The Journal of Infection in Developing Countries https://jidc.org/index.php/journal <p>A peer-reviewed open access journal, focusing on global health.</p> The Journal of Infection in Developing Countries en-US The Journal of Infection in Developing Countries 1972-2680 <p>Authors who publish with this journal agree to the following terms:</p> <ol type="a"> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="Creative Commons Attribution License" href="http://creativecommons.org/licenses/by/4.0/" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a title="The Effect of Open Access" href="http://opcit.eprints.org/oacitation-biblio.html" target="_new">The Effect of Open Access</a>).</li> </ol> Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients https://jidc.org/index.php/journal/article/view/11189 <p>Introduction: Carbapenem-resistant <em>Klebsiella pneumoniae </em>(KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality. The purpose of our study was to identify the risk factors for KP bloodstream infections (BSIs) and mortality in onco-hematological patients.</p> <p>Methodology: A retrospective observation study was conducted on KP BSIs in the onco-hematology departments at Xiangya hospital from January 2014 to September 2018. Multivariate analysis was employed to identify the independent risk factors for carbapenem-resistant (CR) KP BSIs and related mortality.</p> <p>Results: A total of 89 strains of KP were analyzed in our study, in which 20 strains were CRKP. The only risk factor for CRKP BSI was carbapenem exposure within 30 days before the onset of BSIs (HR 25.122). The 30-day mortality was 24.7%. CRKP caused more mortality than carbapenem-susceptible KP (55.0% vs 15.9%, P = 0.001). In the multivariate analysis, unresolved neutropenia (HR 16.900), diarrhea (HR 3.647) and RDW &gt; 14% (HR 6.292) were independent risk factors for mortality, and appropriate empirical therapy (HR 0.164) was protective against mortality.</p> <p>Conclusions: Our findings showed that carbapenem resistance was spreading in our setting, and a precise combination of antibiotics covering the common pathogen is crucial to improving patient survival.</p> Jianling Liu Haichen Wang Ziyan Huang Xiaoyan Tao Jun Li Yongmei Hu Qingya Dou Mingxiang Zou Copyright (c) 2019 Jianling Liu, Haichen Wang, Ziyan Huang, Xiaoyan Tao, Jun Li, Yongmei Hu, Qingya Dou, Mingxiang Zou https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 357 364 10.3855/jidc.11189 Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients https://jidc.org/index.php/journal/article/view/11099 <p>Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from <em>Escherichia coli</em> bacteremia among children and adolescents with hematological disorders.</p> <p>Methodology: A retrospective observational study of <em>E. coli</em> bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated.</p> <p>Results: Of the 45 strains of <em>E. coli</em>, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (&gt; 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (&lt; 300/mm<sup>3</sup>, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (&gt; 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group.</p> <p>Conclusions: MDR infections from <em>E. coli</em> bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.</p> Haichen Wang Jianling Liu Ziyan Huang Xiaoyan Tao Jun Li Yongmei Hu Qingya Dou Mingxiang Zou Qun Yan Wen' en Liu Copyright (c) 2019 Haichen Wang, Jianling Liu, Ziyan Huang, Xiaoyan Tao, Jun Li, Yongmei Hu, Qingya Dou, Mingxiang Zou, Qun Yan, Wen' en Liu https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 365 373 10.3855/jidc.11099 Antibiotic resistance, virulence factors and genotyping of Pseudomonas aeruginosa in public hospitals of northeastern Mexico https://jidc.org/index.php/journal/article/view/10953 <p>Introduction: <em>Pseudomonas aeruginosa</em> is the second most prevalent opportunistic pathogen causing nosocomial infections in Mexico. This study evaluated antibiotic resistance, production of virulence factors and clonal diversity of <em>P. aeruginosa</em> strains isolated from patients undergoing nosocomial infections in public hospitals of northeastern Mexico.</p> <p>Methodology: Ninety-two <em>P. aeruginosa</em> isolates from urine culture, Foley catheter, ear, wounds, respiratory tract secretions, scalp, blood culture, bronchoalveolar lavage, expectoration and cerebrospinal fluid causing nosocomial infections were analyzed. The isolates were identified by MALDI-TOF and antibiotic resistance profiles obtained by MicroScan®. The production of virulence factors was analyzed with spectrophotometric techniques and isolates genotyped by ERIC-PCR.</p> <p>Results: Out of the 92 isolates, 26 (28.2%) were found to be multidrug resistant (MDR); 21 (22.7%) were classified as extremely drug resistant (XDR). Highest resistance rate was found for gatifloxacin (42%) while ciprofloxacin accounted for the antibiotic with the lowest resistance rate (2%). Bronchoalveolar lavage isolates produced the highest amounts of virulence factors: biofilm (44.4% ± 2.7%), elastase (58.5% ± 4.3%), alkaline protease (60.1% ± 5.0%); except for pyocyanin production. The ERIC-PCR assay showed 83 genetic patterns (90% clonal diversity) and 13 isolates had 100% genetic similarity, forming 4 real clones, 3 of these clones were obtained from different anatomical site and/or hospital.</p> <p>Conclusions: Antibiotic resistance and virulence factors production was heterogeneous among samples analyzed. Genotyping of <em>P. aeruginosa</em> strains showed high genetic diversity in the studied isolates.</p> Eliab M González-Olvera Rebeca Pérez-Morales Alberto González Zamora Graciela Castro-Escarpulli Ingrid Palma-Martínez José J Alba-Romero Copyright (c) 2019 Rebeca Pérez Morales, Eliab M González Olvera, Alberto González Zamora, PhD, Graciela Castro Escarpulli, PhD, Ingrid Palma Martínez, PhD, José J Alba Romero, PhD https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 374 383 10.3855/jidc.10953 Serotype diversity and slaughterhouse-level risk factors related to Salmonella contamination on poultry carcasses in Algiers https://jidc.org/index.php/journal/article/view/10450 <p>Introduction: In Algeria, the latest studies on <em>Salmonella</em> demonstrated warning contamination rates in farms and slaughterhouses. This pathogen can contaminate poultry meat and put humans at risk especially that such product is nowadays widely consumed.</p> <p>Methodology: a cross-sectional study was conducted in Algiers to evaluate prevalence, determine serotypes and quantify risk for <em>Salmonella</em> contamination in broiler chickens and turkeys at the post-chill stage of slaughter process.</p> <p>Results: batch prevalence was 63.1% for chickens and 34.9% for turkeys. Eleven serotypes were isolated from chickens and five from turkeys. The most predominant at both sample and batch levels was <em>S</em>. Kentucky either in chicken (65.1%) or in turkey carcasses (63.2%). Univariate analysis screened 3 variables for chickens and 5 variables for turkeys. Final multivariate regression models provided one potential risk factor for <em>Salmonella</em> contamination in each poultry species. Presence of less than 6 broilers simultaneously in the traditional scalding tank of small scale slaughterhouses had a significantly reduced contamination risk (OR = 0.31; <em>p</em> &lt; 0.05). Slaughtering turkeys in sites processing only this specie than in mixed poultry slaughterhouses increased significantly the contamination probability (OR = 4.44; <em>p</em> &lt; 0.05).</p> <p>Conclusions: Our study indicates a high prevalence of <em>Salmonella</em>-contaminated poultry carcass with wide diversity of serotypes. Moreover, two potential risk factors identified for the first time in Algeria are found to be associated with the lack in hygienic management on production sites. A real threat for consumers exists highlighting the imperative need for improved safety throughout the local poultry meat supply chain.</p> Lynda Mezali Faiza Mebkhout Siham Nouichi Sofiane Boudjellaba Taha-Mossadak Hamdi Copyright (c) 2019 Lynda Mezali, Faiza Mebkhout, Siham Nouichi, Sofiane Boudjellaba, Taha Mossadak Hamdi https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 384 393 10.3855/jidc.10450 Seroprevalence of antibodies for pertussis and diphtheria among people leaving or entering China: a cross-sectional study https://jidc.org/index.php/journal/article/view/10147 <p>Introduction: Despite high population immunity, pertussis remains one of the leading causes of vaccine-preventable deaths worldwide. The aim of this study was to determine the seroprevalence of IgG antibodies to pertussis toxin (PT) and diphtheria among the adult male population leaving or entering China.</p> <p>Methodology: Blood samples were obtained from 240 Chinese and 207 African healthy adults that were leaving and entering China, respectively. Serum IgG antibodies against PT (anti-PT IgG) and diphtheria were determined.</p> <p>Results: The mean concentration of anti-PT IgG antibodies was 13.82 IU/mL and 18.11 IU/mL for the leaving and entering populations, respectively. None of the studied Chinese leaving China were seropositive for pertussis. Of the 240 subjects leaving China, 209 (87.1%) had anti-diphtheria antibody concentrations of ≥ 0.1 IU/mL and 31 (12.9%) had antibody concentrations between 0.01 and 0.099 IU/mL. Eleven (5.31%) of the studied Africans entering China had anti-PT IgG antibodies higher than 30 IU/mL and thus were considered seropositive for pertussis. Of the 207 Africans entering China, antibody concentrations of ≥ 0.1 IU/mL were found in 164 subjects (79.2%) while 43 (20.8%) had antibody concentrations between 0.01 and 0.099 IU/mL.</p> <p>Conclusions: Almost all Chinese adult men leaving China and most African men entering China have very low serum antibody levels of pertussis. Furthermore, the antibody level of diphtheria among these two populations was low among adults. A larger population study is needed to determine whether booster vaccinations against pertussis and diphtheria should be considered for adults in China and also for Africans entering China.</p> Hui Han Zhiqiang Fang Xiangguang Ye Hailei Wu Feng Zuo Quan Shi Jinping Mu Baoliang Xu Copyright (c) 2019 Hui Han, Zhiqiang Fang, Xiangguang Ye, Hailei Wu, Feng Zuo, Quan Shi, Jinping Mu, Baoliang Xu https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 394 399 10.3855/jidc.10147 Prevalence of methicillin resistant Staphylococcus aureus (MRSA) in pigs and workers at abattoirs in Trinidad and Tobago https://jidc.org/index.php/journal/article/view/10552 <p>Introduction: Methicillin resistant <em>Staphylococcus aureus</em> (MRSA), a major cause of zoonotic infections, has emerged globally in livestock, particularly pigs. People with occupational contact with food producing animals are at high risk of colonization. The aim of this study was to determine the prevalence of MRSA in pigs and abattoir workers throughout Trinidad and Tobago as well as their resistance to other antimicrobial agents.</p> <p>Methodology: Nasal and skin behind the ear swabs from pigs and nasal swabs from humans were enriched in Mueller Hinton broth with 6.5% sodium chloride, followed by phenol red mannitol broth with 75 mg/L aztreonam and 5 mg/L ceftizoxime. The enriched sample was then plated on both CHROMagar MRSA and Brilliance MRSA. All incubation was at 37ºC for approximately 24 h. Suspect MRSA isolates were confirmed as MRSA using the Penicillin-Binding Protein (PBP2a) test kit and polymerase chain reaction (PCR) to detect the <em>mecA </em>gene. Resistance of the <em>S. aureus</em> and MRSA isolates to 16 antimicrobial agents was determined using the disc diffusion method.</p> <p>Results: Of the 929 pigs and 44 humans sampled, MRSA strains were isolated at a frequency of 0.9% (8/929) and 2.3% (1/44) respectively. All isolates exhibited resistance to one or more of the 16 antimicrobial agents.</p> <p>Conclusions: The study demonstrated that pigs and workers at slaughter houses in Trinidad and Tobago harbour multidrug resistance <em>S. aureus</em> and MRSA. This is of public health significance as occupational exposure of humans can lead to an increased risk of infection and therapeutic failure.</p> Alva Stewart-Johnson Francis Dziva Woubit Abdela Saed Rahaman Abiodun Adesiyun Copyright (c) 2019 Alva Stewart-Johnson, Francis Dziva, Woubit Abdela, Saed Rahaman, Abiodun Adesiyun https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 400 409 10.3855/jidc.10552 Human miscarriage and infection in Tunisia: Role of Mycoplasma hominis and high Waddlia seroprevalence https://jidc.org/index.php/journal/article/view/9829 <p>Introduction: Miscarriage is one of the most common adverse pregnancy outcomes. The aim of this study was to investigate the relationship between miscarriage in humans and infections caused by zoonotic bacteria and genital pathogens.</p> <p>Methodology: Cervicovaginal swabs and placenta samples from 132 women with miscarriage (patient group: PG), and cervicovaginal swabs from 54 women with normal pregnancy (control group:CG), were subjected to bacteriological culture and real time PCRs detecting <em>Coxiella burnetii</em>, <em>Brucella </em>spp, <em>Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum</em>, <em>Chlamydia trachomatis</em>, <em>Waddlia chondrophila</em> and <em>Parachlamydia acanthamoebeae</em> DNA. Serology of<em> C. burnetii</em>, <em>C. trachomatis </em>and <em>W. chondrophila </em>was also performed.</p> <p>Results: Placenta samples were positive for <em>E. coli</em>, <em>S. agalactiae</em>, <em>U. urealyticum</em>, <em>M. hominis </em>and <em>C. trachomatis</em> in 4.7%, 3.1%, 3.1%, 0.7% and 0.7% of cases, respectively. For cervicovaginal swabs, <em>M. hominis </em>was more frequently detected among PG than CG with a significant statistical difference (<em>p =</em> 0.02). <em>C. trachomatis </em>was detected in 3.3% and 5.5% among PG and CG, respectively. <em>U. urealyticum</em> DNA was detected with high percentages in the two groups. Samples from both groups showed negatives results for <em>C. burnetii</em>, <em>Waddlia,</em> and <em>Brucella </em>qPCRs<em>. </em>A high rate of <em>W. chondrophila </em>seroprevalence (42%) was noted with significant difference among women with early miscarriage.</p> <p>Conclusions: <em>C. trachomatis</em>, <em>S. agalactiae</em> and <em>M. hominis </em>may play a role in miscarriage. However, the full characterization of the vaginal flora using other technologies such as NGS-based metagenomics is needed to clarify their role in miscarriage. Finally, further investigations should be performed to explain high <em>W. chondrophila</em> seroprevalence.</p> Mariem Smaoui Kebbi Carole Hanen Sellami Salma Kammoun Khaled Choura Leila Maazoun Houssem Mestiri Sebastien Aeby Doulira Louati Mohamed Derbel Kais Chaabene Adnene Hammami Gilbert Greub Abir Znazen Copyright (c) 2019 Smaoui mariem, PhD, Kebbi Carole, Sellami Hanen, Kammoun Salma, Choura Khaled, Maazoun Leila, Mestiri Houssem, Aeby Sebastien, Louati Doulira, Derbel Mohamed, Chaabene Kais, Hammami Adnene, Greub Gilbert, Znazen Abir https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 410 418 10.3855/jidc.9829 Relevance of TNF-α, IL-6 and IRAK1 gene expression for assessing disease severity and therapy effects in tuberculosis patients https://jidc.org/index.php/journal/article/view/10949 <p>Introduction: Tuberculosis (TBC) is a contagious chronic respiratory disease which despite the known cause, <em>Mycobacterium tuberculosis</em> (<em>Mtb</em>), and many decades of successful therapy, remains one of the leading global health problems. Immune responses against <em>Mtb </em>infection involve both of types of immunity, but cellular immunity, in which certain cytokines and Th1 cells play a key role, is crucial. A better understanding of the functions of the cytokine network involved in the state and progression of TBC could identify specific molecular markers for monitoring of disease activity as well as therapy outcomes in TBC patients.</p> <p>Methodology: We investigated expression of <em>TNF-α, IL-6 </em>and<em> IRAK1 </em>genes using an RT-qPCR technique in peripheral blood mononuclear cells of 33 TBC patients and 10 healthy individuals.</p> <p>Results: Comparison between TBC patients and healthy individuals revealed statistically significant differences for all analyzed genes. The levels of expression of TNF-α and IL-6 mRNA were higher, while the level of IRAK1 mRNA was lower in the TBC group compared to controls. Moreover, a strong positive correlation was observed between <em>TNF-</em>α and <em>IL-6</em> gene expression. When clinical parameters were analyzed, increased levels of TNF-α mRNA were detected in patients with a longer duration of therapy (&gt;2 months) compared to those with a shorter therapy duration (&lt; 2 months), and in patients without anemia.</p> <p>Conclusions: Our results indicate that the inflammatory genes we examined play a crucial role in the pathogenesis of tuberculosis, and that the expression of the <em>TNF-α</em> gene could be a marker for monitoring the clinical effect of the ant-tuberculosis drugs during therapy.</p> Ivana Buha Vesna Škodrić-Trifunović Tatjana Adžić-Vukičević Aleksandra Ilić Ana Blanka-Protić Mihailo Stjepanovic Marina Anđelković Miša Vreća Jelena Milin-Lazović Vesna Spasovski Sonja Pavlović Copyright (c) 2019 Ivana Buha, Vesna Škodrić-Trifunović, Tatjana Adžić-Vukičević, Aleksandra Ilić, Ana Blanka-Protić, Mihailo Stjepanovic, Marina Anđelković, Miša Vreća, Jelena Milin-Lazović, Vesna Spasovski, Sonja Pavlović https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 419 425 10.3855/jidc.10949 Presence of blaCTX-M antibiotic resistance gene in Lactobacillus spp. isolated from Hirschsprung diseased infants with stoma https://jidc.org/index.php/journal/article/view/10968 <p>Introduction: Although antibiotics have revolutionized health care by saving lives, the evolution of both pathogenic and commensal antibiotic-resistant bacteria are emerging as a threat in the health sector. As for <em>Lactobacillus</em> spp., it is usually a non-pathogenic bacteria. However, it can cause infection in immunocompromised condition. In this study, <em>Lactobacillus </em>spp. has been isolated from the faeces of infants with Hirschsprung disease (HD), which is congenital aganglionosis of intestine, where surgical approach and antibiotics are frequently used as medical intervention. The aim of this study is to assess the antibiotic resistance pattern and determine the presence of resistance genes, if any, in <em>Lactobacillus</em> spp. isolated from HD infants with ileostomy.</p> <p>Methodology: Six <em>Lactobacillus</em> spp. were isolated from faeces of six HD infants and confirmed using both conventional and molecular methods. Antibiotic resistance pattern was checked through disc diffusion method and was further investigated for the presence of antibiotic resistance genes (<em>bla</em><sub>TEM</sub><em>, bla</em><sub>CTX-M</sub><em>, bla</em><sub>OXA-2</sub><em>, bla</em><sub>IMP</sub><em>, bla</em><sub>VIM-2</sub><em>, bla</em><sub>NDM-1 </sub>and <em>mcr-1)</em>.</p> <p>Results: Antibiotic susceptibility of the isolates showed high level of resistance towards cephalosporins, oxacillin, aztreonam, meropenem and polymyxin group. However, four of the isolates showed the presence of <em>bla</em><sub>CTX-M </sub>gene after PCR amplification.</p> <p>Conclusions: To our knowledge, this is the first report on the presence of antibiotic resistance gene <em>bla</em><sub>CTX-M</sub> in <em>Lactobacillus</em> spp. and this presence may pose a serious threat in treatment regimen. As not much is known regarding the presence of <em>bla</em><sub>CTX-M </sub>in <em>Lactobacillus</em> spp., this finding may provide new light to research on antibiotic resistance in gut microflora.</p> Umama Khan Sadia Afsana Maria Kibtia Mahboob Hossain Naiyyum Choudhury Chowdhury Rafiqul Ahsan Copyright (c) 2019 Umama Khan, Sadia Afsana, Maria Kibtia, Mahboob Hossain, Naiyyum Choudhury, Chowdhury Rafiqul Ahsan https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 426 433 10.3855/jidc.10968 Elevated serum levels of adiponectin and interlukin-28B after IFN/RIB therapy in hepatitis C virus-infected patients https://jidc.org/index.php/journal/article/view/11190 <p>Introduction: The <em>interleukin 28B</em> (<em>IL28B</em>) genotype is associated with changes of lipid metabolism in patients infected with hepatitis C virus (HCV). The association of steatosis with serum levels of adiponectin in chronic hepatitis C (CHC) patients has also been documented. This study aimed for the evaluation of serum levels of IL28B and adiponectin as well as the association of <em>IL28B</em> SNPs with different clinicopathological parameters in HCV-infected patients.</p> <p>Methodology: All 142 HCV-infected patients received peg-interferon plus ribavirin. Detection of rs8099917 and rs12979860 IL-28B genotypes was done with specific primers. Serum IL28 and adiponectin levels were measured using commercial ELISA kits.</p> <p>Results: Higher levels of both IL28 and adiponectin were found in patients. In Genotype 3a (G3a) -infected patients, IL28 and adiponectin serum levels were significantly higher than those infected with G1a. A correlation was found between increasing levels of AST and ALT in G3a-infected patients and the decrease in IL28 and adiponectin serum levels, respectively, in contrast to G1a-infected patients. Higher levels of both IL28 and adiponectin were associated with both CT allele of rs12979860 and TT allele of rs8099917 in patients in comparison with corresponding alleles in controls.</p> <p>Conclusions: In contrast to other studies, this study showed higher serum adiponectin levels in HCV-infected patients compared to that in healthy controls. This finding is possibly due to adiponectin resistance caused by down-regulation of adiponectin receptors or tumorigenic effects of adiponectin. Our genotype-based analyses revealed, at least in part, the involvement of the viral factors in the outcome of HCV infection.</p> Kaveh Sadeghi Abbas Ahmadi Vasmehjani Rasoul Baharlou Zamaneh Hajikhezri Seyed Jalal Kiani Copyright (c) 2019 Kaveh Sadeghi, Abbas Ahmadi Vasmehjani, Rasoul Baharlou, Zamaneh Hajikhezri, Seyed Jalal Kiani https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 434 444 10.3855/jidc.11190 Should male doctors in Sri Lanka wear a necktie to be recognized and respected? https://jidc.org/index.php/journal/article/view/11211 <p>Introduction: European cultural norms have influenced physicians’ attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care.</p> <p>Methododology: A descriptive cross-sectional study was carried out at the National Hospital of Sri Lanka. An interviewer-administered questionnaire was used to collect data from doctors and patients.</p> <p>Results: The study included 105 doctors (57% males) and 333 patients (54% males). Mean ages of the doctors and patients were 37 years (95% C.I. 36-39) and 47 years (95% C.I. 45-49) respectively. Sixty-nine percent of the patients had completed secondary education or above. None of the patients were aware of the risk of spreading infections by wearing a necktie. Of the 41% of doctors who thought it was unnecessary to wear a necktie, 95% believed the necktie can spread infections. Ninety-five percent of patients believed doctors should wear neckties to be identified and respected and to maintain trustworthiness.</p> <p>Conclusions: None of the patients were aware of the possible risk of spreading infections by wearing a necktie, while most of the doctors who thought neckties were unnecessary also believed neckties can spread infections. Almost all patients thought that doctors should wear a necktie to be recognized and respected. Therefore, implementing a change in dress policy for doctors is a challenging task in Sri Lanka.</p> Prabath K Abeysundara Nilanga Nishad Karthiha Balendran Manod Pabasara Poornima K Bandara Narmada M Perera Heshani De Silva Shamila De Silva Maheswaran Umakanth Prasantha Wijesinghe Copyright (c) 2019 Prabath Kularathne Abeysundara, A A N Nishad, K Balendran, G M Pabasara, P K Bandara, W N M Perera, E G H E De Silva, S T De Silva, Maheswaran Umakanth, P S Wijesinghe https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 445 448 10.3855/jidc.11211 Seroprevalence of Borrelia burgdorferi among the indigenous people (Orang Asli) of Peninsular Malaysia https://jidc.org/index.php/journal/article/view/11001 <p>Introduction: Lyme disease has been well-described in the North America and European countries. However, information is still very limited in the developing countries including Malaysia. The Orang Asli (OA), the indigenous people of Peninsular Malaysia reside mostly in the forest and forest fringe areas abundant with the vector for Lyme disease. Here, we described the seroprevalence of <em>Borellia burgdorferi </em>(<em>B</em>.<em> burgdorferi</em>) among the OA and demographic variables that could be associated with seroprevalence.</p> <p>Methodology: A total of 16 OA villages distributed across 8 states in Peninsular Malaysia participated in this study. Sera obtained from 904 OA volunteers were screened for anti-<em>B. burgdorferi </em>IgG antibodies. ELISA results obtained and demographic information collected were analysed to identify possible variables associated with seroprevalence.</p> <p>Results: A total of 73 (8.1%) OA tested positive for anti-<em>B. burgdorferi</em> IgG antibodies. Among all the variables examined, village of residence (p = 0.045) was the only significant predictor for seropositivity. High (&gt; 10.0%) prevalence was associated with three OA villages. Those living in one particular village were 1.65 times more likely to be seropositive as compared to other OA villages. Age, gender, marital status, household size, level of education, monthly household income and occupation were not significant predictors for seropositivity.</p> <p>Conclusion: Results of the present study support earlier findings that <em>B. burgdorferi </em>infection among Malaysians is currently under-recognized. Further studies will be needed at these locations to confirm the presence of Lyme disease among these populations.</p> Chee-Sieng Khor Habibi Hassan Nurul-Farhana Mohd-Rahim Josephine Rebecca Chandren Siti-Sarah Nore Jefree Johari Shih-Keng Loong Juraina Abd-Jamil Jing-Jing Khoo Hai-Yen Lee Brian L Pike Wong Li-Ping Yvonne Ai-Lian Lim Sazaly AbuBakar Copyright (c) 2019 Sazaly AbuBakar, Chee-Sieng Khor, Mr., Habibi Hassan, Ms., Nurul-Farhana Mohd-Rahim, Ms., Josephine-Rebecca Chandren, Ms., Siti-Sarah Nore, Ms., Jefree Johari, Mr., Shih-Keng Loong, Juraina Abd-Jamil, Ms., Jing-Jing Khoo, Dr., Hai-Yen Lee, Dr., Brian L Pike, Dr., Li-Ping Wong, Prof., Yvonne Ai-Lian Lim, Prof. https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 449 454 10.3855/jidc.11001 Detection and quantification of Salmonella spp. in poultry slaughterhouses of southern Brazil https://jidc.org/index.php/journal/article/view/11107 <p>Introduction: <em>Salmonella</em> is a major cause of foodborne illness throughout the world. The use of quantitative techniques is important for assessing the risk and determining the capacity of each step of the slaughtering process to decrease or increase bacterial contamination. We aimed to detect and to quantify the presence of <em>Salmonella</em> in Brazilian processing plants by real-time quantitative polymerase chain reaction (qPCR).</p> <p>Methodology: A total of 139 poultry slaughterhouses samples were collected in order to detect to and quantify <em>Salmonella </em>by qPCR.</p> <p>Results: Almost all collection points (3/18), except water from pre-chiller tank, carcasses after pre-chiller, and carcasses frozen at -12ºC for 60 days, and 49% (68/139) of samples were positive for <em>Salmonella</em>. Quantification means varied equally among all of the tested sources, and we could not establish any pattern of variation. A large proportion (52.6%) of cloacal swabs was <em>Salmonella</em>-positive. Also, contamination in transport cages was increased after the cleaning process, indicating that the process was ineffective. The overall prevalence in samples obtained during the slaughtering process was 48.9%, and on the whole rinsed carcasses, this proportion was 50%. The detection of <em>Salmonella</em> in frozen carcasses, even after long periods of storage, indicates that the carcasses are a potential source of infection for consumers.</p> <p>Conclusions: We found that contamination levels remain similar throughout the slaughtering. qPCR proved to be an efficient method for the detection of <em>Salmonella</em>.</p> Karen Apellanis Borges Eduarda Boff Martelo Lilian Andriva dos Santos Thales Quedi Furian Isabel C Cisco Luciane Manto Luciana R dos Santos Copyright (c) 2019 Karen Apellanis Borges, Eduarda Boff Martelo, Lilian Andriva dos Santos, Thales Quedi Furian, Isabel Cristina Cisco, Luciane Manto, Luciana Ruschel dos Santos https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 455 460 10.3855/jidc.11107 Seroprevalence and risk assessment of viral hepatitis E infection in a group of exposed persons from Republic of Moldova https://jidc.org/index.php/journal/article/view/11397 <p>Introduction: Viral hepatitis E is considered to be an important issue for public health in developing countries. The aim of the present study is to evaluate morbidity and risk factors in occupationally exposed groups such as people working on sausage production.</p> <p>Methodology: Seroprevalence of HEV (hepatitis E virus) and risk factors to infection were determined in a cross-sectional study of two groups of populations: people working on sausage production (n = 70) and persons without occupational exposure (people working in the textile industry n = 70) in Moldova, a country without reported cases of hepatitis E.</p> <p>Results: The seroprevalence of HEV was 14.3% (CI 95%, 13.1-15.5%) in the group of exposed, compared with no cases in the non-exposed group that indicates on no previous infectious contact with hepatitis E virus.</p> <p>Conclusions: The increased seroprevalence of HEV among persons with occupational exposure to swine meat suggest animal-to-human transmission of this infection.</p> Octavian Sajin Constantin Spînu Iurie Pînzaru Maria Isac Igor Spînu Veaceslav Guțu Angela Paraschiv Luminița Suveică Copyright (c) 2019 Octavian Sajin, Constantin Spînu, Iurie Pînzaru, Maria Isac, Igor Spînu, Veaceslav Guțu, Angela Paraschiv, Luminița Suveică https://creativecommons.org/licenses/by/4.0 2019-05-31 2019-05-31 13 05 461 464 10.3855/jidc.11397