The Scientific World Journal: Infectious Diseases The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Design, Synthesis, Molecular Docking, and Antibacterial Evaluation of Some Novel Flouroquinolone Derivatives as Potent Antibacterial Agent Tue, 09 Dec 2014 13:29:21 +0000 Objective. Quinolone moiety is an important class of nitrogen containing heterocycles widely used as key building blocks for medicinal agents. It exhibits a wide spectrum of pharmacophores and has bactericidal, antiviral, antimalarial, and anticancer activities. In view of the reported antimicrobial activity of various fluoroquinolones, the importance of the C-7 substituents is that they exhibit potent antimicrobial activities. Our objective was to synthesize newer quinolone analogues with increasing bulk at C-7 position of the main 6-fluoroquinolone scaffold to produce the target compounds which have potent antimicrobial activity. Methods. A novel series of 1-ethyl-6-fluoro-4-oxo-7-4-[2-(4-substituted phenyl)-2-(substituted)-ethyl]-1-piperazinyl-1,4-dihydroquinoline-3-carboxylic acid derivatives were synthesized. To understand the interaction of binding sites with bacterial protein receptor, the docking study was performed using topoisomerase II DNA gyrase enzymes (PDB ID: 2XCT) by Schrodinger’s Maestro program. In vitro antibacterial activity of the synthesized compounds was studied and the MIC value was calculated by the broth dilution method. Results. Among all the synthesized compounds, some compounds showed potent antimicrobial activity. The compound 8g exhibited good antibacterial activity. Conclusion. This investigation identified the potent antibacterial agents against certain infections. Mehul M. Patel and Laxman J. Patel Copyright © 2014 Mehul M. Patel and Laxman J. Patel. All rights reserved. Detection, Characterization, and Molecular Typing of Human Mycoplasma spp. from Major Hospitals in Cairo, Egypt Sun, 23 Nov 2014 08:55:14 +0000 Mycoplasmas are fastidious slow growing organisms lacking a cell wall and mostly isolated from the mucosal surfaces of the respiratory and genitourinary tracts. There is a dearth of information regarding clinical Mycoplasma spp. isolates among Egyptian patients. A total of 170 samples were collected from patients and apparently healthy personnel in local public hospitals in Cairo, Egypt. Isolation of Mycoplasma spp. was carried out using appropriate culture media and further identification was carried out by biochemical tests followed by serotyping using specific antisera. Confirmation was done by PCR for detection of different Mycoplasma spp. using genus-specific primers targeting 16S ribosomal RNA gene. Characterization of the antibiotic resistance and sensitivity pattern against different antimicrobials was carried out using disc diffusion test. The results indicated the presence of six Mycoplasma spp. in 22.94% of the samples. Mycoplasmas were detected more frequently in throat swabs than sputum. Mycoplasma pneumoniae was highly sensitive to macrolides and quinolones but less sensitive to aminoglycosides and tetracyclines. Molecular techniques were found to be of more rapid, highly sensitive, able to detect nonviable organisms, and cost effective. These results shed light on difficulties of Mycoplasma detection and the superiority of molecular techniques over culture. Mirihan A. Metwally, Aymen S. Yassin, Tamer M. Essam, Hayam M. Hamouda, and Magdy A. Amin Copyright © 2014 Mirihan A. Metwally et al. All rights reserved. Antihepatitis B Virus Activity of a Protein-Enriched Fraction from Housefly (Musca domestica) in a Stable HBV-Producing Cell Line Sun, 22 Jun 2014 12:40:19 +0000 Hepatitis B virus (HBV) infection remains a major public health problem. Although several vaccines and therapeutic strategies are currently being implemented to combat HBV virus, effective antiviral therapy against HBV infection has not been fully developed. Alternative strategies and new drugs to combat this disease are urged. Insects and insect derivatives are a large and unexploited source of potentially useful compounds for modern medicine. In the present study, we investigated the first anti-HBV activity of a protein-enriched fraction (PE) from the larvae of the housefly (Musca domestica) in a stable HBV-producing cell line. HBsAg and HBeAg in the culture medium were measured by enzyme-linked immunosorbent assay. HBV-DNA was quantified by fluorescent quantification PCR. HBV core protein was assayed by immunofluorescent staining. Results indicate PE treatment inhibited both HBsAg, HBeAg secretion, and HBV-DNA replication. Furthermore, PE could also suppress HBV core protein expression. PE could be a potential candidate for the development of a novel and effective drug for the treatment of HBV infection. Xuemei Lu, Xiaobao Jin, Jie Wang, Fujiang Chu, and Jiayong Zhu Copyright © 2014 Xuemei Lu et al. All rights reserved. Hepatitis C Worldwide and in Brazil: Silent Epidemic—Data on Disease including Incidence, Transmission, Prevention, and Treatment Tue, 10 Jun 2014 00:00:00 +0000 Hepatitis C virus (HCV) is endemic worldwide and according to the World Health Organization (WHO), there are about 150 million chronic carriers worldwide. The infection is a leading cause of liver diseases like cirrhosis and hepatocellular carcinoma (HCC); thus, HCV infection constitutes a critical public health problem. There are increasing efforts worldwide in order to reduce the global impact of hepatitis C through the implementation of programmatic actions that may increase the awareness of viral hepatitis and also improve surveillance, prevention, and treatment. In Brazil, about 1,5 million people have been chronically infected with HCV. The country has a vast territory with uneven population density, and hepatitis C incidence rates are variable with the majority of cases concentrated in the most populated areas. Currently, the main priorities of Brazilian Ministry of Health's strategies for viral hepatitis management include the prevention and early diagnosis of viral hepatitis infections; strengthening of the healthcare network and lines of treatment for sexually transmitted diseases, viral hepatitis, and AIDS; improvement and development of surveillance, information, and research; and promotion of universal access to medication. This review aims to summarize the available data on hepatitis C epidemiology and current status of efforts in prevention and infection control around the world and in Brazil. Iara Fabricia Kretzer, Andrea do Livramento, Joel da Cunha, Sabrina Gonçalves, Iraci Tosin, Celso Spada, and Aricio Treitinger Copyright © 2014 Iara Fabricia Kretzer et al. All rights reserved. Prospective Study of BK Virus Infection in Patients with Inflammatory Bowel Disease Thu, 13 Feb 2014 10:09:50 +0000 Patients with inflammatory bowel disease (IBD) have an immune-deficient baseline status further modulated by immunosuppressive therapy that may promote the reactivation of latent viruses such as BK virus (BKV). The aim of this prospective study was to determine the prevalence of BKV infection in IBD patients and its potential relationship with the immunosuppressive treatment. Paired urine and plasma samples from 53 consecutive patients with IBD and 53 controls were analyzed. BKV detection was performed by conventional PCR and positive samples were further quantified by real-time PCR. No viremia was detected. BKV viruria was significantly more common in IBD patients than among the controls (54.7% versus 11.3%; ). The only risk factor for BKV viruria in IBD was age ( versus ; ), and there was a trend towards higher rate of viruria in outpatients (61.5% versus 38.5%; ) and in those not receiving ciprofloxacin (59.5% versus 40.5%; ). A clear impact of the immunosuppressive regimen on BKV infection could not be demonstrated. Virginia Flores, Belén Rodríguez-Sánchez, Ignacio Marín-Jiménez, Emilio Bouza, Luis Menchén, and Patricia Muñoz Copyright © 2014 Virginia Flores et al. All rights reserved. Identification of Family Specific Fingerprints in β-Lactamase Families Tue, 11 Feb 2014 11:12:20 +0000 Beta-lactamases are a superfamily of enzymes which degrade the β-lactam class of antibiotics. They are produced endogenously by the bacterial cells, which when exposed to the β-lactam class of antibiotics inactivate them by cleaving the β-lactam ring. Based on the presence or absence of metallic ligand, β-lactamases have been divided into two broad functional classes. β-Lactamases are a constitutively evolving and expanding superfamily of enzymes, which could be further subdivided on the basis of presence/absence of conserved motifs. In the present study we have used the MEME/MAST suit to identify the patterns/motifs which are specific to a particular family or subfamily of β-lactamases. The family specific patterns/motifs can be also useful in recognizing and assigning newly discovered β-lactamases to one or the other family or subfamily. Cross-validation showed that the proposed method is highly sensitive and specific. We have also designed a webserver, LactFP, for this purpose. Abhishikha Srivastava, Neelja Singhal, Manisha Goel, Jugsharan Singh Virdi, and Manish Kumar Copyright © 2014 Abhishikha Srivastava et al. All rights reserved. High Level Aminoglycoside Resistance and Distribution of Aminoglycoside Resistant Genes among Clinical Isolates of Enterococcus Species in Chennai, India Tue, 04 Feb 2014 13:15:20 +0000 Enterococci are nosocomial pathogen with multiple-drug resistance by intrinsic and extrinsic mechanisms. Aminoglycosides along with cell wall inhibitors are given clinically for treating enterococcal infections. 178 enterococcal isolates were analyzed in this study. E. faecalis is identified to be the predominant Enterococcus species, along with E. faecium, E. avium, E. hirae, E. durans, E. dispar and E. gallinarum. High level aminoglycoside resistance (HLAR) by MIC for gentamicin (GM), streptomycin (SM) and both (GM + SM) antibiotics was found to be 42.7%, 29.8%, and 21.9%, respectively. Detection of aminoglycoside modifying enzyme encoding genes (AME) in enterococci was identified by multiplex PCR for aac(6′)-Ie-aph(2′′)-Ia; aph(2′′)-Ib; aph(2′′)-Ic; aph(2′′)-Id and aph(3′)-IIIa genes. 38.2% isolates carried aac(6′)-Ie-aph(2′′)-Ia gene and 40.4% isolates carried aph(3′)-IIIa gene. aph(2′′)-Ib; aph(2′′)-Ic; aph(2′′)-Id were not detected among our study isolates. aac(6′)-Ie-aph(2′′)-Ia and aph(3′)-IIIa genes were also observed in HLAR E. durans, E. avium, E. hirae, and E. gallinarum isolates. This indicates that high level aminoglycoside resistance genes are widely disseminated among isolates of enterococci from Chennai. Elango Padmasini, R. Padmaraj, and S. Srivani Ramesh Copyright © 2014 Elango Padmasini et al. All rights reserved. Optimization and Validation of Indirect ELISA Using Truncated TssB Protein for the Serodiagnosis of Glanders amongst Equines Mon, 03 Feb 2014 15:30:31 +0000 Objective. To express truncated TssB protein of Burkholderia mallei and to evaluate its diagnostic efficacy for serological detection of glanders among equines. Materials and Methods. In an attempt to develop recombinant protein based enzyme-linked immunosorbent assay (ELISA), N-terminal 200 amino acid sequences of B. mallei TssB protein—a type 6 secretory effector protein—were expressed in prokaryotic expression system. Diagnostic potential of recombinant TssB protein was evaluated in indirect ELISA using a panel of glanders positive (), negative (), and field serum samples (). Cross-reactivity of the assay was assessed with equine disease control serum and human melioidosis positive serum. Results. In comparison to CFT, diagnostic sensitivity and specificity of ELISA were 99.7% and 100%, respectively. Conclusions. The indirect ELISA method using the truncated TssB offered safer and more rapid and efficient means of serodiagnosis of glanders in equines. These data highlight the use of TssB as potential diagnostic antigen for serological diagnosis of glanders. Harisankar Singha, Praveen Malik, Sachin K. Goyal, Sandip K. Khurana, Chiranjay Mukhopadhyay, Vandana K. Eshwara, and Raj K. Singh Copyright © 2014 Harisankar Singha et al. All rights reserved. Decreasing Prevalence of Transfusion Transmitted Infection in Indian Scenario Mon, 27 Jan 2014 10:58:23 +0000 Transfusion transmitted infections are major problem associated with blood transfusion. Accurate estimates of risk of TTIs are essential for monitoring the safety of blood supply and evaluating the efficacy of currently employed screening procedures. The present study was carried out to assess the percentage of voluntary donors and replacement donors and to find out prevalence and changing trends of various TTIs blood donors in recent years. A study was carried out on blood units of voluntary and replacement donors which were collected from January 2008 to December 2012. On screening of 180,371 replacement units, seropositivity of transfusion transmitted disease in replacement donors was 0.15% in HIV, 1.67% in hepatitis B surface antigen, 0.49% in hepatitis C virus, 0.01% in VDRL, and 0.009% in malaria. Of 11,977 voluntary units, seropositivity of transfusion transmitted disease in voluntary donors was 0.08% in HIV, 0.24% in hepatitis B surface antigen, 0.001% in hepatitis C virus, 0.008% in VDRL (sexually transmitted disease), and 0.01% in malaria. From results it has been concluded that prevalence of transfusion transmitted infection (HIV, HBV, HCV, VDRL, and malaria) was more in replacement donors in comparison to voluntary donors. Extensive donor selection and screening procedures will help in improving the blood safety. Tulika Chandra, S. Nishat Fatima Rizvi, and Devisha Agarwal Copyright © 2014 Tulika Chandra et al. All rights reserved. Antimicrobial Resistance Trends among Community-Acquired Respiratory Tract Pathogens in Greece, 2009–2012 Mon, 27 Jan 2014 08:17:14 +0000 The aim of the present study was to determine the antimicrobial resistance trends of respiratory tract pathogens isolated from patients with community-acquired respiratory tract infections (CARTIs) in Crete, Greece, over a 4-year period (2009–2012). A total of 588 community-acquired respiratory pathogens were isolated during the study period. Streptococcus pneumoniae was the most common organism responsible for 44.4% of CARTIs, followed by Haemophilus influenzae (44.2%) and Moraxella catarrhalis (11.4%). Among S. pneumoniae, the prevalence of isolates with intermediate- and high-level resistance to penicillin was 27.2% and 12.3%, respectively. Macrolide resistance slightly decreased from 29.4% over the period 2009-2010 to 28.8% over the period 2011-2012. Multiresistance was observed among 56 (54.4%) penicillin nonsusceptible isolates. A nonsignificant increase in resistance of H. influenzae isolates was noted for β-lactams, cotrimoxazole, and tetracycline. Among the 67 M. catarrhalis tested, 32 produced beta-lactamase and were resistant to ampicillin. Macrolide resistance decreased over the study period. All isolates were susceptible to amoxicillin + clavulanic acid, chloramphenicol, rifampicin, and the fluoroquinolones. Although a decreasing trend in the prevalence of resistance of the three most common pathogens involved in CARTIs was noted, continuous surveillance of antimicrobial susceptibility at the local and national level remains important, in order to guide appropriate empirical antimicrobial therapy. Sofia Maraki and Ioannis S. Papadakis Copyright © 2014 Sofia Maraki and Ioannis S. Papadakis. All rights reserved. Isolation of Escherichia coli 0157:H7 Strain from Fecal Samples of Zoo Animal Mon, 30 Dec 2013 15:18:49 +0000 The isolation and characterization of Escherichia coli O157:H7 strains from 22 out of 174 fecal samples from petting zoo animals representing twenty-two different species (camel, lion, goats, zebra, bear, baboon monkey, Siberian monkey, deer, elk, llama, pony, horses, fox, kangaroo, wolf, porcupine, chickens, tiger, ostrich, hyena, dogs, and wildcats) were investigated. One petting Al-Zawraa zoological society of Baghdad was investigated for E. coli O157:H7 over a 16-month period that spanned two summer and two autumn seasons. Variation in the occurrence of E. coli O157:H7-positive petting zoo animals was observed, with animals being culture positive only in the summer months but not in the spring, autumn, or winter. E. coli O157:H7 isolates were distinguished by agglutination with E. coli O157:H7 latex reagent (Oxoid), identified among the isolates, which showed that multiple E. coli strains were isolated from one petting zoo animal, in which a single animal simultaneously shed multiple E. coli strains; E. coli O157:H7 was isolated only by selective enrichment culture of 2 g of petting zoo animal feces. In contrast, strains other than O157:H7 were cultured from feces of petting zoo animals without enrichment. Aseel Mohammed Hamzah, Aseel Mohammed Hussein, and Jenan Mahmoud Khalef Copyright © 2013 Aseel Mohammed Hamzah et al. All rights reserved. Characterization of the Occult Hepatitis B Virus Variants Circulating among the Blood Donors from Eastern India Mon, 04 Nov 2013 15:01:43 +0000 A previous study from West Bengal documented very high rate of occult HBV infection (OBI) among the HBsAg negative blood donors. This study was aimed to characterize the OBI strains circulating among the blood donors and to estimate the risk associated with the prevailing viral variants/mutants. Blood samples from 2195 voluntary blood donors were included in the study. HBsAg, HBeAg, anti-HBc, and anti-HBs statuses of the samples were done by ELISA based detection. PCR amplification and sequencing were done to determine HBV genotypes, basal core promoter (BCP), and precore (Pre-C) mutations. Among the study samples, 268 were anti-HBc positive/HBsAg negative, among which 65 (24.25%) were HBV DNA positive. Phylogenetic analysis revealed the presence of HBV/D (87.23%), HBV/A (8.51%), and HBV/C (4.26%) ( HBV/D3 (65.85%) was the significantly prevalent subgenotype over HBV/D2 (26.83%) and HBV/D1 (7.31%) (). Considerable prevalence of differential BCP (1752C, 1753C, 1762T/1764A, 1753C+1762T/1764A, 1773C, and 1814C) and reverse transcriptase (rt) gene (rtI91L, rtL93P, rtS106C, rtR110G, rtN118T, rtS119T, rtY126H, rtG127W/R, rtC136R, and rtY158H) mutations was identified. Association of specific HBV subgenotypes with OBI was interesting and needs further study. Clinically relevant mutations were prevalent among the OBI strains which are of serious concern. Avik Biswas, Rajesh Panigrahi, Partha Kumar Chandra, Arup Banerjee, Sibnarayan Datta, Manisha Pal, Subhashish Chakraborty, Prasun Bhattacharya, Sekhar Chakrabarti, and Runu Chakravarty Copyright © 2013 Avik Biswas et al. All rights reserved. Identification of Urban Leprosy Clusters Wed, 30 Oct 2013 14:36:40 +0000 Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion. This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease. José Antonio Armani Paschoal, Vania Del’Arco Paschoal, Susilene Maria Tonelli Nardi, Patrícia Sammarco Rosa, Manuela Gallo y Sanches Ismael, and Eduvaldo Paulo Sichieri Copyright © 2013 José Antonio Armani Paschoal et al. All rights reserved. Beliefs and Attitudes of Medical Students from Public and Private Universities in Malaysia towards Individuals with HIV/AIDS Tue, 29 Oct 2013 13:15:29 +0000 We describe the findings from a survey assessing the beliefs regarding testing, confidentiality, disclosure, and environment of care and attitudes towards care of people with HIV/AIDS (PLHWA), in 1020, 4th and 5th year medical students, from public and private medical universities in Malaysia. A self-administered validated questionnaire based on the UNAIDS Model Questionnaire with a 5-point Likert scale (5, strongly disagree; 4, disagree; 3, neutral; 2, agree; 1, strongly agree) was used as a survey tool. The survey included demographic data and data on undergraduate training received on HIV/AIDS. Statistical significance in the demographic data and training received by respondents was evaluated using the chi-square test while the independent Student’s t-test was used for comparison of means between public and private universities. A value of <0.05 was considered statistically significant with 95% confidence interval. Our study revealed less than 20% of medical students received adequate training to care for PLHWA. They had prevalent negative beliefs regarding testing, confidentiality, disclosure and environment of care towards PLHWA although in giving care to PLHWA, their attitudes were largely positive and nondiscriminatory. Koh Kwee Choy, Teh Jae Rene, and Saad Ahmed Khan Copyright © 2013 Koh Kwee Choy et al. All rights reserved. Periprosthetic Joint Infections: Clinical and Bench Research Sun, 27 Oct 2013 11:00:25 +0000 Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections. Laurence Legout and Eric Senneville Copyright © 2013 Laurence Legout and Eric Senneville. All rights reserved. Immune Response in Severe Infection: Could Life-Saving Drugs Be Potentially Harmful? Mon, 30 Sep 2013 11:48:29 +0000 Critically ill patients suffer a high rate of nosocomial infection with secondary sepsis being a common cause of death. Usage of antibiotics and catecholamines is often necessary, but it can compromise complex immune response to infection. This review explores influence of these life-saving drugs on host immune response to severe infection. Maja Surbatovic, Jasna Jevdjic, Milic Veljovic, Nada Popovic, Dragan Djordjevic, and Sonja Radakovic Copyright © 2013 Maja Surbatovic et al. All rights reserved. Association between TLR4 and TLR9 Gene Polymorphisms with Development of Pulmonary Tuberculosis in Zahedan, Southeastern Iran Sun, 26 May 2013 14:26:54 +0000 Some evidence suggests that a variety of genetic factors contribute to development of the tuberculosis (TB). TLR4 and TLR9 have been proposed as susceptibility genes for TB. This study was performed in 124 newly diagnosed TB cases and 149 healthy controls in a TB-endemic region of Iran. The TLR4 genes Asp299Gly, Thr399Ile, and TLR9 gene T-1486C polymorphisms were amplified by polymerase chain reaction (PCR) and then detected by PCR-restriction fragment length polymorphism (RFLP). The frequencies of the mutant alleles of TLR4 Arg299Gly, Thr399Ile, and TLR9 T-1486C polymorphisms were 0.8 versus 0.1, 5.6 versus 3, and 28.6 versus 25.2 in patients and controls, respectively, that were not significant. The synergic effect of TI,II/CC genotypes for TLR4 Thr399Ile and TLR9 T-1486C polymorphisms showed increased risk of PTB susceptibility. In conclusion, no significant relation was found between TLR4 and TLR9 polymorphisms alone and PTB. However, synergic effects of TLR4 Thr399Ile and TLR9-1486T/C polymorphisms might increase risk of PTB. Danial Jahantigh, Saeedeh Salimi, Roya Alavi-Naini, Abolfazl Emamdadi, Hamid Owaysee Osquee, and Farzaneh Farajian Mashhadi Copyright © 2013 Danial Jahantigh et al. All rights reserved. Evaluation of Compliance in Control and Prevention Study of Vancomycin Resistant Enterococcus Outbreak Wed, 06 Feb 2013 11:55:15 +0000 Objective. Vancomycin resistant enterococci (VRE) colonization and the spread decrease with compliance and isolation guidelines. For the isolation methods to succeed, compliance with the isolation guidelines needs to be overseen. In this study, VRE outbreak among the Pediatric Ward patients, the preventative efforts to control this outbreak, and the impact of scoring tables used in controlling this outbreak on the success are explained. Design. Rectal swab cultures were taken from patients who were admitted to the Ward between October and December 2010 due to diagnoses of VRE and urinary tract infection. Results. VRE were isolated in the rectal swab samples of 34 patients. VRE infection findings were clinically detected in two of the cases with VRE isolation. Two isolations of VRE were detected on cultures from patient room door handle surface and the telephone in the room for common use. Close contact isolation was achieved and barrier precautions were taken for all cases, as soon as the detections were made. A scoring system was developed to evaluate the feasibility of and the compliance with the precautions to be taken. Conclusions. With the method presented in this study, the outbreak at our hospital was under control within two months. Vuslat Kecik Bosnak, Mustafa Namiduru, Ilkay Karaoglan, and Ayse Ozlem Mete Copyright © 2013 Vuslat Kecik Bosnak et al. All rights reserved. Development of a Novel Rapid Immunodiagnostic Kit Based on Flagellar 40 kDa Antigen Epitope for the Detection of Typhoid Fever in Indian Patients Tue, 05 Feb 2013 08:13:34 +0000 To aid the clinical diagnosis of typhoid fever in India, where most hospitals and primary health centres have no facilities for culture, we report on the development of a novel and rapid immunodiagnostic kit for the direct detection of Salmonella Typhi—specific IgG antibodies against S. Typhi flagellar H antigen. The disease often does not show a specific clinical picture, and can be confused with other febrile illness such as malaria, dengue fever and Staphylococcus aureus. To overcome the problem of cross reactivity specific epitope of the flagellar H antigen was immobilised on the testing kit strip eliminating chances of cross reactivity and false positive results thereby increasing the specificity of the test. Since the immunodiagnostic kit, uses the flagellar H antigen from bacteria present in our country, the antibodies present in the serum of patients of our country will have maximum binding affinity, enhancing the sensitivity of our test kit. The immunodiagnostic kit on analysis gave a positive result with clinically diagnosed typhoid positive patient serum and negative results were obtained with the sera of clinically diagnosed malaria, abscess of Staphylococcus aureus and Visceral leishmaniasis (Kala-azar) patients. Rahul Mitra, Surya Bhan, Gopal Nath, Narender Kumar, and Ziledar Ali Copyright © 2013 Rahul Mitra et al. All rights reserved. Timing of Initiating Glycopeptide Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: The Impact on Clinical Outcome Sun, 20 Jan 2013 15:21:54 +0000 When a Staphylococcus-like organism (SLO) is microscopically found in Gram staining of blood culture (BC) specimen, it seems reasonable to administrate a glycopeptide (GP) for empirical therapy. The paper investigates the risk factors for 14-day mortality in patients with methicillin-resistance Staphylococcus aureus bacteremia (MRSAB) and clarifies the impact of the timing for initiating GP therapy. A retrospective study identifies patients with MRSAB (endocarditis was excluded) between 2006 and 2009. Patients were categorized as receiving GP at the interval before a preliminary BC report indicating the growth of SLO and the onward 24 hours or receiving GP 24 h after a preliminary BC report indicating the growth of SLO. Total 339 patients were enrolled. There was no difference on the 14-day overall or infection-related mortality rates at the time to administer GP. Multivariate analysis disclosed pneumonia (OR = 4.47; of 95% CI; of 2.09–9.58; ) and high APACHE II score (OR, 2.81, with 95% CI, 1.19–6.65; ) were independent risk factors for infection-related mortality. The mortality rate did not decrease following administrating GP immediately after a preliminary BC indicating SLO growth. An additional research for the optimal timing for initiating GP treatment is warranted. Chen-Hsiang Lee, Chun-Chih Chien, and Jien-Wei Liu Copyright © 2013 Chen-Hsiang Lee et al. All rights reserved. Tuberculous Meningitis in Adults: A Review of 160 Cases Tue, 24 Apr 2012 12:47:23 +0000 Objective. This study aimed to evaluate epidemiological, clinical, laboratory, and neuroimaging features of 160 adult patients with tuberculous meningitis (TBM) according to “Thwaites’ diagnostic index.” Methods. The subjects of this retrospective study are the patients with TBM who were followed up between years 1998 and 2009 in a tertiary referral hospital. Diagnosis of TBM was based on clinical, laboratory, and neuroimaging signs and Thwaites’ diagnostic index. Results. Mycobacterium tuberculosis was isolated from CSF in 59 of 148 patients. Seventeen percent of the patients died, 71% recovered completely, and 13% recovered with neurological sequel at the end of the sixth month. Conclusions. Despite new developments in laboratory or neuroimaging techniques, the diagnosis of TBM is still based on clinical features with the help of laboratory. Early diagnosis by suspecting TBM may prevent therapy delay and may result in decrease in the mortality and morbidity. Filiz Pehlivanoglu, Kadriye Kart Yasar, and Gonul Sengoz Copyright © 2012 Filiz Pehlivanoglu et al. All rights reserved. Seroprevalence Study of Human Brucellosis by Conventional Tests and Indigenous Indirect Enzyme-Linked Immunosorbent Assay Sun, 01 Apr 2012 09:12:27 +0000 Brucellosis is one of the most important reemerging zoonoses in many countries. Brucellosis is caused by Gram-negative coccobacillus belonging to genus Brucella. Human brucellosis often makes the diagnosis difficult. The symptoms and clinical signs most commonly reported are fever, fatigue, malaise, chills, sweats headaches, myalgia, arthralgia, and weight loss. Some cases have been presented with only joint pain, lower backache, and involuntary limb movement, burning feet, or ischemic heart attacks. The focus of this work was to develop a highly sensitive and specific indirect ELISA by using smooth lipopolysaccharide antigen of Brucella abortus 99 to detect anti-Brucella antibodies at Project Directorate on Animal Disease Monitoring and Surveillance. Serum samples collected from 652 individuals in whom fever was not the major symptom but the complaint was of joint pain, headache, lower backache, and so forth, were screened by Rose Bengal plate agglutination test (RBPT) and standard tube agglutination test (STAT). Subsequent testing of sera by indigenous indirect ELISA detected 20 samples positive (3.6% seroprevalence), and indirect ELISA was found to be more sensitive than RBPT and STAT. The seroprevalence in South Karnataka was 2.14%, and in North Karnataka it was 0.92%. Annapurna S. Agasthya, Srikrishna Isloor, and Prabhudas Krishnamsetty Copyright © 2012 Annapurna S. Agasthya et al. All rights reserved. Tuberculosis in Sheltered Homeless Population of Rome: An Integrated Model of Recruitment for Risk Management Wed, 01 Feb 2012 13:30:30 +0000 The authors show the results of an integrated model for risk management of tuberculosis in a sample of sheltered homeless in Rome. Tuberculin skin test (TST) was used for evaluating the prevalence of latent infection (LTBI). In TST positives, expectorate was collected and chest X-ray was achieved. Multiple logistic regression analysis was performed to investigate determinants of infection. Out of 288 recruited subjects, 259 returned for the TST reading; 45.56% were positive and referred to a specialized center; 70 accessed the health facility and completed the clinical pathway. The risk factors associated to LTBI were male gender (OR=3.72), age over 60 years (OR=3.59), immigrant status (OR=3.73), and obesity (OR=2.19). This approach, based on an integrated social network, guarantees high adherence to screening (89.93%), allowing patients testing positive for latent tuberculosis infection to be diagnosed and rapidly referred to a specialized center. Patrizia Laurenti, Stefania Bruno, Gianluigi Quaranta, Giuseppe La Torre, Antonio G. Cairo, Pierangela Nardella, Giovanni Delogu, Giovanni Fadda, Tommaso Pirronti, Salvatore Geraci, Salvatore Pelargonio, Francesco N. Lauria, Delia Goletti, and Gualtiero Ricciardi Copyright © 2012 Patrizia Laurenti et al. All rights reserved. Neurocysticercosis: A Review Wed, 04 Jan 2012 10:55:45 +0000 Neuroysticercosis is the most common helminthic infection of the nervous system, and a leading cause of acquired epilepsy worldwide. The disease occurs when humans become intermediate hosts of Taenia solium by ingesting its eggs from contaminated food or, most often, directly from a taenia carrier by the fecal-to-oral route. Cysticerci may be located in brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing pathological changes that are responsible for the pleomorphism of neurocysticercosis. Seizures are the most common clinical manifestation, but many patients present with focal deficits, intracranial hypertension, or cognitive decline. Accurate diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunological tests. The introduction of cysticidal drugs have changed the prognosis of most patients with neurocysticercosis. These drugs have shown to reduce the burden of infection in the brain and to improve the clinical course of the disease in most patients. Further efforts should be directed to eradicate the disease through the implementation of control programs against all the interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment. Oscar H. Del Brutto Copyright © 2012 Oscar H. Del Brutto. All rights reserved. Abiotrophia spp. and Staphylococcus epidermidis Endocarditis Treated with Daptomycin Mon, 01 Jan 1900 00:00:00 +0000 Endocarditis due to Abiotrophia spp. occurs in about 5% of endocarditis cases. Most of the cases respond to a combination of penicillin and gentamicin, or vancomycin. We describe a case of Staphylococcus epidermidis (CONS) and Abiotrophia spp. endocarditis that failed vancomycin treatment, but responded to daptomycin and rifampin. E. Bishburg, D. Ghuman, A. Cohen, T. Chan, and S. Nalmas Copyright © 2008 E. Bishburg et al. All rights reserved. Peripheral Nerve Degeneration in the HIV-1 Transgenic Rat Mon, 01 Jan 1900 00:00:00 +0000 F.J. Denaro, N. Hayes, O. Jones, M. McCready, H. Davis, B. Reid, R. Gallo, and J. Bryant Copyright © 2001 F.J. Denaro et al. All rights reserved. Structural Predestination of Individual Diversity in the Course and Severity of Infectious Diseases Mon, 01 Jan 1900 00:00:00 +0000 Infectious diseases can be manifested by a spectrum of clinical signs and resultant clinical courses that range from acute to chronic and possible persistence in the victim in a latent form. Until recently, the origins of this kind of biodiversity were poorly understood, but advances in immunology — especially in identifying the constitutional mechanisms of immunity — have contributed to our understanding of the origins of biodiversity in infectious diseases. Infectious diseases affect only focal areas in the affected organisms, and the amounts and distribution of infectious lesions vary from patient to patient. In a population attacked by an infectious agent, individuals can be conveniently divided into three categories: totally resistant organisms which contain no susceptible structures and are not affected; mildly susceptible organisms in which a few foci appear and in which the infection runs a benign course; organisms in which the number of constitutionally susceptible structures is high and the infectious process develops in a severe form. The diversity is determined by the differences in susceptibility of various parts of the organism under consideration. Sergey N. Rumyantsev Copyright © 2002 Sergey N. Rumyantsev. All rights reserved. Nonsexual Transmission of Anogenital Warts in Children: A Retrospective Analysis Mon, 01 Jan 1900 00:00:00 +0000 The purpose was to evaluate the prevalence of sexual abuse in patients who were referred to a pediatric gynecologist for evaluation based on the clinical findings of anogenital warts. A retrospective analysis was performed on 131 patients between the ages 6 month and 9 years referred to a pediatric gynecologist after the finding of anogenital warts by a clinical provider, parent or caregiver. A complete physical examination under colposcopy by a the same, trained pediatric gynecologist was completed, and a complete medical and family history including maternal and sibling history for evidence of Human Papillomavirus (HPV) and anogenital warts. The legal system completed a full investigation to examine the sexual abuse allegations. In 131 patients with anogenital warts, a maternal history of warts, cervical dysplasia or both was present in 66 (50%). The remaining patients had either a negative maternal history for HPV clinical findings (54 patients or 41.2%), or maternal history was unknown (11 patients, or 8.3%). Of 131 patients, 81 (61%) patients had a sibling. Of those with siblings 40 (49.4%) had warts and 41 (50.6%) did not. Forty-five (34%) of the cases had a positive maternal history for warts, dysplasia or both but also had a sibling. In that cohort, 32 (71%) of the siblings also had anogenital warts. Three of 131 patients were ruled suspicious for sexual abuse by the legal authorities but not confirmed. Of those three patients two were female and one was male. Two had no maternal history for HPV and both of these patients had a sibling without anogenital warts. Most cases of anogenital warts in children are likely to be the result of non-sexual transmission, namely prenatal mode. Thus, these patients should be handled differently by the legal system unless other reasons for suspicion exist. This study also showed the importance of maternal gynecologic history. Valerie Jones, Shawn J. Smith, and Hatim A. Omar Copyright © 2007 Valerie Jones et al. All rights reserved. Tuberculous Pyonephrosis Involving Duplex Kidney: First Reported Case Mon, 01 Jan 1900 00:00:00 +0000 We report a case of tuberculosis (TB) involving duplex kidney that has not been reported in the literature so far. Conservative surgery was done, which was effective in our case. Tanweer A.N. Bhatty and Ahmed M. Alkhayat Copyright © 2004 Tanweer A.N. Bhatty and Ahmed M. Alkhayat. All rights reserved. Streptococcus constellatus and Prevotella bivia Penile Abscess Mon, 01 Jan 1900 00:00:00 +0000 Streptococcus constellatus (S. constellatus) is known to cause abscesses in the oral, genitourinary, and gastrointestinal tracts, frequently in association with anaerobic bacteria. We report a rare case of S. constellatus and Prevotella bivia (P. bivia) causing a penile abscess, which was successfully treated with surgical drainage and antibiotic treatment. Sandhya Nalmas, Eliahu Bishburg, and Trini Chan Copyright © 2007 Sandhya Nalmas et al. All rights reserved. The Limited Role of Microbiological Culture and Sensitivity in the Management of Superficial Soft Tissue Abscesses Mon, 01 Jan 1900 00:00:00 +0000 The aim of this study was to assess the role of the routine practice of microbial culture and sensitivity at incision and drainage of superficial soft tissue abscesses. The case notes of 162 consecutive patients, selected from the microbiology database over a period of 1 year, were reviewed. All had incision and drainage of superficial soft tissue abscesses and included perianal, pilonidal, axillary, and breast abscesses. Patients with chronic wounds, recurrent abscesses, diabetes, pregnancy, and immunosuppression were excluded. The impact of pus culture and sensitivity (C/S) on management and clinical outcome was documented. Out of 162 patients, 97 were male (59.8%) and 65 were female (40.1%). Only 115 (70.9%) yielded positive cultures and 47 (29.1%) were sterile. The cultured microbial flora was predictable and sensitive to empirical antibiotics. In four patients, the results of microbial culture sensitivity showed microbial resistance to empirical antibiotics; however, it did not affect the management or the outcome for these patients. The routine practice of sending swabs for C/S after incision and drainage of superficial soft tissue abscesses does not contribute significantly towards patient management. Most patients are already on antibiotics prior to the referral and in the remainder, surgeons start antibiotics empirically. These broad-spectrum antibiotics cover the common pathogens involved, and there is no significant change in the antibiotic treatment after reviewing the culture reports following incision and drainage of uncomplicated superficial skin abscesses. Muhammad N. Khan, Raghavan Vidya, and Richard E. Lee Copyright © 2006 Muhammad N. Khan et al. All rights reserved. Macrophage Apoptosis Induced by an Avian Strain of Escherichia coli Mon, 01 Jan 1900 00:00:00 +0000 Fabiana Horn, Michele Bastiani, and D.S. Santos Copyright © 2001 Fabiana Horn et al. All rights reserved. “A Forgotten Disease”: A Case of Lemierre Syndrome Mon, 01 Jan 1900 00:00:00 +0000 P. Velagapudi, Mohit Turagam, C. Are, H. Patel, and L. Yekkirala Copyright © 2009 P. Velagapudi et al. All rights reserved. Early Onset of Tenofovir-Induced Renal Failure: Case Report and Review of the Literature Mon, 01 Jan 1900 00:00:00 +0000 Tenofovir is an acyclic nucleotide analogue reverse transcriptase inhibitor that is commonly prescribed as part of a highly active antiretroviral therapy (HAART) regimen in HIV-infected patients. Although it is generally well tolerated, renal insufficiency has been associated with its use. We report a biopsy-proven case of acute renal failure that developed within weeks of initiating a HAART regimen containing tenofovir, and review the literature with specific attention to cases of renal failure occurring within 8 weeks of tenofovir initiation. Our patient developed renal insufficiency within 3 weeks of initiating tenofovir-containing HAART and overt renal failure was noted within 5 weeks. Renal biopsy demonstrated histopathologic changes suggestive of HIV nephropathy, despite normal baseline serum creatinine values. Thirty additional cases of tenofovir-associated renal failure have been reported. In the majority (n = 22, 73%), renal failure occurred months after initiating therapy (range: 5–26 months). However, in a significant subset (n = 8, 27%), renal failure occurred within 8 weeks of treatment initiation. Our data suggest that some patients are at risk for developing renal failure within weeks of tenofovir initiation. Thorough evaluation of renal function should be undertaken before prescription of tenofovir-containing HAART. For those in whom subclinical renal disease is discerned, added vigilance when monitoring renal function may be warranted. Shilpa M. Patel, Teresa R. Zembower, Frank Palella, Yashpal S. Kanwar, and Shubhada N. Ahya Copyright © 2007 Shilpa M. Patel et al. All rights reserved. Plants and Fungal Products with Activity Against Tuberculosis Mon, 01 Jan 1900 00:00:00 +0000 Tuberculosis (TB) is becoming an ever more serious worldwide problem. This contagious disease kills four people every minute somewhere in the world and accounts for more than 2 million deaths per year. Due to the rapid spread of TB strains resistant to all the major anti-TB drugs on the market, and the association of TB with human immunodeficiency virus (HIV) infection in AIDS, we urgently need to develop new drugs to fight against TB. In this context, due to the importance of nature in the development of new drugs, the aim of the present review is to highlight a series of new and promising anti-TB agents derived from plants and fungi discovered between 2001 and 2005. Marcus Vinicius Nora De Souza Copyright © 2005 Marcus Vinicius Nora De Souza. All rights reserved. Eradication of HIV by Transplantation of CCR5-Deficient Hematopoietic Stem Cells Mon, 01 Jan 1900 00:00:00 +0000 Today, 30 years after the onset of the HIV pandemic, although treatment strategies have considerably improved, there is still no cure for the disease. Recently, we described a successful hematopoietic stem cell transplantation in an HIV-1–infected patient, transferring donor-derived cells with a natural resistance against HIV infection. These hematopoietic stem cells engrafted, proliferated, and differentiated into mature myeloid and lymphoid cells. To date, the patient has not required any antiretroviral treatment, more than 4 years after allogeneic transplantation. In the analysis of peripheral blood cells and different tissue samples, including gut, liver, and brain, no viral load or proviral DNA could be detected. Our report raises the hope for further targeted treatment strategies against HIV and represents a successful personalized treatment with allogeneic stem cells carrying a beneficial gene. However, this case has ignited a controversy regarding the question of whether this patient has achieved complete eradication of HIV or not. Here we give an update on open questions, unsolved aspects, and clinical consequences concerning this unique case. Gero Hütter and Susanne Ganepola Copyright © 2011 Gero Hütter and Susanne Ganepola. All rights reserved. Urologic Problems in Patients with Acquired Immunodeficiency Syndrome Mon, 01 Jan 1900 00:00:00 +0000 Victoria R. Staiman and Franklin C. Lowe Copyright © 2004 Victoria R. Staiman and Franklin C. Lowe. All rights reserved. Marine Natural Products Against Tuberculosis Mon, 01 Jan 1900 00:00:00 +0000 Natural products represent an outstanding source of compounds that play an important role in the treatment of human diseases. Due to the importance of nature as a source of new drug candidates, the aim of this review is to highlight the marine natural products, which exhibit antituberculosis activity, discovered between 2000 and 2005. Marcus Vinícius Nora De Souza Copyright © 2006 Marcus Vinícius Nora De Souza. All rights reserved. Anal Carcinoma in an HIV-Infected Woman Mon, 01 Jan 1900 00:00:00 +0000 Elena Sendagorta, Pedro Herranz, Héctor Guadalajara, Francisco Zamora, and Juan Gonzalez Copyright © 2010 Elena Sendagorta et al. All rights reserved. Synthesis and Anti–Mycobacterium tuberculosis Evaluation of Aza-Stilbene Derivatives Mon, 01 Jan 1900 00:00:00 +0000 Tuberculosis (TB) is a truly global disease, found in every country on earth. One-third of humanity, over 2 billion people, carry the bacillus that causes TB and 2 million people die of the disease each year. Despite that, no new specific drug against Mycobacterium tuberculosis has been developed since the 1960s. There are several candidates for new anti-TB agents, but none proven clinically effective. Stilbenes are compounds found in numerous medicinal plants and food products with some known biological and even antimycobacterial activity. This paper describes the synthesis and the anti–M. tuberculosis activity of eight stilbene analogues. The synthesis and characterization of these compounds are shown, and the results compared with one “first”-line drug used in current therapy. Fernando R. Pavan, Gustavo Senra G. de Carvalho, Adilson D. da Silva, and Clarice Q. F. Leite Copyright © 2011 Fernando R. Pavan et al. All rights reserved.