The Journal of Infection in Developing Countries <p>A peer-reviewed open access journal, focusing on global health.</p> en-US <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> (JIDC Central Office) (JIDC Tech Support) Thu, 28 Feb 2019 12:28:56 -0800 OJS 60 Pooled analysis of 1270 infective endocarditis cases in Turkey <p>Introduction: Despite developments in medicine, infective endocarditis (IE) is still associated with significant morbidity and mortality. In this study it was aimed to systematically review the infective endocarditis literature published or presented from Turkey.</p> <p>Methods: To find the published series, one national database (Ulakbim), and three international databases (Scopus, Pubmed and Sci-e) were searched between 31 October-3 November 2014. also, abstracts of congresses by three national congresses were searched for studies regarding infective endocarditis.</p> <p>Results: Data for 1270 patients (38.3% female, mean age 46.2, 28% prosthetic valve endocarditis) with a diagnosis of infective endocarditis were obtained from 21 reports (18 published articles and three congress abstracts). Of the 18 articles, four were in peer-reviewed medical journals indexed in national databases and 14 were in international databases. There was an underlying heart disease in 51.9% and history of dental procedure was 6.7%. Fever, heart murmur and fatigue were present in 94%, 71.4% and 69% respectively. most commonly involved site was mitral valve (43.3%), followed by aortic (33.8%) and tricuspid valve (6.4%). <em>Staphylococcus aureus</em>, coagulase-negative staphylococci and enterococci comprised the 22.8%, 9.7% and 7.5% of the cases while 31.1% were culture-negative. Overall mortality was 23.4%. When we compared series related to years 2008 and before and 2009 and after, the mortality rates were (24.1%-224/931) vs (20.1%-32/159), respectively (p = 0,31).</p> <p>Conclusion: Infective endocarditis is still associated with significant mortality. <em>S. aureus</em> seems to be the most common etiologic agent. There was a slight decrease in the recent years in mortality.</p> Arman Vahabi, Funda Gül, Sabina Garakhanova, Hilal Sipahi, Oğuz Reşat Sipahi ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study <p>Introduction: Between February and November 2016, 17 tuberculosis (TB) cases were identified among high school students in Novi Pazar, Serbia. The objectives of our study were to describe the outbreak, to identify potential risk factors and to evaluate the applied control measures.</p> <p>Methodology: The outbreak was described by time, person and place. A retrospective cohort study was conducted. Attack rates, unadjusted relative risks (RR) and 95% confidence intervals (CI) were calculated. Multiple log-binomial regression analysis was performed to calculate adjusted RR.</p> <p>Results: Sixteen of the total 17 cases occurred among grade 3 students, AR 5.5%. Previous TB family history, (RR = 5.29; 95% CI = 1.63-17.12), spending time with a known TB case at school (RR = 5.38; 95% CI = 1.48-19.55) and exposure to secondhand smoke (RR = 3.37; 95% CI = 1.11-10.29) were all significantly and independently associated with the occurrence of TB.</p> <p>Conclusions: Delayed diagnosis and reporting resulted in delayed initiation of the contact investigation and non-identification of latent TB cases probably favored the occurrence of this outbreak in a low incidence country. Public health authorities should consider revising the existing guidelines, promoting inter-sectorial collaboration and increasing awareness of public health professionals.</p> Maja B Stosic, Dragana Plavsa, Nikoletta Mavroeidi, Dragana Jovanovic, Violeta Vucinic, Goran Stevanovic, Lidija Sagic, Sefadil Spahic, Uros Rakic, Anita Grgurevic ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 A qualitative study of hand hygiene compliance among health care workers in intensive care units <p>Introduction: Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. We aimed to explore the reasons for poor hand hygiene compliance.</p> <p>Methodology: A qualitative study based on the Theory of Planned Behavior as a framework in explaining compliance, consisting four focus group discussions and six in-depth interviews.</p> <p>Results: Participants mostly practiced hand hygiene depending on the sense of "dirtiness" and "cleanliness". Some of the participants indicated that on-job training delivered by the infection control team changed their perception of "emotionally" based hand hygiene to "indication" based. Direct observations and individual feedback on one-to-one basis were the core of this training. There was low social cohesiveness and a deep polarization between the professional groups that led one group accusing the other for not being compliant.</p> <p>Conclusions: The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. But there is need to base this training model on a structured behavioral modification program and test its efficacy through a quasi-experimental design. Increasing social cohesiveness and transforming the blaming culture to a collaborative safety culture is also crucial to improve compliance. High workload, problems related to work-flow and turnover should be addressed.</p> Pinar Ay, Ayse Gulsen Teker, Seyhan Hidiroglu, Pinar Tepe, Aysen Surmen, Uluhan Sili, Volkan Korten, Melda Karavus ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Suspected cutaneous anthrax in rural areas <p>Introduction: Cutaneous anthrax (CA), a zoonotic infectious disease is an important endemic public health disease in rural areas around the world, accounting for 95% of anthrax cases.</p> <p>Methodology: Fifty patients with CA were diagnosed by the presence of characteristic skin lesions and positive response to treatment. Twenty-nine patients had been treated with oral ciprofloxacin or doxycyclin for 14 days and 21 patients had been treated with intramuscular procaine penicillin for 7 days. The demographic risk factors, characteristics and treatment of CA in rural areas were evaluated. The responses to two different systemic medications were compared using χ<sup>2</sup> test.</p> <p>Results: Twenty-two males and 28 females were included in this study. The predominant skin lesions were black eschar, ulcer and swelling of the skin. The predilection sites were the hand and fingers. The most common route of contamination for both male and female patients was handling raw meat. The most common occupation was housewife for female patients and animal industry for male patients. The patients under ciprofloxacin or doxycyclin administration responded better to treatment; pain at lesion site and new lesions at the time of treatment were significantly lower. Secondary infection appeared to be higher in patients under procaine penicillin administration, although this difference was not statistically significant.</p> <p>Conclusions: In rural areas that lack medical facilities with diagnostic tools, in the presence of black eschar, rapid diagnosis and treatment of CA is essential. The administration of a broad-spectrum antibiotic is recommended as the first line treatment of suspected CA.</p> Melike Kibar Ozturk ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Enhanced directly-observed treatment short-course for tuberculosis control program in mountain areas of Taiwan <p>Introduction: Directly Observed Treatment Short course (DOTS) is one of the most cost-effective approaches for TB treatment. However, TB incidence rates remain high in the mountain areas of Taiwan. A lay health advisor (LHA) strategy is integrated into DOTS as an Enhanced-DOTS (E-DOTS) to provide trustworthy, culturally-specific services in mountain areas that consider the characteristics of local ethnic groups.</p> <p>Methodology: We recruited two Taiwanese indigenes as LHAs (one for each county) to screen close contacts in five townships of Hualien and Nantou counties from January 1, 2011 to December 31, 2013. Incidence and active finding rates of TB during the E-DOTS periods (2011-2013 for Hualien and 2012-2013 for Nantou) were compared with data when traditional DOTS was implemented (2006-2010 for Hualien and 2006-2011 for Nantou) to evaluate the effectiveness of E-DOTS using the before-and-after study design.</p> <p>Results: Incidence rate in Hualien decreased from 393.3 in 2011 to 235.7 in 2013 per 100,000 population and from 338 in 2012 to 235.5 in 2013 in Nantou mountain area. Furthermore, the active case finding rate increased from 15.42% in 2012 to 27.38% in 2013 as compared to an average of 6.5% for CDC, Taiwan, for the specified years. TB treatment success rates were significantly improved from an average of less than 80% to an average of higher than 90% after E-DOTS was implemented.</p> <p>Conclusions: Our findings highlighted that the use of LHAs in E-DOTS is an effective and applicable strategy for controlling tuberculosis in the mountain areas of Taiwan.</p> Yi-Wen Huang, Chang-Yao Tsao, Wei-Wen Chen, Pai-Sheng Yen, Jen-Jyh Lee, Sheng-Shiung Huang, Hao-Jan Yang ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Antimicrobial role of Lactobacillus species as potential probiotics against enteropathogenic bacteria in chickens <p>Introduction: The emergence of antimicrobial resistance among bacterial community resulted in a ban on drugs as the growth promoter in poultry feed. This situation demands to explore alternatives as food supplements with health benefit to poultry. Therefore, probiotic microorganisms, which are considered as safe and possess various health benefits can be a choice. Present study was designed to explore the probiotic potential of the isolated <em>lactobacillus</em> species in chickens.</p> <p>Methodology: Out of 220 samples, 100 <em>Lactobacillus</em> species were isolated from various regions of chicken intestine. They were further characterized on the basis of morphology, staining and catalase test. Species-level identification was made by amplifying <em>Lactobacillus</em> specific 16S rRNA gene. Out of 100 isolates, 21 were selected for sequencing on the basis of band intensity.</p> <p>Results: Among 21 sequences, 16 were identified as <em>L. paracasei</em> (n = 6), <em>L. salivarius</em> (n = 3), <em>L. johnsonii</em> (n = 3), and <em>L. agilis, L. fermentum, L. sakei, </em>and <em>L. curvatus</em> (n = 1 each). These strains were found to be significantly acid-tolerant with 81.68 - 85.01% survival rate at pH 2)and bile-tolerant with 81.96 -84.65% survival rate at 0.3% bile. Except three; all strains showed salt tolerance to 2% and 4% NaCl. Among 21 <em>Lactobacillus</em> strains, 6 showed good antimicrobial activities against <em>S. aureus</em>, <em>Salmonella </em>Typhimurium<em> and E. coli.</em></p> <p>Conclusion: Lactobacillus species with probiotic property can be used in poultry feed formulation for their health benefit to combat gastrointestinal infections.</p> Zulfiqar Ahmed, Muhammad Sufyan Vohra, Muhammad Noman Khan, Ayaz Ahmed, Taseer Ahmed Khan ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Characterization and transfer of antimicrobial resistance in lactic acid bacteria from fermented dairy products in China <p>Introduction: Lactic acid bacteria (LAB) are commonly found in foods and are also natural intestinal inhabitants in humans and most animals. However, information regarding antimicrobial resistance and the transfer of resistance genes of LAB from fermented dairy products in China is limited.</p> <p>Methodology: In this study, LAB isolates (n = 82) of <em>Lactobacillus </em>(n = 43) and <em>Streptococcus thermophilus </em>(n = 39) were isolated from 51 commercial fermented food samples in China. All isolates were subjected to pulsed-field gel electrophoresis (PFGE), antimicrobial susceptibility, detecting resistance genes, as well as investigating the transferability of resistance genes.</p> <p>Results: The 43<em> Lactobacillus</em> isolates yielded 24 PFGE patterns and the 34 isolates of <em>S. thermophilus</em> generated 32 different PFGE patterns. Among the 43 <em>Lactobacillus</em> strains, the most commonly observed resistance was that to streptomycin (83.7%) and gentamycin (83.7%). Among the 39 <em>S. thermophilus</em> strains, the most frequently observed resistance was that to streptomycin (92.3%), gentamycin (87.2%), ciprofloxacin (79.5%), and chloramphenicol (71.8%), whereas the lowest level of resistance was that against erythromycin (7.7%). Antimicrobial resistance genes for erythromycin (<em>emrB</em>), gentamycin (<em>aac(6')-aph(2")</em>), streptomycin (<em>ant(6)</em>), sulfamethoxazole (<em>sulI</em> and <em>sulII</em>), tetracycline (<em>tetM</em> and <em>tetS</em>) were detected in the 18 resistance LAB strains. Conjugation experiments showed that <em>tetM</em> from <em>L. delbrueckii</em> subsp. <em>bulgaricus </em>R6 and <em>tetS</em> from <em>L. plantarum </em>R41 were successfully transferred to <em>L. monocytogenes</em> by filter mating.</p> <p>Conclusions: LAB strains could potentially act as reservoirs of resistance genes and play an active role in the transfer of resistance to humans via the food chain.</p> Chao Yang, Tao Yu ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Hepatic/splenic abscess and/or skin and soft tissue infection as predictors of melioidosis in children <p>Introduction: Melioidosis can have multiple organ involvement which can then mimic other infections. The aim of this study was to determine if there are any factors significantly associated with melioidosis which can inform diagnostic evaluations before receiving the results of confirming laboratory testing.</p> <p>Methodology: The charts of patients aged &lt; 16 years admitted to Songklanagarind Hospital during 2002-2014 with a clinical presentation suspicious of melioidosis were reviewed.</p> <p>Results: Of the 145 suspected cases, 27 patients had a confirmed diagnosis of melioidosis by either serology and/or culture. The melioidosis group had a higher proportion of patients with liver or splenic abscess (44.4% <em>vs.</em> 11.9%, <em>p</em> &lt; 0.01) and were less likely to have splenomegaly by physical examination (3.7% <em>vs.</em> 22.9%, <em>p </em>= 0.02) than patients without melioidosis. Logistic regression analysis found that patients suspected of melioidosis who had (a) hepatic abscess or (b) splenic abscess or (c) skin or soft tissue infection were more likely to have melioidosis with likelihood ratios of 5.6, 4.0, and 2.2 respectively, and specificities of 0.94, 0.89, and 0.68 respectively. Suspected patients who did not have hepatic abscess, splenic abscess, or soft tissue infection were unlikely to have melioidosis with negative predictive value of 0.90.</p> <p>Conclusion: patients who have clinically suspected melioidosis without skin or soft tissue infection should have hepatic-splenic ultrasonography performed, and suspected patients who have one of these 3 findings should be treated initially as melioidosis while waiting for culture or serologic test results.</p> Supatjaree Chanvitan, Alan Geater, Kamolwish Laoprasopwattana ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Screening municipal waste collectors for cystic echinococcosis and toxocariasis in southwestern Iran <p>Introduction: Cystic Echinococcosis (CE) and toxocariasis caused by the larval stages of intestinal dog worms including <em>Echinococcus granulosus</em> and <em>Toxocara </em>spp. are among the most widespread zoonotic diseases.</p> <p>Methodology: Four hundred municipal waste collectors were serologically evaluated for CE and toxocariasis. To identify the seropositive cases of CE, an ELISA test was performed using native AgB. <em>Toxocara</em> IgG detection was carried out using ELISA DRG kit (USA), and the seropositive cases were then examined by a Western blot kit (LDBIO, France) to confirm the positive ELISA results.</p> <p>Results: 15 (3.7%) workers were seropositive for CE according to the ELISA. A significant relationship was observed between being seropositive and having contact with soil and dogs. No significant correlations were observed between education and the prevalence of these diseases. Of the 15 seropositive workers for CE, ten worked in district 5 of Ahvaz. <em>Toxocara</em> IgG was identified in 11 (2.7%) cases using the ELISA; however, none of them were confirmed by Western blotting.</p> <p>Conclusion: The 3.7% rate of seroprevalence for CE in asymptomatic municipal waste collectors living in urban regions of Ahvaz suggests a high rate. The higher rate of infection among workers in district 5 is likely associated with the presence of stray and owned dogs in that area of the city. A prolonged exposure to contaminated soil, the lack of awareness about the risk of diseases that can be transmitted through waste and the lack of general availability of suitable personal protective equipment for waste collectors might cause infectious diseases.</p> Molouk Beiromvand, Abdollah Rafiei, Mehdi Tavalla, Roya Daneshbakhtyar ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Enhancement of antimicrobial activity of pump inhibitors associating drugs <p>Introduction: with the continuous emergence of pathogenic resistance to conventional drugs through efflux pumps, increasing efforts are directed toward discovering efflux inhibitory molecules.</p> <p>Methodology: in this study three P-glycoprotein (P13CP, P22CP, P34CP) efflux-inhibitors (EIs), belonging to the series of phenoxymethylquinoxalines capable to restore/potentiate the antiproliferative activity of doxorubicin and vincristine against human tumor cell lines and different antibiotics against clinical isolates, were investigated on 10 clinical strains of <em>Candida</em> and 12 clinical and ATCC strains of Gram positive and Gram-negative bacteria.</p> <p>Results: MFC values of FLC were reduced in all <em>Candida</em> strains by the P22CP and P34CP inhibitors, and in 5/10 fungal strains by the P13CP inhibitor.</p> <p>Conclusion: novel antibiotics with new modes of action are urgently required to suppress the rise of MDR bacteria. An alternative approach would be to identify molecules that can interfere with the process of efflux.</p> Donatella Usai, Matthew Donadu, Alessandra Bua, Paola Molicotti, Stefania Zanetti, Sandra Piras, Paola Corona, Roberta Ibba, Antonio Carta ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Enhanced influenza vaccination among healthcare personnel prevents cases despite community burden <p>Introduction: Influenza vaccination for healthcare personnel is not obligatory in Mexico, and compliance relies on promotion and persuasion. The objective of this study was to determine the impact of influenza vaccination compliance on the reduction of influenza and influenza-like illness among healthcare personnel throughout two consecutive influenza seasons.</p> <p>Methodology: A retrospective study comparing cases of influenza and influenza-like illness among vaccinated and unvaccinated healthcare personnel registered in a Mexican 500-bed University Hospital surveillance and immunization registry during seasons 2015-16 and 2016-17.</p> <p>Results: Total influenza immunization compliance was 21.3% and 42.7%, respectively. Reduction of the number of influenza-like illness (58 in 2015-16 and 15 in 2016-17; P = 0.0001) and confirmed influenza cases (28 in 2015-16 and 13 in 2016-17; P = 0.036) was evident. During 2016-17, influenza activity in the community was higher than 2015-16 (4800 and 1338 cases, respectively).</p> <p>Conclusions: Increased influenza vaccination compliance among healthcare personnel was associated with reduction of the overall number of influenza and influenza-like illness cases, even in the setting of high activity of the disease in the community through 2016-17 and reported suboptimal vaccine effectiveness during both seasons.</p> Isaí Medina-Piñón, Magaly Padilla-Orozco, Lidia Mendoza-Flores, Elvira Garza-González, Raul G Salazar-Montalvo, Samantha Flores-Treviño, Adrián Camacho-Ortiz ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Serologic characteristics of hepatitis B virus among hill-tribe children in Omkoi district, Chiangmai province, Thailand <p>Introduction: Thailand has integrated hepatitis B (HB) vaccination of newborns into the national Expanded Program on Immunization (EPI) in 1992. This has led to a dramatic decrease of HBsAg prevalence in children. However, HB vaccine coverage in remote areas is not well-known. This study aimed to investigate serologic characteristics of hepatitis B virus (HBV) among hill-tribe children in Omkoi District, Chiangmai Province, Thailand.</p> <p>Methodology: This cross-sectional study was conducted on stored samples collected from hill-tribe children attending the primary/secondary school in Omkoi District in December 2014. Sera were tested for HBsAg, anti-HBs and anti-HBc using enzyme immunoassays (MUREX, DiaSorin, Italy). Samples with anti-HBc positive were further assessed for HBV DNA using an in-house HBV DNA semi-nested polymerase chain reaction (PCR) assay.</p> <p>Results: Of 210 children evaluated, 4 (1.9%:95% CI 0.5-4.8) were HBsAg-positive. Of the 206 children HBsAg negative, 17 were anti-HBc and anti-HBs positive, 15 anti-HBc positive only, 26 anti-HBs positive only and 148 negative for both anti-HBc and anti-HBs. None of the children with anti-HBc were positive for HBV DNA.</p> <p>Conclusions: A high percentage of children had no markers of HBV protection suggesting that HB vaccine coverage was not optimal in this area. Our results warrant HBV serologic investigations in other remote areas to assess whether HB vaccine coverage needs to be improved and to identify children who should be vaccinated.</p> Woottichai Khamduang, Nichagamon Ponchomcheun, Witchuda Yaaupala, Phongpatchara Puwaruengpat, Sayamon Hongjaisee, Tanawan Samleerat, Jintana Yanola, Sakorn Pornprasert, Kwanchai Ratanasthien, Gonzague Jourdain, Nicole Ngo-Giang-Huong, Wasna Sirirungsi ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Intraoperative rupture of tuberculous pseudoaneurysm associated with spinal tuberculosis: A case report and literature review <p>Introduction: The increase in the incidence of tuberculosis in developing countries has resulted in increased reporting on more related complications. We report the successful management of an intraoperative spontaneous rupture of a tuberculous pseudo aneurysm associated with spinal tuberculosis.</p> <p>Methodology: We report the case of a 66 years old woman diagnosed with spinal tuberculosis of the T3/T4 vertebrae. During an anterior approach surgical reconstruction for the degenerative vertebrae, massive hemorrhage was observed after the removal of a portion of the prevertebral fascia of the affected vertebrae. This led to the exploration of the hilar fascia for the possibility of hilar hemorrhage, and when no hemorrhage was observed, aneurysm rupture was suspected. A portion of the hilar fascia was then sutured to the prevertebral fascia and the hemorrhage was partially controlled.</p> <p>Results: On the 32<sup>nd</sup> month post-operative follow-up, the symptoms of chest and back pain had disappeared and the tuberculous lesion eradicated.</p> <p>Conclusion: Presently, there are few reports on the successful treatment of intraoperative spontaneous rupture of tuberculous pseudoaneurysms. We therefore report on the successful management of such a case.</p> Haijun Tang, Yun Liu, Abu Moro, Zengming Xiao, Xinli Zhan ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800 Curli pili affect the intracellular survival of Mycobacterium tuberculosis Saiyur Ramsugit, Manormoney Pillay ##submission.copyrightStatement## Thu, 28 Feb 2019 00:00:00 -0800