Megan Vanneman, and Elaine LarsonCopyright © 2011 Shanelle Nelson et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/504280/abs/The fungal pathogen Candida albicans is one of the leading causative agents of death in immunocompromised individuals. It harbors an arsenal of cell wall anchored factors that are implicated in virulence such as filamentation inducing factors, adhesins, lipases, proteases, and superoxide dismutases. Dse1 is a cell wall protein involved in cell wall metabolism. The purpose of this study is to characterize the role Dse1 plays in virulence. Dse1 appears to be an essential gene as no homozygous null mutant was possible. The heterozygote mutant exhibited increased susceptibility to calcofluor white, a cell wall disrupting agent, with a subsequent reduction in cell wall chitin content, decreased oxidative stress tolerance, a 30% reduction in biofilm formation, and a delay in adhesion that was mirrored by a reduction in virulence in a mouse model of infection. Dse1 thus appears to be an important protein involved in cell wall integrity and rigidity.Jalil Y. Daher, Joseph Koussa, Samer Younes, and Roy A. KhalafCopyright © 2011 Jalil Y. Daher et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/795219/The gut microflora is an important constituent in the intestinal mucosal barrier and has been introduced as the concept of probiotic therapy that beneficially affects the host by improving its intestinal microbial balance. Therefore, the main objective of the study was to explore the protective potential of various lactobacilli strains for murine giardiasis. By experimentation, it was found that the probiotic supplementation of either Lactobacillus casei, L. acidophilus, L. plantarum, or L. rhamnosus GG, 7 days prior to inoculation with G. lamblia trophozoites, reduced the rate of cyst excretion compared with Giardia-infected mice. Interestingly, L. GG was found to be the most effective probiotic in reducing the duration of giardia cycle and acts as an effective prophylactic probiotic for murine giardiasis but needs to be clinically correlated due to entirely different human microflora.Nisha Goyal, Ram Prakash Tiwari, and Geeta ShuklaCopyright © 2011 Nisha Goyal et al. All rights reserved.http://www.hindawi.com/journals/ipid/2011/830286/There is an obvious and urgent need for novel approaches to treat infectious diseases. The use of monoclonal antibodies in therapy of infectious diseases is now experiencing renewed interest. During the last 5 years radioimmunotherapy (RIT), a modality previously developed only for cancer treatment, has been successfully adapted for the treatment of experimental fungal, bacterial, and viral infections. As our model organism for studying the efficacy, mechanisms, potential toxicity, and radioresistance to RIT, as well as for comparison of RIT with the existing antimicrobial therapies we have chosen the encapsulated yeast Cryptococcus neoformans (CN). The success of RIT approach in laboratory studies provides encouragement for feasibility of therapeutically targeting microbes with labeled antibodies. In addition, the creation of “panantibodies” for RIT which would recognize antigens shared by the whole class of pathogens such as fungi, for example, would facilitate the introduction of RIT into the clinic.Ekaterina Dadachova and Arturo CasadevallCopyright © 2011 Ekaterina Dadachova and Arturo Casadevall. All rights reserved.http://www.hindawi.com/journals/ipid/2011/146376/To help understand the potential impact of bacterial coinfection during pandemic influenza periods, we undertook a far-reaching review of the existing literature to gain insights into the interaction of influenza and bacterial pathogens. Reports published between 1950 and 2006 were identified from scientific citation databases using standardized search terms. Study outcomes related to coinfection were subjected to a pooled analysis. Coinfection with influenza and bacterial pathogens occurred more frequently in pandemic compared with seasonal influenza periods. The most common bacterial coinfections with influenza virus were due to S. pneumoniae, H. influenzae, Staphylococcus spp., and Streptococcus spp. Of these, S. pneumoniae was the most common cause of bacterial coinfection with influenza and accounted for 40.8% and 16.6% of bacterial coinfections during pandemic and seasonal periods, respectively. These results suggest that bacterial pathogens will play a key role in many countries, as the H1N1(A) influenza pandemic moves forward. Given the role of bacterial coinfections during influenza epidemics and pandemics, the conduct of well-designed field evaluations of public health measures to reduce the burden of these common bacterial pathogens and influenza in at-risk populations is warranted.Xuan-Yi Wang, Paul E. Kilgore, Kyung Ah Lim, Song-Mei Wang, Jeongseok Lee, Wei Deng, Mei-Qi Mo, Batmunkh Nyambat, Jing-Chen Ma, Michael O. Favorov, and John D. ClemensCopyright © 2011 Xuan-Yi Wang et al. All rights reserved.http://www.hindawi.com/journals/ipid/2010/931530/Mycobacterium tuberculosis is the etiological agent of tuberculosis. The World Health Organization has estimated that 8 million of people develop active TB every year and the situation is complicated by an increase of Mycobacterium tuberculosis strains resistant to drugs used in antitubercular therapy: MDR and XDR-TB. Myrtle leaf extracts, used as an antiseptic in Sardinian traditional medicine, have strong antibacterial activity as several investigations showed. In this study we investigated the antimicrobial properties of the essential oil of Myrtus communis against clinical strains of M. tuberculosis and M. paratuberculosis.Stefania Zanetti, Sara Cannas, Paola Molicotti, Alessandra Bua, Marina Cubeddu, Silvia Porcedda, Bruno Marongiu, and Leonardo Antonio SechiCopyright © 2010 Stefania Zanetti et al. All rights reserved.http://www.hindawi.com/journals/ipid/2010/753512/Cryptosporidium spp. are coccidians, oocysts-forming apicomplexan protozoa, which complete their life cycle both in humans and animals, through zoonotic and anthroponotic transmission, causing cryptosporidiosis. The global burden of this disease is still underascertained, due to a conundrum transmission modality, only partially unveiled, and on a plethora of detection systems still inadequate or only partially applied for worldwide surveillance. In children, cryptosporidiosis encumber is even less recorded and often misidentified due to physiological reasons such as early-age unpaired immunological response. Furthermore, malnutrition in underdeveloped countries or clinical underestimation of protozoan etiology in developed countries contribute to the underestimation of the worldwide burden. Principal key indicators of the parasite distribution were associated to environmental (e.g., geographic and temporal clusters, etc.) and host determinants of the infection (e.g., age, immunological status, travels, community behaviours). The distribution was geographically mapped to provide an updated picture of the global parasite ecosystems. The present paper aims to provide, by a critical analysis of existing literature, a link between observational epidemiological records and new insights on public health, and diagnostic and clinical impact of cryptosporidiosis.Lorenza Putignani and Donato MenichellaCopyright © 2010 Lorenza Putignani and Donato Menichella. All rights reserved.http://www.hindawi.com/journals/ipid/2010/615604/The association between mental disorders (MDs) and iatrogenic complications after hip fracture surgery has been poorly studied. Among iatrogenic complications, nosocomial infections (NIs) are a major factor in hip fracture surgery. The aim of this paper was to determine whether patients with a MD and a hip fracture develop more NIs after hip surgery than patients with no MD. We studied 912 patients who underwent surgery for a hip fracture (223 patients with a MD who underwent surgery for a hip fracture and 689 control patients without a MD who also underwent surgery for a hip fracture) and followed them after surgery. Univariable and multivariable analyses were performed using simple and multiple logistic regression analysis (confidence interval, crude and adjusted odds ratios, and P value). We found that MDs, gender, and comorbidities were not associated with a higher risk of developing a NI after surgery for a hip fracture. Only age increases the risk of a NI.Enrique Guerado, Juan Ramon Cano, Encarnacion Cruz, Nicolás Benitez-Parejo, and Emilio Perea-MillaCopyright © 2010 Enrique Guerado et al. All rights reserved.http://www.hindawi.com/journals/ipid/2010/605125/Porphyromonas gingivalis and Treponema denticola are periodontal pathogens that express virulence factors associated with the pathogenesis of periodontitis. In this paper we tested the hypothesis that P. gingivalis and T. denticola are synergistic in terms of virulence; using a model of mixed microbial infection in rats. Groups of rats were orally infected with either P. gingivalis or T. denticola or mixed microbial infections for 7 and 12 weeks. P. gingivalis genomic DNA was detected more frequently by PCR than T. denticola. Both bacteria induced significantly high IgG, IgG2b, IgG1, IgG2a antibody levels indicating a stimulation of Th1 and Th2 immune response. Radiographic and morphometric measurements demonstrated that rats infected with the mixed infection exhibited significantly more alveolar bone loss than shaminfected control rats. Histology revealed apical migration of junctional epithelium, rete ridge elongation, and crestal alveolar bone resorption; resembling periodontal disease lesion. These results showed that P. gingivalis and T. denticola exhibit no synergistic virulence in a rat model of periodontal disease.Raj K. Verma, Sunethra Rajapakse, Archana Meka, Clayton Hamrick, Sheela Pola, Indraneel Bhattacharyya, Madhu Nair, Shannon M. Wallet, Ikramuddin Aukhil, and Lakshmyya KesavaluCopyright © 2010 Raj K. Verma et al. All rights reserved.http://www.hindawi.com/journals/ipid/2010/412624/Background. Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. In Armenia, case reports of active TB increased from 590 to 1538 between 1990 and 2003. However, the TB case detection rate in Armenia in 2007 was only 51%, indicating that many cases go undetected or that suspected cases are not referred for confirmatory diagnosis. Understanding why Armenians do not seek or delay TB medical care is important to increase detection rates, improve treatment outcomes, and reduce ongoing transmission. Methods. Two hundred-forty patients hospitalized between August 2006 and September 2007 at two Armenian TB reference hospitals were interviewed about symptoms, when they sought medical attention after symptom onset, outcomes of their first medical visit, and when they began treatment after diagnosis. We used logistic regression modeling to identify reasons for delay in diagnosis. Results. Fatigue and weight loss were significantly associated with delay in seeking medical attention [aOR=2.47 (95%CI=1.15, 5.29); aOR=2.99 (95%CI=1.46, 6.14), resp.], while having night sweats protected against delay [aOR=0.48 (95%CI=0.24, 0.96)]. Believing the illness to be something other than TB was also significantly associated with delay [aOR=2.63 (95%CI=1.13, 6.12)]. Almost 20% of the 240 TB patients were neither diagnosed at their first medical visit nor referred for further evaluation. Conclusions. This study showed that raising awareness of the signs and symptoms of TB among both the public and clinical communities is urgently needed.Dana Schneider, Scott J. N. McNabb, Marina Safaryan, Vladimir Davidyants, Ludmila Niazyan, and Sona OrbelyanCopyright © 2010 Dana Schneider et al. All rights reserved.http://www.hindawi.com/journals/ipid/2010/254159/Enteroaggregative Escherichia coli (EAEC) are quite heterogeneous category of an emerging enteric pathogen associated with cases of acute or persistent diarrhea worldwide in children and adults, and over the past decade has received increasing attention as a cause of watery diarrhea, which is often persistent. EAEC infection is an important cause of diarrhea in outbreak and non-outbreak settings in developing and developed countries. Recently, EAEC has been implicated in the development of irritable bowel syndrome, but this remains to be confirmed. EAEC is defined as a diarrheal pathogen based on its characteristic aggregative adherence (AA) to HEp-2 cells in culture and its biofilm formation on the intestinal mucosa with a “stacked-brick” adherence phenotype, which is related to the presence of a 60 MDa plasmid (pAA). At the molecular level, strains demonstrating the aggregative phenotype are quite heterogeneous; several virulence factors are detected by polymerase chain reaction; however, none exhibited 100% specificity. Although several studies have identified specific virulence factor(s) unique to EAEC, the mechanism by which EAEC exerts its pathogenesis is, thus, far unknown. The present review updates the current knowledge on the epidemiology, chronic complications, detection, virulence factors, and treatment of EAEC, an emerging enteric food borne pathogen.P. Kaur, A. Chakraborti, and A. AseaCopyright © 2010 P. Kaur et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/372691/Bhanja virus (BHAV) is pathogenic for young domestic ruminants and also for humans, causing fever and affections of the central nervous system. This generally neglected arbovirus of the family Bunyaviridae is transmitted by metastriate ticks of the genera Haemaphysalis, Dermacentor, Hyalomma, Rhipicephalus, Boophilus, and Amblyomma. Geographic distribution of BHAV covers southern and Central Asia, Africa, and southern (partially also central) Europe. Comparative biogeographic study of eight known natural foci of BHAV infections in Europe (in Italy, Croatia, Bulgaria, Slovakia) has revealed their common features. (1) submediterranean climatic pattern with dry growing season and wet mild winter (or microlimatically similar conditions, e.g., limestone karst areas in central Europe), (2) xerothermic woodland-grassland ecosystem, with plant alliances Quercetalia pubescentis, Festucetalia valesiacae, and Brometalia erecti, involving pastoral areas, (3) presence of at least one of the tick species Haemaphysalis punctata, Dermacentor marginatus, Rhipicephalus bursa, and/or Hyalomma marginatum, and (4) presence of ≥60% of the 180 BHAV bioindicator (157 plant, 4 ixodid tick, and 19 vertebrate spp.). On that basis, Greece, France (southern, including Corsica), Albania, Spain, Hungary, European Turkey, Ukraine (southern), Switzerland (southern), Austria (southeastern), Germany (southern), Moldova, and European Russia (southern) have been predicted as additional European regions where BHAV might occur.Zdenek HubálekCopyright © 2009 Zdenek Hubálek. All rights reserved.http://www.hindawi.com/journals/ipid/2009/137609/Fever in a returned traveller may be the manifestation of a self-limiting, trivial infection but it can also presage an infection that can be rapidly progressive and lethal. We studied the diagnostic accuracy of procalcitonin (PCT) as a biomarker for a bacterial cause of fever in a cohort of 157 consecutive travellers with fever after a stay in the (sub)tropics. Elevated procalcitonin levels were observed not only in about 50% of travellers with proven bacterial infection, but also in a significant proportion of travellers with a likely infection. Using a cutoff point of 0.5 ng/mL, procalcitonin had a sensitivity of 0.52 and a specificity of 0.76 for a bacterial cause of fever on admission. Interestingly, only 1 out of 16 patients with a proven viral infection had a marginally elevated PCT concentration on admission, suggesting that an increased PCT level likely excludes a viral infection as the cause of fever. However, the diagnostic accuracy of this semiquantitative procalcitonin test for a bacterial cause of fever on admission is too poor to advocate its use in the initial clinical evaluation of fever in a setting of ill-returned travellers.Dennis A. Hesselink, Hanna Bosmans-Timmerarends, Jan-Steven Burgerhart, Pieter L. Petit, and Perry J. van GenderenCopyright © 2009 Dennis A. Hesselink et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/984934/In vitro synergy testing using levofloxacin (LVX) plus piperacillin/tazobactam (TZP) was performed by Etest and time-kill assay (TKA) for 31 unique fluoroquinolone-resistant Pseudomonas aeruginosa isolates. The Etest method showed synergy for 9/31 (29%) of isolates, while TKA showed synergy with 14/31 (45%) of isolates. When comparing the Etest method and TKA, concordant results for synergy, antagonism, and indifference were obtained for 24/31 (77%) of the isolates tested.Vladimir Chachanidze, Aixa Curbelo-Irizarry, Deborah Ashcraft, and George PankeyCopyright © 2009 Vladimir Chachanidze et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/864359/Periodontal disease is one of the most common infectious diseases of humans. Immune responses to infection trigger loss of alveolar bone from the jaw and eventual tooth loss. We investigated the contribution of B cell IgD to alveolar bone loss by comparing the response of B cell normal BALB/cJ mice and IgD deficient BALB/c-Igh-5−/−J mice to oral infection with Porphyromonas gingivalis, a gram-negative periodontopathic bacterium from humans. P. gingivalis-infected normal mice lost bone. Specific antibody to P. gingivalis was lower and oral colonization was higher in IgD deficient mice; yet bone loss was completely absent. Infection increased the proportion of CD69+ activated B cells and CD4+ T cells in immune normal mice compared to IgD deficient mice. These data suggest that IgD is an important mediator of alveolar bone resorption, possibly through antigen-specific coactivation of B cells and CD4+ T cells.Pamela J. Baker, Nicole Ryan Boutaugh, Michaela Tiffany, and Derry C. RoopenianCopyright © 2009 Pamela J. Baker et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/476150/This study aimed at detecting the presence of antibiotic-resistant Gram-negatives in samples of meals delivered at the University General Hospital of Palermo, Italy. Antibiotic resistant Gram negatives were isolated in July—September 2007 ffrom cold dishes and food contact surfaces and utensils. Bacterial strains were submitted to susceptibility test and subtyped by random amplification of polymorphic DNA (RAPD). Forty-six of 55 (83.6%) food samples and 14 of 17 (82.3%) environmental swabs were culture positive for Gram negative bacilli resistant to at least one group of antibacterial drugs. A total of 134 antibiotic resistant strains, 51 fermenters and 83 non-fermenters, were recovered. Fermenters and non-fermenters showed frequencies as high as 97.8% of resistance to two or more groups of antibiotics and non fermenters were 28.9% resistant to more than three groups. Molecular typing detected 34 different profiles among the fermenters and 68 among the non-fermenters. Antibiotic resistance was very common among both fermenters and non-fermenters. However, the wide heterogeneity of RAPD patterns seems to support a prominent role of cross-contamination rather than a clonal expansion of a few resistant isolates. A contribution of commensal Gram negatives colonizing foods to a common bacterial resistance pool should not been overlooked.Maria Rosa Anna Plano, Anna Maria Di Noto, Alberto Firenze, Sonia Sciortino, and Caterina MamminaCopyright © 2009 Maria Rosa Anna Plano et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/513609/Georgia, a country of 4.5 million people, has a high incidence of tuberculosis (TB) including drug resistant cases. Easy access and inappropriate use of anti-TB drugs are risk factors for further development of multidrug resistant (MDR)-TB. We carried out an investigation to assess the availability of over the counter anti-TB agents in pharmacies in Tbilisi. During February 2006, 15 pharmacies were randomly selected and the pharmacist at each store was interviewed. We found that all anti-TB medications stocked by these pharmacies were available and sold without a prescription. All 15 pharmacies sold isoniazid, rifampicin, and streptomycin; 13 (87%) of 15 pharmacies also sold pyrazinamide, ethambutol. Second line anti-TB drugs such as amikacin and kanamycin (injectable agents) and older fluoroquinolones (ofloxacin and ciprofloxacin) were available at 13 pharmacies while newer generation fluoroquinolones were less available(3 sold leovofloxacin, none sold moxifloxacin). The ease access and availability of anti-TB agents is of a great concern given the high prevalence of TB including MDR-TB in Georgia. The potential for misuse of these anti-TB drugs can lead to the development of further drug resistance. These drugs should only be available by prescription in order to reduce the chance of amplifying drug resistance.Ketevan Kobaidze, Archil Salakaia, and Henry M. BlumbergCopyright © 2009 Ketevan Kobaidze et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/214216/Streptococcus pneumoniae is the most common bacterial cause of community-acquired meningitis worldwide. Despite optimal antibiotic therapy and supportive care, the mortality of this condition remains very high at 20–30% in the developed world and over 60% in under-resourced hospitals. In developed countries, approximately half of the survivors suffer intellectual impairment, hearing loss, or other neurological damage. There is an urgent need for more information about the mechanisms of brain damage and death in pneumococcal meningitis so that new treatments can be designed. Using proteomic techniques and bioinformatics, the protein content of cerebrospinal fluid can be examined in great detail. Animal models have added greatly to our knowledge of possible mechanisms and shown that hippocampal apoptosis and cortical necrosis are distinct mechanisms of neuronal death. The contribution of these pathways to human disease is unknown. Using proteomic techniques, neuronal death pathways could be described in CSF samples. This information could lead to the design of novel therapies to minimize brain damage and lower mortality. This minireview will summarize the known pathogenesis of meningitis, and current gaps in knowledge, that could be filled by proteomic analysis.U. R. Goonetilleke, S. A. Ward, and S. B. GordonCopyright © 2009 U. R. Goonetilleke et al. All rights reserved.http://www.hindawi.com/journals/ipid/2009/840452/During the latter half of the twentieth century, fungal pathogens such as Cryptococcus neoformans were increasingly recognized as a significant threat to the health of immune compromised populations throughout the world. Until recently, the closely related species C. gattii was considered to be a low-level endemic pathogen that was confined to tropical regions such as Australia. Since 1999, C. gattii has emerged in the Pacific Northwest region of North America and has been responsible for a large disease epidemic among generally healthy individuals. The changing epidemiology of C. gattii infection is likely to be a consequence of alterations in fungal ecology and biology and illustrates its potential to cause serious human disease. This review summarizes selected biological and clinical aspects of C. gattii that are particularly relevant to the recent North American outbreak and compares these to the Australian and South American experience.Ashwin Dixit, Scott F. Carroll, and Salman T. QureshiCopyright © 2009 Ashwin Dixit et al. All rights reserved.