Volume 26, Issue 4, 2018
Review
Burkholderia cepacia complex outbreaks among non-cystic fibrosis patients in the intensive care units: A review of adult and pediatric literature.
Abdallah Mohammad,
Abdallah Hassan A.,
Memish Ziad A.
Burkholderia cepacia complex (Bcc) is a Gram-negative bacterium commonly found in moist environments and soil. Bcc species are associated with many outbreaks in intensive care units (ICUs). In this review, we describe the sources of Bcc outbreaks among non-cystic fibrosis (CF) patients in various ICUs that include neonatal intensive care units, pediatric intensive care units and adult ICUs. Also we summarize the risk factors and outcome predictors of Bcc infection or colonization in non-CF critically ill patients. Finally, we describe the infection control measures that are used to manage and prevent the spread of Bcc outbreaks.
PubMed was searched from 1 January 1994 and 31 December 2017. We found 30 outbreaks of Bcc among non-cystic fibrosis patients in ICUs; 17 outbreaks occurred in adult ICUs. The source was identified in 22 outbreaks. B. cepacia was the most common Bcc species causing outbreaks in ICUs; it was detected in 21 outbreaks. Indwelling central lines, presence of renal failure on hemodialysis, multiple bronchoscopic procedures, and recent abdominal surgery are independently associated with the development of B. cepacia bacteremia, while prolonged duration on a mechanical ventilator, a large number of nebulized albuterol therapies delivered, and prescription of beta-lactam, aztreonam, or macrolide-vancomycin antibiotics are risk factors for respiratory tract acquisition of B. cepacia. Disease severity and age were the main significant independent predictors of 14-day mortality in adult ventilated non-CF patients with Bcc acquisition.
Bcc species have been linked to many outbreaks in non-CF patients in ICUs. Strict application of infection control standards is critical to limit the emergence and spread of Bcc in ICU settings.
Original article
A multicenter-based study on epidemiology, antibiotic susceptibility and risk factors of toxigenic Clostridium difficile in hospitalized patients in southwestern Iran
Ebrahim-Saraie Hadi Sedigh,
Heidari Hamid,
Amanati Ali,
Bazargani Abdollah,
Alireza Taghavi Seyed,
Nikokar Iraj,
Kalantar Kurosh,
Motamedifar Mohammad
Clostridium difficile (recently Clostridioides difficile) is a leading cause of hospital- and antimicrobial-associated diarrhea (AAD). The present study was carried out to investigate the prevalence of toxigenic C. difficile, antibiotic resistance and its associated risk factors in Iranian hospitalized patients. This cross-sectional study was conducted from October 2017 to June 2018 in three teaching hospitals in southwestern Iran. During this period, a total of 215 nonduplicated nosocomial AAD samples were collected from the hospitalized patients older than two years of age. Presumptive C. difficile isolates were identified by standard microbiologic methods and confirmed by specific PCR primers. The minimum inhibitory concentrations (MICs) were determined by the agar dilution method. PCR was carried out to determine the presence of toxin genes (tcdA, and tcdB). In all, from the 215 diarrheal samples, the frequency of C. difficile culture-positive samples was 21.4% (n = 46). Of the 46 C. difficile isolates, 43 carried both toxins, two isolates only had the tcdB gene, and one was negative for both toxins. Overall, all isolates of C. difficile were susceptible to metronidazole and vancomycin. The MIC50/MIC90 of metronidazole and vancomycin were 0.75/2 µg/mL, 0.25/0.75 µg/mL, respectively. The findings of this study show the prevalence of CDI in hospitalized patients in southwestern Iran, highlighting the importance of active surveillance of CDI in hospitals. Meanwhile, all of the tested isolates were susceptible to metronidazole and vancomycin, which encourages the use of these antibiotics as the drug of choice for initial treatment of CDI in our region.
Investigation of Salmonella enteritidis outbreak in four kindergartens
Pavlova Maria,
Velev Valeri,
Karageorgiev Miroslav,
Aleksandrova Ekaterina,
N. Ivanov Ivan,
Kamenov Galin,
Halova Boriana,
Popov Metodi,
Pentchev Dancho,
Dinkova Maria,
Mangarov Atanas,
Kantardjiev Todor
In June 2018, in the city of Sofia, Bulgaria, 40 children from four different kindergartens suffered from salmonellosis caused by S. enteritidis. They were reported to have consumed food prepared and delivered by a private catering service. The patients had fever, diarrhea, and some had vomiting and abdominal pain. Sixteen of them were treated in hospital, and the other 24 received home treatment. Some of the outpatients received antibiotic treatment despite WHO recommendations. All 40 isolates were positive for O: D, H: gm and H: m, and were confirmed to be Salmonella enteritidis, respectively. Using conventional and molecular methods, such as serotyping, Multiplex-PCR and PFGE, it was confirmed that the strains were epidemiologically related. Based on molecular genetic methods, we established that the epidemic outbreak had a common origin: contaminated food delivered by a private catering service, which was consumed at all four kindergartens.
Molecular epidemiology and genetic characterization of Shigella in pediatric patients in Iran
Mehdi Soltan Dallal Mohammad,
Ranjbar Reza,
Yaghoubi Sajad,
Rajabi Zahra,
Aminharati Farzaneh,
Adeli Behrooz Hamidreza
Infection with Shigella is considered a major cause of morbidity and mortality in children with diarrhea in developing countries, especially in Iran. Due to the importance of country-level epidemiological data, molecular characterization of genetic determinants of Shigella spp. is a necessity. The aim of the present study was to investigate the prevalence of integron types, blaCTX-M, blaSHV and blaTEM β-lactamase genes of Shigella isolates in pediatric patients in Tehran, Iran. In a time period of 18 months from May 2015 to August 2017, 75 Shigella spp. were isolated from non-duplicative diarrheal stool specimens in six different hospitals in Tehran. The isolates from patients were further analyzed for their antibiotic susceptibility and extended-spectrum beta-lactamase (ESBL) production. Polymerase chain reaction was performed for amplification of the integrons (I, II, III), TEM, SHV, CTX-M15. The prevalence of S. sonnei, S. flexneri, S. dysenteriae and S. boydii were 40 (53.3%), 33 (44%), 1 (1.3%) and 1 (1.3%), respectively. The results of an antimicrobial resistance test showed that the high percentage of resistance to nalidixic acid (NA), ampicillin (AMP) and trimethoprim/sulfamethoxazole (SXT) included 38 (50.6%), 59 (81.3%) and 64 (88%) isolates, respectively. Further results revealed that 52% and 76% of Shigella isolates carried intI and intII genes, respectively. In this study, the rates of CTX-M (10.7%), SHV (28%) and TEM (21.3%) were determined, all of which were positive for blaCTX-M15. This study showed the high prevalence of multidrug resistant S. sonnei and S. flexneri. Furthermore, it highlighted the increasing integrons (intI and intII) and ESBL genes, especially blaCTX-M15, in Shigella isolates.
The diversity of class B and class D carbapenemases in clinical Acinetobacter baumannii isolates
Gholami Mehrdad,
Moshiri Mona,
Ahanjan Mohammad,
Salimi Chirani Alireza,
Hasannejad Bibalan Meysam,
Asadi Arezoo,
Eshaghi Morteza,
Pournajaf Abazar,
Abbasian Sara,
Kouhsari Ebrahim,
Irajian Gholamreza
Wide distribution of multidrug-resistant Acinetobacter baumannii strains has become a foremost concern in hospital environments. Treatment of infections caused by multidrug resistant strains has conventionally involved the use of ß-lactams such as carbapenems. In this study, we report the distribution of carbapenemase genes in A. baumannii isolated from hospitalized patients. The study was conducted on 110 non-repetitive A. baumannii isolates collected from hospitalized patients, over a nine-month period. Clinical isolates were examined by conventional susceptibility testing, using the disk-diffusion method and multiplex polymerase chain reaction to detect acquired carbapenemase genes. All of the isolates were completely resistant to TOB, SXT, IPM, MEM, CTX, CRO, FEP, CAZ, CIP, PTZ, PIP and were susceptible to colistin, but moderately susceptible TET (2.72%), AK (4.54%) and GEN (3.63%). The prevalence of blaOXA-51-like, blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, blaSIM and blaSPM genes was 100%, 96.36%, 35.45%, 7.27%, 7.279% and 3.63%, respectively. blaGIM and blaVIM genes were not detected among the strains. Our results suggest that OXA-type carbapenemase genes plus class B β-lactamases contribute to carbapenem resistance in the collected isolates. Drug administration correction of the physicians, based on antibiotic susceptibility testing and more knowledge on the nosocomial infection control policies as essential need.
Changes in bone mineral density in HIV-positive, virologically suppressed patients switching to lamivudine/dolutegravir dual therapy: preliminary results from clinical practice.
Ciccullo Arturo,
D’Avino Alessandro,
Pia Lassandro Anna,
Baldin Gianmaria,
Borghetti Alberto,
Dusina Alex,
Emiliozzi Arianna,
Gagliardini Roberta,
Moschese Davide,
Belmonti Simone,
Lombardi Francesca,
Di Benedetto Simona
Bone toxicity is a well-known side effect of several antiviral agents. In a cohort of virologically suppressed HIV-infected patients, we investigated the effects of a lamivudine/dolutegravir dual therapy on bone mineral density (BMD). We observed a significant improvement in lumbar spine BMD as well as T-score after 12 months of observation with concomitant bisphosphonate therapy independently predicting a greater improvement. These preliminary data show a favorable effect of this 2-drug regimen on bone health.
Effects of platelet function on the haemorrhagic manifestations and mortality in Crimean-Congo haemorrhagic fever
Duygu Fazilet,
Sari Tugba,
Celik Hakim
Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease which can lead to life-threatening with haemorrhagic manifestations. We aimed here in this study was to evaluate the effect of the platelet count and volume-related indices, such as the mean platelet volume (MPV), platelet distribution width (PDW) which is a measure of platelet anisocytosis and plateletcrit, in the haemorrhagic manifestations and mortality seen in CCHF cases.
We retrospectively examined data derived from 173 patients. The age, gender, alanine transaminase (ALT), aspartate transaminase (AST), platelet counts and MPV, PDW and PCT values upon admission (MPV1, PDW1 and PCT1) and those values measured at the time when the PLT was at the lowest level (MPV2, PDW2 and PCT2), haemorrhagic manifestations and the mortality status of patients diagnosed with CCHF were recorded.
ALT and AST values were higher among the haemorrhagic patients when compared with the others (p<0.001), while platelet 1 (PLT1), platelet 2 (PLT2), plateletcrit 1 (PCT1), plateletcrit 2 (PCT2) and platelet distribution width 2 (PDW2) values were significantly lower (p=0.001, p<0.001, p=0.002, p<0.001 and p=0.003, respectively). A negative correlation was documented between haemorrhage and the PLT1, PLT2, PCT1, PCT2 and PDW2 (r=-0.255, r=-0.415, r=-0.241, r=-0.377, r=-0.223, respectively); however, there was a positive correlation between haemorrhage and mortality (r=0.34).
This was the first study evaluating the platelet functions in CCHF, such as the PLT, PDW and PCT, in CCHF correlated with the mortality and haemorrhagic manifestations. The platelet functions contribute as much to the prediction of haemorrhage and mortality as the PLT. The present study suggests that the PCT and PDW values could be beneficial in anticipating the inclination toward haemorrhage and mortality.
Prevalence of parasitic infections in migrants: do official symptom-driven guidelines apply to the current situation?
Mazzitelli Maria,
Torti Carlo,
Greco Giuseppe,
Strazzulla Alessio,
Costa Chiara,
Pisani Vincenzo,
Sorace Chiara,
Giancotti Aida,
Lamberti Angelo,
Settimo Barreca Giorgio,
Quirino Angela,
Carla Liberto Maria,
Focà Alfredo,
Matera Giovanni,
In recent years, migration has become a significant challenge in Western countries. Migrant populations, coming from hyper-endemic areas, may present parasitic infections that remain latent and asymptomatic even for years, eventually leading to severe complications. Italian guidelines have been established to perform screening guided by the presence of symptoms and/or hypereosinophilia. Parasitological screening was conducted in a migrant population to carry out preventative measures. All migrants were asked to report any symptoms suggesting parasitic infections and list any previous treatment received. Travel data were recorded. Parasitological examination of stools and urine were conducted in all patients regardless of symptoms. In all, 208 consecutive patients were enrolled in our outpatient clinic from November 2016 to August 2017. Thirty-four patients were excluded due to the previous assumption of albendazole or because they did not exhibit suitable samples. Prevalence of parasitic infections was 33/174 (18.9%). A statistically significant difference for the prevalence of parasitic infections was not found between patients who were asymptomatic and without hypereosinophilia compared to those who presented symptoms and/or hypereosinophilia (27/151 [17.9%] vs. 6/23 [26.0%]; p=0.39). By contrast, a statistically significant difference was found for the length of time between arrival in Italy and parasitological examinations (4/51 [7.8%] migrants who arrived in Italy more than six months prior to screening vs. 29/123 [23.6%] migrants who arrived within six months; p=0.016). Our results did not demonstrate any significant differences in prevalence of parasitic infections between symptomatic or hypereosinophilic and asymptomatic migrants. Thus we feel it inappropriate to support recent guidelines recommending parasitological examinations only in migrants with symptoms and/or hypereosinophilia. By contrast, it would appear important to perform parasitological screening in migrants as soon as possible after their arrival. Since such infestations, if untreated, could result in chronic diseases and complications, and could be transmitted in the host countries, our results have potential implications for public health.
Case report
Erysipelothrix rhusiopathiae septicaemia in systemic lupus erythematosus.
Feasi Marcello,
Pontali Emanuele,
Usiglio David,
Mori Marco,
Cassola Giovanni
Erysipelothrix rhusiopathiae is a Gram-positive bacillus that is rarely reported as a causative agent of infections in humans. Human cases in most instances present as localized or generalized skin infections. Invasive infections are exceptionally described and septic forms are usually associated with endocarditis. We report a case of invasive infection caused by Erysipelothrix rhusiopathiae without skin or endocardium involvement in a patient with systemic lupus erythematosus (SLE). To our knowledge, this is the first report of an isolated bacteraemia due to this pathogen in a patient with SLE without skin or endocardium involvement.
A case of necrotizing fasciitis caused by Finegoldia magna in a patient with type 2 diabetes mellitus.
Scapaticci Margherita,
Marchetto Sabina,
Nardi Andrea,
Zoppelletto Maira,
Bartolini Andrea
Diabetes mellitus is one of the serious conditions associated with necrotizing fasciitis, a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in devascularization and necrosis of the associated tissues. In addition to debridement and aggressive surgery procedures, the effectiveness of therapy depends on choosing the appropriate antibacterial agents. Hence the key to successful management is an early and accurate diagnosis. We report a case of necrotizing fasciitis caused by Finegoldia magna in a patient with type 2 diabetes mellitus.
Three cases of Chronic Suppurative Otitis Media (CSOM) caused by Kerstersia gyiorum and a review of the literature
Özcan Nida,
Saat Neriman,
Yıldırım Baylal Müzeyyen,
Akpolat Nezahat,
Atmaca Selahattin,
Gül Kadri
New identification techniques such as gene sequencing and mass spectrometry have increased the incidence of novel agents such as Kerstersia gyiorum. As a new member of the Alcaligenaceae family, K. gyiorum was isolated from wounds, respiratory tract, urine specimens and most frequently from chronic suppurative otitis media (CSOM). We isolated three K. gyiorum strains from three CSOM cases over a one-year period. The strains were analyzed by mass spectrometry and identified by Bruker Biotyper 3.1 (Bruker Daltonics, USA). The cases were young patients without chronic diseases and immunodeficiencies. Two strains were resistant to ciprofloxacin.
A clinical case of sepsis due to Staphylococcus pettenkoferi
Vecchia Marco,
Lombardi Andrea,
Zuccaro Valentina,
Mariani Bianca,
Morea Alessandra,
Asperges Erika,
Grecchi Cecilia,
Sacchi Paolo,
Bruno Raffaele
Coagulase-negative staphylococci are part of the human skin flora but are frequently responsible for bloodstream infection, especially in the presence of intravascular devices or immunosuppressive conditions. Antibiotic resistance in such bacteria is common, with more than 80% of isolates resistant to methicillin. Among this genus Staphylococcus pettenkoferi is a recently identified organism, reported to be responsible for a growing number of infections. Here we describe a case of sepsis due to methicillin-resistant S. pettenkoferi.
Ralstonia mannitolilytica bacteraemia: a case report and literature review
Boattini Matteo,
Bianco Gabriele,
Biancone Luigi,
Cavallo Rossana,
Costa Cristina
Ralstonia mannitolilytica is a difficult-to-diagnose, aerobic, Gram-negative bacillus, mainly causing healthcare infections in immunocompromised hosts. We report the first case of R. mannitolilytica bacteraemia in a kidney transplant recipient. Identification of R. mannitolilytica was finally performed by 16S rRNA gene sequencing. All cases of R. mannitolilytica bacteraemia reported in the English language literature over the past 20 years are reviewed to alert clinicians to the epidemiological, clinical, diagnostic, prognostic and microbiologic features of this emerging pathogen.
Treatment of refractory paediatric giardiasis using secnidazole plus albendazole: a case series
A. Escobedo Angel,
Almirall Pedro,
Chirino Elaine,
Pacheco Frank,
Duque Ana,
Avila Ivonne
Giardia lamblia, the aetiological agent of human giardiasis, is a frequently identified protozoan infection of the upper small intestine. It mainly affects children and has a wide range of clinical manifestations, from asymptomatic carriage to acute or chronic diarrhoea with dehydration, abdominal pain, nausea, vomiting, excessive flatulence and weight loss. Standard treatment for giardiasis is commonly with 5-nitroimidazole (5-NI) compounds, or nitazoxanide; however, some individuals experience treatment failure. For such patients, a combination of two or more drugs may be a viable approach. We report our experience with 11 paediatric patients with drug-refractory giardiasis, for whom therapy with a combination of secnidazole (SNZ) (30 mg/kg/day, divided into 2 doses, for 3 days) and albendazole (ABZ) (400 mg daily for 5 days) resulted in cure for 9 of the 11 (82%) patients. This combination of drugs was well tolerated; only mild, transient, and self-limited side effects were reported and these did not require discontinuation of treatment. These results support the use of SNZ plus ABZ as an alternative treatment for paediatric patients with giardiasis who have failed conventional treatments. Further research is needed to establish the safety of this combination and how it compares to other combination strategies.
Oral and cutaneous myiasis in a five- year-old child from Karachi, Pakistan
Ahmed Khan Bilal,
Sabir Tooba,
Perveen Bushra,
Bin Nazir Maaz
Myiasis is a pathological condition in which there is a pestilence of fly larvae feeding on living or dead tissues. This disease is common in the tropics and subtropics of Africa and America and rarely affects humans. Our case report describes a five-year-old boy from Karachi, Pakistan with a history of extraction sockets and incisional biopsy of the left parotid lymph node. Lack of proper wound maintenance led to infestation of maggots both over the overlying skin of the left parotid region and the posterior oral cavity. The plan was wound debridement both outside and intra-orally under local anesthesia and the removal of maggots. A cotton swab impregnated with turpentine oil was placed on the wounds for a few minutes. The wounds were then properly debrided with pyodine and hydrogen peroxide. Around 15 to 16 maggots were extracted from the wound on the left parotid region using medical forceps whereas five maggots were extracted from the intraoral wound with the help of turpentine oil and forceps. This case demonstrates the importance of oral health and proper wound management, and also that myiasis, despite its distinctiveness, can be managed by promoting awareness of the disease and by suitable treatment methods.
The Infections in the History of Medicine
Caelius Aurelianus (5th century AD) study on worms
Laios Konstantinos
Caelius Aurelianus (5th century AD) translated in Latin the work of Soranus of Ephesus (2nd half of 1st century - 1st quarter of 2nd century AD) On Acute and on Chronic Diseases. In this Latin translation, the 8th chapter of the fourth book of chronic diseases is devoted in worm’s infection in children and in adults. This study is the most complete and comprehensive analysis of this special infection of the Greek and Roman antiquity. In this chapter, the physician examined in great detail the semiology, differential diagnosis and treatment of such an infection. In addition, there are saved the views of many other ancient Greek physicians whose original text now are lost. Although the study of Caelius Aurelianus was based on the original Greek text of Soranus of Ephesus it should not be denied that Caelius Aurelianus made his own additions and arranged the text in a more accurate and organized manner.
Paleoparasitology in Iran: A Review
Khodkar Iman,
Hossein Feizhadad, Mohammad,
Tavalla Mehdi
Paleoparasitology was created to trace and recover the natural development of parasites as well as the origin of infectious diseases. Paleoparasitology is defined as the study of parasites in ancient material and their interactions with hosts and vectors. Advances in the field have helped to open up new prospects for anthropologists, archaeologists, biologists and medical scientists. In recent years, Iranian parasitologists and biologists have developed immense interest in this field. One of the first human settlements on earth was established in Iran and there is extensive evidence of early human life in this ancient land. Therefore, the aim of the review was to assess paleoparasitological research conducted in Iran in order to facilitate the discovery of the origin of infectious diseases in the region. English and Persian electronic databases including Web of Science, Sciencedirect, PubMed, Scopus, Google Scholar, Iran Doc, SID, Iran Medex and Magiran were employed as search engines (up to 2017) using the keywords: Iran, Islamic Republic of Iran, Parasitology, Parasites and Archaeology. According to the current review, the results of the parasitological study revealed the incidence of human and animal parasitic infection in Iran dating back to 8100 BC.
Letters to the editor
Poliovirus: a long-due battle for Pakistan
Asad Ameema,
Kumar Ochani Rohan,
Shaikh Asim,
Batra Simran
Not available
