The Journal of Infection in Developing Countries

Helicobacter pullorum: A potential hurdle emerging pathogen for public health

Wafaa A Abd El-Ghany — 2020-11-30

Emerging zoonotic pathogens gain more attention due to the adverse effects on human and animal’s health and productivity. One of these zoonotic pathogens is Helicobacter pullorum (H. pullorum) which was firstly diagnosed in 1994. This bacterium is enterpathogenic in poultry and contaminates the carcasses meat during processing or improper handling. Human can get H. pullorum infection mainly through mishandling of contaminated carcasses or consumption of undercooked meat. Infection of H. pullorum in human is associated with gastroenteritis and hepatitis. Diagnosis of H. pullorum is very difficult as misdiagnosis with other enteric zoonotic pathogens like Campylobacter and other Helicobacter species is common. Unlike other types of Helicobacter, there are little information and few researches regarding prevalence, pathogenesis, diagnosis and control of H. pullorum infection either animals or human. Accordingly, this review article was prepared to give more details about H. pullorum sources of infection, pathogenicity, incidence in poultry and human as well as its treatment.

What influences the infection of COVID-19 in healthcare workers?

Xiaoquan Lai — 2020-11-30

Introduction: The outbreak of COVID-19 has spread worldwide. The evidence about risk factors of healthcare workers who infected COVID-19 is limited. This study aims to describe characteristics and influencing factors of the COVID-19 infection in healthcare workers.

Methodology: The study was performed among COVID-19 infected and uninfected healthcare workers in three hospitals in Wuhan. A total of 325 healthcare workers participated; among them 151 COVID-19-infected healthcare workers were included. Characteristics of infected healthcare workers, and influencing factors including exposure histories, the use of protective equipment in different risk conditions and areas, perceptions, emotions, satisfactions and educations were described and analyzed.

Results: Healthcare workers got infected clustered mostly in the physical examination center. When performing general operations on confirmed or suspected patients, the use of protective equipment including the effectiveness of masks (p < 0.001), gloves (p < 0.001); and the use of gloves (p < 0.001), suits (p < 0.001), gowns (p < 0.001), shoe covers (p < 0.001), and hats (p < 0.001) were protective factors. The use of protective equipment was a protective factor in most cases. Negative emotions and dissatisfaction to the hospital response were associated with the increased risk of infection.

Conclusions: The use of protective equipment, emotions and satisfactions to hospital responses are key COVID-19-infected factors. The awareness, the supply and the use of protective equipment, the layout of departments and other environmental and management factors should be strictly equipped. In addition, hospitals should also pay attention to emotions and satisfaction of healthcare workers.

A review of the prevalence of COVID-19 in the Arab world

Nasar Alwahaibi — 2020-11-30

Introduction: Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease worldwide. It is a real test for all health authorities including Arab countries. In this review, we aimed to assess the prevalence of COVID-19 in the Arab world. In addition, to compare the findings of this study with other top affected countries.

Methodology: We searched for official websites from the Ministries of Health and other official sources in all 22 Arab countries. Medline, Science Direct and Google Scholar websites were also used to search for COVID-19, 2019 novel coronavirus, SARS-CoV-2 and coronavirus. The time period was from 1 January 2020 to 31 May 2020.

Results: As of May 31, 2020, COVID-19 has caused 290,428 confirmed cases, 3,696 deaths and 157,886 cured cases in all Arab countries. In terms of confirmed cases, Saudi Arabia followed by Qatar, UAE, Kuwait and Egypt have the highest reported cases. However, the total number of deaths was dominant in Egypt, followed by Algeria, Saudi Arabia, Sudan and UAE. In comparison to other non-Arab countries and confirmed cases, Arab countries come fourth after USA, Brazil and Russia. In terms of death, the Arab world is not listed as the top ten affected countries as only scored eight deaths per million have been recorded.

Conclusions: Most Arab countries took some serious early steps to minimize the outbreak of COVID-19. At the moment, controlling the source of infection, the route of transmission and taking care of infected patients are the main challenges for health authorities in all Arab countries.

What should we do for the safe transportation of COVID-19 patients?

Masayuki Akatsuka — 2020-11-30

Atypical course of COVID-19 in patient with Bruton agammaglobulinemia

Ivana Milošević — 2020-11-30

We present atypical course of the novel coronavirus disease (COVID-19) in 34-year man with Bruton agammaglobulinemia. The patient was successfully treated by a combination of available drugs, including convalescent plasma and interleukin-6 (IL-6) inhibitor.

Clinical Characteristics of 33 Asymptomatic COVID-19 Infections in Wuhan, China

Yuanyuan Chen — 2020-11-30

Clinical characteristics of 33 asymptomatic COVID-19 infections were analyzed in this study. The data showed most of asymptomatic patients had small body mass index, good prognosis and low infectivity. This study suggests that screening from high-risk populations to find and isolate asymptomatic patients is an important disease prevention and control strategy for COVID-19.

Multidrug resistance bacteremia in neonates and its association with late-onset sepsis and Coagulase-negative Staphylococci

Antonio M Quispe — 2020-11-30

Introduction: This study aimed to assess the association between multidrug resistance (MDR) and late-onset sepsis (LOS) among newborns with bloodstream infection (BSI).

Methodology: In this cross-sectional study, we routinely tested every newborn with a presumptive diagnosis of sepsis admitted to the largest reference maternity hospital in Lima, Peru for BSI over an 18-month period. We tested every isolate for MDR by using the disk-diffusion method and assessed its associated factors by using a robust Poisson regression analysis with a particular focus on its association with LOS (vs. early-onset sepsis, EOS).

Results: We analyzed a total of 489 subjects, including 340 (69%) newborns with LOS, and estimated an MDR rate of 80% (95% confidence interval, CI: 76%-83%), which was significantly higher (p-value < 0.001) among LOS (85%; 95% CI: 81%-89%) than EOS cases (67%; 95% CI: 59%-75%). The primary isolate was coagulase-negative Staphylococci (CoNS) (60%), which exhibited a limited subset of antibiotic MDR patterns, most of which were characterized by their resistance to cefoxitin, gentamicin, and clindamycin and levofloxacin. Overall, the prevalence of MDR was higher among LOS compared to EOS cases (adjusted prevalence ratio [aPR] = 1.28; 95% CI: 1.14-1.45), and among BSI due to CoNS compared to other bacteria (Apr = 1.10; 95% CI: 1.01-1.20).

Conclusions: MDR among newborns with sepsis is exceptionally high, being even higher among those with LOS than newborns with EOS, and among those infected with CoNS compared to other bacteria. Furthermore, CoNS exhibited a limited subset of MDR patterns, which could be used to guide therapeutic decisions.

Hematological parameters in patients with bloodstream infection: A retrospective observational study

Wei Tang — 2020-11-30

Introduction: To date, the relationship between the causative pathogens and the changes of hematological parameters was rarely referred and deserves further investigation.

Methodology: A total of 825 adult patients, including 134 negative blood cultures patients and 691 bloodstream infection (BSI) patients, were screened for eligibility in this study. Receiver operating characteristic curves and binary logistic regression models were used to assess the power of hematological parameters to distinguish patients with BSI caused by different pathogens.

Results: Except for platelet-to-lymphocyte ratio (PLR) and platelet larger cell count (P-LCC), the other hematological parameters investigated in the study were significantly different in patients with BSI caused by different pathogens, including Candida. The specific combinations of lymphocyte count (LYM), platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), MPV-to-PLT ratio (MPV/PLT), platelet larger cell ratio (P-LCR), and C-reactive protein (CRP) can improve the ability to distinguish various BSI from negative blood cultures. The highest area under the curve of was 0.753 (95% CI 0.709-0.797) for positive blood cultures, 0.715 (95% CI 0.658-0.771) for Gram-positive pathogens BSI, 0.777 (95% CI 0.730-0.824) for Gram-negative pathogens BSI, 0.797 (95% CI 0.747-0.846) for Escherichia coli BSI, 0.943 (95% CI 0.899-0.987) for Enterobacter aerogenes BSI, 0.830 (95% CI 0.740-0.921) for Pseudomonas aeruginosa BSI, and 0.767 (95% CI 0.695-0.839) for Staphylococcus aureus BSI.

Conclusions: The specific combinations of hematological parameters can improve the power to distinguish patients with BSI caused by different pathogens. Attention to these parameters can be easily integrated into daily medical activities, without extra costs.

Molecular characterization of beta-lactamase genes produced by community-acquired uropathogenic Escherichia coli in Nouna

Dramane Kiemde — 2020-11-30

Introduction: Extended-Spectrum Beta-Lactamases (ESBL) are a common mechanism of bacterial resistance in Enterobacteriaceae. The purpose of this study is to characterize the ESBL genes produced by community-acquired uropathogenic Escherichia coli strains in the Nouna District, in the West-African country, Burkina Faso.

Methodology: Samples were collected from non-hospitalized patients who came for consultation at the CMA (Centre Médical avec Antenne chirurgicale) in Nouna and were sent to the laboratory for a urine culture test. The detection of ESBL production by the bacteria was carried out with the double-disc synergy test and the extraction of the ESBL genes with the heat shock method. Molecular characterization of ESBL genes was performed with three sequential multiplex polymerase chain reaction (PCR) assays.

Results: One hundred and eighty-two (182) bacteriological cultures were analyzed and 29 E. coli isolated, between 01/07/2017 and 01/07/2018. The ESBL phenotype was found in 13/29 (44.8%). Multiplex PCR yielded many beta-lactamase genes, predominantly bla_CTX-M-1,3,15 (12/13; 92.3%) followed by beta-lactamase genes bla_OXA-1,4,30 (8/13; 61.5%) and beta-lactamase genes bla_TEM-1,2 (7/13; 53.8%).

Conclusion: This study showed that the bla_CTX-M-1,3,15 genes produced by uropathogenic E. coli were predominant. Sequencing of these genes would be needed to better characterize the different types of ESBL circulating in Nouna.

Inducible clindamycin resistance in clinical isolates of staphylococcus aureus in Suez Canal University Hospital, Ismailia, Egypt

Rania Mohammed Kishk — 2020-11-30

Introduction: The increasing incidence of methicillin resistance among Staphylococci has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat S. aureus infections, with clindamycin being the preferable agent owing to its excellent pharmacokinetic properties. Inducible clindamycin resistance my lead to therapeutic failure.

Aim: Detection of the prevalence of constitutive and inducible clindamycin resistance in clinical isolates of S. aureus to improve the clinical outcomes in patients.

Methodology: A total of 176 non-duplicate staphylococcal isolates were isolated from different clinical samples. Methicillin resistance was detected using Cefoxitin disk diffusion (CDD) method. Phenotypic clindamycin resistance was performed for all isolates by D test. Polymerase Chain Reaction (PCR) assay were done for detection of erm resistance genes (ermA, ermB and ermC).

Results: Out of 176 strains of S. aureus, 108 isolates (61.3%) were identified as MRSA. Erythromycin and clindamycin resistance was detected in 96 isolates (54.5%) and 68 isolates (38.6%) respectively. Clindamycin resistance (cMLS_B) was significantly higher (p value < 0.001) in MRSA strains (56 isolates) compared to MSSA (12 isolates). Resistant genes were detected in 160 isolates (91%). The ermA gene was detected in 28 isolates (16%), the ermB gene was detected in 80 isolates (45.5%) (p < 0.001).

Conclusions and recommendations: The frequency of constitutive and inducible clindamycin resistance in MRSA isolates emphasizes the need to use D test in routine antimicrobial susceptibility testing to detect the susceptibility to clindamycin as the inducible resistance phenotype can inhibit the action of clindamycin and affect the treatment efficacy.

Risk factors for negative T-SPOT.TB assay results in patients with confirmed active tuberculosis: A retrospective study

Yanwan Shangguan — 2020-11-30

Introduction: The interferon-γ release assays as potent adjunct tools for the quick detection of TB in high burden countries is feasible. In this retrospective study, we aimed to identify the risk factors for negative T-SPOT results in confirmed active tuberculosis.

Methodology: We consecutively enrolled 1,021 patients who were positive for acid-fast bacilli smear staining or culture-confirmed mycobacterial infection and simultaneously tested with the T-SPOT.TB assay. All of the included specimens were used to discriminate the Mycobacterium species using the biochip assay. We collected basic clinical characteristics and laboratory results for further analysis.

Results: Of the 1,021 patients enrolled in the study, 89 patients were identified as having nontuberculous mycobacteria (NTM). Ninety-nine patients were excluded from the analysis because of indeterminate T-SPOT.TB results, while the remaining 833 patients were identified as having Mycobacterium tuberculosis infection. In total, 159 patients had false-negative T-SPOT.TB results (19.1% of 833). The concordance rate between the T-SPOT.TB results and final diagnoses in females was always lower than that in males. Multivariate logistic regression analysis showed that female sex (OR 1.81; 95% CI 1.19, 2.7; p = 0.006), age (OR 1.02; 95% CI 1.01, 1.03; p = 0.003), acid-fast bacilli (AFB) smear-negative (OR 5.45; 95% CI 3.62, 8.19; p < 0.001), HIV coinfection (OR 6.83; 95% CI 2.73, 17.10; p < 0.001) were associated with negative T-SPOT.TB result.

Conclusions: Female is another independent risk factor of negative T-SPOT.TB results, besides to elder, HIV co-infection, acid-fast bacilli (AFB) smear-negative who are suspected of having active TB infection.

Genetic diversity of Mycobacterium tuberculosis using 24-locus MIRU-VNTR typing and Spoligotyping in Upper Myanmar

Waing Waing Moe Sann — 2020-11-30

Introduction: MIRU-VNTR typing and Spoligotyping are the useful molecular tools for TB epidemiology study. Information regarding genetic diversity and tuberculosis (TB) transmission in Upper Myanmar only is scares.

Methodology: We determined the genetic diversity of Mycobacterium tuberculosis (Mtb) and TB transmission from Upper Myanmar TB Reference Laboratory, Mandalay Region, including Mandalay (72), Shan (22), Magway (15), Sagaing (13), Nay Pyi Taw (8), Kachin (7), Chin (2) and Kayah (1). One hundred and forty Mtb isolates were genotyped using 24-locus MIRU-VNTR typing and spoligotyping. Lineage classification and TB transmission analysis were performed.

Results: 24-locus MIRU-VNTR typing identified 135 unique profiles and two clusters compared to 35 spoligotyping profiles which contained 12 clusters and 23 unique isolates, Beijing (n=100, 71.4%) was found to be prominent lineage by combine two methods. The expected proportion attributable to recent transmission based on clustering rate was 2.1%. One cluster case was more likely to be in MDR patient.

Conclusions: Our findings showed Beijing genotypes were dominant in Upper Myanmar. The usage and analysis of 24-locus MIRU-VNTR typing might prove useful for our broader understanding of TB outbreaks and epidemiology than spoligotyping. The genotypic pattern of this combined method suggests that the lower transmission rate may be due to a higher possibility of reactivation cases in Upper Myanmar.

A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy

Khalid Mohammed Akkour — 2020-11-30

Introduction: Surgical site infections (SSIs) are a major health issue in surgical specialties in terms of health care costs and patients’ clinical outcomes. At the level of the patient, prolonged hospital stays or readmissions for SSIs, can affect the patient’s quality of life. At the level of the health care system, it exhausts the hospital’s resources and increases the burden on the medical staff due to the need for continuous wound care, microbiological cultures, laboratory tests and medications. In this study, we assessed the effectiveness of two antibiotic prophylaxis regimens for the prevention of SSIs in patients undergoing elective hysterectomy surgeries.

Methodology: A retrospective cohort, analyzing 141 patients, was conducted between November 2016 and January 2019 at a university hospital. We compared the efficacy of a single dose vs. 24-hour multiple doses of Cefazolin in patients who underwent elective hysterectomy for benign or malignant indications. The secondary objective was to identify potential risk factors associated with SSIs.

Results: There was no statistically significant difference between both groups (p = 0.872). Obesity and a laparotomy surgical approach are risk factors to the development of SSIs (p = 0.001 and 0.014, respectively). Other potential risk factors include the duration of hospital stay, the duration of the surgery and the amount of blood loss.

Conclusions: Although the rate of SSIs is not significantly different between both groups, risk stratification can be done after screening patients and the prophylactic regimen must be tailored for each patient in a cost-effective manner and using a multidisciplinary approach.

Vagococcus sp. a porcine pathogen: molecular and phenotypic characterization of strains isolated from diseased pigs in Brazil

Carlos Emilio Cabrera Matajita — 2020-11-30

Introduction: Vagococcus spp. is known for its importance as a systemic and zoonotic bacterial pathogen even though it is not often reported in pigs. This is related to the pathogen misidentification due to the lack of usage of more discriminatory diagnostic techniques. Here we present the first report of Vagococcus lutrae in swine and the characterization of Vagococcus fluvialis and Vagococcus lutrae isolated from diseased animals.

Methodology: Between 2012 and 2017, 11 strains with morphological characteristics similar to Streptococcus spp. were isolated from pigs presenting different clinical signs. Bacterial identification was performed by matrix assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry and confirmed by 16S rRNA sequencing and biochemical profile. Strains were further genotyped by single-enzyme amplified fragment length polymorphism (SE-AFLP). Broth microdilution was used to determine the minimal inhibitory concentration of the antimicrobials of veterinary interest.

Results: Ten strains were identified as V. fluvialis and one was identified as V. lutrae. The SE-AFLP analysis enabled the species differentiation with specific clustering of all V. fluvialis separately from the V. lutrae strain. Most strains presented growth in the maximum antibiotic concentration values tested for eight of the 10 analyzed antimicrobial classes.

Conclusions: The observed resistance pattern can represent a problem for veterinary and producers in the treatment of diseases associated Vagococcus spp. in swine production. Vagococcus species may also be a risk for pig industry workers. The data described here will be of great value in further understanding the behavior of this pathogen in animal production.

Frequency and genotype distribution of high risk human papillomavirus in esophageal squamous cell carcinoma

Nuzhat Sultana — 2020-11-30

Introduction: Esophageal squamous cell carcinoma (ESCC) is a dismal disease exhibiting striking geographical differences in its incidence. It is multifactorial in origin. Among infectious agents, human papillomavirus (HPV) was introduced as a possible causative agent in the development of ESCC in 1982. Subsequent studies using various methods have confirmed the presence of HPV in ESCC. We aimed to determine the frequency of HPV in ESCC in northwest Pakistan which is part of high risk belt for this disease.

Methodology: This study was conducted on two hundred and forty-three (243) diagnosed cases of ESSC at two tertiary care hospitals of Peshawar, Pakistan, from 2011 to 2016. DNA was extracted from all specimens. Polymerase chain reaction (PCR) was used to check the quality of DNA using β-globin primers and frequency and genotypes of HPV using HPV general primers and type-specific primers respectively. HPV and its genotypes were confirmed through the sequencing of a few selected cases.

Results: Two hundred and three (203) tissue specimens had adequate DNA and were further analyzed. HPV positivity with general primers alone was 15.7% (32/203). Using HPV general primers and type-specific primers (HPV 16 or HPV 18), the overall positivity of HPV was 31% (63/203). For type-specific primers, frequency of HPV types 16 and 18 was 20.19% (41) and 7.8% (16) respectively where 6 cases were positive for both HPV 16 and 18.

Conclusions: The overall high prevalence of HPV indicates it as a possible risk factor for ESSC.

Oral melatonin improves the detection of parasitemia in malaria

Chandan Kumar Kedarisetty — 2020-11-30

Introduction: Malaria is a growing global threat and a major cause of mortality in the tropics. The gold standard diagnosis is peripheral blood smear examination. It has been demonstrated that melatonin acts as messenger molecule in malaria pathophysiology. This concept was used to evolve a clinical study wherein use of exogenous melatonin could improve the chance of detection of the parasite.

Methodology: In a prospective study, 80 consecutive patients seen in the Department of Medicine at Kasturba Hospital, Manipal, suspected to have malarial fever were enrolled with proper informed consent, and randomly assigned to the groups given oral melatonin 3mg (melatonin group, n = 40) or placebo (control group, n = 40). Blood samples were collected for peripheral smear examination at baseline and then at two, three, four and five hours after drug administration. The primary end point was the parasite detection index.

Results: Baseline characteristics of patients were comparable. In the melatonin group, there was a significant increase of 0.0943 ± 0.22 in the mean parasite index from 0.217 ± 0.42 pre-melatonin to 0.3114 ± 0.5 post-melatonin (p = 0.001), compared to a difference of 0.0025 ± 0.22 in mean parasite index before and after placebo in the control group (p = 0.95). The maximum rise in parasite detection was seen at five hours after melatonin.

Conclusions: In a single centre study, for the first time, it has been shown that a significantly higher proportion of patients was diagnosed with malaria on peripheral smear after oral melatonin administration, maximal at five hours after administration of melatonin.

Epidemiological trends of malaria in the Western regions of Saudi Arabia: a cross sectional study

Omar SO Amer — 2020-11-30

Introduction: Saudi Arabia has successfully reduced malaria cases to be constrained largely in the western regions. This study aimed to determine the epidemiological trends of malaria infection in five western regions of Saudi Arabia.

Methodology: A retrospective analysis was conducted to investigate the epidemiological trends of malaria infection in the western regions, based on the published registry of the Saudi Ministry of Health, during the period from 2014 to 2017 using the appropriate statistical tools.

Results: A total of 8925 confirmed cases of malaria were reported in the western regions during the period from 2014 to 2017 with the mean of 2231 malaria cases per year. The minimum (n = 1097) and maximum (n = 4075) number of cases were reported in 2014 and 2016 respectively. The highest (n = 5919, 66.3%) number of cases were reported from Jazan region, while lowest (n = 86, 1.0%) number of cases were reported from Al-Bahah region. Plasmodium falciparum was the most frequently reported species with 7485 (83.9%) cases, while Plasmodium vivax accounted 1386 (15.5%) cases. Plasmodium malariae and mixed infections were insignificant and accounted 0.5% (n = 48) and 0.1% (n = 6) cases respectively. In relation to malaria infection and age group, malaria was predominant in > 15 age group. The highest number of malaria cases in almost all years was observed from January until March and the lowest number was reported from May until July.

Conclusions: Plasmodium falciparum was the most dominant species in this survey and Jazan was the most affected region.

Cytomegalovirus associated severe pneumonia in three liver transplant recipients

Adem Kose — 2020-11-30

Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria.

Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device.

Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures.

Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.

Multi-parasite infection in an immigrant from Ghana: potential for new epidemic foci

Maura Fiamma — 2020-11-30

Introduction: Imported parasitosis, which do not require an invertebrate vector, are extremely dangerous and can lead to the occurrence of disease in currently parasite free areas. In the present study we report a case of multi-parasitic infection in a young immigrant from Ghana to Italy caused by filaria, Schistosoma sp. and Strongyloides sp.

Case presentation: A 27-year-old Ghanaian man attended the Hospital of Nuoro (Sardinia), Italy, at the end of August 2015, claiming pain to the kidney and hypertensive crisis; the patient presented with dyspnea and epistaxis, chronic itchy skin of the back, shoulders, arms and legs, anuria and high creatinine, metabolic acidosis and hypereosinophilic syndrome. Serological test for parasitic infections were done, and showed a marked positivity for filaria, Schistosoma sp. and Strongyloides sp. The patient started the treatment immediately with two doses per day of Bassado Antibiotic (tetracycline) for twenty days and then with a single dose of 3 mg of ivermectin that was repeated after 3 months.

Conclusions: Immigrant patients from endemic areas who show clinical signs, such as a general itching on the back, shoulders and arms and legs, should have a thorough history in order to make early diagnosis and prevent further complications. Therefore, general practitioners and doctors in Europe and in other parasitosis non-endemic countries, should consider to test for parasites in any immigrant from endemic countries to aid in establishing the final diagnosis and prevent further complications.

A case of infective endocarditis due to Herbaspirillum Huttiense in a pediatric oncology patient

Ahmet Alptuğ Güngör — 2020-11-30

Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation). This condition might damage the endocardial tissue and/or valves. An indwelling central venous catheter is a major risk factor for bacteremia at-risked pediatric populations such as premature infants; children with cancer and/or connective tissue disorders. Herbaspirillum huttiense is a Gram-negative opportunistic bacillus that may cause bacteremia and pneumonia rarely in this fragile population. Herein we report the very first case of bacteremia and IE in a pediatric oncology patient caused by H. huttiense.