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> Clinical, epidemiological and epizootic features of a Q fever outbreak in the border region between Serbia and Montenegro <p>Introduction: Q fever is a zoonosis which commonly manifests as an acute febrile disease accompanied by pneumonia or hepatitis. The aim of this study was to reveal the reservoirs, sources and routes of infection relevant for the Q fever outbreak that occurred in the border region between Serbia and Montenegro.</p> <p>Methodology: A prospective study was conducted from 3<sup>rd</sup> to 23<sup>rd</sup> March, 2016 in Brodarevo, village near the Serbian-Montenegro border. The EU case definition for Q fever was applied and serological evidence of IgM and/or IgG antibody for phase II antigen <em>Coxiella burnetii</em> used for laboratory confirmation. Animal infection was proven by detection of specific biomarkers for Q fever by ELISA and Real-Time PCR.</p> <p>Results: In total, ten patients were registered with Q fever, giving an attack rate of 0.5% in the village. A severe form of disease with atypical pneumonia ended up with hospitalization of eight patients. Serological surveillance was conducted in 30 herds of the receptive animals in the outbreak area. Overall the anti-Coxiella antibody seroprevalence was 20.6%. Positive molecular findings (68.4%) accompanied with high seroprevalence (63.2%) were identified in a mini-farm of sheep and cattle in the nearby Orasac, these were considered to be active sources of infection. The most probable route of <em>C. burnetii</em> transmission was the inhalation of contaminated aerosols originating from infected animals.</p> <p>Conclusion: The main reservoirs for human Q fever at the border region between Serbia and Montenegro are infected cattle and ruminants. Adoption of a comprehensive strategy for disease prevention and control at the intergovernmental level is urgent.</p> Zoran Debeljak Snezana Medić Marija Baralić Aleksandra Andrić Aleksandar Tomić Dejan Vidanović Milanko Šekler Kazimir Matović Nikola Vasković ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 290 296 10.3855/jidc.9918 Pathogen killing pathogen: antimicrobial substance from Acinetobacter active against foodborne pathogens <p>Introduction: Antimicrobial substances (AMS) produced by bacteria may reduce or prevent the growth of pathogenic and spoilage microorganisms in food. In this study, 16 isolates of <em>Acinetobacter baumannii/calcoaceticus</em> (ABC) complex, previously obtained from reconstituted infant milk formula (IMF) samples and the preparation and distribution utensils from the nursery of a public hospital, were used to screen for AMS production.</p> <p>Methodology: Antimicrobial substance production and spectrum of activity assays were performed by agar-spot assay. Optimization of growth conditions for AMS production was also evaluated.</p> <p>Results: Three (17.6%) isolates, namely JE3, JE4, and JE6, produced AMS against the principal indicator strain <em>Salmonella enterica </em>subsp<em>. enterica</em> serotype Typhi ATCC 19214. JE6 was also able to inhibit strains of <em>Klebsiella pneumoniae</em>, <em>Proteus vulgaris</em>, and <em>Bacillus cereus, </em>a Gram-positive bacteria. Remarkably, JE6 was able to inhibit all the tested resistant and multidrug-resistant (MDR) strains of the ABC complex and <em>Shigella dysenteriae </em>associated with IMF and utensils, indicating a potentially valuable application. AMS produced by JE6 does not appear to be affected by proteolytic enzymes and the producer strain showed specific immunity to its own AMS.</p> <p>Conclusion: This study highlights AMS produced by <em>Acinetobacter</em> with applications against MDR spoilage and foodborne pathogens - some of them, infectious disease causing agents - which, to our knowledge, has not been previously described.</p> Cinara Souza da Conceição Barbara Victor Souza Jessica Manya Bittencourt Dias Vieira Janaína dos Santos Nascimento ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 297 304 10.3855/jidc.9894 Validation of diagnostic tests and epidemiology of Helicobacter pylori infection in Bangladesh <p>Introduction: <em>Helicobacter pylori</em> infection is associated with gastritis, peptic ulcer, and gastric cancer. We conducted a cross-sectional study to compare five diagnostic tests for <em>H. pylori</em> infection and studied the epidemiology of the infection in Bangladesh.</p> <p>Methodology: Bangladeshi patients with dyspeptic symptoms referred for endoscopic examination were enrolled in this study. Each patient underwent upper endoscopic examination and four gastric biopsy specimens were taken. We used 5 tests for the diagnosis of <em>H. pylori</em>; culture, histology confirmed by immunohistochemistry, rapid urease test (RUT), urinary and serological test. Demographic and environmental variables were collected.</p> <p>Results: A total of 133 patients participated in the study, 61 males and mean age 37.3 ± 12.3 years. We used the culture and/or histology results as the gold standard to estimate the sensitivity, specificity, positive and negative predictive values for the studied diagnostic tests. RUT, culture and histology had high sensitivity and specificity with moderate positive and negative likelihood ratio, whereas urine test and serology showed a good sensitivity and specificity but poor likelihood ratio. The overall prevalence of <em>H. pylori</em> among study subjects was 47% with no difference between gender and age groups.</p> <p>Conclusions: The invasive tests showed better performance than noninvasive tests among Bangladeshi population. The overall prevalence of <em>H. pylori</em> was less than the previously reported in the region with no difference among all age groups.</p> Hafeza Aftab Yoshio Yamaoka Faruque Ahmed Azad AK Khan Phawinee Subsomwong Muhammad Miftahussurur Tomohisa Uchida Hoda M Malaty ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 305 312 10.3855/jidc.9841 Antimicrobial susceptibility and MLVA analysis of S. Typhimurium strains isolated from human and poultry samples in Tunisia <p>Introduction: <em>Salmonella enterica</em> infections are a significant public health concern worldwide, being <em>Salmonella</em> Typhimurium one of the most prevalent serovars. Human salmonellosis is typically associated with the consumption of contaminated foods, such as poultry, eggs and processed meat. The extensive use of antimicrobials in humans and animals has led to an increase in multidrug resistance among <em>Salmonella</em> strains, becoming multidrug-resistant (MDR) strains a major public health concern.</p> <p>Methodology: This study was designed to investigate the antimicrobial susceptibility and the genotypic diversity of <em>Salmonella</em> Typhimurium strains isolated in Tunisia from human and poultry sources from 2009 to 2015. Fortyfive strains were analyzed by disk-diffusion test to determine the antimicrobial susceptibility. The presence of antimicrobial resistance genes was tested by PCR, and genotyping was performed using multiple-locus variable-number tandem repeats analysis (MLVA).</p> <p>Results: About 50% of the strains were resistant to at least 3 antibiotics (multidrug-resistant strains, MDR). The most frequent resistance profile in clinical strains was AMP-TIC-TET-MIN-SXT (n = 7) and TET-MIN in poultry origin strains (n = 7). The MLVA typing grouped the strains in 2 main clusters. Cluster I was mostly formed by human isolates, whereas in cluster II both human and poultry isolates were grouped. Simpson’s diversity index was 0.870 and 0.989 for antimicrobial resistance profiles and MLVA, respectively.</p> <p>Conclusions: Multiresistance is common in <em>Salmonella</em> Typhimurium isolated from human and poultry sources in Tunisia. The genotyping results suggest that some strains isolated from both sources may descend from a common subtype.</p> Wissal Kalai Ilargi Martinez Joseba Bikandi Lilia Messadi Imed Khazri Nada Souissi Mabrouka Saidani Amine Faouzi Slim Ilhem Boutiba-Ben Boubaker Javier Garaizar ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 313 320 10.3855/jidc.10089 Genotyping of Staphylococcus aureus associated with nasal colonization among healthcare workers using DNA microarray <p>Introduction: Healthcare workers (HCWs) colonized with <em>Staphylococcus aureus </em>may serve as a reservoir of infection. This study was carried to determine the genetic make-up of <em>S. aureus</em> nasal colonizers in HCWs.</p> <p>Methodology: Nasal swabs were obtained from 93 HCWs and molecular characterization of identified <em>S. aureus</em> isolates was carried out using the StaphyType DNA microarray (Alere Technologies GmbH, Jena, Germany).</p> <p>Results: Twenty-nine HCWs (31%) were colonized with <em>S. aureus</em> (MSSA = 23; MRSA = 6). Thus the overall MRSA carriage rate was 6.5% (n/N = 6/93) and 20.7% (n/N = 6/29) of those colonized with <em>S. aureus</em> harboured MRSA. The <em>S. aureus </em>isolates belonged to 16 clonal complexes (CC). MSSA isolates included three each for CC15, CC188, ST2867; two each for CC5, CC97, CC367 as well as one each for CC1, CC8, CC30, CC45, CC101, CC121, ST291/813 and CC1153. The staphylococcal cassette chromosome recombinase genes <em>ccrA-1</em>; <em>ccrB-1</em> and the fusidic acid resistance gene (<em>fus</em>C) were present in two MSSA isolates (CC1 and CC8). The six MRSA isolates included CC5-MRSA-[VI+<em>fusC</em>] (n = 2); one each of CC5-MRSA-V; CC22-MRSA-IV (<em>tst1<sup>+</sup></em>); CC80-MRSA-IV [<em>pvl</em><sup>+</sup>] (“European CA-MRSA Clone”) and CC97-MRSA-[V+<em>fusC</em>].</p> <p>Conclusion: There is wide clonal diversity of <em>S. aureus</em> colonizers with associated high MRSA carriage among the HCWs. The presence of genetically stable MSSA isolates with the capability to transform into MRSA isolates is of concern.</p> Abiola Catherine Senok Ali Somily Muhabat Raji Ghada Garaween Maha Kabil Atef Shibl Stefan Monecke Ralf Ehricht ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 321 325 10.3855/jidc.10328 Nasal colonization by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among medical students <p>Introduction: Nasal carriers of methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) are common and play an important role in nosocomial infections. The prevalence rate and characterization of nasal carriers of MRSA among medical students in Jordan has not been investigated before.</p> <p>Methodology: The resistance of <em>S. aureus</em> to several antibiotics was tested using disc diffusion method, automatic Vitek 2, and penicillin binding protein (PBP) 2 slide test. Bacterial species and resistance genes were confirmed using molecular analysis of three relevant genes by real-time PCR. Two hundred ninety nasal swabs were collected from medical students at Hashemite University from June 2015 to August 2016. All participants signed a voluntary consent form and filled a predesigned questionnaire.</p> <p>Results: The mean age of participants was 19.7 ± 2 years and 61.7% of them were males. 63 out of the 290 (21.7%) samples were identified to have <em>S. aureus</em>, 56 (19.3%) were methicillin-sensitive <em>S. aureus</em> (MSSA) and 7 (2.4%) were MRSA. <em>S. aureus </em>nasal colonization significantly associates with male gender (OR = 1.7, CI = 0.94-3.18, P = 0.049) and chronic illnesses (OR = 4.0, CI = 1.52-10.65, P = 0.006). Consistency between disc diffusion, Vitek 2, and PBP 2 methods for MRSA screening were satisfactory compared to molecular analysis. All MRSA samples were positive for SCCmec:<em>orfx</em> junction gene (MRSA-specific), <em>nuc </em>gene (<em>S. aureus</em>- specific), mecA gene (PBP-mediated resistant), and PBP2 production. All MRSA isolates were multi-drug resistant and were sensitive to Linezolid, Vancomycin, and Tigecycline.</p> <p>Conclusions: This study confirms that nasal colonization by MRSA among medical students necessitates further attention to prevent nosocomial infections.</p> Mohammad Al-Tamimi Nisreen Himsawi Jumana Abu-Raideh Deaa Abu jazar Hussam Al-jawaldeh Sameer Al Haj Mahmoud Nawal Hijjawi Hasan Hawamdeh ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 326 335 10.3855/jidc.9908 Molecular investigation of methicillin-resistant staphylococcus aureus isolates from blood: USA600 emerges as the major type <p>Introduction: The widespread emergence of methicillin-resistant <em>Staphylococcus aureus</em> is turning into a real worry in public health. The goals of the present study were to identify resistance and virulence encoding genes and molecular characteristics of methicillin-resistant <em>S. aureus</em> bloodstream isolates.</p> <p>Methodology: A cross-sectional study was conducted on 84 <em>S. aureus</em> bloodstream isolates during a 10-month period. To evaluate antibiotic susceptibility of the isolates, we used Kirby-Bauer disk diffusion method. In addition, the prevalence of antimicrobial resistance and toxins genes was assessed using polymerase chain reaction. Isolates were typed according to polymorphisms seven housekeeping genes by MLST.</p> <p>Results: All the isolates were resistant to methicillin. The most prevalent resistance gene was <em>mecA</em> gene (100%) followed by <em>tetM </em>(57.1%),<em> aac (6΄)-Ie/aph (2˝) </em>(53.6%)<em>, ant (4΄)-Ia</em> (46.4%),<em> ermA </em>(45.2%), <em>msrA </em>(35.7%), <em>msrB</em> (33.3%), <em>aph (3΄)-IIIa </em>(33.3%), <em>ermB </em>(31%), <em>ermC</em> (16.7%), and <em>mupA</em> (14.3%) genes. The presence of toxin encoding genes <em>tst</em>, <em>pvl</em>, <em>eta</em>, and <em>etb</em> were detected in 25%, 14.3%, 3.6% and 3.6%, respectively. The isolates were classified into five different sequence types: ST45 (29.8%), ST239 (27.4%), ST858 (21.4%), ST22 (17.8%), and ST59 (3.6%). All the high-level mupirocin-resistant (HLMUPR) strains belonged to ST239, while the low-level mupirocin resistant (LLMUPR) strains belonged to ST22 (13%) and ST239 (6%).</p> <p>Conclusions: To the best of our knowledge, the present study is the first report of ST59 in MRSA bloodstream isolates in Iran. Our data demonstrated the need for thorough epidemiological monitoring to detect emergence and dissemination of MDR- MRSA types in our hospitals.</p> Mehdi Goudarzi Fattaneh Sabzehali Mohsen Heidary Hadi Azimi Hossein Goudarzi ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 336 341 10.3855/jidc.9959 Distribution of Helicobacter pylori infection and abnormal body- mass index (BMI) in a developing country <p>Introduction: <em>Helicobacter pylori</em> is prevalent in developing nations. We determined the prevalence of <em>H. pylori</em> infection in relation to body-mass index (BMI) of dyspeptic patients and related comorbid conditions.</p> <p>Methodology: In a cross-sectional study, dyspeptic patients were enrolled and tested for <em>H. pylori</em> infection. “Underweight” was defined as BMI lower than 18.4; “Healthy” 18.5 to 23; “Overweight” 23.1-27.9; and “Obese” greater than 28.</p> <p>Results: Six hundred and ninety-eight patients were included, with a mean age of 44 ± 16 years. Males were 373/698, 53%. <em>H. pylori</em> was positive in 399/698, 57%. Underweight were 36 (5%); BMI-healthy 168 (24%); overweight 236 (34%) and obese 258 (37%). <em>H. pylori </em>infection was present in 65/273 BMI-healthy patients ; 24% compared to obese 208/273; 76% (P &lt; 0.001). In the <em>H. pylori- </em>positive with a “healthy” BMI, dyslipidemia was seen in 6/65; 8% compared to obese 53/208; 25% (P = 0.005); type 2 diabetes in 8/65; 12% with a “healthy” BMI compared to obese 54/208; 26% (P = 0.022) and coronary artery disease in 4/65; 6% of BMI-healthy compared to obese 38/208; 18% patients (P = 0.018). Multivariate analysis showed that age 31-50 years (OR 1.77, 95% CI 1.13-2.77), BMI &gt; 23.1 (OR 2.91, 95% CI infection. 2.01-4.20), and type 2 diabetes (OR 2.41, 95% CI 1.43-4.06) were risk factors for <em>H. pylori</em></p> <p>Conclusions: <em>H. pylori </em>infection was prevalent in the 31-50-year age group. Abnormal BMI was associated with <em>H. pylor</em>i infection.</p> Basit Siddiqui Javed Yakoob Zaigham Abbas Rabeea Azmat Syeda Sadia Fatima Safia Awan ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 342 346 10.3855/jidc.10051 Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon <p>Introduction: Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly <em>Staphylococcus</em> species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative <em>Pseudomonas</em> spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles.</p> <p>Methodology: We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon.</p> <p>Results: Among all isolates, <em>Enterobacteriaceae</em> (42%), <em>Pseudomonas</em> spp. (18.6%) and methicillin-sensitive <em>Staphylococcus aureus</em> (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of <em>Pseudomonas</em> spp. were susceptible to ciprofloxacin and 63.6% of <em>Enterobacteriaceae</em> were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients.</p> <p>Conclusion: In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.</p> Michele Obeid Eric Moughames Petra Aboulhosn Rashad Madi Maya Farah Jinia Feghali Jacques Mokhbat Anna Farra Rima Moughnieh Ziad Daoud Rita Feghaleh Edmond Abboud Emma Abboud Rola Husni-Samaha ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 347 351 10.3855/jidc.10063 Relationship between age and intensive care unit-acquired bloodstream infections in infectious disease patients in Croatia <p>Introduction: Intensive care unit-acquired bloodstream infections (ICU-BSI) belong to the most important nosocomial infections. Since there is scarce data available on their relationship with older age, we performed this study to estimate the age-related incidence of ICU-BSI and the odds of acquiring ICU-BSI in elderly critically ill infectious disease patients.</p> <p>Methodology: A retrospective observational analysis of prospectively collected demographic and clinical data of adult mechanically ventilated infectious disease patients, treated in a teaching hospital in Croatia between 1994 and 2008, using univariate, bivariate, and multivariate logistic regression analyses.</p> <p>Results: Of the 1,093 included patients, 509 (46.6%) were ≥ 65 years old, among 256 (23.4%) of whom a total of 353 ICU-BSI episodes were recorded. No significant difference among ICU-BSI causative microorganisms between the observed age groups was found (P = 0.4940). The rate of patients with ICU-BSI was higher among elderly ones (26.1 <em>vs</em>. 21.1%, <em>P</em> = 0.048), and elderly patients used the ICU facilities (ICU stay, duration of mechanical ventilation and central venous catheter [CVC] use) significantly longer (P &lt; 0.05). However, older age was not positively related with the development of ICU-BSI (OR 0.99, 95% CI: 0.71-1.38); as opposed to the duration of CVC use (OR 1.09, 95% CI: 1.07-1.10).</p> <p>Conclusion: It seems that among adult mechanically ventilated infectious disease patients, borderline significantly higher rate of ICU-BSI among those aged ≥ 65 years was related to longer use of ICU facilities, rather than to their older age itself. The duration of CVC use was identified as the only factor positively related to the development of ICU-BSI.</p> Mirjana Balen Topic Marija Santini Bruno Barsic ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 352 358 10.3855/jidc.9950 Risk factors of severe hand, foot and mouth disease in Shantou, China: a case-control study <p>Introduction: In clinical perspectives, how to distinguish a small proportion of children at risk of developing neurological complications from a large number of children with mild symptoms still remains a challenge for primary care doctors.</p> <p>Methodology: From January 2012 to December 2015, 225 cases with severe hand, foot and mouth disease (HFMD) matched with 492 controls were enrolled in the age-matched, case-control study. Continuous variables were examined by univariate analysis using a chi-squared or Fisher’s exact test, and categorical variables were reported by relative risks (odd’s ratio). Multivariate logistic regression was used to analyze the independent risk factors for severe HFMD.</p> <p>Results: Peak body temperature over 37.5℃,total duration of fever over 3 days, lethargy, enterovirus 71 (EV71) infection were independent risk factors for severe HFMD.</p> <p>Conclusions: Peak body temperature over 37.5℃,total duration of fever over 3 days, lethargy, EV71 infection were independent risk factors for severe HFMD.</p> Chunhua Liu Kaiyan Wang Niyang Lin Jianling Cai Binglin Cui Beiyan Wu ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 359 364 10.3855/jidc.9845 Low serum vitamin A is prevalent in underfive children with severe malaria and is associated with increased risk of death <p>Introduction: Micronutrient deficiencies are prevalent in developing countries and may influence vulnerability to diseases particularly malaria and its severity. This study investigated serum vitamin A profile of under-five children with severe malaria (SM) in South-western, Nigeria and to determine its association with degree of malaria parasitaemia, types of SM and eventual outcome.</p> <p>Methodology: Using HPLC, serum vitamin A concentrations of 170 under-five children with SM and 170 age- and gender-matched controls were determined. Parasite species identification and density were also determined. Association between serum vitamin A levels and the degree of parasitaemia, type of SM and patients’ outcome were examined by both bivariate and logistic regression analyses.</p> <p>Results: Thirty-five (20.6%) of the children with SM compared with 3 (1.8%) of the controls had hypovitaminosis A, p &lt;0.001, OR = 14.4, 95% Confidence Interval = 4.4 – 47.8. The mean serum vitamin A concentration was also lower in the patients (45.23µg/dL vs. 87.28µg/dL; p &lt;0.001). There was inverse correlation between serum vitamin A levels and malaria parasite density (r = - 0.103, p = 0.027). Higher proportions of children with SM and hypovitaminosis A presented with metabolic acidosis and cerebral malaria (p &lt;0.001 and 0.032 respectively). Children with SM and hypovitaminosis A were 9.1 times more likely to die compared to those without low serum vitamin A levels, OR = 9.1, 95% Confidence Interval = 2.2–38.1, p = 0.002.</p> <p>Conclusion: Children with SM had reduced serum vitamin A and significantly contributed to increased morbidity and mortality.</p> Olubunmi Adeola Lawal Samuel Ademola Adegoke Saheed Babatunde Oseni Oyeku A. Oyelami ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 365 372 10.3855/jidc.9572 Pathogenicity and non-opportunistic character of Blastocystis spp.: a hospital-based survey in Central Cameroon <p>Introduction: <em>Blastocystis </em>spp. is a protist found in humans. Although usually the most frequent protozoa found in stool samples of both symptomatic and healthy subjects, its pathogenic or rather opportunistic role is yet to be clearly elucidated. To attempt to fill this gap, a cross-sectional study was conducted to compare the frequency of <em>Blastocystis </em>spp. in HIV positive (HIV<sup>+</sup>) versus HIV negative (HIV<sup>-</sup>) individuals in four health facilities of the Center Region of Cameroon.</p> <p>Methodology: Stool samples were collected from 283 HIV positive and 245 HIV negative subjects and analyzed using direct diagnostic tests.</p> <p>Results: A total of 46 (8.7%) individuals were found infected with <em>Blastocystis</em> spp., including 6.7% HIV positive and 11.0% HIV negative. This species was more frequent in urban and semi-urban areas than in rural areas, but evenly distributed among genders and age groups as well as among all sectors of activity. The prevalence of <em>Blastocystis </em>spp. (11.3%) was higher in HIV<sup>+</sup> patients with a CD4 count ≥ 500 cells / mm<sup>3</sup>, but no significant difference was found among HIV clinical stages. Likewise prevalence, the mean number of cysts per gram of stool was similar between HIV positive and HIV negative individuals. People infected with <em>Blastocystis </em>spp. showed diverse clinical signs, but only flatulence was significantly more prevalent. The frequencies of these clinical signs were not related to HIV status.</p> <p>Conclusion: No clear relationship links the infection with <em>Blastocystis </em>spp. to HIV, although its presence was associated with digestive disorder, suggesting that this parasite might not be opportunist.</p> Stéphanie Jupsa-Mbiandou Samuel Fosso Edimo Billé Tito T Mélachio-Tanekou Gideon Ajeagah-Aghaindum Hugues C Nana-Djeunga Albert Samé-Ekobo Flobert Njiokou ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 373 379 10.3855/jidc.10122 Influenza A H1N1 virus infection among pregnant women in a tertiary hospital in Belgrade, Serbia <p>Introduction: Pregnant women are at higher risk of developing severe influenza. Our aim was to analyze clinical course and risk factors for fatal outcome in pregnant women with influenza (H1N1) infection.</p> <p>Methodology: This retrospective study enrolled eleven pregnant women with confirmed Influenza A (H1N1) infection treated in the Clinic for Infectious and Tropical Diseases, Belgrade, Serbia in a 6-years period.</p> <p>Results: The mean age of pregnant women was 28.9 ± 5.2 years, and mean gestational age was 23.1 ± 7.0 weeks. Nine (81.8%) pregnant women had pneumonia (six had interstitial and three had bacterial pneumonia). Pregnant women developed pneumonia more often than other women in the reproductive period, but without statistical significance (81.8% vs. 65.7%, p = 0.330, OR (95% CI) 2.35 (0.47-11.80)). Nine (81.8%) pregnant women recovered. None of them experienced preterm delivery or abortion. Two women (18.2%) died due to acute respiratory distress syndrome. In one of them fetal death occurred one day before she died. The other one was performed caesarean section three days before death. Her newborn and children of all recovered women were healthy at birth. Prolonged time to initiation of oseltamivir and higher body mass index were statistically significantly associated with fatal outcome (p = 0.002, and p = 0.007, respectively). Gestational week of pregnancy, the etiology of pneumonia and comorbidity were not found to be risk factors for death (p = 0.128, p = 0.499 and p = 1.000, respectively).</p> <p>Conclusion: Pregnant women with H1N1 infection are at higher risk of pneumonia and death than other women in the reproductive period. Early antiviral therapy reduces the risk of unfavorable outcome.</p> Ivana Milosevic Milos Korac Natasa Popovic Lidija Lavadinovic Aleksandar Urosevic Branko Milosevic Djordje Jevtovic Mijomir Pelemis Goran Stevanovic ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 380 384 10.3855/jidc.8454 Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia <p>Introduction: More than 1,300 children aged 0-14 years were infected with HIV in Indonesia by 2016. Adequate antiretroviral therapy (ART) can increase nutritional and immunological status, reduce incidence of opportunistic infection and mortality caused by HIV infection. After ART initiation, the children’s treatment response needs to be monitored with CD4<sup>+</sup> cell count and Viral Load (VL) evaluation. In resource-limited setting, clinical and immunological parameters can be used to evaluate ART outcomes. The aimed of this study to know immunological status of the patient after 6 months ART in Dr. Sardjito Hospital in Yogyakarta, Indonesia.</p> <p>Methodology: A retrospective study was conducted from January 2010 to May 2016. HIV-infected children aged 0-18 years who were given first-line ART at least 6 months were included in this study. Age when ART initiation, gender, residence, nutritional status, clinical staging based on WHO criteria, incidence of hospitalization, baseline CD4<sup>+</sup> cell count and CD4<sup>+ </sup>cell count after 6 months of therapy, tuberculosis treatment, and ART regimens were collected from medical records. Data were entered and analyzed using SPSS version 20.0</p> <p>Results: Thirty-five subjects were included in this study. Median CD4<sup>+</sup> T cell percentage increased from 3.16 (IQR 1-18) % to 11.0 (IQR 2-32) %, whereas median CD4<sup>+</sup> absolute cell count increased from 9.5 (IQR 3-176) cell/mm<sup>3</sup> to 419.5 (IQR 202-1428) cell/mm<sup>3</sup>.</p> <p>Conclusion: Immunologic conditions could improve even with very low levels of CD4<sup>+</sup> T cell percentage and CD4<sup>+</sup> absolute cell count. Monitoring immunologic conditions and adherence of children with ART are essential to improve treatment outcomes.</p> Mardy Pangarungan Eggi Arguni ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 385 389 10.3855/jidc.9743 No molecular evidence of MERS-CoV circulation in Jeddah, Saudi Arabia between 2010–2012: a single-center retrospective study <p>Introduction: Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging zoonotic viral pathogen and a serious public health concern. The virus was first reported in Saudi Arabia in 2012 and continues to be endemic in the region. Most of the initial MERS-CoV cases in 2012 and early 2013 were sporadic, and it remains unclear whether MERS-CoV was circulating before 2012 or not. Therefore, we tried here to find any molecular evidence of MERS-CoV circulation in humans before or during 2012 in the city of Jeddah, Saudi Arabia.</p> <p>Methodology: We examined 349 archived respiratory samples collected between January 2010 and December 2012 from patients with acute respiratory illnesses from the city of Jeddah in Western Saudi Arabia. All samples were screened for MERS-CoV by real-time RT-PCR targeting the upstream E-gene (UpE) and the open reading frame 1 a (ORF1a).</p> <p>Results: All tested samples which were originally found negative for influenza A H1N1 virus were also found to be negative for MERS-CoV.</p> <p>Conclusions: These results suggest that circulation of MERS-CoV was uncommon among patients with acute respiratory symptoms in Western Saudi Arabia between 2010 and 2012.</p> Reem J Alamoudi Leena E Azhar Dareen H Alamoudi Dena H Alamoudi Ahmed M Tolah Rowa Yousef Alhabbab Esam I Azhar Anwar M Hashem ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 390 393 10.3855/jidc.9523 Lack of new HBV infections over 2 years of follow-up in HIV-positive women receiving ART up to 6 or 24 months after delivery Marina Giuliano Maria Franca Pirillo Francesca Lucaroni Giuseppe Liotta Mauro Andreotti Sandro Mancinelli Robert Mphwere Enok Bokola Roberta Amici Maria Cristina Marazzi Leonardo Palombi ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 394 396 10.3855/jidc.9915 Yemen: Cholera outbreak and the ongoing armed conflict <p>Yemen was affected by a major cholera epidemic in 2016, while a civil war, which has devastated the country since March 2015, has exacerbated the humanitarian situation. Cholera is a disease caused by the bacterium <em>Vibrio cholera</em>, thus this study aims to analyze the epidemiological features of the outbreak and explore the relation of the outbreak to the current armed conflict situation.</p> <p>The data were obtained from the national surveillance system in Yemen. This contains details of 15,074 cases registered as suspected cholera patients per governorate from week 39 to 52 in 2016. In addition to the data concerning cholera, other data on conflict-related injuries, and population movement (numbers of Internally Displaced Persons – IDPs – and number of displaced returnees) were used to assess the correlation using Spearman's rho analysis.</p> <p>The data analysis shows the intensity of the conflict as measured by the total casualties per governorate (conflict-related injuries and death) is significantly correlated with the number of cholera cases per governorate (r 0.483, P = 0.026). The analysis also shows a positive, but not significant correlation between cholera cases, and both the number of conflict internal displaced people (IDPs) (r 0.389, P = 0.081), and number of returnees (r = 432, P = 0.050).</p> Fekri Ali Dureab Khalid Shibib Reema Al-Yousufi Albrecht Jahn ##submission.copyrightStatement## 2018-05-31 2018-05-31 12 05 397 403 10.3855/jidc.10129