Volume 26, Issue 3, 2018
Review
What’s new in infectious diseases: Nipah virus, MERS-CoV and the
Blueprint List of the World Health Organization
Rizzardini Giuliano
Not available
Can a non-invasive urine-based test become the next-generation diagnostic tool for malaria?
Pradhan Nitika,
Hazra Rupenangshu K.
This mini review summarises the non-invasive urine-based diagnostic approaches that have been used to diagnose malaria. Amongst all urine-based diagnosis methods, commercially available Rapid Diagnostic kit/strip is most likely to be suitable for malaria detection in a cost-effective, time-consuming and user-friendly manner. With further improvement in sensitivity, specificity and accuracy, this technique may become a useful “next-generation gold standard” malaria diagnostic tool in resource-limited regions and in areas where invasive blood tests are restricted
Original article
A three-year study entailing molecular characterization and epidemiology of Clostridium difficile in an Italian tertiary care hospital
Mancini Alessio,
La Vigna Giorgio,
Pucciarelli Sandra,
Lombardi Francesca Elena,
Barocci Simone
In Italy, there are limited studies on the molecular epidemiology of Clostridium difficile, possibly due to insufficient laboratory diagnostic capacity, low awareness and lack of high-quality surveillance systems. The aim of this study was to evaluate the diffusion of C. difficile in a tertiary care hospital and to genotype all the collected strains in order for hospital staff to take corrective action. All specimens were subjected to a CDI diagnostic algorithm. This included highly specific toxin PCRs and multilocus sequence typing (MLST) to obtain clear, unequivocal genotypization. During a three-year study period, as part of routine C. difficile testing, 711 stool samples were collected from 522 patients to detect the presence of toxigenic genes. After testing, 106 different samples were identified as toxigenic. The proportions of non-toxigenic and toxigenic isolates were respectively 8.7% (62/711) and 14.9% (106/711). The most infection findings in wards for toxigenic strains were in Internal Medicine (56), followed by Neurology (11) and Gastroenterology (11). Three novel sequence types (STs) were found. The two most prevalent STs in wards were clade 1 ST-378 (40) and clade 1 ST-379 (33). Other healthcare-acquired strains were clade 4 ST-37 (11) and clade 5 ST-11 (7). Two STs, namely clade 3 ST-5 (10) and clade 1 ST-380 (5), were isolated among external patients. To prevent an increase in outbreak probability, an active surveillance programme combined with proper hand hygiene, environmental cleaning and contact precautions should be implemented.
A new strategy to control the proliferation of microorganisms in solid hospital waste and the diffusion of nosocomial infections
Motta Oriana,
Zarrella Ilaria,
Cucciniello Raffaele,
Capunzo Mario,
De Caro Francesco
A possible tool to reduce nosocomial infections is to identify unknown sources of contamination and then to provide a measure for controlling the related infections. In this study, solid hospital waste was considered a potential source of contamination, and a strategy to reduce the potential risk of pathogen contamination was tested. This paper describes a novel technique for waste management in healthcare settings with a view to facilitating infection prevention and control. We explored the innovative use of sodium dichloroisocyanurate (NaDCC) by investigating the microbicidal activity of chlorine, which derives from the hydrolysis of NaDCC mediated by humidity, and by testing its effect on the inhibition of microorganism growth.
NaDCC was inserted in a solid hospital waste bin containing also Lauria-Bertani agar plates, with different dilutions of a known titre of three different microorganisms, namely Escherichia coli, Staphylococcus aureus and Aspergillus brasiliensis. The plates were incubated in the container with or without the antimicrobial agent (control, CNT) at room temperature for 5 days. The number of colony-forming units (CFUs) present on each plate was then counted. Microorganisms capable of proliferating in the CNT waste bin were not able to grow in the presence of NaDCC. Furthermore, the molecular chlorine which developed and was released in the waste bin under the experimental conditions (T=20°C, t=5 days) was quantified using iodometric titration. NaDCC hydrolysis, mediated by humidity, has a strong and long-lasting microbicide effect. The proliferation of tested bacteria and fungi is totally inhibited. These results demonstrate the effectiveness of NaDCC in controlling and/or inhibiting microbial proliferation and support its possible use in the treatment of hospital waste to control the spread of nosocomial contamination.
Metallo-beta-Lactamase-producing Pseudomonas aeruginosa in Iran: a systematic review and meta-analysis
Vaez Hamid,
Khademi Farzad,
Salehi-Abargouei Amin,
Sahebkar Amirhossein
Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa is considered to be a serious threat to human health worldwide. Limited information is available concerning the prevalence of MBL-producing P. aeruginosa in Iran. The aim of the present study was to investigate the prevalence of MBL-producing P. aeruginosa in different parts of Iran. We searched major electronic databases including PubMed, ISI Web of Science, Scopus and Google Scholar as well as two Iranian search engines using appropriate keywords. After applying inclusion and exclusion criteria, related papers were recruited for the study. The prevalence of MBL-producing P. aeruginosa in Iranian population was about 32.4 percent. Our findings also revealed that the highest prevalence of MBL-producing P. aeruginosa was in Isfahan with 60% (95% CI: 0.27-0.86). In addition, in Iranian population the most reported MBL gene was blaVIM and blaIMP, with frequencies of 19% (95% CI: 0.15-0.23) and 11% (95% CI: 0.08-0.14), respectively. Based on our findings, in the majority of Iranian hospitals, the prevalence of MBL-producing P. aeruginosa is alarmingly high necessitating the need for designing appropriate infection control programs.
Integron types, antimicrobial resistance genes, virulence gene profile, alginate production and biofilm formation in Iranian cystic fibrosis Pseudomonas aeruginosa isolates
Pournajaf Abazar,
Razav Shabnam,
Irajian Gholamreza,
Ardebili Abdollah,
Erfani Yousef,
Solgi Sana,
Yaghoubi Sajad,
Rasaeian Afsaneh,
Yahyapour Yousef,
Kafshgari Ramin,
Shoja Saeed,
Rajabnia Ramazan
Cystic fibrosis (CF) patients commonly suffer from continuous and recurrent lung infections caused by Pseudomonas aeruginosa, the dominant pathogen in CF airways. This study aimed to determine the integron types, gene cassettes, virulence determinants, β-lactam resistance genes, biofilm formation and alginate production in P. aeruginosa isolated from Iranian CF patients. A total of 143 P. aeruginosa isolates were obtained from CF patients. Susceptibility of isolates to different antimicrobials was evaluated by disc diffusion method. ESBL, MBL and KPC production was assessed. Congo red agar and tissue culture plates were used for evaluation of biofilm formation. Alginate production was determined using the Carbazole assay. Integrase genes, resistance determinants (ESBLs, MBLs and KPC) and genes encoding virulence factors were evaluated by PCR. All isolates were susceptible to colistin, piperacillin-tazobactam and ticarcillin; 8.4% of isolates were considered as MDR phenotype. Out of 6.3% IPM-resistant isolates, prevalence of virulence genes was as follows: lasB (100%) and plcB (100%), plcH (96.5%). Biofilm formation and alginate production ability were found in 54.5% of isolates. The prevalence of the alginate-encoding genes was 92.3%, 86.7% and 67.1% for algD, algU and algL genes, respectively. PpyR, pslA and pelA genes were detected in 98.6%, 89.5% and 57.3% of the isolates, respectively. The high prevalence of colonization in CF lungs may increase the pathogenicity of P. aeruginosa due to their adhesion and protective properties caused by biofilm- and alginate-production. LasB, plcB, plcH, exoS, toxA, algD, ppyR and pslA genes were predominant in CF P. aeruginosa strains.
Prevalence of occult hepatitis C virus infection in patients who achieved sustained virologic response to direct-acting antiviral agents
Yousif Monkez M.,
Elsadek Fakhr Ahmed ,
Morad Emad A.,
Kelani Hesham,
Amed Emad F.,
M. Elsafek Hany,
H. Zahran Mahmoud,
Fahmy Afity Afify,
Ismail Waleed A.,
Elagrody Ahmed I.,
Ibrahim Nevin F.,
Amer Fatma A.,
Zaki Ayman M.,
Sadek Ayman M.E.M.,
Shendi Ali M.,
Emad George,
Farrag Hesham A.
The reappearance of HCV infection months or years after sustained virologic response (SVR) may be due to the persistence of HCV in tissue cells in spite of being undetected in serum. This situation is known as occult hepatitis C infection (OCI). We aimed to assess the prevalence of OCI in Egyptian patients with chronic hepatitis C (CHC) who achieved SVR after treatment with direct-acting antiviral agents (DAA). We carried out a cross-sectional study at the Advanced Center for Liver Diseases of Zagazig University Hospitals and Al-Ahrar Viral Hepatitis Treatment Center, Sharkia Governorate, Egypt. One hundred and fifty adult patients with CHC, who achieved SVR 12-24 weeks after end of treatment with sofosbuvir/daclatasvir ± ribavirin (139 patients, 92.67%), sofosbuvir/ledipasvir ± ribavirin (eight patients, 5.33%), sofosbuvir/simeprevir (two patients, 1.33%), and ombitasvir/ paritaprevir/ritonavir + ribavirin (one patient, 0.67%), according to the Egyptian National Committee for Control of Viral Hepatitis, were included in the study. We tested these patients for HCV RNA in peripheral blood mononuclear cells (PBMCs) immediately after confirmation of SVR12-24 weeks. Statistical analysis was performed by means of the Shapiro-Wilk test, Mann-Whitney U test, Chi-square test, and Fisher's exact test. Seventeen patients (11.33%) were positive for PBMNCs HCV RNA. The prevalence of OCI was highest in patients treated with simeprevir/sofosbuvir (2/2 patients). There is a substantially high prevalence of OCI after treatment with DAAs. We recommend dual testing for HCV RNA in both serum and PBMCs at the end of treatment of HCV infection with DAAs and during validation of the SVR following the initial response.
No effect of MTP polymorphisms on PNPLA3 in HCV-correlated steatosis
Zampino Rosa,
Macera Margherita,
Cirillo Grazia,
Pafundi Pia Clara,
Rinaldi Luca,
Coppola Nicola,
Pisaturo Mariantonietta,
Adinolfi Luigi Elio,
Miraglia del Giudice Emanuele,
Ingrosso Diego,
Capasso Rosanna
PNPLA3 and MTP genes have been associated with liver steatosis and chronic hepatitis C. We studied the influence of MTP and PNPLA3 polymorphisms in 114 Italian patients with chronic hepatitis C, evaluating the histological and clinical presentation of liver disease. The study confirmed the association of PNPLA3 polymorphisms with liver steatosis (p=0.041), but did not show any additive effect of MTP polymorphisms in the development of steatosis. MTP polymorphisms do not seem to influence PNPLA3 in the development of liver steatosis. Further studies with a larger number of patients are required.
Redox alteration in patients infected by different HCV genotypes
Limongi Dolores,
Baldelli Sara,
Santi Flavia,
D’Agostini Cartesio,
Palamara Anna Teresa,
Nencioni Lucia,
Ciotti Marco
Chronic hepatitis C virus (HCV) infection plays a pivotal role in hepatocarcinogenesis and has been associated with oxidative DNA damage. Few data have been reported on the general redox state in patients infected with different HCV genotypes. Total antioxidant capacity (TAC) and hydrogen peroxide levels as well as oxidative stress index were measured in serum of hepatitis C chronic patients in relation to genotype, viral load, transaminases level and degree of fibrosis.
Serum was obtained from two-hundred-fifty-two HCV infected patients and twenty-five healthy donors. TAC was measured by TAC Colorimetric Assay and hydrogen peroxide concentration by Hydrogen Peroxide Colorimetric Assay Kit (BioVision, USA).
In HCV infected patients, mean serum TAC was 5.62 mM Trolox equivalents which was significantly lower (p < 0.0001) than control group (7.25 mM Trolox equivalents). TAC reduction was particularly evident in patients infected by genotype 2 compared to those infected by genotypes 1, 3 and 4. In parallel, high levels of hydrogen peroxide were found in the serum of infected patients, p=0.0015. Although no statistically significant correlation was found with the degree of fibrosis, transaminases level or viral load, oxidative stress index was higher in HCV infected patients compared to uninfected controls, p=0.003.
The results indicate an imbalance of the redox state in HCV infected patients, with a strong reduction of the total antioxidant capacity and high oxidative stress index. Because oxidative burden may favour disease progression, a novel strategy aimed at counteracting it by using antioxidant molecules as adjunct therapy might represent a useful tool in the management of HCV chronic infection.
Relationship between malaria epidemiology and the human development index in Colombia and Latin America
Franco-Herrera Daniela,
González-Ocampo Daniela,
Restrepo-Montoya Valentina,
Gómez-Guevara Juan Esteban,
Alvear-Villacorte Nathalia,
Rodíguez-Morales Alfonso J.
The objective of our study was to establish the relationship between the Human Development Index (HDI), Gini coefficient and Unsatisfied Basic Needs (UBN), with the incidence of malaria in Colombia and five endemic countries of Latin America (Brazil, Venezuela, Ecuador, Mexico and Peru) between 2005 and 2012. Through an ecological study the HDI was obtained from the data base of the United Nations Development Programme; the Gini index and the UBN were obtained from Colombia's National Administrative Department of Statistics, and the malaria incidence from the World Health Organization’s programme “Roll Back Malaria” and from the Colombian epidemiological surveillance system. The annual variation of the variables was evaluated, and linear and non-linear regressions (exponentials) were modelled. Upon analysing the data with the regression models, it was noted that countries with higher malaria incidence rates were those with lower values of HDI, the association being significant (r2=0.4233; p<0.0001). Similarly, it was observed that Colombian departments with higher inequality and poverty rates were those with a higher incidence of malaria (Gini r2=0.1851; p<0.01; UBN r2=0.908; p<0.01). An inverse and significant relationship between HDI and malaria morbidity in the countries studied was found, as well as a positive and significant relationship between Gini and UBN with morbidity in these Colombian departments. This information reflects the significant influence of socioeconomic indicators such as HDI, Gini and UBN on the malaria incidence rate.
Case report
Brevibacterium casei bacteraemia in a port-a-cath carrier patient: a case report and literature review
Magi Barbara,
Migliorini Lucia,
Sansoni Anna,
Cusi Maria Grazia
Brevibacteria are part of the normal flora of the skin and adjacent structures, but have been increasingly encountered in humans as opportunistic pathogens and have been isolated from various clinical specimens, generally causing infections in immuno-compromised patients. We present a case of a port-a-cath-related bacteraemia caused by Brevibacterium casei in a woman with a prior history of bilateral breast cancer. The clinical outcome was favourable.
Liver abscess with Citrobacter koseri bacteremia
Kanzawa Yohei,
Ishimaru Naoto,
Seto Hiroyuki,
Tsutsumi Takahiko,
Kinami Saori
Citrobacter koseri is a rare cause of liver abscess with two reported cases in diabetic patients. We report a rare case of C. koseri liver abscess with C. koseri bacteremia in an elderly male with chronic kidney disease. He presented vomiting and weakness without any other signs. He was diagnosed with liver abscess by ultrasound, and blood culture showed C. koseri growth. The patient was treated effectively with a course of antibiotics and drainage. When C. koseri is isolated in patients with comorbidity, such as chronic kidney disease, we should consider the possibility of abscess including liver abscess and utilize a combined treatment of drainage and course of antibiotics for mixed infection.
Central nervous system tuberculosis following delayed and initially missed lung miliary tuberculosis: a case report
Rodriguez Meregildo,
Dante Edinson
Central nervous system (CNS) tuberculosis includes three clinical entities: tuberculous meningitis, intracranial tuberculoma, and spinal tuberculous arachnoiditis. All three categories are encountered frequently in regions of the world where the incidence of TB is high. Meningeal tuberculosis is a medical emergency: it is the most severe, lethal and disabling form of tuberculosis. Early diagnosis and treatment can be lifesaving. Even, in developed countries the diagnosis of tuberculous meningitis is difficult, frequently delayed or missed, and is often not microbiologically confirmed. Here I report a case of miliary tuberculosis, in a patient with diabetes mellitus and chronic kidney disease, but without HIV infection. Although the patient had regular contact with healthcare staff (hemodialysis), miliary tuberculosis diagnosis was considerably delayed. This patient, subsequently evolved into tuberculous meningitis. In spite of quadruple anti-tuberculosis treatment, corticosteroids, and general supportive care, this case resulted in
Multiple chronic parasitic infections in an immunocompetent immigrant: a challenge for healthcare management
Spertilli Chiara,
Rossetti Barbara,
Zammarchi Lorenzo,
Redi David,
Rinaldi Francesca,
De Luca Andrea,
Montagnani Francesca
The case reports multiple helmintiasis and chronic hepatitis caused by hepatitis B virus (HBV)/hepatitis D virus (HDV) in an immunocompetent immigrant male. It highlights the importance of early diagnosis and treatment of neglected infectious diseases in low endemic areas, besides difficulties that Western countries encounter in responding to immigrants' health needs.
The Infections in the History of Medicine
Amedeo Modigliani and his “great secret”: a brief history of medical and social aspects of tuberculosis in the nineteenth and early twentieth century
Perciaccante Antonio,
Coralli Alessia,
Appenzeller Otto
The pathography of the famous painter and sculptor Amedeo Modigliani (1884-1920) shows that he had tuberculosis and died of tubercular meningitis aged 35. The nineteenth century was characterized by numerous milestones in the history of tuberculosis. In 1853, Hermann Brehmer, first used the term tuberculosis referred to at the time as "phthisis". In 1865, Jean Antoine Villemin demonstrated the infectious etiology of the disease. This was confirmed in 1882 by Robert Koch by identifying the tubercle bacillus. Koch also invented the diagnostic tuberculin test. Charles Mantoux and Florence Seibert improved this test. Identification of the infectious etiology of tuberculosis led to experiments of effective treatments for this disease. The most successful treatment for tuberculosis was by sanatorium regime. From the late nineteenth century, more invasive therapeutic approaches such as artificial pneumothorax were introduced. The advent of streptomycin in 1945 changed the social view of tuberculosis. This previously romanticized disease became a social stigma which was associated with poor social and moral standards; patients were kept in isolation. Fearing social ostracism, Modigliani refused treatment for tuberculosis and instead deliberately fostered his reputation as an alcoholic and addict in order to conceal the disease.
The Knights Hospitaller of Rhodes and the Black Death of 1498: a poetic description of the plague
Tsiamis Costas,
Vrioni Georgia,
Poulakou-Rebelakou Effie,
Gennimata Vassiliki,
Tsakris Athanassios
The study is a presentation of the sole written testimony of the great plague epidemic that struck the island of Rhodes in 1498, at the time when the Order of the Knights of St. John was settled there. The Greek poem “The Thanatikon (i.e., plague) of Rhodes”, which was written by Emmanuel Georgillas Limenitis in the late 15th century and recounts the terrible events of the epidemic, was used as a source of information. Among the 644 verses of the poem, elements like the place, time, duration and how the epidemic spread can be identified. Within the historical context of the era, evaluation and analysis of the data reveal the correlation between human activities and the physical history of the disease in the Mediterranean during the 15th century. The Plague of Rhodes confirms the value of non-medical sources in the medico-historical and historico-epidemiological study of the evolution of the disease caused by Yersinia pestis while highlighting an enduring intrinsic weakness of surveillance systems. Despite modern means of epidemiological surveillance, the risk of relaxation of a health system after a long period of absence of an infectious disease constitutes a major factor for future resurgence of the specific disease.
Letters to the editor
Mapping Zika by Geographic Information System
Joob Beuy,
Wiwnaitkit Viroj
Not available
