The Journal of Infection in Developing Countries 2018-08-13T20:19:37-07:00 JIDC Central Office Open Journal Systems An open access, peer-reviewed, online scientific research journal focused on global health Large-scale hepatitis C combating campaigns in Egypt and Georgia; past, current and future challenges 2018-08-13T20:19:32-07:00 Fatma Abdelaziz Amer <p>Hepatitis C virus (HCV) infection is a major worldwide problem which should be adequately combated. This review summarizes two successful model programs to eradicate Hepatitis C in two countries; Egypt and Georgia. Egypt tops the list of nations affected by HCV, and Georgia is ranked among other countries with huge HCV burden. Currently, both countries are on their ambitious way to making history and completely eliminate Hepatitis C virus infections.</p> <p>The first comprehensive approach to reduce the burden of hepatitis C and associated diseases in Egypt was achievable with the formulation of the National Committee for Control of Viral Hepatitis (NCCVH) in 2006. Assisted by international and national stalk holders, Georgia started its nation- wide HCV fighting program in 2015. Elements of programs mostly addressed in both countries included simplifying and improving access to the package of diagnosis and care- providing effective, affordable or free of charge treatment- issuing, applying and regularly updating practice guidelines- improving surveillance, monitoring, and research focusing specifically on the risky groups- emphasizing infection control (IC) - encouraging patient and community engagement and increasing public and political commitment. Interventions are still going on to eradicate HCV infection in Egypt by 2030 and in Georgia by 2020. Lessons gained from this program can educate comparable activities in different nations and help control the worldwide epidemic of viral hepatitis.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Evaluation of a rapid immunochromatographic diagnostic test (RIDT) for diagnosis of rabies in samples from Argentina 2018-08-13T20:19:37-07:00 Federico Gury Dohmen Esteban Kovacs Natalia Elizabeth Prestrera Fernando Javier Beltrán <p>Introduction: Rabies is a globally widespread zoonosis of viral origin that causes fatal encephalitis in humans and animals. In countries where rabies is endemic and there is a lack of well-equipped diagnostic laboratories, a rapid immunochromatographic diagnostic test (RIDT) for detection of rabies could be an indispensable tool. In this study we evaluated the limit of detection, as well as specificity and sensitivity of RIDT, compared to the standard fluorescent antibody test (FAT).</p> <p>Methodology: A total of 174 samples were diagnosed by both RIDT and FAT. Fresh clinical samples, poorly conserved samples and brains in advanced state of decomposition generated under laboratory conditions were used to resemble field conditions. The sensitivity of RIDT was evaluated with CVS fixed strain of rabies virus (RABV), previously titrated in 21-day old albino mice and compared with the Reverse Transcription – Polimerase Chain Reaction (RT-PCR) technique in parallel. Additionally, the Mouse Inoculation Test (MIT) was used to perform the antigenic characterization of Rabies virus variants.</p> <p>Results: The limit of detection of RIDT was 100 LD50 / 0.03 mL and its performance, as compared to that of FAT, showed a sensitivity of 97.96%, a specificity of 100% and a concordance by the Kappa test of 0.98 with 95% CI.</p> <p>Conclusions: RIDT provides results comparable to those of FAT and this test can be considered as an appropriate method under the field conditions, even in samples that are not suitable for FAT due to their state of decomposition.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Dissemination of ST101 blaOXA-48 producing Klebsiella pneumoniae at tertiary care setting 2018-08-13T20:19:31-07:00 Hadir ElMahallawy Mai Mahmoud Zafer Mohamed Al-Agamy Magdy Aly Amin Mai Muhammed Mersal Rayan Yousef Booq Essam Alyamani Samah Radwan <p>Introduction: The worldwide dissemination of the acquired carbapenemases in Gram-negative bacteria is a strongly expressed demand for the emergence of post antibiotic era. The aim of this study was to test the production of carbapenemase by <em>Klebsiella pneumoniae</em> strains isolated from hospitalized cancer patients and to investigate the genetic relationship of carbapenemase producing carbapenem resistant <em>K. pneumoniae</em> using multilocus sequence typing (MLST).</p> <p>Methodology: Antibiotic susceptibility testing and phenotypic testing for extended spectrum b-lactamases (ESBL) and carbapenemases production were performed. PCR amplification of ESBL and carbapenemase genes was performed. MLST was done to detect the genetic relatedness of the isolates.</p> <p>Results: Our data showed all strains were sensitive to colistin. Carba NP test was positive in thirty-one carbapenem resistant <em>K. pneumoniae</em> isolates and 26 out of 34 <em>K. pneumoniae </em>isolates were metallo-beta-lactamases (MBL) positive. All carbapenemase-positive isolates were ESBL CTX-M-1-like positive. <em>bla</em><sub>OXA-48</sub> gene was detected in 25 isolates (80.65%) and 21 isolates (67.75%) produced <em>bla</em><sub>NDM-1 </sub>like enzyme. VIM and KPC genes were not identified in this study. Association of <em>bla</em><sub>OXA-48 </sub>like and <em>bla</em><sub>NDM-1 </sub>like was found in 15 (48.39%) isolates, while the coproduction of OXA-48-like and IMP-1 was revealed in only one <em>K. pneumoniae</em> isolate. MLST revealed ten distinct sequence types (STs).</p> <p>Conclusion: Here we have documented the coexistence of NDM-type and OXA-48-like, and the coproduction of OXA-48-like and IMP in carbapenem resistant <em>K. pneumoniae</em> in patients with cancer. The dominant clone of the OXA-48-like-producing<em> K. pneumoniae</em> isolates from Egypt was ST101 epidemic clone belonging to clonal complex 101, an association that has been reported worldwide. The second most frequent ST was ST383.ST11 was assigned to OXA-48-producing <em>K. pneumoniae</em>.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Diagnostic accuracy of combinations of serological biomarkers for identifying clinical tuberculosis 2018-08-13T20:19:37-07:00 Zaida Araujo Noe Macias-Segura Juan Ernesto Lopez-Ramos Jacobus Henry de Waard Magnolia Vanegas Manuel Alfonso Patarroyo Antonio Salgado address@notprovi.ded Jose Antonio Enciso-Moreno <p>Introduction: Confirmation of tuberculosis (TB) cases in endemic TB settings is a challenge; obtaining fast and cheap, though accurate, diagnostic tools such as biomarkers is thus urgently needed to enable the early detection of TB. This paper evaluates the diagnostic accuracy of combinations of host serological biomarkers for identifying TB.</p> <p>Methodology: Enzyme-linked immunosorbent assays (ELISA) were used on 70 Venezuelan Creole individuals for evaluating host biomarkers (i.e. CXCL9, sCD14, MMP9 and uPAR proteins) and anti-synthetic peptides covering certain <em>Mycobacterium tuberculosis </em>(<em>Mtb</em>) ESAT-6 (P-12033, P-12034 and P-12037) and Ag85A (P-29878) antigen sequences. The target population consisted of adults having active TB (ATB, n = 28), the tuberculin skin test positive (TST<sup>+</sup>) or individuals with latent TB infection (LTB, n = 28) and TST<sup>-</sup> or control subjects (CTRL, n = 14).</p> <p>Results: Receiver operator curve (ROC) analysis revealed good biosignature discriminative ability for 5 serological biomarkers; the accuracy of 3 combinations had a good discriminative ability for diagnosing TB. Anti-P-12034/uPAR detected TB with 96.7% sensitivity and 86.0% specificity, followed by anti-P-12033/uPAR having 96.7% sensitivity and 81.4% specificity. Anti-P-29878/MMP9 had the highest sensitivity (100%), but low specificity (52.17%). Biomarker combinations did not prove efficacious for identifying incipient subclinical TST<sup>+</sup>TB<sup>−</sup> subjects at high-risk for TB.</p> <p>Conclusions: The anti-P-12034/uPAR combination could be useful for identifying clinical TB patients. Such an approach holds promise for further validation.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies 2018-08-13T20:19:34-07:00 Prathyusha Kokkayil Reshu Agarwal Sarita Mohapatra Sameer Bakshi Bimal Das Seema Sood Benu Dhawan Arti Kapil <p>Introduction: Studies have shown a shift in the prevalence from Gram-positive to Gram-negative bacteraemia in patients with haematological malignancies who develop febrile neutropenia. There are also reports on the spread of drug resistant bacteria among these patients. Information about locally prevalent bacteria and their resistance is important to guide empirical therapy. The aim of this study was to characterise the bacterial spectrum and antibiotic resistance pattern of bacteraemia in neutropenic patients with haematological malignancies</p> <p>Methodology: In this retrospective study, patients admitted to Haematology and Oncology units over a period of 6 months with laboratory-confirmed positive blood cultures were enrolled. Information regarding demographic profile, clinical features, and microbiological profile were recorded. Standard procedures were applied to identify the isolates and their resistance patterns. The data collected was analysed statistically.</p> <p>Results:56 isolates from 53 patients were isolated of which majority were gram negative bacilli (GNB; n = 52 or 93%). <em>Klebsiella pneumoniae</em> (43%, n = 24) was the most frequently isolated bacteria followed by <em>Enterobacter sp</em> (20%, n = 11) and <em>Escherichia coli</em> (12%, n = 7). All isolates were susceptible to colistin. Susceptibility to cefaperazone-sulbactam, piperacillin-tazobactam and carbapenems were 32%, 28.6% and 26.8% respectively. The outcome was fatal for 25 patients.</p> <p>Conclusions: The study documented an alarming rise in the prevalence of GNB and their resistance. Though the results of the study may represent only the tip of the iceberg, the results demonstrate the need for treatment options for drug resistant isolates and for surveillance cultures.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Comparison of serum level of 25(OH) vitamin D3 in brucellosis patients with healthy persons in Hamadan, west of Iran 2018-08-13T20:19:33-07:00 Fariba Keramat Mohammad Yousef Alikhani Jalal Poorolajal Surur Akbari <p>Introduction: The human immune system including phagocytosis, has anessential role in pathogenesis, relapse and improvement of infectious diseases. The immune cells have vitamin D receptor, and vitamin D deficiency causes impaired immune system, specifically macrophages. The aim of study was to compare serum levelof 25-hydroxyvitamin D3 (25-OH- VitD3) among the patients with acute brucellosis and relapsed brucellosis with healthy individuals.</p> <p>Methodology: In this case-control study, 92 patients with acute brucellosis, 92 cases with relapsed brucellosis and 107 healthy persons who referred to Sina hospital and Imam Khomeini clinic were enrolled, and all groups were matched based on age, gender and habitat. The study was done from March 2016 to June 2017. The serum levels of 25-OH- VitD3 were measured based on the Enzyme Linked Fluorescent Assay (ELFA) technology, Vidassystem (France, Biomerieux Kit). The data were analyzed by using SPSS version 16 software.</p> <p>Results: The mean serum levels of 25-OH- VitD3 in acute brucellosis, relapsed brucellosis and healthy persons were 22.55 ± 15.72, 26.82 ± 20.78, 24.44 ± 17.29, respectively .In addition, the mean serum levels of 25-OH- VitD3 by male gender in acute brucellosis, relapsed brucellosis and healthy control groups were 20.35 ± 13.10, 24.88 ± 20.89 and 22.52 ± 13.79, respectively. However, there was no statistically significant difference among three groups (<em>P</em> = 0.275).</p> <p>Conclusions: According to the results, the prevalence of vitamin D deficiency was high in patients with acute or relapsed brucellosis and also healthy persons; however, there was no meaningful difference among three groups and between the patients and healthy persons.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Incidence and antibiotic susceptibility of MRSA infections in a Saudi Arabian Hospital: a 10-year surveillance study 2018-08-13T20:19:32-07:00 Arif Mansour Al-Hamad Afaq Ali Alfaraj Jaffar Altowaileb Sameer Mahdi Al-Shamlan Hussam Leskafi Fatimah Abdullah Alsubeikhy Hussein Radhi Abbas <p>Introduction: Methicillin-resistant<em> Staphylococcus aureus</em> (MRSA) infections remain prevalent and are associated with significant morbidity and mortality. The aim of the present study was to investigate the epidemiology of MRSA infections and antibiotic susceptibility in Qatif, Saudi Arabia.</p> <p>Methodology: All patients who had positive culture for <em>S. aureus</em> from January 1, 2006 through December 31, 2015 were enrolled and analyzed in WHONET, a free database software developed by the World Health Organization (WHO). Patients’ data were collected from electronic medical records and traditional chart reviews to determine whether MRSA acquisition was likely to have been in the community or in the healthcare facility. Susceptibility results for community-associated (CA)-MRSA were compared with isolates from healthcare setting.</p> <p>Results: A total of 3395 patients with <em>S. aureus</em> infections were analyzed, with an overall annual MRSA incidence of 25 cases per 100,000 patients (27% of total <em>S. aureus isolates</em>). While the majority (64%) of MRSA infections occurred in healthcare setting, CA-MRSA isolation increased steadily from 23% in 2006 to 60% in 2015, exceeding rate of isolation of healthcare-associated (HA)-MRSA. Skin and soft tissue, the lung and blood stream were the most common sites of infection, with 20% to 35% of MRSA infections occurring in pediatric patients. In the inpatient setting, the majority of infections due to MRSA were in surgical wards and critical care units. Compared with CA-MRSA, HA-MRSA isolates turned out to be more frequently resistant against ciprofloxacin, clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole.</p> <p>Conclusions: <em>Staphylococcus aureus</em> continues to cause multiple site infections with a relatively stable methicillin-resistance rate, but the isolation of MRSA from the community is increasing.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## High resistance to tetracycline and ciprofloxacin in bacteria isolated from poultry farms in Ibadan, Nigeria 2018-08-13T20:19:30-07:00 Tunmise O. Ayandiran Linda Falgenhauer Judith Schmiedel Trinad Chakraborty Funmilola Abidemi Ayeni <p>Introduction: Resistance to ciprofloxacin and tetracycline is increasing in the food chain especially in <em>E. coli</em> strains and more worrisome will be occurrence of extended-spectrum beta-lactamase (ESBL) producers among ciprofloxacin- and tetracycline-resistant isolates. This study was undertaken to investigate the occurrence and mechanism of ciprofloxacin-, tetracycline- and ESBL-resistant bacteria in poultry in Ibadan, Nigeria.</p> <p>Methodology: Bacteria were isolated from poultry feces in two farms in Ibadan and identified by MALDI-TOF. Antibiotic susceptibility patterns of the isolates were determined by disc diffusion and Minimum Inhibitory Concentration (MIC) using Vitek-2 apparatus. Four tetracycline genes and six plasmids mediated quinolone resistance genes (PMQR) were investigated by PCR. Whole genome sequencing was done for strains that were ESBL producers.</p> <p>Results: Bacterial strains (≥ 10<sup>5</sup> cfu/mL) were counted on ciprofloxacin and tetracycline supplemented plates. 106 bacteria from 14 different species were identified with high resistance to quinolones, tetracycline and trimethoprim. 49% of the strains were<em> E. coli</em> with 90% resistance for nalidixic acid, moxifloxacin (94%), ciprofloxacin (88%) levofloxacin (78%) and tetracycline (77%). The genes <em>tetA, tetB, qnrB, qnrS </em>and<em> qepA </em>were detected with 37%, 4%, 35%, 4% and 2% prevalence in <em>E. coli </em>respectively. Three ESBL-producing <em>E. coli </em>of the sequence type ST-6359 were found and harboured <em>bla</em><sub>CTX-M-15</sub> located in the chromosome, at the same insertion site. All the ESBL producers harboured mutations in <em>gyrA </em>(S83L/D87N/D678E) and <em>parC </em>(S80I).</p> <p>Conclusion: The observed high quinolones and tetracycline resistance with ESBL producers in this study calls for caution in the use of these antibiotics in poultry feeds.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Field accuracy of HIV rapid diagnostic tests for blood donors screening, Bukavu, Eastern Democratic Republic of the Congo 2018-08-13T20:19:33-07:00 Théophile Mitima Kashosi Céléstin Bisangamo Kyambikwa Philémon Mbarabara Mulongo Jean Bisimwa Nachega <p>Introduction: Rapid diagnostic tests (RDTs) are widely used for point-of-care. point-of-care diagnosis of HIV infection in resource-limited settings. However, there are no data about their field diagnostic performance in Eastern Democratic Republic of the Congo (DRC), especially in the context of blood banks screening for transfusion safety purpose.</p> <p>Methodology: Blood specimens were collected from blood donors in Bukavu, Eastern DRC, from May the 1<sup>st</sup> to June the 30<sup>th</sup>, 2015, to evaluate the accuracy of Alere Determine HIV-1/2, Trinity Biotech Uni‑Gold HIV, and DoubleCheckGold Ultra HIV 1&amp; 2 compared to the laboratory-based 4<sup>th</sup> generation ELISA apDia HIV Ag/Ab assay. Sensitivity, specificity, positive and negative predictive values, and related 95% confidence intervals were calculated using MedCalc statistical software version 15.1. Reliability was evaluated using Cohen’s Kappa Statistic, κ.</p> <p>Results: Among 312 participants who provided blood bags, 96/312 (30.7%) were female and the mean age (SD) was 31.7 years (± 8.1years). Sensitivity for the three tests was 57.1% (95% CI: 18.4-90.1). The specificity was 99.7% (95% CI: 18.4-90.1) for Alere Determine HIV 1/2, 100% (95% CI: 98.8-100.0) for Uni-Gold HIV, and (100% (95% CI: 98.8-100.0) for DoubleCheckGold Ultra HIV 1&amp;2. Cohen’s Kappa Statistic showed moderate agreement between the 4th generation ELISA apDia HIV Ag/Ab and RDTs Alere Determine HIV 1/2 and Uni-Gold HIV (κ = 0.66; 95% CI: 0.55- 0.76) but good agreement for DoubleCheckGold Ultra HIV1&amp;2 (κ = 0.72; 95% CI: 0.61 – 0.82).</p> <p>Conclusions: Compared to the laboratory-based ELISA apDia HIV Ag/Ab assay, the currently used 3rd generation HIV RDTs showed poor field accuracy results in a context of blood donors screening. These data support the need for 4th generation Ag-Ab RDTs in transfusion blood qualification.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## The Human papillomavirus among women living with Human Immunodeficiency Virus in Morocco A prospective cross-sectional study 2018-08-13T20:19:35-07:00 Ahd Ouladlahsen Naouar Fayssel Rajaa Bensghir Hanâ Baba Hassan Lamdini Mustapha Sodqi Latifa Marih Meryem Essebbani Sellama Nadifi Soumaya Benjelloun Hakima Himmich Abdelfattah Chakib Lahcen Wakrim Kamal Marhoum El Filali Sayeh Ezzikouri <p>Introduction: Women infected with human immunodeficiency virus (HIV) have a higher risk of contracting human papillomavirus (HPV) infections and are more prone to develop cervical cancer. The objective of this study was to determine the prevalence of HPV and its association with risk factors among Moroccan women living with HIV/AIDS.</p> <p>Methodology: We enrolled 251 HIV-infected non-pregnant women in Morocco from February 2013 to September 2016. Sociodemographic, lifestyles, behavioral and clinical data were collected. Polymerase chain reaction followed by sequencing were performed for molecular detection and HPV genotyping in cervical samples, respectively.</p> <p>Results: Abnormal cervical smears were found in 34/246 patients (13.82%). The overall prevalence of HPV was 74.50%. HPV 58 was the most prevalent (39.29%) followed by HPV 18 (10.71%), HPV 70 (8.93%), HPV 33 (7.14%), HPV 6 (6.25%) and other genotypes (&lt; 3%). Overall, high-risk HPV (HR-HPV) types were present in 75% (84/112) of patients and the prevalence of HR-HPV types in samples with abnormal Pap was higher than in normal Pap (55/83, 66.27% vs. 28/83, 33.33%, p &lt; 0.0001). Univariate analyses showed that none of the socio-demographic and behaviors factors was associated with HPV infection. Moreover, Pap results were not affected by HPV status (p = 0.532). Whereas, CD4 T-cell counts above 200/mm<sup>3</sup> at enrolment were apparently not protective to HPV infection. We found a high prevalence of HPV infection and HR-HPV types among HIV-positive women that significantly associated with abnormal Pap.</p> <p>Conclusion: Our findings suggest a high prevalence of HPV infection with high-risk types was observed among HIV-positive women warrant to implement a regular screening by Pap smear.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Anti-Human Herpesvirus 8 antibodies affect both insulin and glucose uptake by virus-infected human endothelial cells 2018-08-13T20:19:29-07:00 Fabrizio Angius Enrica Piras Stefano Spolitu Luisa Marras Sara Federica Armas Angela Ingianni Pierpaolo Contini Raffaello Pompei <p>Introduction: Human Herpesvirus 8 (HHV8) is known to be the cause of the malignant tumour named Kaposi’s sarcoma. It is believed to induce an intense modification of cell metabolism in endothelial cells. In this work we analysed the role of anti-HHV8 antibodies in both the insulin and glucose uptake of HHV8-infected primary human endothelial cells (HUVEC).</p> <p>Methodology: Western blotting, immunofluorescence and radiolabelled glucose were employed to assess the pPI3K expression, insulin binding and glucose-uptake by HUVEC cells, respectively.</p> <p>Results: We confirmed that HHV8-infection is able to enhance both insulin binding and glucose-uptake in HHV8-infected primary endothelial cells; in addition, we found that anti-HHV8 specific antibodies are able to further increase both insulin and glucose uptake during the late latent phase of HHV8-infection <em>in vitro</em>.</p> <p>Conclusions: These findings suggest that a specific immune response to HHV8-infection may cooperate in boosting the cell metabolism, further enhancing the already increased insulin binding and glucose-uptake in HHV8-infected cells, which is a peculiar property of several oncogenic viruses.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Hematological profile in natural progression of giardiasis: kinetics of experimental infection in gerbils 2018-08-13T20:19:36-07:00 Frederico Ferreira Gil Luciana Laranjo Amorim Ventura Joice Freitas Fonseca Helton Costa Saniago Haendel Busatti Joseph Fabiano Guimarães Santos Maria Aparecida Gomes <p>Introduction: The clinical manifestations of giardiasis and its impact are harmful to children, and may cause deficits in their physical and cognitive development. The pathogenic mechanisms are usually unknown and the available reports can be controversial.</p> <p>Methodology: The present study aimed to know, for the first time, the evolution of the hematological profile of the gerbils, experimentally infected with <em>Giardia lamblia</em>, up to the infection’s resolution. Hematological variables have been tested.</p> <p>Results: White blood cells have not presented meaningful alterations during the course of the infection. A significant reduction in the number of red blood cells (p = 0.021), in the concentration of hemoglobin (p = 0.029) and in the value of the hematocrit (p = 0.016) has been observed, starting from the second week of infection, ratifying an anemia related to giardiasis. Reduction in the level of serum iron starting from the third week of infection, despite not being significant, could suggest the participation of iron in the anemia. However, the weight of the animals was kept and the hematimetric parameters started to return to the basic values after the parasitological cure without iron reposition.</p> <p>Conclusions: The outcomes found suggest the idea that not only malabsorption but also other mechanisms such as chronic inflammation may be implicated in iron deficiency anemia in giardiasis and may explain how asymptomatic patients may have anemia without malabsorption. In this context, considering the highlighting character of the anemia in our study, we believe that anemia should be investigated in children with giardiasis. And in the cases of anemia without a definite etiology, giardiasis should also be investigated.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Imported brucellosis and Q-fever coinfection in Croatia: a case report 2018-08-13T20:19:30-07:00 Ljiljana Peric Dario Sabadi Ilija Rubil Maja Bogdan Marija Guzvinec Oktavija Dakovic Rode Bernard Kaic Irena Tabain Tatjana Vilibic-Cavlek <p>The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as <em>Brucella melitensis</em>. 16S rRNA gene sequencing of the isolate confirmed it as a <em>Brucella</em> sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), <em>Coxiella burnetii</em> phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement## Comparative evaluation of susceptibility testing methods for colistin and polymyxin B among clinical isolates of carbapenem- resistant Klebsiella pneumoniae and Acinetobacter baumannii 2018-08-13T20:19:35-07:00 Yamuna Devi Bakthavatchalam Abirami Shankar Bhuvaneswari Thukaram Dhanabhagyam Naveena Krishnan Balaji Veeraraghavan <p>Susceptibility testing (ST) of colistin and polymyxin B is challenging. Disc diffusion testing is not reliable for polymyxin ST, because of poor diffusion. Currently, for polymyxin ST, the EUCAST-CLSI joint commission recommending broth microdilution (BMD) as the reference method. &nbsp;In this study, reliability of E-test and Vitek 2 was compared with BMD, using the susceptible breakpoint of ≤ 2μg/ml for both colistin and polymyxin B.&nbsp; Overall, essential agreement (EA) for colistin between E-test, Vitek2 and BMD were 37% and 74% respectively. EA for polymyxin B between E-test and BMD were 65%. Very major error (VME) for colistin and polymyxin B with E-test were 42% and 55% respectively. An unacceptable VME of 11% was seen for colistin with Vitek2. Major errors (MEs) were rather limited with both E-test and Vitek2. E-test and Vitek2 may lead to inappropriate decision-making for colistin/polymyxin B therapy. Thus, clinical laboratories should consider BMD for polymyxin ST.</p> 2018-06-30T00:00:00-07:00 ##submission.copyrightStatement##