The Journal of Infection in Developing Countries An open access, peer-reviewed, online scientific research journal focused on global health The Journal of Infection in Developing Countries en-US The Journal of Infection in Developing Countries 2036-6590 <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="" 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="" target="_new">The Effect of Open Access</a>).</li> </ol> QuantiFERON-TB Gold In-Tube in Saudi Arabia benchmarked with other sites of the Middle East: A meta-analysis review <p>Introduction: Screening for Latent Tuberculosis Infections (LTBI) constitutes a key step in health surveillance programs especially among adults of high-risk groups. To our knowledge, this is the first systematic and meta-analysis review that aims to critically assess and compare the agreement of QuantiFERON-TB Gold In-Tube (QFT-GIT) and Tuberculin Skin Testing (TST) among adults of high-risk groups in Saudi Arabia and compare results with other sites of the Middle East.</p> <p>Methodology: Kappa estimates were meta-analyzed using random effect model and several subgroup analyzes were performed to explain overall heterogeneity. Funnel plot, Begg’s and Egger’s tests were employed to assess overall publication bias.</p> <p>Results: 18 studies were meta-analyzed, comprising 5070 adults of high-risk groups. Pooled kappa estimates from Saudi Arabia (κ = 0.29, 95% CI: 0.16, 0.41) showed lower rate of agreement compared to other sites of the Middle East (κ = 0.33, 95% CI: 0.25, 0.41). However, a significant level of heterogeneity (<em>I<sup>2</sup></em> = 96.7%, p &gt; 0.001) were identified across collected evidence. Begg’s and Egger’s tests confirmed absence of significant publication bias in this review (p = 0.49 and p = 0.16, respectively).</p> <p>Conclusion: This work revealed fair to poor agreement between TST and QFT-GIT, indicating that these two tests are not interchangeable in such settings. Substantial evidence is still needed before considering the sole use of QFT-GIT as an alternative to TST in these populations. Moreover, there is an urgent need for longitudinal studies in Saudi Arabia and the Middle East to accurately assess precision of LTBI diagnosis.</p> Hawra Al-Ghafli Sahal Al-Hajoj ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 687 699 10.3855/jidc.10311 PCR detection of Vibrio cholerae, Escherichia coli, and Salmonella sp. from bottled drinking water in Iran <p>Introduction: The quality of drinking water has an important role in human health. This study was aimed to detect <em>Escherichia</em>. <em>coli</em>, <em>Salmonella sp.</em> and <em>Vibrio cholerae</em> from bottled drinking waters produced in Iran.</p> <p>Methodology: A total of 240 samples of bottled water of different brands were collected for testing between March 2015 to December 2015 in Shahrekord-Iran. Samples were examined by polymerase chain reaction (PCR) combined with culture methods for the detection of <em>E</em>. <em>coli</em>, <em>Salmonella sp.</em>, and <em>V. cholerae</em>.</p> <p>Results: The results of PCR revealed that the <em>uidA</em> gene from <em>E</em>. <em>coli</em>, <em>IpaB</em> gene from <em>Salmonella sp</em>, and <em>epsM</em> gene from <em>V. cholerae</em> were detected in 6 (2.5%), 1 (0.4 %), 0 (0%) of the samples, respectively. But in culture methods, only <em>E. coli </em>5 (2.1%) were isolated from the samples. The contamination with <em>E. coli</em> was significantly higher (P &lt; 0.05) in water produced during the hot seasons than the cold seasons.</p> <p>Conclusions: This study confirmed the presence of <em>Escherichia coli</em> as the main microorganism in bottle drinking water in Iran. Also, our study showed that PCR can be used as a screening method for monitoring the enteric pathogens in drinking water.</p> Mojtaba Bonyadian Hamdallah Moshtaghi Hanie Nadi ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 700 705 10.3855/jidc.10160 Determinants of adherence to tuberculosis treatment in Iranian patients: Application of health belief model <p>Introduction: Adherence to TB treatment is an important issue for TB control, with key health consequences. Identification of the factors associated with that adherence is also important. The objective of this study was to identify factors associated with adherence to tuberculosis treatment, using the health belief model (HBM).</p> <p>Methodology: Overall 297 TB patients were recruited to the study using the census method. All patients completed a 40-question survey form anonymously. The questionnaire was developed based on the Health Belief Model. Data collection was carried out through interviews and questionnaires, as well as observing medical records and medical cards to be used in medical performance checklists.</p> <p>Results: The participants comprised 159 men and 138 women with an average age of 56.8 years (range 19-72 years). The results showed that the variables of perceived threat, benefits, barriers, and self-efficacy accounted for 42% of the variance in therapeutic adherence. The strongest predictor of adherence was found to be self-efficacy.</p> <p>Conclusion: HBM appears to be a suitable model in predicting therapeutic adherence in TB patients. Our results emphasize the centrality of self-efficacy in treatment adherence, that health educators should consider when developing programs to motivate patients to adhere to treatment.</p> Nemat Azizi Mahmood Karimy Vahid Naseri Salahshour ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 706 711 10.3855/jidc.9653 rial activity of Ilex paraguariensis (Yerba Mate) against Gram-positive and Gram-negative bacteria <p>Introduction: The stems and leaves of <em>Ilex paraguariensis</em> are popularly used for tea infusions in South America and the Middle East. The health benefits have been previously studied, revealing anti-mutagenic, anti-oxidant, hepatoprotective, hypocholesteremic and glycemic improvement. Limited research was performed on the antibacterial activity of the aqueous extract of Yerba Mate on standard and clinical isolates of Gram-positive and Gram-negative bacteria.</p> <p>Methodology: Commercial <em>Ilex paraguariensis</em> stems and leaves were ground and extracted with sterile deionized water at 70°C. Four ATCC bacterial strains and twenty-five bacterial clinical strains were used for testing. To obtain the minimal inhibitory concentration (MIC), the Yerba Mate aqueous solution was serially diluted according to the microdilution method. For the minimal bactericidal concentration (MBC), the tubes with clear broth were sub-cultured. To identify the types of ESBLs present in the clinical isolates, a multiplex PCR was performed.</p> <p>Results: An antibacterial activity was observed against most of tested strains, with a greater activity against Gram-positive bacteria. MIC and MBC values ranged between 0.468 mg/mL and 15 mg/mL of aqueous extract of Yerba Mate.</p> <p>Conclusion: The aqueous extract of the stems and leaves of <em>Ilex paraguariensis</em> extracted at 70°C showed a significant antibacterial activity. There was no correlation found between the different molecular resistance profiles and the antibacterial activity range.</p> Tania Noureddine Ziad El Husseini Ali Nehme Roula Abdel Massih ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 712 719 10.3855/jidc.10380 Staphylococcus aureus carrying lukS/F Panton-Valentine Leukocidin (PVL) toxin genes in hospitals of Lahore city <p>Introduction: Panton Valentine-Leukocidin (PVL) toxin is secreted by <em>Staphylococcus</em> <em>aureus </em>and is mostly associated with skin and soft tissue infections (SSTI). This study aims to find out the prevalence of <em>luk</em>S/F-PV gene, which encode PVL toxin from strains of SSTI, burn wounds and nasal colonizers of out-patients and to measure the antimicrobial susceptibility of <em>S. aureus</em> isolates.</p> <p>Methodology: This is an analytical observational cross-section study and was conducted from July 2014 to June 2015 at four tertiary care hospitals and PCSIR Laboratories Complex, Lahore, Pakistan. A total of 376 random clinical swabs were collected from SSTI (n = 179), nasal nares (n = 134) and burn wounds (n = 63) from out-patients’ departments (OPD). The specimens were cultured on nutrient and mannitol salt agar (MSA) and the organism was identified by catalase, coagulase, and DNase tests. Antimicrobial susceptibility, methicillin, inducible clindamycin, and high-level mupirocin (HLMR) resistance were determined as per CLSI guidelines. Molecular identification of <em>mec</em>A and <em>luk</em>S/F-PV genes was performed by PCR.</p> <p>Results: We isolated 127 S<em>. aureus</em>, where 41 (32.3%) were MRSA and 86 (67.7%) were MSSA. All MRSA carried <em>mec</em>A gene whereas <em>luk</em>S/F-PV gene was found in 21 MRSA and 31 MSSA strains. Overall, a high antimicrobial resistance was found against MRSA and <em>luk</em>S/F-PV positive MSSA. Inducible clindamycin and high-level mupirocin resistance (HLMR) was 23.6% and 19.5% respectively.</p> <p>Conclusions: A high rate of PVL toxin gene was detected among <em>S. aureus</em> strains and a high prevalence of antimicrobial resistant strains was observed.</p> Muhammad Shaheen Iqbal Yasar Saleem Farheen Ansari Muhammad Usman Qamar Sania Mazhar Abida Hassan, Mrs Shaista Nawaz Salman Saeed Quratulain Syed ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 720 725 10.3855/jidc.9633 Investigating knowledge regarding antibiotics among pharmacy and allied health sciences students in a Sri Lankan university <p>Introduction: Education and adequate training regarding the appropriate use of antibiotics for health care professionals is essential in developing countries. Educational strategies can also influence appropriate antibiotic use in the community. The aim of this study was to assess and compare knowledge of antibiotics and antimicrobial resistance (AMR) between pharmacy and other allied health sciences (AHS) students at the University of Peradeniya, Sri Lanka.</p> <p>Methodology: A cross-sectional study was conducted at the University of Peradeniya, Sri Lanka, which offers undergraduate teaching in pharmacy and other AHS; nursing, radiography and medical laboratory sciences. All students in each program were invited to participate in this study. Data was collected using a self-administered questionnaire. Descriptive data analysis and Chi square tests were performed.</p> <p>Results: Pharmacy (n = 102) and other AHS students (n = 284) completed the questionnaire (response rate 69%). A majority of participants (76%) reported antibiotic use in the past year. A significantly higher proportion of pharmacy students reported antibiotic use was appropriate for the management of skin wound infection, urinary tract infection and sore throat compared to AHS students, <em>p</em> &lt; 0.05. No significant differences were observed between pharmacy and AHS students regarding knowledge of AMR. Most students understood terms related to antibiotic resistance through their undergraduate studies.</p> <p>Conclusion: Pharmacy students demonstrated better knowledge and understanding regarding antibiotics utilization than AHS students. Both pharmacy and AHS students had good understanding regarding AMR. The undergraduate curricula of pharmacy and AHS have contributed significantly to understanding the terminology associated with antibiotics and AMR.</p> Mohamed HF Sakeena Alexandra A Bennett Fahim Mohamed Herath MDR Herath Indika Gawarammane Andrew J McLachlan ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 726 732 10.3855/jidc.10388 Chlamydia trachomatis screening in resource-limited countries – Comparison of diagnostic accuracy of 3 different assays <p>Introduction: Commercially available assays were evaluated in order to determine diagnostic accuracy of <em>Chlamydia trachomatis</em> specific tests for screening.</p> <p>Methods: The study included 225 sexually active men and women, who were tested for genital chlamydial infection in Institute of Public Health Kragujevac. Three screening tests were used: direct immunofluorescence (DIF) and rapid lateral immunochromatographic test (RT) for qualitative detection of chlamydial antigens and immunoenzyme (ELISA) test for detection of serum levels of anti-chlamydial IgA and IgG antibodies. Diagnostic efficiency of these tests were determined in relation to results obtained by RT-PCR method.</p> <p>Results: Statistical significance between the results obtained by RT-PCR as a gold standard and DIF, RT and ELISA were analyzed using chi-square (χ<sup>2</sup>) test. Statistical analysis showed a significant difference between RT-PCR and analyzed screening tests: DIF (χ<sup>2</sup> = 303; p &lt; 0.001), RT (χ<sup>2</sup> = 4.19; p = 0.041), serum IgA (χ<sup>2</sup> = 4.19; p = 0.041) and serum IgG (χ<sup>2</sup> = 67; p &lt; 0.001) which indicates poor agreement between these tests. Large numbers of false positive (FP) and false negative (FN) results were observed for all tested assays. According to Youden’s index, serum IgG and DIF testing demonstrated the most-balanced sensitivity-specificity rate. RT assay exhibits the highest expanded Youden’s index, as well as the best overall diagnostic accuracy.</p> <p>Conclusions: None of evaluated screening tests can be recommended as individual method for the diagnosis of acute infection. We suppose that RT-PCR is unlikely to be a cost-effective screening strategy within the Serbian health system.</p> Jelena Zivadin Tosic-Pajic Predrag Sazdanovic Marija Sorak Jelena Cukic Aleksandra Arsovic Dragan Milovanovic Dejan Baskic ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 733 740 10.3855/jidc.10442 Infections in patients with lymphoma: An analysis of incidence, relationship and risk factors <p>Introduction: Bacterial infections and febrile neutropenia (FN) are major causes of morbidity and mortality in patients with hematological malignancy. The aim of this study was to investigate the incidence and risk factors of infections in lymphoma patients.</p> <p>Methodology: This retrospective study was conducted on 200 lymphoma patients diagnosed and treated between January 2009 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital, a tertiary referral hospital in Ankara, Turkey.</p> <p>Results: The mean follow-up period was 20.09 ± 19.81 months. The incidence of infection episode (IE) was 32.5% (65/200) and FN was 18.5% (37/200). Analysis of the data revealed that patients with IE had significantly higher rates of diagnosis of primary central nervous system lymphoma (PCNSL), lower baseline hemoglobin, lower baseline hematocrit, higher baseline lactate dehydrogenase levels, higher usage of central cathater, and a higher number of chemotherapy lines compared to patients with no IE. In logistic regression analysis, disease subtype of PCNSL, usage of central catheter and lactate deyhydrogenase (LDH) were found to increase the risk of infection. The odds ratio for PCNSL was 37.866 (p = 0.003), 2.679 for central catheter (p = 0.008) and 1.001 for LDH (p = 0.011).</p> <p>Conclusions: The risk of infection in patients with lymphoma was associated with central catheter usage, higher LDH levels and a diagnosis of PCNSL. Baseline hematological parameters were not determined to have any impact on the occurrence of infection. Patients with these risk factors should be monitored more carefully and the maximum level of infection prevention should be taken.</p> Abdulkerim Yıldız Murat Albayrak Çiğdem Pala Osman Şahin Hacer Berna Afacan Öztürk Gürsel Güneş Senem Maral Harika Okutan ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 741 747 10.3855/jidc.10399 Management of a difficult infectional disease: Descending necrotizing mediastinitis <p>Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental-odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our clinic.</p> <p>Methodology: We retrospectively evaluated 13 consecutive patients with the diagnosis of DNM between February 2005 and February 2018. All of them had the typical physical appearance, history and radiological findings.</p> <p>Results: Ten (77%) patients were male, 3 (23%) patients were female with a median age of 48.2 (18-76 years). All patients underwent Cervico-Mediastinal Drainage (CMD) with debridement of the necrotic and infected tissues. Other supplimantary surgical procedures were tube thoracostomy (n = 8), VATS mediastinal drainage (n = 4), tracheostomy (n = 2) and thoracatomy (n = 1). The median time to diagnosis of DNM, tube drainage (inserted after CMD) removal time, tube thoracostomy removal time, lenght of hospital stay were 1.8 (range 1-4) days, 13.6 (range 10-20), 12.6 days (range 10-27) and 21.5 days (range 15-30), respectively. Appropriate and potent antibiotics were used according to the fever-CRP response with the consultation on infectious disease specialist. Two patients were lost due to fulminant sepsis (n = 1) and massive cervical haemorrhage (n = 1). Overall mortality rate was 15%. Complications were recorded in 6 patients (46%).</p> <p>Conclusions: The critical point in the management of DNM is the correct diagnosis, rapid surgical intervention with antibiotherapy and close follow-up for possible complications. We concluded that the combination of minimally invasive management as VATS-tube thoracostomy with CMD is the most appropriate surgical interventions.</p> Fazlı Yanık Yekta Altemur Karamustafaoğlu Yener Yoruk ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 748 754 10.3855/jidc.10482 Assessment of biosafety measures in clinical laboratories of Al-Madinah city, Saudi Arabia <p>Introduction: Workers in clinical laboratories are exposed to occupational hazards on a daily basis and their health and safety may be threatened if appropriate protective standards are not implemented. The aim of this study was to assess the knowledge and practices of clinical laboratory workers towards biosafety measures, in Al-Madinah city, Saudi Arabia.</p> <p>Methodology: Clinical laboratory staff was recruited from both the public and private sectors. A structured self-administered questionnaire was used to achieve the aim of the study.</p> <p>Results: A total of 208 workers participated in the study (64% were males, 57% were from the public sector and 71% held a BSc degree). About 68% of the workers were trained in laboratory safety. The majority (&gt; 80%) followed guidelines for disposing medical wastes, decontamination of sample spills, and use of protective lab coats, gloves, etc. However, among participants, 24.2% used to eat, drink or use gum, 18.3% used cosmetics and 24.6% used the mobile phone in the lab. About 18.4% reported that they continued working with a finger cut, whereas 67% reported that they used to recap needles after blood withdrawal. These unacceptable behaviors were associated with lack of lab safety training (P &lt; 0.05), biology degree holders (P &lt; 0.05), and low experience (3 years and less, P &lt; 0.01). With respect to facilities, most of the laboratories complied with standard safety measures.</p> <p>Conclusion: The majority of the sample showed good laboratory practices with respect to safety measures. However, some behaviors are not accepted and need interventions</p> Omar Falah Khabour Khalil H. Al Ali Jamal N. Aljuhani Mousa A. Alrashedi Fuaad H. Alharbe Ahmed Sanyowr ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 755 761 10.3855/jidc.10081 Impact of IL28B genetic variant's and viral genotype on treatment outcome of hepatitis C infected patients <p>Introduction: Viral genotype and variation in host genes involved in the immune response may predict the treatment response in patients infected with HCV. The present study was designed to determine the distribution pattern of HCV and host genotypes in Chronic Hepatitis C (CHC) patients and their association with virological response and other risk factors.</p> <p>Methodology: Two hundred and fifty (n = 250) HCV positive patients were included in the study. HCV and Interleukin 28B (<em>IL28B</em>) genotyping was carried out by PCR-RFLP.</p> <p>Results: Viral genotype 3 was the predominant genotype seen in 187 (74.8%) patients. Wild genotype predominated in <em>rs</em>12979860, <em>rs</em>12980275 and <em>rs</em>8099917 SNP of <em>IL28B</em> gene. A significant difference was found in end stage virological response (EVR) between HCV genotype 1 infected patients with wild and variant genotype for <em>rs</em>12980275 and <em>rs</em>8099917 SNPs respectively (P &lt; 0.05). On multivariate analysis all the SNPs were found to be associated with each other (P &lt; 0.05) with <em>rs</em>12980275 SNP associated with history of Jaundice (P &lt; 0.05). Viral genotype 3 was significantly associated with age (&lt; 50 years) and rapid virological response (RVR) while as viral genotype 1 was significantly associated with history of surgery on multivariate analysis (P &lt; 0.05).</p> <p>Conclusions: The viral genotype and <em>IL28B</em> polymorphisms are important factors to personalize antiviral therapy of patients with CHC.</p> Mosin S Khan Abid Shoukat Syed Mudassar Zaffar Kawoosa Altaf H Shah Showkat Ali Zargar ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 762 770 10.3855/jidc.10175 Untreated villages and factors associated with the absence of Community-Directed Treatment with Ivermectin (CDTI) in DRC <p>Introduction: The African Programme for Onchocerciasis Control (APOC), the main objective of which was the Community-Directed Treatment with Ivermectin (CDTI), was closed by the end of 2015. The purpose of this study was to describe untreated villages in DRC and to assess the factors associated with the absence of CDTI in endemic villages, between 2001 and 2014.</p> <p>Methodology: This retrospective study was descriptive. Several annual technical reports of the National Onchocerciasis Task Force (NOTF) and national technical reports of CDTI projects were analysed; 21 projects implemented to control the disease were considered, representing the coverage of 42,778 endemic villages. Data were collected over a 3 month-period, between October and December 2016.</p> <p>Results: Only 15,700 endemic villages were not treated through an annual CDT with Mectizan, i.e. 36.7%. The population at risk totalled 29,712,381 individuals and 7,681,995 of them were not treated, i.e. 25.9%. Eight projects recorded high proportions of untreated villages, i.e. 7,100 endemic entities (16.6%). Factors independently associated with non-treatment were the fear of serious side effects (adjusted OR: 10.6; 95% CI: 4.5-27.7), supply impaired by insecurity (adjusted OR: 15.9; 95% CI: 6.7-41.4) and geographical inaccessibility (adjusted OR: 19; 95% CI: 6.9-63.9).</p> <p>Conclusion: After 15 CDTI-cycles in DRC, the mean geographical coverage and therapeutic coverage rates reached 63.3% and 74.1%, respectively. The 2025 target of onchocerciasis eradication, as advocated by APOC, will not be reached. Untreated areas are partly responsible for such results. Many weaknesses persist in the National Program for Onchocerciasis Control (NPOC) and new strategies of disease control should be investigated.</p> Jean-Claude Makenga Bof Fortunat Ntumba Tshitoka Dieudonné Mpunga Mukendi Paul Mansiangi Mankadi Félicien Ilunga - Ilunga Yves Coppieters ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 771 779 10.3855/jidc.9881 Candida albicans induces TLR2/MyD88/NF-κB signaling and inflammation in oral lichen planus-derived keratinocytes <p>Introduction: The risk of oral lichen planus (OLP), a chronic inflammatory oral mucosal disease, becoming malignant increases by 21-fold in patients with fungal infection. This study examined the impact of <em>Candida albicans </em>exposure on Toll-like receptor (TLR) signaling in primary keratinocyte cultures obtained from OLP patients.</p> <p>Methodology: Following co-culture of primary OLP keratinocyte cultures with <em>C. albicans </em>for 24 hours<em>, </em>inflammatory cytokine concentrations were determined by ELISA. TLR2, MyD88, and NF-κBp65 mRNA and protein expression were assessed using quantitative RT-PCR and Western blot analyses, respectively. Keratinocyte apoptosis was also determined by flow cytometry.</p> <p>Results: IL-10, IL-8, IL-2, and TNF-ɑ levels were significantly higher following co-culture with <em>C. albicans</em> (all <em>p </em>≤ 0.034). MyD88, NF-κB p65, and TLR2 mRNA (all <em>p</em> &lt; 0.001) and protein (all <em>p</em> ≤ 0.004) expression levels were significantly higher in OLP keratinocytes following <em>C. albicans</em> exposure. Finally, the apoptosis rates of OLP keratinocytes were 21.2%, 29.4%, and 25.4% for the control cells and 3.9%, 5.6%, and 4.4% for those exposed to <em>C. albicans</em>, suggesting that co-culture with <em>C. albicans</em> inhibits the apoptosis of OLP keratinocytes.</p> <p>Conclusions: <em>C. albicans</em> activates the TLR2/MyD88/NF-κB signaling pathway in OLP keratinocytes, resulting in increased cytokine expression and decreased keratinocyte apoptosis. Two key events in the pathogenesis of OLP and its progression to malignancy, namely increased inflammation and decreased apoptosis, were induced by exposure to <em>C. albicans.</em> Thus, targeting this signaling pathway may represent a novel therapeutic strategy to prevent OLP malignant transformation.</p> Jianwei Liu Fanghui Geng Hongying Sun Xiaxia Wang Hui Zhang Qiaozhen Yang Jie Zhang ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 780 786 10.3855/jidc.8062 Invasive fungal rhinosinusitis in patients with diabetes <p>Introduction: We report the clinical and radiological features as well as outcomes of invasive fungal rhinosinusitis in patients with diabetes from a tertiary care center in North India.</p> <p>Methodology: All patients admitted with a diagnosis of invasive fungal rhinosinusitis with pre-existing or newly diagnosed diabetes from 1st January 2008 to 31<sup>st</sup> December 2015 were included. Hospital records were used to identify clinical features, biochemical investigations and treatment modalities used. The imaging findings were reported at baseline, 30, 60,90 and 120 days of admission and progression of disease was reported as static, worse or improved. The outcomes were sight loss and survival at end of hospital stay.</p> <p>Results: 22 patients of invasive fungal sinusitis and diabetes were identified. At presentation, 5 had ketoacidosis, all of whom died at the end of hospital stay. Loss of vision in one eye was seen in 70% cases. The survival at end of hospital stay was 72.7% and at six months after end of study period was 57.8%. No patients had radiological improvement at day 30 imaging (including those who subsequently improved).</p> <p>Conclusion: Radiological improvement is not apparent before two months of therapy. Ketoacidosis is a predictor of mortality in invasive fungal sinusitis with diabetes.</p> Nishant Raizada Viveka P Jyotsna Devasenathipathy Kandasamy Immaculata Xess Alok Thakar Nikhil Tandon ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 787 793 10.3855/jidc.9699 Drug-resistant bacteria screening and patient barrier precautions are associated with decreased neonatal nosocomial infection <p>Introduction: Neonates are at high risk of nosocomial infections, especially in developing countries. This study aimed to examine the effectiveness of drug-resistant bacteria (DRB) screening in combination with patient barrier precautions in controlling nosocomial infections in neonatal wards.</p> <p>Methodology: The clinical data of neonates admitted to the Mianyang Central Hospital, Mianyang, China in 2010 and 2012 were retrospectively analyzed. In 2010, DRB screening was conducted using nasal and anal swabs. In 2012, in addition to the DRB screening, patient barrier precautions were implemented. The barrier precautions were lifted if the patients were negative for the DRB screening. Patients with DRB colonization were further isolated to reduce the risk of nosocomial infection. The rate of nosocomial infections in the two years was compared.</p> <p>Results: A total of 1280 neonates in 2010 and 1504 neonates in 2012 were included in the analysis. No significant difference was noticed between the two years in gestational weeks, age, gender, and birth weight. The rate of nosocomial infections was reduced significantly from 2.34% in 2010 to 1.13% in 2012.</p> <p>Conclusions: DRB screening in combination with the patient barrier precautions may reduce the risk of nosocomial infection in neonates.</p> Li-rong Guan Jia Chen Li-rong Wei Xiao-shuang Wang Dan Xue Qin-yu Yang Yan-ping Li Jing Yu ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 794 798 10.3855/jidc.9526 Secondary antifungal prophylaxis in allogeneic hematopoietic stem cell transplant recipients with invasive fungal infection <p>Introduction: Invasive fungal infection (IFI) is a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. A previous history of IFI is not an absolute contraindication for allo-HSCT, particularly in the era of secondary antifungal prophylaxis (SAP). Prompt diagnosis and therapy are essential for HSCT outcome.</p> <p>Methodology: The charts of 58 allo-HSCT recipients [median age:29.5 (16-62); M/F:41/17] who had a previous history of IFI were retrospectively reviewed.</p> <p>Results: Possible IFI was demonstrated in 32 (55.2%), probable in 13 (22.4%) and proven in 13 patients (22.4%). All patients received SAP [liposomal amphoterisin B (n ꞊ 35), voriconazole (n ꞊ 17), caspofungin (n ꞊ 2), posaconazole (n ꞊ 1), combination therapy (n = 3)] which was started on the first day of the conditioning regimen. Treatment success was better in the voriconazole group when compared to the amphotericin B arm (100% vs 69.2%; p = 0.029). Development of breakthrough IFI was more frequent in patients on amphotericin B prophylaxis (42.4% vs 23.1%; p = 0.036). Clinical and radiological response were achieved in 13 of 18 patients (72.2%) who developed breakthrough infection. Overall survival of the study population was 13.5% at a median follow-up of 154 (7-3285) days. Fungal mortality was found to be 23%. Overall survival was better in the voriconazole arm, without statistical significance (90% vs 65.8%, p &gt; 0.05).</p> <p>Conclusions: Secondary antifungal prophylaxis is considered to be an indispensible strategy in patients with pre-HSCT IFI history. Voriconazole seems to be a relatively better alternative despite an underlying necessity of larger prospective trials.</p> Mehmet S Pepeler Şeyma Yildiz Zeynep A Yegin Zübeyde N Özkurt Özlem G Tunçcan Gonca Erbaş Nurdan Köktürk Ayşe Kalkanci Zeki Yildirim, Professor ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 799 805 10.3855/jidc.9961 Early prosthetic valve endocarditis caused by Corynebacterium amycolatum: the first case reported in Brazil <p>Non-diphtheriae <em>Corynebacterium</em> species are usually considered as contaminants of clinical specimens due to their widely environmental distribution and colonization of the human skin and mucous membranes. However, these bacteria have been increasingly recognized as agents of life-threatening infections mainly in individuals in immunosuppressive conditions. These organisms have vast variation in morphology and biochemical reaction, characteristics that make the correct identification of <em>Corynebacterium</em> at the species level extremely difficult using conventional phenotypic methods. The precise identification of <em>C. amycolatum</em> requires approaches rarely available in conventional clinical microbiology laboratories, such as API Coryne system, 16s rRNA and<em> rpoB</em> gene sequencing. In this setting, MALDI-TOF, a quick, accurate, and relatively unexpansive molecular technique, arises as a cost-effective alternative for characterizing these agents. Here, a rare and lethal case of endocarditis caused by <em>C. amycolatum</em> is presented. This is the first case of infective endocarditis due to <em>C. amycolatum</em> reported in Brazil.</p> Jaqueline Abel da Rocha Natalia Chilinque Zambão da Silva Ana SDN Silva Rafael Guaresma Garrido Beatriz Meurer Moreira Ianick Souto Martins ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 806 807 10.3855/jidc.10587 Atypical presentation of Middle East respiratory syndrome coronavirus in a Lebanese patient returning from Saudi Arabia <p>Around 2090 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from 27 countries have been reported to the World Health Organization (WHO) between September 2012 and October 2017, the majority of whom occurring in countries in the Arabian Peninsula, mainly in Saudi Arabia. MERS- CoV can have atypical and misleading presentations resulting in delays in diagnosis and is associated with a high mortality rate especially in elderly patients with multiple comorbidities. Herein, we present the first case of confirmed MERS-CoV infection diagnosed at the American University of Beirut Medical Center (AUBMC) - Lebanon in June 2017 presenting without any respiratory symptoms. This is the second confirmed case of MERS-CoV infection in Lebanon since 2014. The first case presented with a febrile respiratory infection with persistent symptoms despite antibiotic treatment.</p> Saeed El Zein Jinane Khraibani Nada Zahreddine Rami Mahfouz Nada Ghosn Souha S Kanj ##submission.copyrightStatement## 2018-09-30 2018-09-30 12 09 808 811 10.3855/jidc.9979