Interdisciplinary Perspectives on Infectious Diseases http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Influenza A/H1N1 Severe Pneumonia: Novel Morphocytological Findings in Bronchoalveolar Lavage Tue, 14 Oct 2014 13:56:29 +0000 http://www.hindawi.com/journals/ipid/2014/470825/ We present the results of bronchoalveolar lavage (BAL) performed in three patients with severe influenza A/H1N1 pneumonia complicated by acute respiratory distress syndrome (ARDS). Light microscopy analysis of BAL cytocentrifugates showed the presence of characteristic large, mononuclear, plasmoblastic/plasmocytoid-like cells never described before. Via transmission electron microscopy, these cells were classified as atypical type II pneumocytes and some of them showed cytoplasmic vesicles and inclusions. We concluded that plasmoblastic/plasmocytoid-like type II pneumocytes might represent a morphologic marker of A/H1N1 influenza virus infection as well as reparative cellular activation after diffuse alveolar damage. Paola Faverio, Stefano Aliberti, Clinton Ezekiel, Grazia Messinesi, Ambrogio Brenna, and Alberto Pesci Copyright © 2014 Paola Faverio et al. All rights reserved. Ecotope-Based Entomological Surveillance and Molecular Xenomonitoring of Multidrug Resistant Malaria Parasites in Anopheles Vectors Wed, 01 Oct 2014 06:11:18 +0000 http://www.hindawi.com/journals/ipid/2014/969531/ The emergence and spread of multidrug resistant (MDR) malaria caused by Plasmodium falciparum or Plasmodium vivax have become increasingly important in the Greater Mekong Subregion (GMS). MDR malaria is the heritable and hypermutable property of human malarial parasite populations that can decrease in vitro and in vivo susceptibility to proven antimalarial drugs as they exhibit dose-dependent drug resistance and delayed parasite clearance time in treated patients. MDR malaria risk situations reflect consequences of the national policy and strategy as this influences the ongoing national-level or subnational-level implementation of malaria control strategies in endemic GMS countries. Based on our experience along with current literature review, the design of ecotope-based entomological surveillance (EES) and molecular xenomonitoring of MDR falciparum and vivax malaria parasites in Anopheles vectors is proposed to monitor infection pockets in transmission control areas of forest and forest fringe-related malaria, so as to bridge malaria landscape ecology (ecotope and ecotone) and epidemiology. Malaria ecotope and ecotone are confined to a malaria transmission area geographically associated with the infestation of Anopheles vectors and particular environments to which human activities are related. This enables the EES to encompass mosquito collection and identification, salivary gland DNA extraction, Plasmodium- and species-specific identification, molecular marker-based PCR detection methods for putative drug resistance genes, and data management. The EES establishes strong evidence of Anopheles vectors carrying MDR P. vivax in infection pockets epidemiologically linked with other data obtained during which a course of follow-up treatment of the notified P. vivax patients receiving the first-line treatment was conducted. For regional and global perspectives, the EES would augment the epidemiological surveillance and monitoring of MDR falciparum and vivax malaria parasites in hotspots or suspected areas established in most endemic GMS countries implementing the National Malaria Control Programs, in addition to what is guided by the World Health Organization. Prapa Sorosjinda-Nunthawarasilp and Adisak Bhumiratana Copyright © 2014 Prapa Sorosjinda-Nunthawarasilp and Adisak Bhumiratana. All rights reserved. Effect of Different Terpene-Containing Essential Oils on the Proliferation of Echinococcus granulosus Larval Cells Sun, 28 Sep 2014 10:00:18 +0000 http://www.hindawi.com/journals/ipid/2014/746931/ Human cystic echinococcosis remains a major public health problem on several countries and the treatment strategies are not solved. The aim of the present work was to determine the in vitro effect of thymol and Mentha piperita, M. pulegium, and Rosmarinus officinalis essential oils on the proliferation of E. granulosus larval cells. Isolated cells and cellular aggregates were obtained from hydatid cyst’s germinal layer and exposed to 1, 5, and 10 μg/ml of thymol and the different essential oils for 7 days. Drug effect was evaluated using test viability and scanning electron microscopy. Control cell culture viability was 2.1 x 106 (100%) after 7 days of incubation. At day 7, thymol 5 μg/ml caused a reduction in cell viability of 63% and the essential oils of M. piperita 10 μg/ml, M. pulegium 10 μg/ml, and R. officinalis 10 μg/ml produced a reduction in the viability of 77, 82, and 71%, respectively. Moreover essential oils caused reduction in cell number, collapsed cells, and loss of normal tridimensional composition of the aggregates. Due to the inhibitory effect caused by essential oils on E. granulosus cells we suggested that it would be an effective means for suppression of larval growth. Clara María Albani, Guillermo María Denegri, and María Celina Elissondo Copyright © 2014 Clara María Albani et al. All rights reserved. The Prevalence of HIV by Ethnic Group Is Correlated with HSV-2 and Syphilis Prevalence in Kenya, South Africa, the United Kingdom, and the United States Wed, 24 Sep 2014 08:41:03 +0000 http://www.hindawi.com/journals/ipid/2014/284317/ Background. This paper investigates two issues: do ethnic/racial groups with high HIV prevalences also have higher prevalences of other STIs? and is HIV prevalence by ethnic group correlated with the prevalence of circumcision, concurrency, or having more than one partner in the preceding year? Methods. We used Spearman’s correlation to estimate the association between the prevalence of HIV per ethnic/racial group and HSV-2, syphilis, symptoms of an STI, having more than one partner in the past year, concurrency, and circumcision in Kenya, South Africa, the United Kingdom, and the United States. Results. We found that in each country HSV-2, syphilis, and symptomatic STIs were positively correlated with HIV prevalence (HSV-2: Kenya rho = 0.50, P = 0.207; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, Syphilis: Kenya rho = 0.33, P = 0.420; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, and STI symptoms: Kenya rho = 0.92, P = 0.001; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). The prevalence of circumcision was only negatively associated with HIV prevalence in Kenya. Both having more than one partner in the previous year and concurrency were positively associated with HIV prevalence in all countries (concurrency: Kenya rho = 0.79, P = 0.036; South Africa rho-1, P = 0.000; UK 0.87, P = 0.058; USA rho-1, P = 0.000 and multiple partners: Kenya rho = 0.82, P = 0.023; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). Not all associations were statistically significant. Conclusion. Further attention needs to be directed to what determines higher rates of partner change and concurrency in communities with high STI prevalence. Chris Richard Kenyon, Kara Osbak, and Jozefien Buyze Copyright © 2014 Chris Richard Kenyon et al. All rights reserved. In Vitro Cestocidal Activity of Thymol on Mesocestoides corti Tetrathyridia and Adult Worms Wed, 03 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/ipid/2014/268135/ Nothing is known about the possible effect of thymol or other compounds of essential oils against the adult worms of cestodes. The aim of the present work was to determine in vitro cestodicidal activity of thymol against Mesocestoides corti adult worms. Moreover, the in vitro effect on tetrathyridia was also demonstrated. Tetrathyridia exposed to different concentrations of thymol showed a concentration and time-dependent effect. At lower concentrations, the main change observed was mainly in morphology, with larvae exhibiting an elongation of the body. When tetrathyridia were exposed to higher concentrations, increased surface alterations and damage were detected. The body appeared elongated and flattened, and a complete loss of morphology and microtriches was observed. Thymol was able to kill M. corti tetrathyridia, since following inoculation of treated parasites in mice no parasites could be recovered. The effect on M. corti adult worms was dose and time-dependent. Changes in motility coincide with the tissue damage were observed at the structural and ultrastructural level. Thymol caused severe damages to both developmental stages analyzed. Damages were more significant in fully segmented worms. The data reported in this paper demonstrate a clear in vitro effect of thymol against M. corti tetrathyridia and adult worms. M. Maggiore and M. C. Elissondo Copyright © 2014 M. Maggiore and M. C. Elissondo. All rights reserved. Antibiotic Resistance Profiling of Staphylococcus aureus Isolated from Clinical Specimens in a Tertiary Hospital from 2010 to 2012 Wed, 03 Sep 2014 00:00:00 +0000 http://www.hindawi.com/journals/ipid/2014/898457/ MRSA infection can affect a wide array of individuals that may lead to treatment failure. Also, the infection has the potential to spread from one area to another particularly health care facilities or communities eventually causing minor outbreaks. With this premise, the study aimed to describe MRSA infections using the hospital-based data of a tertiary hospital in Bacolod City, Philippines, from 2010 to 2012. Specifically, this study aimed to evaluate the antimicrobial resistance of S. aureus isolated from clinical specimens and to put emphasis on the prevalence of MRSA and Inducible Clindamycin Resistance. A total of 94 cases from 2010 to 2012 were diagnosed to have S. aureus infection using conventional bacteriologic methods. From these cases, 38 (40.6%) were identified as MRSA and 37 (39.4%) were inducible clindamycin resistant. Wounds and abscesses were considered to be the most common specimens with MRSA infections having 71.05% while blood was the least with 5.3%. For drug susceptibility, out of the 94 S. aureus cases, including MRSA, 100% were susceptible to linezolid making it the drug of choice for this study. It was then followed by tetracycline having a mean susceptibility of 95%;, while penicillin G was ineffective with 94 cases having 0% susceptibility. Alain C. Juayang, Gemma B. de los Reyes, April Joy G. de la Rama, and Christine T. Gallega Copyright © 2014 Alain C. Juayang et al. All rights reserved. Clinical Features and Outcome of Mucormycosis Wed, 20 Aug 2014 08:38:34 +0000 http://www.hindawi.com/journals/ipid/2014/562610/ Mucormycosis (MCM) is a life-threatening infection that carries high mortality rates despite recent advances in its diagnosis and treatment. The objective was to report 14 cases of mucormycosis infection and review the relevant literature. We retrospectively analyzed the demographic and clinical data of 14 consecutive patients that presented with MCM in a tertiary-care teaching hospital in northern Mexico. The mean age of the patients was 39.9 (range 5–65). Nine of the patients were male. Ten patients had diabetes mellitus as the underlying disease, and 6 patients had a hematological malignancy (acute leukemia). Of the diabetic patients, 3 had chronic renal failure and 4 presented with diabetic ketoacidosis. All patients had rhinocerebral involvement. In-hospital mortality was 50%. All patients received medical therapy with polyene antifungals and 11 patients underwent surgical therapy. Survivors were significantly younger and less likely to have diabetes than nonsurvivors, and had higher levels of serum albumin on admission. The clinical outcome of patients with MCM is poor. Uncontrolled diabetes and age are negative prognostic factors. Carlos Rodrigo Camara-Lemarroy, Emmanuel Irineo González-Moreno, René Rodríguez-Gutiérrez, Erick Joel Rendón-Ramírez, Ana Sofía Ayala-Cortés, Martha Lizeth Fraga-Hernández, Laura García-Labastida, and Dionicio Ángel Galarza-Delgado Copyright © 2014 Carlos Rodrigo Camara-Lemarroy et al. All rights reserved. Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility Sun, 17 Aug 2014 00:00:00 +0000 http://www.hindawi.com/journals/ipid/2014/291841/ The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard . A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; (95% CI: 0.10–0.18) and on lymphadenopathy moderate (95% CI: 0.18–0.36). M.O [75% (95% CI: 34.9%–96.8%)] and C.Os [63% (95% CI: 24.5%–91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features. G. Kaguthi, V. Nduba, J. Nyokabi, F. Onchiri, R. Gie, and M. Borgdorff Copyright © 2014 G. Kaguthi et al. All rights reserved. The Impact of Cooperative Social Organization on Reducing the Prevalence of Malaria and Intestinal Parasite Infections in Awramba, a Rural Community in South Gondar, Ethiopia Mon, 11 Aug 2014 06:46:52 +0000 http://www.hindawi.com/journals/ipid/2014/378780/ Introduction. Parasitic diseases are the major causes of human health problem in Ethiopia. The high prevalence of parasitic infections is closely correlated with poverty, poor environmental hygiene, and impoverished health services. Objective. The study was conducted to assess the impact of health-conscious Awramba cooperative community and its neighboring communities on the prevalence of parasitic infections in South Gondar, Ethiopia. Methods. Single stool specimens were collected from 392 individuals from Awramba and the neighboring communities. Specimens were examined microscopically for the presence of parasites using microscopy. Questionnaire was administered to determine the knowledge attitude and practice (KAP) of study participants. Results. Of the total 392 study participants examined, 58(14.8%) were positive for malaria and 173 (44.1%) for intestinal parasites. The prevalence of malaria in Awramba community (5.1%) was less than that in neighboring communities (24.5%). The prevalence of parasitic infections in Awramba (18.8%) was less than that of the neighboring communities (69.4%). Conclusion. This study showed that good household and environmental hygiene, good toilet construction and usage, and proper utilization of ITN in Awramba cooperative community have significantly contributed to the reduction of the burden of parasitic infections. Thus, the positive achievement in reducing parasitic infections in Awramba cooperative community could be used as a model for affordable health intervention in the neighboring communities, in particular, and the whole country in general. Gebeyehu Yihenew, Haileeyesus Adamu, and Beyene Petros Copyright © 2014 Gebeyehu Yihenew et al. All rights reserved. Performance of an ELISA and Indirect Immunofluorescence Assay in Serological Diagnosis of Zoonotic Cutaneous Leishmaniasis in Iran Mon, 11 Aug 2014 05:28:39 +0000 http://www.hindawi.com/journals/ipid/2014/505134/ Serological assays have been extensively evaluated for diagnosis of visceral leishmaniasis (VL) and considered as a routine method for diagnosis of VL while these methods are not properly evaluated for diagnosis of cutaneous leishmaniasis (CL). This study aimed to assess the performance of indirect immunofluorescent-antibody test (IFA) and enzyme-linked immunosorbent assay (ELISA) for serodiagnosis of cutaneous leishmaniasis in Iran. Sixty-one sera samples from parasitologically confirmed CL patients and 50 sera from healthy controls along with 50 sera from non-CL patients were collected. Antigen was prepared from promastigotes and amastigotes of Leishmania major. IFA was used to detect anti-Leishmania IgG while ELISA was used to detect anti-Leishmania IgM, total IgG, or IgG subclasses (IgG1 and 4). ELISA, for detection of total IgG and IgM, showed sensitivity of 83.6% and 84.7% and specificity of 62.7% and 54.6%, respectively. Sensitivity and specificity of ELISA for detecting IgG1 and IgG4 were 64%, 75% and 85%, 49%, respectively. Sensitivity and specificity of IFA were 91.6% and 81%. Conclusion. Findings of this study demonstrated that serological test, especially IFA, can be used for proper diagnosis of CL. Bahador Sarkari, Marzieh Ashrafmansouri, GholamReza Hatam, Parvaneh Habibi, and Samaneh Abdolahi Khabisi Copyright © 2014 Bahador Sarkari et al. All rights reserved. Efficacy of Essential Oils of Thymus vulgaris and Origanum vulgare on Echinococcus granulosus Sun, 10 Aug 2014 12:50:27 +0000 http://www.hindawi.com/journals/ipid/2014/693289/ The aim of the present work was to determine the in vitro effect of T. vulgaris and O. vulgare essential oils against E. granulosus protoscoleces and cysts. Essential oils were added to the medium resulting in thymol final concentrations of 10 μg/mL. The essential oils had a time-dependent effect provoking the complete loss of protoscolex viability after 72 days of postincubation. The results were confirmed at the ultrastructure level. Loss of infectivity in protoscoleces incubated with O. vulgare after 60 days was observed. On the other hand, the weight of cysts recorded in mice inoculated with T. vulgaris treated protoscoleces was significantly lower than that obtained in control group. Gamma-glutamyl-transpeptidase activity was readily detected in the culture supernatant of protoscoleces treated either with the essential oils or thymol. T. vulgaris and O. vulgare essential oils and thymol can induce cell apoptosis of protoscoleces after short incubation times. The efficacy of T. vulgaris and O. vulgare essential oils was also demonstrated in vitro on E. granulosus murine cysts. Our data suggest that essential oils of T. vulgaris and O. vulgare have anthelmintic effect against protoscoleces and cysts of E. granulosus. P. E. Pensel, M. A. Maggiore, L. B. Gende, M. J. Eguaras, M. G. Denegri, and M. C. Elissondo Copyright © 2014 P. E. Pensel et al. All rights reserved. Multidrug Resistance: An Emerging Crisis Wed, 16 Jul 2014 10:52:34 +0000 http://www.hindawi.com/journals/ipid/2014/541340/ The resistance among various microbial species (infectious agents) to different antimicrobial drugs has emerged as a cause of public health threat all over the world at a terrifying rate. Due to the pacing advent of new resistance mechanisms and decrease in efficiency of treating common infectious diseases, it results in failure of microbial response to standard treatment, leading to prolonged illness, higher expenditures for health care, and an immense risk of death. Almost all the capable infecting agents (e.g., bacteria, fungi, virus, and parasite) have employed high levels of multidrug resistance (MDR) with enhanced morbidity and mortality; thus, they are referred to as “super bugs.” Although the development of MDR is a natural phenomenon, the inappropriate use of antimicrobial drugs, inadequate sanitary conditions, inappropriate food-handling, and poor infection prevention and control practices contribute to emergence of and encourage the further spread of MDR. Considering the significance of MDR, this paper, emphasizes the problems associated with MDR and the need to understand its significance and mechanisms to combat microbial infections. Jyoti Tanwar, Shrayanee Das, Zeeshan Fatima, and Saif Hameed Copyright © 2014 Jyoti Tanwar et al. All rights reserved. ITS1 PCR-RFLP Diagnosis and Characterization of Leishmania in Clinical Samples and Strains from Cases of Human Cutaneous Leishmaniasis in States of the Mexican Southeast Tue, 01 Jul 2014 08:46:22 +0000 http://www.hindawi.com/journals/ipid/2014/607287/ American cutaneous leishmaniasis includes a spectrum of clinical forms localized cutaneous, diffuse cutaneous, and mucocutaneous leishmaniasis which can be caused by different strains of Leishmania belonging to the L. mexicana or L. braziliensis complexes which may coexist in the same endemic area. We evaluated the PCR-RFLP assay of the ITS1 genes for direct identification of Leishmania species in 163 clinical samples and 21 Mexican isolates of Leishmania. In relation to the Mexican isolates of Leishmania 52% displayed a pattern similar to the L. (L.) mexicana, 5% showed a mixed pattern compatible with L. (L.) mexicana and L. (V.) braziliensis, eight with L. (L.) amazonensis and L. (L.) mexicana, and one to L. (V.) braziliensis. Most of the clinical samples, 109/116 (94%), gave a pattern similar to that of the L. mexicana, two clinical samples gave similar patterns to that of Leishmania braziliensis, and 5 samples gave patterns that suggest a coinfection of L. (L.) mexicana and L. (V.) braziliensis or L. (L.) mexicana and L. (L.) amazonensis. The ITS1 PCR-RFLP assay is a multipurpose tool for diagnosis of Leishmania from clinical samples and enables determination of the infecting species of New World Leishmania in the field in relatively short time and low cost. Amalia Monroy-Ostria, Abedelmajeed Nasereddin, Victor M. Monteon, Carmen Guzmán-Bracho, and Charles L. Jaffe Copyright © 2014 Amalia Monroy-Ostria et al. All rights reserved. HIV Risk Perception, Sexual Behavior, and HIV Prevalence among Men-Who-Have-Sex-with-Men at a Community-Based Voluntary Counseling and Testing Center in Kuala Lumpur, Malaysia Wed, 25 Jun 2014 11:41:08 +0000 http://www.hindawi.com/journals/ipid/2014/236240/ We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk. Kwee Choy Koh and Lit Sin Yong Copyright © 2014 Kwee Choy Koh and Lit Sin Yong. All rights reserved. Impact of Environmental Conditions on the Survival of Cryptosporidium and Giardia on Environmental Surfaces Tue, 17 Jun 2014 07:58:40 +0000 http://www.hindawi.com/journals/ipid/2014/210385/ The objective of this study was to find out the impact of environmental conditions on the survival of intestinal parasites on environmental surfaces commonly implicated in the transmission of these parasites. The study was performed by incubating Cryptosporidium and Giardia (oo)cysts on environmentally relevant surfaces such as brushed stainless steel, formica, ceramic, fabric, and skin. Parallel experiments were conducted using clean and soiled coupons incubated under three temperatures. The die-off coefficient rates () were calculated using first-order exponential formula. For both parasites, the fastest die-off was recorded on fabric, followed by ceramic, formica, skin, and steel. Die-off rates were directly correlated to the incubation temperatures and surface porosity. The presence of organic matter enhanced the survivability of the resting stages of test parasites. The decay rates calculated in this study can be used in models for public health decision-making process and highlights the mitigation role of hand hygiene agents in their prevention and control. Absar Alum, Isra M. Absar, Hamas Asaad, Joseph R. Rubino, and M. Khalid Ijaz Copyright © 2014 Absar Alum et al. All rights reserved. Cervical Infection with Herpes simplex Virus, Chlamydia trachomatis, and Neisseria gonorrhoeae among Symptomatic Women, Dubai, UAE: A Molecular Approach Tue, 27 May 2014 08:57:03 +0000 http://www.hindawi.com/journals/ipid/2014/347602/ Tragically, genital tract infections are still a major public health problem in many regions. This study was undertaken to determine the prevalence of cervical infection with Herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among married women referring to Iranian Hospital, Dubai, UAE. In a retrospective cross-sectional survey, 201 female patients aged 16–80 years who referred to the Obstetrics and Gynecology Department of Iranian Hospital, Dubai, UAE, in 2010 were enrolled. The patients were categorized into three age groups: 15–30 (group I), 31–40 (group II), and 41 years old (group III). A cervical swab sample was collected from each woman and the prevalence of cervical infection with HSV, CT, and NG was determined by PCR method. HSV, CT, and NG were detected in 6.5%, 10.4%, and 5.5% of swab samples, respectively. Regarding age, a significant difference was noticed for prevalence of NG and HSV between groups I and III. Because of public health importance of sexual transmitted diseases (STDs), their long-lasting impact on quality of life, and their economic burden, preventing measures and education of women seem necessary. Davood Mehrabani, Mohammad Amin Behzadi, Saeed Azizi, Hamid Payombarnia, Ali Vahdani, Mandana Namayandeh, and Mazyar Ziyaeyan Copyright © 2014 Davood Mehrabani et al. All rights reserved. Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review Wed, 07 May 2014 15:15:39 +0000 http://www.hindawi.com/journals/ipid/2014/849432/ HIV positive patients on ritonavir-containing antiretroviral therapy (ART) can develop iatrogenic Cushing syndrome (IACS) and adrenal insufficiency as a result of drug-drug interactions with inhaled or intranasal glucocorticoid therapy. Reports related to epidural triamcinolone injections are relatively uncommon but increasingly reported. We describe a 48-year-old woman with immunologically and virologically well-controlled HIV on ritonavir-based ART, who developed headache, dizziness, and candida and herpes simplex virus (HSV) ulcerative esophagitis 7 days after receiving an epidural triamcinolone injection for cervical radicular pain. Iatrogenic Cushing syndrome and relative adrenal insufficiency were suspected and proven. The patient’s ART was changed to a non-HIV protease inhibitor- (PI-) containing program, her symptoms improved, and she did not require hydrocortisone replacement. In this paper, we review the literature on IACS and relative secondary adrenal insufficiency from epidural triamcinolone injections in HIV patients on ritonavir-containing ART regimens. A high index of clinical suspicion is needed for diagnosis. Prevention of drug-drug interactions by taking a thorough medication history for patients on ritonavir-containing ART regimens before prescribing any form of corticosteroid is crucial and effective and sustained interdisciplinary communication in the care of such patients. Sapna Sadarangani, Melody L. Berg, William Mauck, and Stacey Rizza Copyright © 2014 Sapna Sadarangani et al. All rights reserved. Serotypes and Antimicrobial Resistance of Human Nontyphoidal Isolates of Salmonella enterica from Crete, Greece Tue, 22 Apr 2014 00:00:00 +0000 http://www.hindawi.com/journals/ipid/2014/256181/ We report on the serotype distribution and the antimicrobial resistance patterns to 20 different antimicrobials of 150 Salmonella enterica strains isolated from stools of diarrhoeal patients on the island of Crete over the period January 2011-December 2012. Among the S. enterica serotypes recovered, Enteritidis was the most prevalent (37.3%), followed by Typhimurium (28.7%) and Newport (8.7%). No resistance was detected to extended-spectrum cephalosporins and carbapenems. Rates of resistance to ampicillin, amoxicillin/clavulanic acid, chloramphenicol, tetracycline, and cotrimoxazole were 9.3%, 4%, 2%, 15.3%, and 8.7%, respectively. Resistance to ≥4 antibiotics was primarily observed for serotypes Typhimurium and Hadar. Enteritidis remains the predominant serotype in Crete. Although low resistance to most antimicrobials was detected, continued surveillance of susceptibility is needed due to the risk of resistance. Sofia Maraki and Ioannis S. Papadakis Copyright © 2014 Sofia Maraki and Ioannis S. Papadakis. All rights reserved. Thailand Momentum on Policy and Practice in Local Legislation on Dengue Vector Control Tue, 01 Apr 2014 07:50:33 +0000 http://www.hindawi.com/journals/ipid/2014/217237/ Over a past decade, an administrative decentralization model, adopted for local administration development in Thailand, is replacing the prior centralized (top-down) command system. The change offers challenges to local governmental agencies and other public health agencies at all the ministerial, regional, and provincial levels. A public health regulatory and legislative framework for dengue vector control by local governmental agencies is a national topic of interest because dengue control program has been integrated into healthcare services at the provincial level and also has been given priority in health plans of local governmental agencies. The enabling environments of local administrations are unique, so this critical review focuses on the authority of local governmental agencies responsible for disease prevention and control and on the functioning of local legislation with respect to dengue vector control and practices. Adisak Bhumiratana, Apiradee Intarapuk, Suriyo Chujun, Wuthichai Kaewwaen, Prapa Sorosjinda-Nunthawarasilp, and Surachart Koyadun Copyright © 2014 Adisak Bhumiratana et al. All rights reserved. Frequencies of Blood Group Systems MNS, Diego, and Duffy and Clinical Phases of Carrion’s Disease in Amazonas, Peru Mon, 31 Mar 2014 09:24:33 +0000 http://www.hindawi.com/journals/ipid/2014/576107/ Carrion’s disease (CD), is a human bartonellosis, that is, endemic in the Andes of Peru, Ecuador, and Colombia. Bartonella bacilliformis, a native hemotrophic bacteria, is the causative agent of CD, and the interaction with the host could have produced changes in the gene frequencies of erythrocyte antigens. The goal here is to investigate the relationship between allele frequencies of blood group systems MNS, Diego, and Duffy and the clinical phases of CD, within a genetic context. In this associative and analytical study, 76 individuals from Bagua Grande, the province of Utcubamba, and the department of Amazonas in Peru, were enrolled. Forty of them resided in Tomocho-Collicate-Vista Hermosa area (high prevalence of cases in chronic phase, verrucous, or eruptive phase, without previous acute phase). Thirty-six individuals were from the area of Miraflores (high prevalence of cases in acute phase only) and were evaluated for blood group systems MNS, Diego, and Duffy. This study constitutes one of the first attempts at evaluating the genetic factors and clinical phases of CD. No significant statistical differences between allele frequencies of blood groups MNS, Diego, and Duffy and the prevalence of chronic and acute phases were detected in the two areas of Amazonas, Peru. Oscar Acosta, Luis Solano, Jorge Escobar, Miguel Fernandez, Carlos Solano, and Ricardo Fujita Copyright © 2014 Oscar Acosta et al. All rights reserved. A Multicenter Study of Beta-Lactamase Resistant Escherichia coli and Klebsiella pneumoniae Reveals High Level Chromosome Mediated Extended Spectrum β Lactamase Resistance in Ogun State, Nigeria Mon, 24 Mar 2014 12:02:15 +0000 http://www.hindawi.com/journals/ipid/2014/819896/ As a result of the ever increasing problem of multiresistant bacteria, we instituted a surveillance program with the aim of identifying the basic molecular properties of ESBL in our environment. About 197 isolates of Escherichia coli and Klebsiella pneumoniae were selected and tested for ESBL production and antimicrobial susceptibility. Plasmid profiles were determined and curing ability was tested. ESBL prevalence was 26.4% for all isolates tested, with E. coli having a greater proportion. There was absolute resistance to ampicilin, tetracycline, and co-trimaxole among tested isolates. There was above average susceptibility to the 2nd and 3rd generation cephalosporins. Plasmid profiles of tested isolates ranged from 9 kbp to 26 kbp with average of  kbp for E. coli and  kbp K. pneumoniae, 9.6% of ESBL positive E. coli plasmids were cured, while 3.9% of K. pneumoniae plasmids were cured after treatment. The present study shows an upsurge in ESBL acquisition by gram negative bacteria and evidence of cocirculation of varying subtypes of ESBL with both plasmid transmissible and chromosome encoded subtypes. This calls for universal surveillance and more effort towards molecular epidemiology of this public health treatment. Folasoge A. Adeyankinnu, Babatunde O. Motayo, Akinniyi Akinduti, John Akinbo, Joseph I. Ogiogwa, Bukola W. Aboderin, and R. A. Agunlejika Copyright © 2014 Folasoge A. Adeyankinnu et al. All rights reserved. A Comparative Systematic Review of the Optimal CD4 Cell Count Threshold for HIV Treatment Initiation Thu, 20 Mar 2014 08:48:34 +0000 http://www.hindawi.com/journals/ipid/2014/625670/ HIV infection is no longer characterized by high morbidity, rapid progression to AIDS, and death as when the infection was first identified. While anti-retroviral drugs have improved the outcome of AIDS patients, clinical research on the appropriate time to initiate therapy continues to evolve. Optimal therapy initiation would maximize the benefits of these drugs, while minimizing side effects and drug resistance. Recent 2013 WHO guidelines changed HIV therapy initiation from 350 cells/μL to 500 cells/μL. This systematic review provides an evidence-based comparison of starting treatment at >500 cells/μL with starting treatment at the range between 350 cells/μL and 500 cells/μL. An 11% increase in risk was detected from initiation therapy at the 350–500 cells/μL range (0.37 [0.26, 0.53]), when compared with starting treatment before 500 cells/μL (0.33 [0.22, 0.48]). Most individual study comparisons showed a benefit for starting treatment at 500 cells/μL in comparison with starting at the 350–500 cells/μL range with risks ranging from 19% to 300%, though a number of comparisons were not statistically significant. Overall, the study provides evidence based support for initiating anti retroviral therapy at cell counts >500 cells/μL wherever possible to prevent AIDS mortality and morbidity. Babatunde Olubajo, Kathryn Mitchell-Fearon, and Oluseye Ogunmoroti Copyright © 2014 Babatunde Olubajo et al. All rights reserved. Identification of Sphingomyelinase on the Surface of Chlamydia pneumoniae: Possible Role in the Entry into Its Host Cells Thu, 13 Mar 2014 12:28:23 +0000 http://www.hindawi.com/journals/ipid/2014/412827/ We have recently suggested a novel mechanism, autoendocytosis, for the entry of certain microbes into their hosts, with a key role played by the sphingomyelinase-catalyzed topical conversion of sphingomyelin to ceramide, the differences in the biophysical properties of these two lipids providing the driving force. The only requirement for such microbes to utilize this mechanism is that they should have a catalytically active SMase on their outer surface while the target cells should expose sphingomyelin in the external leaflet of their plasma membrane. In pursuit of possible microbial candidates, which could utilize this putative mechanism, we conducted a sequence similarity search for SMase. Because of the intriguing cellular and biochemical characteristics of the poorly understood entry of Chlamydia into its host cells these microbes were of particular interest. SMase activity was measured in vitro from isolated C. pneumoniae elementary bodies (EB) and in the lysate from E. coli cells transfected with a plasmid expressing CPn0300 protein having sequence similarity to SMase. Finally, pretreatment of host cells with exogenous SMase resulting in loss plasma membrane sphingomyelin attenuated attachment of EB. Tuula A. Peñate Medina, Juha T. Korhonen, Riitta Lahesmaa, Mirja Puolakkainen, Oula Peñate Medina, and Paavo K. J. Kinnunen Copyright © 2014 Tuula A. Peñate Medina et al. All rights reserved. Serine Proteases of Malaria Parasite Plasmodium falciparum: Potential as Antimalarial Drug Targets Tue, 11 Mar 2014 11:36:44 +0000 http://www.hindawi.com/journals/ipid/2014/453186/ Malaria is a major global parasitic disease and a cause of enormous mortality and morbidity. Widespread drug resistance against currently available antimalarials warrants the identification of novel drug targets and development of new drugs. Malarial proteases are a group of molecules that serve as potential drug targets because of their essentiality for parasite life cycle stages and feasibility of designing specific inhibitors against them. Proteases belonging to various mechanistic classes are found in P. falciparum, of which serine proteases are of particular interest due to their involvement in parasite-specific processes of egress and invasion. In P. falciparum, a number of serine proteases belonging to chymotrypsin, subtilisin, and rhomboid clans are found. This review focuses on the potential of P. falciparum serine proteases as antimalarial drug targets. Asrar Alam Copyright © 2014 Asrar Alam. All rights reserved. Multilocus Sequence Typing for Interpreting Blood Isolates of Staphylococcus epidermidis Sun, 02 Mar 2014 11:14:53 +0000 http://www.hindawi.com/journals/ipid/2014/787458/ Staphylococcus epidermidis is an important cause of nosocomial infection and bacteremia. It is also a common contaminant of blood cultures and, as a result, there is frequently uncertainty as to its diagnostic significance when recovered in the clinical laboratory. One molecular strategy that might be of value in clarifying the interpretation of S. epidermidis identified in blood culture is multilocus sequence typing. Here, we examined 100 isolates of this species (50 blood isolates representing true bacteremia, 25 likely contaminant isolates, and 25 skin isolates) and the ability of sequence typing to differentiate them. Three machine learning algorithms (classification regression tree, support vector machine, and nearest neighbor) were employed. Genetic variability was substantial between isolates, with 44 sequence types found in 100 isolates. Sequence types 2 and 5 were most commonly identified. However, among the classification algorithms we employed, none were effective, with CART and SVM both yielding only 73% diagnostic accuracy and nearest neighbor analysis yielding only 53% accuracy. Our data mirror previous studies examining the presence or absence of pathogenic genes in that the overlap between truly significant organisms and contaminants appears to prevent the use of MLST in the clarification of blood cultures recovering S. epidermidis. Prannda Sharma, Ashley E. Satorius, Marika R. Raff, Adriana Rivera, Duane W. Newton, and John G. Younger Copyright © 2014 Prannda Sharma et al. All rights reserved. Steroids Decrease Prevalence of Positive Tuberculin Skin Test in Rheumatoid Arthritis: Implications on Anti-TNF Therapies Mon, 24 Feb 2014 11:38:03 +0000 http://www.hindawi.com/journals/ipid/2014/430134/ Tuberculin skin test has been used as an indicator of latent tuberculosis in patients with Rheumatoid Arthritis (RA) before administration of biologicals. Effect of Disease modifying antirheumatic drugs (DMARDs) and steroids on the result of tuberculin skin test (TST) may have important implications in interpretation of results of this test. Objectives. To find the prevalence of positive TST in rheumatoid patients and the effect of standard treatment on the results of TST. Method. In this cross-sectional study two hundred and fifty patients of RA above 18 years of age, classified using 1987 ACR criteria for RA, were enrolled from rheumatology outdoor. Demographics, disease activity, disease duration, and therapy were recorded. All patients underwent TST. Results. Fifty-one (20.4%) patients were found to be tuberculin positive. Tuberculin positivity was not affected by MTX intake but it was significantly low in patients with recent steroid intake as compared to patients who had not taken steroids in last 3 months (3% versus 25%, P = 0.002). Conclusion. Prevalence of tuberculin positivity in patients with RA was found to be low. Results were not affected by methotrexate; however tuberculin skin test results in patients with recent use of steroids are likely to be negative. Shweta Agarwal, Siddharth Kumar Das, Girdhar G. Agarwal, and Ragini Srivastava Copyright © 2014 Shweta Agarwal et al. All rights reserved. Level of CD8 T Lymphocytes Activation in HIV-Infected Pregnant Women: In the Context of CD38 and HLA-DR Activation Markers Wed, 22 Jan 2014 10:06:08 +0000 http://www.hindawi.com/journals/ipid/2014/715279/ Background. To date the effect of pregnancy on the immune activation of CD8 T cells that may affect HIV disease progression has not been well studied and remains unclear. Objective. To determine the effect of pregnancy on CD8 T lymphocyte activation and its relationship with CD4 count in HIV infected pregnant women. Study Design. Case control. Study Site. AMPATH and MTRH in Eldoret, Kenya. Study Subjects. Newly diagnosed asymptomatic HIV positive pregnant and nonpregnant women with no prior receipt of antiretroviral medications. Study Methods. Blood samples were collected from the study participants and levels of activated CD8 T lymphocytes (CD38 and HLA-DR) were determined using flow cytometer and correlated with CD4 counts of the study participants. The descriptive data focusing on frequencies, correlation, and cross-tabulations was statistically determined. Significance of the results was set at . Results. HIV positive pregnant women had lower activated CD8 T lymphocyte counts than nonpregnant HIV positive women. Activated CD8 T lymphocyte counts were also noted to decrease in the second and third trimesters of pregnancy. Conclusion. Pregnancy has a significant suppression on CD8+ T lymphocyte immune activation during HIV infections. Follow-up studies with more control arms could confirm the present study results. Stanslaus Musyoki, Simeon Mining, and Paul Nyongesa Copyright © 2014 Stanslaus Musyoki et al. All rights reserved. Control of a Clonal Outbreak of Multidrug-Resistant Acinetobacter baumannii in a Hospital of the Basque Country after the Introduction of Environmental Cleaning Led by the Systematic Sampling from Environmental Objects Mon, 30 Dec 2013 15:18:19 +0000 http://www.hindawi.com/journals/ipid/2013/582831/ Background. Between July 2009 and September 2010, an outbreak of multidrug-resistant (MDR) Acinetobacter baumannii was detected in one critical care unit of a tertiary hospital in the Basque Country, involving 49 infected and 16 colonized patients. The aim was to evaluate the impact of environmental cleaning and systematic sampling from environmental objects on the risk of infection by MDR A. baumannii. Methods. After systematic sampling from environmental objects and molecular typing of all new MDR A. baumannii strains from patients and environmental isolates, we analyzed the correlation (Pearson’s r) between new infected cases and positive environmental samples. The risk ratio (RR) of infection was estimated with Poisson regression. Results. The risk increased significantly with the number of positive samples in common areas (RR = 1.40; 95%CI = 0.99–1.94) and positive samples in boxes (RR = 1.19; 95%CI = 1.01–1.40). The number of cases also positively correlated with positive samples in boxes (; ) and common areas (; ). Conclusion. Once conventional measures have failed, environmental cleaning, guided by systematic sampling from environmental objects, provided the objective risk reduction of new cases and enabled the full control of the outbreak. Jesús Delgado Naranjo, José Ignacio Villate Navarro, Mercedes Sota Busselo, Alberto Martínez Ruíz, José María Hernández Hernández, María Pilar Torres Garmendia, and María Isabel Urcelay López Copyright © 2013 Jesús Delgado Naranjo et al. All rights reserved. Utility of Serum Neopterin and Serum IL-2 Receptor Levels to Predict Absolute CD4 T Lymphocyte Count in HIV Infected Cases Thu, 05 Dec 2013 14:49:53 +0000 http://www.hindawi.com/journals/ipid/2013/143648/ A prospective study was carried out to evaluate the efficacy of serum neopterin and soluble IL-2 receptor (sIL-2R) concentrations in comparison to CD4 count to study the progression of HIV disease and monitor response to ART in HIV cases. One hundred newly diagnosed HIV seropositive subjects were recruited. CD4 counts were determined by FACS system. Serum neopterin and sIL-2R levels were measured using enzyme immunoassay. In our study, levels of neopterin and sIL-2R were significantly higher in subjects with CD4 200 cells/μL (with S. neopterin levels of 25.1 nmol/L and sIL-2R levels of 47.1 pM as cutoff values for CD4 200 cells/μL) compared to those in subjects with CD4 200 cells/μL at baseline which indicate that these markers can be utilized for initiation of ART in HIV cases. The levels of these markers decreased significantly after initiation of ART. In patients with CD4 200 cells/μL, these markers are helpful in predicting disease progression. Sanjim Chadha, Preena Bhalla, Hitender Gautam, Anita Chakravarti, Sanjeev Saini, S. Anuradha, and Richa Dewan Copyright © 2013 Sanjim Chadha et al. All rights reserved. The Importance of IgG Avidity and the Polymerase Chain Reaction in Treating Toxoplasmosis during Pregnancy: Current Knowledge Thu, 26 Sep 2013 13:52:13 +0000 http://www.hindawi.com/journals/ipid/2013/370769/ A brief report on the nature and epidemiology of T. gondii infection is firstly presented. The importance of the specific IgG avidity test and polymerase chain reaction (PCR) for toxoplasmosis is discussed, along with their significance and importance as auxiliary methods for determining the most likely time for the initial infection by this coccidian and for defining the therapeutic strategy. Lastly, practical comments are made in relation to the classical therapeutic regimens, with special attention to the indications for fetal treatment, when this is necessary. João Bortoletti Filho, Edward Araujo Júnior, Natália da Silva Carvalho, Talita Micheletti Helfer, Priscila de Oliveira Nogueira Serni, Luciano Marcondes Machado Nardozza, and Antonio Fernandes Moron Copyright © 2013 João Bortoletti Filho et al. All rights reserved.