Interdisciplinary Perspectives on Infectious Diseases The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Serum Ferritin: A Backstage Weapon in Diagnosis of Dengue Fever Mon, 02 Oct 2017 08:04:59 +0000 Aims. This retrospective study evaluates ferritin as a surrogate marker for dengue infection (NS1 and IgM negative stage) as opposed to other febrile illnesses of infective or inflammatory etiology (OFI). Methodology. Data of all patients admitted to medical ward and medical ITU during the dengue outbreak were collected. Patients admitted between 5 and 10 days of febrile illness without a diagnosis were included. Patients with NS1 positivity (Days 2–8) and/or positive IgM for dengue (Days 6–10) were considered to be dengue cases and those with other confirmed diagnoses were considered in the OFI group. Ferritin, CRP, TC of WBC, platelet count, SGOT, SGPT, and albumin levels were analysed for both groups. Results. We examined 30 cases of clinically and serologically confirmed dengue fever and 22 cases of OFI. Ferritin level in dengue cohort was significantly higher than the OFI group (). The best cut-off for ferritin level to differentiate dengue from OFI was found to be 1291. The sensitivity at this cut-off is 82.6% and the specificity at this cut-off is 100%. Conclusion. Ferritin may serve as a significant marker for differentiating between dengue fever and OFI, in absence of a positive NS1 antigen or a positive IgM antibody for dengue. Soumyabrata Roy Chaudhuri, Subhayan Bhattacharya, Mainak Chakraborty, and Kingshuk Bhattacharjee Copyright © 2017 Soumyabrata Roy Chaudhuri et al. All rights reserved. Local Diversity and Biting Pattern of Anopheles Species in Southern Minahasa Sun, 06 Aug 2017 08:29:21 +0000 Background. To optimize the preventive measures of malaria, it is important to synchronize the efforts with the behavior of local Anopheles species. However, the data of Anopheles species and their behavior in Indonesia is still lacking. Method. Explorative research was conducted from April to September 2016 in Southern Minahasa district. The Anopheles mosquito was baited by using animal and human (indoor or outdoor) from 18.00 to 06.00 hours. Then, the species were identified and Man Biting Rate (MBR) and Man/Animal Biting per Hour (MBPH) were calculated followed by statistical analysis by using SPSS 17. Result. The data showed that the dominant species in Southern Minahasa were An. barbirostris, An. kochi, and An. vagus. An. vagus was found to be zoophilic and An. barbirostris was showing strict anthropophilic characteristics. Meanwhile, An. kochi feeds on both human and animal. The MBR of An. kochi was found to be the highest (), but its MBPH only significantly exceeded that of An. vagus. All species tend to be more active during the early evening. Conclusion. An. barbirostris, An. kochi, and An. vagus were the dominant Anopheles species in Southern Minahasa. Further research is needed to determine the Plasmodium infestation rate of these species. O. R. Pinontoan, I. G. P. Supadmanaba, I. B. A. Manuaba, I. D. M. Sukrama, and I. B. P. Manuaba Copyright © 2017 O. R. Pinontoan et al. All rights reserved. Association between Virulence Factors and Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae Compared to Nonproducing Isolates Thu, 08 Jun 2017 07:19:39 +0000 Klebsiella pneumoniae is considered an important opportunistic multidrug-resistant pathogen. Extended spectrum β-lactamases (ESBLs) and expression of a multitude of virulence factors may work in a harmony resulting in treatment failure. This study was undertaken to compare the virulence characteristics and genetic relatedness between ESBL and non-ESBL producing K. pneumoniae. Methods. Antibiotic sensitivity test of all isolates was determined by disc diffusion assay. Phenotypic and genotypic detection of ESBL were done. Various virulence factors and some virulence factor-associated genes were screened. Random amplified polymorphic DNA (RAPD) was employed to investigate the genetic fingerprints of ESBL from non-ESBL producing K. pneumoniae. Results. 50% of isolates were ESBL producers. A significant association was observed between ESBL production and biofilm (strong and moderate), serum resistance, and iss gene. Moreover, significant association between non-ESBL producers and hypermucoviscosity was identified. Dendogram analysis of RAPD profile classified K. pneumoniae isolates into four clusters (a, b, c, and d). Seventy-six percent of ESBL producers belonged to cluster a. In conclusion, this study suggests a correlation between ESBL production and some virulence factors. Therefore, success of treatment depends mainly on increased clinicians awareness and enhanced testing by laboratories to reduce the spread of these isolates. Mustafa Muhammad Gharrah, Areej Mostafa El-Mahdy, and Rasha Fathy Barwa Copyright © 2017 Mustafa Muhammad Gharrah et al. All rights reserved. Epidemiological and Clinical Parameters Features of Patients with Clonorchiasis in the Geum River Basin, Republic of Korea Wed, 26 Apr 2017 00:00:00 +0000 This study was conducted to evaluate the infection rates of Clonorchis sinensis and laboratory findings in infected people. The 3,167 fecal samples, from nine villages in Okcheon-gun, were examined. Hee-Eun Shin, Myoung-Ro Lee, Jung-Won Ju, Byong-Suk Jeong, Mi-Yeoun Park, Keoung-Sook Lee, and Shin-Hyeong Cho Copyright © 2017 Hee-Eun Shin et al. All rights reserved. Hematological Parameters and Hemozoin-Containing Leukocytes and Their Association with Disease Severity among Malaria Infected Children: A Cross-Sectional Study at Pawe General Hospital, Northwest Ethiopia Sun, 19 Feb 2017 00:00:00 +0000 Hematological parameter changes are the most common complications in malaria. We aimed to determine the hematological parameters and hemozoin-containing leukocytes and their association with disease severity in malaria infected children aged between 1 and 15 years. A facility-based cross-sectional study was conducted at Pawe General Hospital from July 31 to December 30, 2014. Demographic and clinical data were collected using structured questionnaire. Blood specimen was collected from each study participant for hematological investigations. Data were analyzed using SPSS version 20. The overall prevalence of anemia was 40.3%, most of which were mildly anemic. Leukocytosis was found in 15.4% of study participants. More than a fourth (27%) of the children had severe malaria. Hemozoin-containing monocytes and neutrophils were found in 80.1% and 58.9% of the study participants, respectively. Under-five years of age (AOR = 3.01, 95% CI: 1.83–7.39, ), leukocytosis (AOR = 3.20, 95% CI: 1.65–6.24, ), mean hemozoin-containing monocytes >5% (AOR = 6.26, 95% CI: 2.14–14.29, ), mean hemozoin-containing neutrophils >5% (AOR = 7.93, 95% CI: 3.09–16.86, ), and high density parasitemia (AOR = 1.90, 95% CI: 1.13–3.18, ) were associated with severe malaria. Hemozoin-containing leukocytes, leukocytosis, and other identified associated factors should be considered for proper management of children with severe malaria. Muluken Birhanu, Yaregal Asres, Wondimagegn Adissu, Tilahun Yemane, Endalew Zemene, and Lealem Gedefaw Copyright © 2017 Muluken Birhanu et al. All rights reserved. Sulfated Glycans and Related Digestive Enzymes in the Zika Virus Infectivity: Potential Mechanisms of Virus-Host Interaction and Perspectives in Drug Discovery Thu, 19 Jan 2017 00:00:00 +0000 As broadly reported, there is an ongoing Zika virus (ZIKV) outbreak in countries of Latin America. Recent findings have demonstrated that ZIKV causes severe defects on the neural development in fetuses in utero and newborns. Very little is known about the molecular mechanisms involved in the ZIKV infectivity. Potential therapeutic agents are also under investigation. In this report, the possible mechanisms of action played by glycosaminoglycans (GAGs) displayed at the surface proteoglycans of host cells, and likely in charge of interactions with surface proteins of the ZIKV, are highlighted. As is common for the most viruses, these sulfated glycans serve as receptors for virus attachment onto the host cells and consequential entry during infection. The applications of (1) exogenous sulfated glycans of different origins and chemical structures capable of competing with the virus attachment receptors (supposedly GAGs) and (2) GAG-degrading enzymes able to digest the virus attachment receptors on the cells may be therapeutically beneficial as anti-ZIKV. This communication attempts, therefore, to offer some guidance for the future research programs aimed to unveil the molecular mechanisms underlying the ZIKV infectivity and to develop therapeutics capable of decreasing the devastating consequences caused by ZIKV outbreak in the Americas. Vitor H. Pomin Copyright © 2017 Vitor H. Pomin. All rights reserved. Prevalence, Characteristics, and One-Year Follow-Up of Congenital Cytomegalovirus Infection in Isfahan City, Iran Wed, 14 Dec 2016 08:23:52 +0000 Introduction. Need of neonatal screening for Cytomegalovirus (CMV) infection is under debate, in part because of limited data on importance of the disease regarding the prevalence of congenital CMV (cCMV) infection and associated morbidity and mortality. We aimed to evaluate the prevalence and prognosis of cCMV infection in Iran, where there is high maternal seroprevalence of CMV. Methodology. This prospective study was conducted in Isfahan city, Iran, from 2014 to 2016. CMV was investigated in urine specimens by using the real-time polymerase chain reaction (RT-PCR) method. CMV-infected infants were examined for clinical and laboratory findings attributed to CMV infection and followed up for one year. Results. Among 1617 studied neonates, eight (0.49%) were positive for CMV infection. CMV-infected neonates were more likely to be preterm than noninfected ones (25% versus 4.5%, ), and they had lower birth weight. Three out of the eight CMV-infected neonates had transient symptoms at birth. At follow-up, one case had mild hearing loss. Most patients had impaired growth during the one-year follow-up. Conclusions. The primary object of this study was determination of prevalence of cCMV infection in Iran as a developing country, which was at the lower range compared with other such countries. cCMV infection may result in short-term impairment in growth. Pegah Karimian, Omid Yaghini, Hossein Nasr Azadani, Majid Mohammadizadeh, Seyed Ali Mohammad Arabzadeh, Atosa Adibi, and Hamid Rahimi Copyright © 2016 Pegah Karimian et al. All rights reserved. Antimicrobial Stewardship: A Cross-Sectional Survey Assessing the Perceptions and Practices of Community Pharmacists in Ethiopia Tue, 22 Nov 2016 09:43:04 +0000 Background. Community pharmacists are key healthcare professionals for antimicrobial stewardship programs owing to their role in dispensing of antimicrobials. The aim of the present study was to assess the perception and practices of community pharmacists towards antimicrobial stewardship (AMS) in Ethiopia. Methods. A cross-sectional survey was conducted by selecting pharmacy sites through stratified simple random sampling technique. Descriptive and inferential statistics were used to analyze the data. Results. Majority of respondents strongly agreed or agreed that AMS program is vital for the improvement of patient care. Almost all of respondents agreed that pharmacists can play a prominent role in AMS and infection prevention (93.2%, median = 5; IQR = 2–5). However, only 26.5% of respondents strongly agreed or agreed that AMS should be practiced at community pharmacy level (median = 4, IQR = 1–3) and more than half of community pharmacists (59.9%) often/always dispense antimicrobial without a prescription. Conclusion. The present study revealed positive perceptions and practices of community pharmacists towards antimicrobial stewardship. Yet, some weak areas like integration of AMS program in community pharmacies, the significance of interprofessional involvement, and dispensing of antimicrobials without a valid prescription still need improvement. Daniel Asfaw Erku Copyright © 2016 Daniel Asfaw Erku. All rights reserved. Clinical Significance of Molecular Diagnostic Tools for Bacterial Bloodstream Infections: A Systematic Review Wed, 16 Nov 2016 07:44:45 +0000 Bacterial bloodstream infection (bBSI) represents any form of invasiveness of the blood circulatory system caused by bacteria and can lead to death among critically ill patients. Thus, there is a need for rapid and accurate diagnosis and treatment of patients with septicemia. So far, different molecular diagnostic tools have been developed. The majority of these tools focus on amplification based techniques such as polymerase chain reaction (PCR) which allows the detection of nucleic acids (both DNA and small RNAs) that are specific to bacterial species and sequencing or nucleic acid hybridization that allows the detection of bacteria in order to reduce delay of appropriate antibiotic therapy. However, there is still a need to improve sensitivity of most molecular techniques to enhance their accuracy and allow exact and on time antibiotic therapy treatment. In this regard, we conducted a systematic review of the existing studies conducted in molecular diagnosis of bBSIs, with the main aim of reporting on clinical significance and benefits of molecular diagnosis to patients. We searched both Google Scholar and PubMed. In total, eighteen reviewed papers indicate that shift from conventional diagnostic methods to molecular tools is needed and would lead to accurate diagnosis and treatment of bBSI. Jean Pierre Rutanga and Therese Nyirahabimana Copyright © 2016 Jean Pierre Rutanga and Therese Nyirahabimana. All rights reserved. Retracted: Contamination of Hospital Water Supplies in Gilan, Iran, with Legionella pneumophila, Escherichia coli, and Pseudomonas aeruginosa Wed, 12 Oct 2016 07:08:04 +0000 Interdisciplinary Perspectives on Infectious Diseases Copyright © 2016 Interdisciplinary Perspectives on Infectious Diseases. All rights reserved. Evaluation and Verification of the Global Rapid Identification of Threats System for Infectious Diseases in Textual Data Sources Tue, 06 Sep 2016 11:30:46 +0000 The Global Rapid Identification of Threats System (GRITS) is a biosurveillance application that enables infectious disease analysts to monitor nontraditional information sources (e.g., social media, online news outlets, ProMED-mail reports, and blogs) for infectious disease threats. GRITS analyzes these textual data sources by identifying, extracting, and succinctly visualizing epidemiologic information and suggests potentially associated infectious diseases. This manuscript evaluates and verifies the diagnoses that GRITS performs and discusses novel aspects of the software package. Via GRITS’ web interface, infectious disease analysts can examine dynamic visualizations of GRITS’ analyses and explore historical infectious disease emergence events. The GRITS API can be used to continuously analyze information feeds, and the API enables GRITS technology to be easily incorporated into other biosurveillance systems. GRITS is a flexible tool that can be modified to conduct sophisticated medical report triaging, expanded to include customized alert systems, and tailored to address other biosurveillance needs. Andrew G. Huff, Nathan Breit, Toph Allen, Karissa Whiting, and Christopher Kiley Copyright © 2016 Andrew G. Huff et al. All rights reserved. Epidemiological Mapping of Human Onchocerciasis in Transmission Suspected Districts of Bale, Borena, and West Arsi Zones of Eastern Ethiopia Thu, 25 Aug 2016 17:11:26 +0000 Onchocerciasis is mainly found in western part of Ethiopia and there is no evidence of transmission in the east ward. However, some zones (Bale, Borena, and West Arsi) are suspected for transmission given the area has fast flowing rivers and is covered with vegetation. Therefore, this study was conducted to map onchocerciasis transmission in those zones. About 19 villages were selected based on proximity to the rivers, representation of districts, zones, and vegetation covers, whereas the study participants, all village residents of age > 5 years with good health condition, were skin sniped and examined using microscopy. In this study a total of 2560 study participants were surveyed of which 1332 were female (52%) and 122 were male (48%). The age group of 21–30 years was highest (34.4%) and that of age > 51 years was the lowest (3.1%) study participants. The survey result revealed that none of the study participants regardless of age, sex, and location demonstrated skin snip Onchocerca microfilariae. The prevalence of microfilariae and community microfilarial load (CMFL) were 0% and 0 mf/s, respectively. The finding implied that there is no onchocerciasis in the area and, therefore, there is no need for interventions. Black fly distribution, cytotaxonomic study, and intraborder cross transmission monitoring are recommended. Sindew Mekasha Feleke, Gemechu Tadesse, Kalkidan Mekete, Afework Hailemariam Tekle, and Amha Kebede Copyright © 2016 Sindew Mekasha Feleke et al. All rights reserved. Predictors of Staphylococcus aureus Colonization and Results after Decolonization Tue, 26 Jul 2016 13:24:48 +0000 Protocols for the screening and decolonization of Staphylococcus aureus prior to total joint arthroplasty (TJA) have become widely adopted. The goals of this study were to determine: (1) whether implementation of a screening protocol followed by decolonization with mupirocin/vancomycin and chlorhexidine reduces the risk of revision compared with no screening protocol (i.e., chlorhexidine alone) and (2) whether clinical criteria could reliably predict colonization with MSSA and/or MRSA. Electronic medical records of primary patients undergoing TJA that were screened (,927) and were not screened (,751) for Staphylococcus aureus at least 4 days prior to surgery, respectively, were retrospectively reviewed. All patients received chlorhexidine body wipes preoperatively. Patients carrying MSSA and MRSA were treated preoperatively with mupirocin and vancomycin, respectively, along with the standard preoperative antibiotics and chlorhexidine body wipes. Screened patients were 50% less likely to require revision due to prosthetic joint infection compared to those not screened (). Multivariate regression models were poorly accurate in predicting colonization with MSSA (AUC = 0.58) and MRSA (AUC = 0.62). These results support the routine screening and decolonization of S. aureus prior to TJA. Tennison L. Malcolm, Le Don Robinson, Alison K. Klika, Deepak Ramanathan, Carlos A. Higuera, and Trevor G. Murray Copyright © 2016 Tennison L. Malcolm et al. All rights reserved. Evaluation of Antimicrobial Resistance in Staphylococcus aureus Isolates by Years Mon, 09 May 2016 12:59:53 +0000 Objective. Recently, community and hospital-acquired infections with Staphylococcus aureus have increased and raised antibiotic resistant isolates. In this study, we aimed to evaluate the antibiotic resistance profile of S. aureus isolates over several years in various clinical specimens from our hospital. Materials and Methods. S. aureus strains from 2009 to 2014 were isolated from various clinical samples at Yuzuncu Yil University, Dursun Odabas Medical Center, Microbiology Laboratory, and their antibiotic susceptibility test results were retrospectively investigated. The isolates were identified by conventional methods, and antibiotic susceptibility tests were performed by the Phoenix (Becton Dickinson, USA) automated system method according to Clinical and Laboratory Standards Institute (CLSI) standards. Results. A total of 1,116 S. aureus isolates were produced and methicillin-resistant S. aureus (MRSA) to 21% of all S. aureus isolates between 2009 and 2014. According to the results of susceptibility tests of all isolates of S. aureus, they have been identified as sensitive to vancomycin, daptomycin, linezolid, and levofloxacin. While the resistance rates to nitrofurantoin, quinupristin-dalfopristin, and trimethoprim-sulfamethoxazole were determined as 0.3%, 2.4%, and 6%, respectively, resistance rates to penicillin, erythromycin, rifampicin, gentamicin, and clindamycin were determined as 100%, 18%, 14%, 14%, and 11%, respectively. The highest percentage of methicillin resistance was determined as 30% in 2009, and the resistance was determined to have decreased in subsequent years (20%, 16%, 13%, 19%, and 21%) (). Conclusion. Currently, retrospective evaluations of causes of nosocomial infection should be done periodically. We think that any alteration of resistance over the years has to be identified, and all centers must determine their own resistance profiles, in order to guide empirical therapies. Reducing the rate of antibiotic resistance will contribute to reducing the cost of treatment. Cennet Rağbetli, Mehmet Parlak, Yasemin Bayram, Huseyin Guducuoglu, and Nesrin Ceylan Copyright © 2016 Cennet Rağbetli et al. All rights reserved. Using MALDI-TOF Mass Spectrometry to Identify Drug Resistant Staphylococcal Isolates from Nonhospital Environments in Brunei Darussalam Sun, 03 Apr 2016 12:44:42 +0000 Drug resistant bacteria have been a growing threat to the community and hospitals due to the misuse of antibiotics by humans, industrialization, and lack of novel antimicrobials currently available. Little is known about the prevalence of drug resistant bacteria in nonhealthcare environments in Brunei Darussalam and about how antibiotic resistant genes are transferred within these environments. Human contact points from different types of environments in Brunei Darussalam, varying from urban to jungle settings, were swabbed and cultured onto selective media to isolate staphylococci bacteria before performing antimicrobial susceptibility testing on the isolates. The identity of the isolates was determined using MALDI-TOF mass spectrometry (MS). Staphylococci isolates resistant to oxacillin were further tested for their minimum inhibitory concentration (MIC). PCR analysis of the mecA gene, a gene that confers resistance to oxacillin, is done to determine the level of resistance to oxacillin. Ten different staphylococcal species were identified by MALDI-TOF-MS analysis. Out of the 36 staphylococci isolates, 24 were resistant to multiple antibiotics including two isolates which were oxacillin resistant. Some staphylococci isolates had similar antibiotic resistance profiles to other staphylococci isolates of different species in the same location. This work provides the first-ever evidence of drug resistant staphylococci in the nonhospital environment in Brunei Darussalam. Ko S. Chong, Siti A. Shazali, Zhen Xu, Ronald R. Cutler, and Adi Idris Copyright © 2016 Ko S. Chong et al. All rights reserved. Parasitaemia and Its Relation to Hematological Parameters and Liver Function among Patients Malaria in Abs, Hajjah, Northwest Yemen Wed, 09 Mar 2016 07:05:40 +0000 Plasmodium falciparum malaria is the most common infection in Yemen. The present study aims to investigate changes in hematological and hepatic function indices of P. falciparum infected individuals. This study included 67 suspected falciparum malarial patients attended in clinics and rural Abs Hospital (Tehama, Hajjah), Yemen, from October 2013 to April 2014. The diagnosis of malaria was confirmed by thick and thin film with Giemsa staining of malaria parasite. Hematological parameters and serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and bilirubin (total and direct) as test indicators of liver function were studied. Patients with parasitaemia tended to have significantly lower hemoglobin, hematocrit, white blood cell count, lymphocytes, and platelets, compared with healthy normal subjects. Neutrophils levels were significantly higher in cases of falciparum malaria in comparison to healthy normal subjects. Serums AST, ALT, ALP, and bilirubin (total and direct) in falciparum malaria patients were significantly higher () than those of falciparum malaria of free individuals. Hematological and liver dysfunctions measured parameters were seen associated with moderate and severe parasitaemia infection. This study concludes that hematological and hepatic dysfunction parameters could be indicator of malaria in endemic regions. Mohamed Al-Salahy, Bushra Shnawa, Gamal Abed, Ahmed Mandour, and Ali Al-Ezzi Copyright © 2016 Mohamed Al-Salahy et al. All rights reserved. The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review Wed, 17 Feb 2016 14:10:29 +0000 The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed. Fereshte Sheybani, HamidReza Naderi, and Sareh Sajjadi Copyright © 2016 Fereshte Sheybani et al. All rights reserved. Impact of HIV Infection and Zidovudine Therapy on RBC Parameters and Urine Methylmalonic Acid Levels Thu, 11 Feb 2016 13:19:40 +0000 Background. Anaemia is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the impact of HIV infection and zidovudine on red blood cells (RBC) parameters and urine methylmalonic acid (UMMA) levels in patients with HIV infection. Material and Methods. A cross-sectional study involving 114 subjects, 94 of which are HIV-infected nonanaemic and 20 HIV negative subjects (Cg) as control. Full blood count parameters and urine methylmalonic acid (UMMA) level of each subject were determined. Associations were determined by Chi-square test and logistic regression statistics where appropriate. Results. Subjects on zidovudine-based ART had mean MCV (93 fL) higher than that of control group (82.9 fL) and ART-naïve (85.9 fL) subjects and the highest mean RDW. Mean UMMA level, which reflects vitamin B12 level status, was high in all HIV-infected groups but was significantly higher in ART-naïve subjects than in ART-experienced subjects. Conclusion. Although non-zidovudine therapy may be associated with macrocytosis (MCV > 95 fL), zidovudine therapy and ART naivety may not. Suboptimal level of vitamin B12 as measured by high UMMA though highest in ART-naïve subjects was common in all HIV-infected subjects. Adewumi Adediran, Vincent Osunkalu, Tamunomieibi Wakama, Sarah John-Olabode, Akinsegun Akinbami, Ebele Uche, and Sulaimon Akanmu Copyright © 2016 Adewumi Adediran et al. All rights reserved. Correlation between Trichomonas vaginalis and Concurrency: An Ecological Study Tue, 02 Feb 2016 13:17:27 +0000 Objective. There is a large variation in the prevalence of Trichomonas vaginalis (TV) between different countries and between racial groups within countries. Sexual partner concurrency may play a role. We investigate the correlation between the prevalence of sexual partner concurrency and TV prevalence. Methods. Spearman’s correlation to assess relationship between TV prevalence in women and point prevalence of concurrency in men in (1) 11 countries with comparable data (concurrency data from WHO Survey and TV prevalence data from Global Burden of Disease estimates) and (2) three racial groups in the United States (Add Health Study). Results. The prevalence of TV and concurrency was positively correlated in the international (rho = 0.84, ) and USA study (rho = 1.0, ). Conclusion. Prospective longitudinal studies that include measures of partner behavior are required to definitively establish the role of concurrency in the spread of TV. Chris R. Kenyon and Deven T. Hamilton Copyright © 2016 Chris R. Kenyon and Deven T. Hamilton. All rights reserved. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India Sun, 24 Jan 2016 07:17:39 +0000 Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient’s underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp. Sachin C. Deorukhkar and Santosh Saini Copyright © 2016 Sachin C. Deorukhkar and Santosh Saini. All rights reserved. Ulcerative Colitis and Its Association with Salmonella Species Wed, 20 Jan 2016 06:06:33 +0000 Ulcerative colitis (UC) is characterized by presence of ulcer in colon and bloody diarrhea. The present study explores the possibility of association between Salmonella and ulcerative colitis. The present study comprised 59 cases of UC, 28 of colon cancer (CC), 127 of irritable bowel syndrome (IBS), and 190 of healthy control. The serological study was done by Widal and Indirect Haemagglutination Assay (IHA) for ViAb. Nested PCR was performed targeting fliC, staA, and stkG gene for Typhi and Paratyphi A, respectively. A total of 15.3% patients were positive for Salmonella “O” antigen among them 18.6% UC, 35.5% CC, 12.6% IBS, and 15.3% healthy control. A total of 36.9% patients were positive for “H” antigen including 39.0%, 57.1%, and 67.7% UC, CC, and IBS, respectively. About 1.73% show positive agglutination for AH antigen including 3.4%, 3.6%, and 1.6%, UC, CC, and IBS. A total of 10.89% were positive for ViAb. While 6.8% of UC, 10.7% of CC, 11.0% of IBS, and 12.1% of healthy subjects were positive for the antibody, the PCR positivity rates for Salmonella specific sequences were 79.7% in UC, 53.6% in CC, 66.1% in IBS, and 16.3% in healthy controls. The present study suggested that higher prevalence of Salmonella might play important role in etiopathogenesis of UC, IBS, and CC. Manish Kumar Tripathi, Chandra Bhan Pratap, Vinod K. Dixit, Tej Bali Singh, Sunit K. Shukla, Ashok K. Jain, and Gopal Nath Copyright © 2016 Manish Kumar Tripathi et al. All rights reserved. Bacteriospermia and Its Impact on Basic Semen Parameters among Infertile Men Wed, 06 Jan 2016 12:53:20 +0000 Introduction. Semen analysis is considered as the surrogate marker for male fecundity while assessing infertile men. There are several reasons for altered semen quality and bacteriospermia could be one among them. Thereby the aim of our work is to study the semen culture and its impact on semen parameters among infertile men. Materials and Methods. Semen samples were collected from men attending infertility clinic. Semen parameters were analysed based on WHO guidelines. Also, samples were subjected to culture using standard bacteriological techniques. Results. A total of 85 samples were collected. A number of 47 (55.30%) had normal sperm count, 37 (43.50%) had oligozoospermia, and one (1.17%) had azoospermia. Teratozoospermia was the most common abnormality observed (81.17%) followed by asthenozoospermia (28.23%). The prevalence of bacteriospermia was 35.3%. Enterococcus faecalis (30%) was the most common organism isolated followed by Coagulase negative Staphylococcus (23.33%), Staphylococcus aureus (20%), and E. coli (10%). Other less frequently isolated organisms were Klebsiella pneumoniae (6.66%), Proteus sp. (6.66%), and Citrobacter sp. (3.33%). Conclusion. The presence of asymptomatic bacteriospermia did not correlate with abnormal semen parameters. Sangeetha Vilvanathan, Balan Kandasamy, Abiramy Lakshmy Jayachandran, Sarasa Sathiyanarayanan, Vijayalakshmi Tanjore Singaravelu, Veeraraghavan Krishnamurthy, and Vanithadevi Elangovan Copyright © 2016 Sangeetha Vilvanathan et al. All rights reserved. Circulating Interferon-Gamma Levels Are Associated with Low Body Weight in Newly Diagnosed Kenyan Non-Substance Using Tuberculosis Individuals Tue, 05 Jan 2016 12:12:07 +0000 Although interferon-gamma, interleukin-10, and adiponectin are key immunopathogenesis mediators of tuberculosis, their association with clinical manifestations of early stage disease is inconclusive. We determined interferon-gamma, interleukin-10, and adiponectin levels in clinically and phenotypically well-characterised non-substance using new pulmonary tuberculosis patients () and controls () from Kenya. Interferon-gamma levels () and interferon-gamma to interleukin-10 () and interferon-gamma to adiponectin () ratios were elevated in tuberculosis cases. Correlation analyses in tuberculosis cases showed associations of interferon-gamma levels with body weight (; ), body mass index (; ), hip girth (; ), and plateletcrit (; ); interferon-gamma to interleukin-10 ratio with diastolic pressure (; ); and interferon-gamma to adiponectin ratio with body weight (; ), body mass index (; ), and plateletcrit (; ). Taken together, our results suggest mild-inflammation in early stage infection characterised by upregulation of circulating interferon-gamma production in newly infected TB patients. Nathan Shaviya, Valentine Budambula, Mark K. Webale, and Tom Were Copyright © 2016 Nathan Shaviya et al. All rights reserved. Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach Tue, 08 Dec 2015 11:17:55 +0000 Liver fibrosis represents the repair mechanism in liver injury and is a feature of most chronic liver diseases. The degree of liver fibrosis in chronic viral hepatitis infections has major clinical implications and presence of advanced fibrosis or cirrhosis determines prognosis. Treatment initiation for viral hepatitis is indicated in most cases of advanced liver fibrosis and diagnosis of cirrhosis entails hepatology evaluation for specialized clinical care. Liver biopsy is an invasive technique and has been the standard of care of fibrosis assessment for years; however, it has several limitations and procedure related complications. Recently, several methods of noninvasive assessment of liver fibrosis have been developed which require either serologic testing or imaging of liver. Imaging based noninvasive techniques are reviewed here and their clinical use is described. Some of the imaging based tests are becoming widely available, and collectively they are shown to be superior to liver biopsy in important aspects. Clinical utilization of these methods requires understanding of performance and quality related parameters which can affect the results and provide wrong assessment of the extent of liver fibrosis. Familiarity with the strengths and weaknesses of each modality is needed to correctly interpret the results in appropriate clinical context. Hicham Khallafi and Kamran Qureshi Copyright © 2015 Hicham Khallafi and Kamran Qureshi. All rights reserved. Comparison between Two Decades of Prevalence of Intestinal Parasitic Diseases and Risk Factors in a Brazilian Urban Centre Wed, 25 Nov 2015 12:11:25 +0000 Objectives. This study’s objective was to compare the prevalence of intestinal parasites and associated risk factors in children in urban communities, in the Brazilian Northeast, between two decades. Methods. This quantitative transversal study consisted of a comparative analysis of two different samples: the first viewing the years 1992–1996 and the other through a coproepidemiological data survey undertaken in 2010-2011. Results. It was evidenced that there was a reduction of intestinal parasites and that there were improvements in the socioenvironmental conditions between the two decades evaluated. It was observed that, in the period 1992–1996, playing out in the streets was associated with a higher risk for acquiring intestinal parasites. Over the 2010-2011 period, the characteristics of more than five residents per household, houses with dirt floors, children who live in homes without piped water, and children who play out in the streets were associated with a higher risk of intestinal parasitic infection. Conclusion. The study showed a reduction of intestinal parasitic diseases to 23.8% in 2010-2011 from 81.3% in 1992–1996 and improvement of the social-sanitary conditions of the population between the decades analyzed. Maria Aparecida Alves de Oliveira Serra, Cristina de Souza Chaves, Zirlane Castelo Branco Coêlho, Naya Lúcia de Castro Rodrigues, Josias Martins Vale, Maria Jânia Teixeira, Francisco Josemar Alves de Oliveira, Márcio Flávio Moura de Araújo, and Ivo Castelo Branco Coelho Copyright © 2015 Maria Aparecida Alves de Oliveira Serra et al. All rights reserved. Prevalence of Asymptomatic Brucellosis in Children 7 to 12 Years Old Tue, 20 Oct 2015 08:55:36 +0000 Background. Brucellosis is one of the most common diseases of humans and animals and its clinical manifestations differ from asymptomatic infection to chronic illness associated with recurrence of symptoms. This study aimed to evaluate the prevalence of brucellosis in asymptomatic children 7 to 12 years old in Kahak, Iran. Methods. In this study, 186 children 7 to 12 years old were evaluated. Demographic data and exposure to the brucellosis agent were recorded and blood samples for the Wright, Coombs, and 2ME tests were collected. All the study subjects were followed up for one year about the appearance of symptoms. Results. The mean age was 10 ± 1.72 years and 51% were boys. Family history was positive for brucellosis in 15% of children. A total of 8 children were brucellosis seropositive and, in subsequent follow-up, 6 of them showed the disease symptoms. Conclusion. This study showed that approximately 4.3% of children in endemic areas can have asymptomatic brucellosis and many of these children may be symptomatic in short term. Mohammad Aghaali, Siamak Mohebi, and Hosein Heydari Copyright © 2015 Mohammad Aghaali et al. All rights reserved. Contamination of Hospital Water Supplies in Gilan, Iran, with Legionella pneumophila, Escherichia coli, and Pseudomonas aeruginosa Mon, 07 Sep 2015 09:42:02 +0000 This study is designed to determine the contamination degree of hospital water supplies with Pseudomonas aeruginosa, Legionella pneumophila, and E. coli in Gilan, Iran. Samples were collected directly into sterile containers and concentrated by centrifuge. Half part of any sample transferred to yeast extract broth and the second part transferred to Trypticase Soy Broth and incubated for 3 days. DNA was extracted by using commercial kit. Four rounds of PCR were performed as follows: multiplex PCR for detecting Pseudomonas aeruginosa, Integron 1, and Metallo-β-lactamases gene; PCR for detecting Legionella pneumophila and mip gene separately; PCR for detecting E. coli; and another PCR for detecting whole bacterial presence. Contamination rates of cold, warm, and incubator water samples with P. aeruginosa, were 16.6%, 37.5%, and 6.8% consequently. Degrees of contamination with L. pneumophila were 3.3%, 9.3%, and 10.9% and with E. coli were zero, 6.2%, and zero. Total bacterial contamination of cold, warm, and incubator water samples was 93.3%, 84.4%, and 89.0% consequently. Metallo-β-lactamases gene was found in 20.0% of all samples. Contamination degree with P. aeruginosa was considerable and with L. pneumophila was moderate. Metallo-β-lactamases gene was found frequently indicating widespread multiple drug resistance bacteria. We suggest using new decontamination method based on nanotechnology. Masoumeh Ahmadi Jalali Moghadam, Hamidreza Honarmand, and Sajad Asfaram Meshginshahr Copyright © 2015 Masoumeh Ahmadi Jalali Moghadam et al. All rights reserved. Breeding Sites of Aedes aegypti: Potential Dengue Vectors in Dire Dawa, East Ethiopia Mon, 07 Sep 2015 06:57:31 +0000 Background and Objectives. Entomological survey was carried out from May-June to September-October 2014 to investigate the presence of dengue vectors in discarded tires and artificial water containers in houses and peridomestic areas. Methods. A cross-sectional immature stage survey was done indoors and outdoors in 301 houses. Mosquito larval sampling was conducted using pipette or dipper depending on container types. Larvae were identified morphologically and larval indices were also calculated. Results. A total of 750 containers were inspected, and of these 405 were positive for mosquito larvae. A total of 1,873 larvae were collected and morphologically identified as Aedes aegypti (: 84.4%) and Culex (: 15.6%). The larval indices, house index, container index, and breteau index, varied from 33.3 to 86.2, from 23.2 to 73.9, and from 56.5 to 188.9, respectively. Conclusion. Aedes aegypti is breeding in a wide range of artificial containers. To control these mosquitoes, the integration of different methods should be taken into consideration. Dejene Getachew, Habte Tekie, Teshome Gebre-Michael, Meshesha Balkew, and Akalu Mesfin Copyright © 2015 Dejene Getachew et al. All rights reserved. Occupational Hepatitis B Exposure: A Peek into Indian Dental Students’ Knowledge, Opinion, and Preventive Practices Sun, 30 Aug 2015 14:05:22 +0000 Objective. To determine the level of knowledge, opinions, and preventive practices followed by dental students against Hepatitis B. The study also explored if any correlation existed between knowledge, opinion, and preventive practices score. Materials and Methods. A cross-sectional study was conducted in a dental teaching institution. The subjects comprised 216 dental students. The study was conducted using a pretested, self-administered questionnaire. The questionnaire was prepared to assess knowledge, opinion, and preventive practices against Hepatitis B. Kruskal-Wallis and Kendall Tau test were performed. Results. The study found that only 44.4% of the students were vaccinated with Hepatitis B vaccine. 59.3% of the students reported washing their hands after contact with patient’s body fluids. 63.9% used personal protective measures like facemask, aprons, head cap, eye shields, and so forth, while treating patients. Median knowledge, opinion, and practice scores were found to be 5.00, 3.00, and 3.00, respectively. Significant correlation was obtained between knowledge and preventive practices score (, value ). Conclusion. Effective measures need to be taken to improve preventive practices of the students to prevent them from risk of Hepatitis transmission. Mandatory vaccination against Hepatitis B needs to be implemented. Sandeep Kumar, Debashish Basak, Amit Kumar, Pralhad Dasar, Prashant Mishra, Arunoday Kumar, Siddharth Kumar Singh, Nitai Debnath, and Anjali Gupta Copyright © 2015 Sandeep Kumar et al. All rights reserved. Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai Wed, 26 Aug 2015 14:10:15 +0000 Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai’s private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector. Carolyn Kavita Tauro and Nilesh Chandrakant Gawde Copyright © 2015 Carolyn Kavita Tauro and Nilesh Chandrakant Gawde. All rights reserved.