International Journal of Infectious Diseases

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ISSN / EISSN : 1201-9712 / 1878-3511
Current Publisher: Elsevier BV (10.1016)
Total articles ≅ 15,796
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International Journal of Infectious Diseases, Volume 106, pp 171-175; doi:10.1016/j.ijid.2021.03.004

Background Polymyxins (colistin) have emerged for the treatment of carbapenem resistant (CR) gram-negative infections. There is a paucity of data on treatment outcomes and adverse effects of high-dose colistin treatment in Pakistan. The aim of this study was to determine the efficacy and toxicity of colistin in CR bacteremia, including patients with renal failure and on hemodialysis, and to determine patient outcomes. Methods This prospective cohort study was performed from May to December 2017 at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Patients aged >18 years with documented gram-negative bacteremia were included. Data were compared between those who received colistin and those who did not, including risk factors for CR bacteremia, bacterial clearance, adverse effects, and all-cause mortality up to 14 days of follow-up. Results The study included 137 patients, 73 (53.3%) in the colistin group and 64 (46.7%) in the non-colistin group. Patients in the colistin group were 1.47 times more likely to have died by day 14 of follow-up as compared to those in the non-colistin group (19.2% vs 7.8%; relative risk 1.47, p= 0.05). Patients in both groups achieved more than 80% bacteriological clearance. The colistin group patients were less likely to have received appropriate empirical antibiotics as compared to the non-colistin group patients (4.1% vs 62.5%; relative risk 0.09, p < 0.001). Factors significantly associated with mortality were inappropriate empirical antibiotics and acute renal failure. Of the 73 patients in the colistin group, 27 (37.0%) developed reversible neurological adverse effects. Patients with renal insufficiency, not on hemodialysis, were evaluated for colistin nephrotoxicity. Creatinine decreased from 8.08 mg/dl at baseline to 4.85 mg/dl on day 7 in the colistin group, and from 6.5 mg/dl to 3.9 mg/dl in the non-colistin group. Patients with normal renal function had no significant rise in serum creatinine. Conclusions Colistin is efficacious in clearing bacteremia even in patients with impaired renal function. The adverse effects were found to be minimal and reversible. We recommend the use of colistin in combination with carbapenems for CR gram-negative bacteria in renal failure. Most importantly, however, this study highlights the role of empirical colistin treatment in patients with risk factors for CR bacteremia.
Noppadol Wacharachaisurapol, Surinda Kawichai, Ankanee Chanakul,
International Journal of Infectious Diseases, Volume 106, pp 91-97; doi:10.1016/j.ijid.2021.03.059

Objectives A colistin loading dose is required to achieve adequate drug exposure for the treatment of multidrug-resistant Gram-negative bacteria. However, data on acute kidney injury (AKI) rates associated with this approach in children have been unavailable. The aim of this study was to examine AKI rates in children who were prescribed a colistin loading dose. Methods A retrospective study was conducted in patients aged 1 month to 18 years who had received intravenous colistin for ≥48 h. Loading dose (LD) was defined as colistin methanesulfonate at 4–5 mg of colistin base activity/kg/dose. AKI was defined according to KDIGO serum creatinine (SCr) criteria — SCr ≥ 1.5 times the baseline, measured 3–7 days after colistin initiation. Augmented renal clearance (ARC) was defined as an estimated glomerular filtration rate (eGFR) >150 mL/min/1.73 m2. The rates of AKI were compared between children receiving or not receiving an LD, and between different eGFR groups. Results In total, 181 children were enrolled. The mean age was 4.3 years (95% confidence interval [CI], 3.6–4.9 years). Ninety-five of the subjects (52.5%) were male. There were 157 children with a baseline eGFR of ≥ 80 mL/min/1.73 m2. The overall AKI rate within the first week in this group was 20.4% (95% CI, 14.4–27.6%): LD, 16.1% vs no LD, 23.2% (p = 0.29). Subgroup analysis, excluding patients with ARC, showed a lower AKI rate of 12.8% (95% CI, 6.8–21.3%): LD, 9.7% vs no LD, 14.3% (p = 0.53). Conclusions AKI rate was not different among children who received an intravenous colistin loading dose. This approach should be implemented to ensure the necessary drug exposure required for good treatment outcomes.
Satoshi Irifune, , Sosuke Ishijima, Yuta Koike, Junya Fukuoka, Hiroshi Mukae
International Journal of Infectious Diseases, Volume 106, pp 183-184; doi:10.1016/j.ijid.2021.03.077

International Journal of Infectious Diseases, Volume 106, pp 208-212; doi:10.1016/j.ijid.2021.03.079

Background Human Immunodeficiency Virus (HIV) is a global public health threat, and all frontline Health care workers (HCWs) are at a higher risk of exposure to body fluids from potential HIV patients and to sharp instruments. Though timely Post Exposure Prophylaxis (PEP) decreases the possibility of seroconversion to HIV after occupational exposure, most HCWs rarely adhere to the PEP protocol. This study aims to determine the predictors of adherence to PEP among frontline healthcare workers in the Ho Teaching Hospital, Ghana. Methods A facility-based cross-sectional study was conducted among 199 frontline HCWs. Data were collected using a pretested self-administered questionnaire and analyzed using STATA version 14 software. Binomial logistic regression was performed at the 0.05 level of significance and 95% confidence interval. Findings Overall, 17.9% of HCWs adhered to PEP. Frontline HCWs who perceived they had low and very low risk of occupational exposure to HIV transmission were 96% [AOR = 0.04 (95% C.I: 0.00, 0.39) P = 0.006] and 94% [AOR = 0.06 (95% C.I: 0.00, 0.62) P = 0.019] respectively less likely to adhere to PEP. HCWs who received training on PEP were 4 times more likely to adhere to PEP compared to those who had never received it [AOR = 4.24 (1.31, 13.19) P = 0.013]. Conclusion Adherence to PEP protocol among HCWs was low. Therefore, there is a need for interventions to increase the perception of risk of occupational exposure to HIV transmission and to intensify training on PEP among frontline HCWs in the Ho Teaching Hospital. This will go a long way to increase their adherence to PEP.
, , Farah Khalid, , Hamna Shahbaz, Aneeta Hotwani, Najeeb Rehman, , Usma Mehmood, Arjumand Rizvi, et al.
International Journal of Infectious Diseases, Volume 106, pp 176-182; doi:10.1016/j.ijid.2021.03.040

Objective To determine population-based estimates of coronavirus disease 2019 (COVID-19) in a densely populated urban community of Karachi, Pakistan. Methods Three cross-sectional surveys were conducted in April, June and August 2020 in low- and high-transmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies. A Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district. Results In total, 3005 participants from 623 households were enrolled in this study. In Phase 2, adjusted seroprevalence was estimated as 8.7% [95% confidence interval (CI) 5.1–13.1] and 15.1% (95% CI 9.4–21.7) in low- and high-transmission areas, respectively, compared with 0.2% (95% CI 0–0.7) and 0.4% (95% CI 0–1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3–17.7) and 21.5% (95% CI 15.6–28) in low- and high-transmission areas, respectively. The conditional risk of infection was 0.31 (95% CI 0.16–0.47) and 0.41 (95% CI 0.28–0.52) in low- and high-transmission neighbourhoods, respectively, in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. The infection fatality rate was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3, respectively. Conclusion Continuing rounds of seroprevalence studies will help to improve understanding of secular trends and the extent of infection during the course of the pandemic.
, Andrew Chung Ho Lee, Wai Shan Wong, Yin Lan Yip
International Journal of Infectious Diseases, Volume 106, pp 221-222; doi:10.1016/j.ijid.2021.03.049

A 42-year-old man with a history of travel to Qatar and India was admitted to the hospital for fever, headache and epigastric discomfort. Peripheral blood smears showed intraerythrocytic parasites compatible with Plasmodium vivax [Figure 1(a) and (b)]. S ome extra-erythropoietic parasites were also noted [Figure 1(c)–(f)]. The extra-erythropoietic parasites mimicked atypical spirochetes or non-malarial parasites such as trypanosomes but were later identified as exflagellated microgametes of P. vivax. The patient received chloroquine and primaquine therapy. Blood smears were negative for malaria parasites after treatment.Figure 1The patient’s peripheral blood smear showed intraerythrocytic parasites compatible with Plasmodium vivax (a) and (b); exflagellated microgametes were also noted (c)–(f).View Large Image Figure ViewerDownload Hi-res image Download (PPT)
Suryadi N.N. Tatura, Dionisius Denis, Marsha S. Santoso, Rahma F. Hayati, Billy J. Kepel, ,
International Journal of Infectious Diseases, Volume 106, pp 185-196; doi:10.1016/j.ijid.2021.03.065

Background In early 2019, an outbreak of severe dengue was reported in Manado, North Sulawesi Province, Indonesia. This epidemic raised public concern and recorded the highest number of cases in the last 10 years. This study aimed to determine the clinical spectrum, disease aetiology and virological characteristics associated with this outbreak of severe dengue. Methods Dengue was diagnosed using non-structural protein 1 detection, reverse transcription polymerase chain reaction and immunoglobulin (Ig)G/IgM serology. Envelope gene sequencing was conducted to determine the phylogeny of the dengue virus (DENV). Results In total, 146 patients with a median age of 8 years (interquartile range IQR 5–11 years) were recruited. Most patients experienced expanded dengue syndrome, characterized by severe organ involvement including liver enlargement, stomach ache and coagulation problems. During the outbreak, DENV-3 was the dominant serotype (75.9%). Smaller numbers of DENV-1, -2 and -4 were also detected. Phylogenetically, the dominant DENV-3 strains were grouped in multiple clusters and were related to other Indonesian strains, suggesting the emergence of heterogenous local viruses. Conclusion The occurrence of an outbreak of severe dengue in Manado was confirmed, and DENV-3 was found to be the dominant serotype during the outbreak. This study shows the benefits of virological surveillance in understanding the aetiological agents responsible for outbreaks of severe dengue.
, Andre Frontzek, Stephanie Heinrich, Andreas Breil-Wirth, Julian Messler, Stefan Hegermann, Martin Ulatowski, Christos Koutras, Enno Steinheisser, Thomas Kruppa, et al.
International Journal of Infectious Diseases, Volume 106, pp 302-307; doi:10.1016/j.ijid.2021.03.085

Objectives In the microbiological diagnosis of periprosthetic joint infection (PJI), there is much discussion about the methodology of obtaining proper specimens, the processing technique, and suitable culture media. This retrospective study was conducted to analyse the accuracy of our culture techniques. Methods Tissue samples and components from 258 patients after revision arthroplasty of the hip, knee, and shoulder were investigated, and the results of tissue cultures (TC) were compared to those of sonicate fluid cultures (SFC). Furthermore, an evaluation was performed of the influence of different culture media on the detection rate. Results PJI was confirmed in 186 patients. The overall sensitivity of TC was no different to that of SFC (91.3% vs 90.8%, P=1). In 153 cases (82.3%), TC and SFC showed concordant positive results. Results were discordant in 33 cases (17.7%). When differentiated according to the type of infection, TC showed significantly better results than SFC in detecting polymicrobial infections (97.0% vs 67.0%, P=0.004). There were also significant differences between the culture media regarding the yield of microorganisms. Conclusions TC was more effective in detecting co-infections. The best results were obtained using both TC and SFC. The choice of culture media has a significant influence on the quality of results.
Renske Meijer, Paula van Biezen, Gerrie Prins,
International Journal of Infectious Diseases, Volume 106, pp 262-264; doi:10.1016/j.ijid.2021.03.091

Presented is a patient with dyspnea and painful ulcers finally resulting in multi-organ failure. A detailed history resulted in positive PCR testing for Chlamydia psittaci. We emphasize the importance of a definitive history in establishing the correct diagnosis. When clinicians observe dyspnea with multi-organ failure, they should be aware of psittacosis.
, Supeda Thongyen, Aroonwan Lam-Ubol, Nattida Chotechuang, Wannarat Pongpirul, Wisit Prasithsirikul
International Journal of Infectious Diseases, Volume 106, pp 329-337; doi:10.1016/j.ijid.2021.03.083

Objectives The aim of this study was to investigate the association between taste and smell losses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and to elucidate whether taste preference influences such taste loss. Methods A matched case–control study was conducted in 366 Thai participants, including 122 who were confirmed SARS-CoV-2-positive by RT-PCR (case group) and 244 who were SARS-CoV-2-negative (control group). Taste, smell, and appetite changes were assessed by self-reported visual analog scale. Preference for sweet, salty, umami, sour, bitter, and spicy were judged using the validated TASTE-26 questionnaire. Results Partial taste and smell losses were observed in both groups, while complete losses (ageusia and anosmia) were detected only in the case group. Moreover, only ageusia and anosmia were associated with SARS-CoV-2 positivity (P < 0.001, odds ratio of 14.5 and 27.5, respectively). Taste, smell, and appetite scores were more severely reduced in the case group (P < 0.0001). Multivariate analysis showed that anosmia and ageusia were the best predictors of SARS-CoV-2 positivity, followed by appetite loss and fever. Simultaneous losses of taste and smell but not taste preferences were associated with SARS-CoV-2 positivity (P < 0.01, odds ratio 2.28). Conclusions Complete, but not partial, losses of taste and smell were the best predictors of SARS-CoV-2 infection. During the current COVID-19 pandemic, healthy persons with sudden simultaneous complete loss of taste and smell should be screened for COVID-19.
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