The Journal of Infection in Developing Countries An open access, peer-reviewed, online scientific research journal focused on global health 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 Administrator) Tue, 06 Feb 2018 13:45:21 -0800 OJS 60 Role of efflux pump and OprD porin expression in carbapenem resistance of Pseudomonas aeruginosa clinical isolates <p>Introduction: In recent years, the prevalence of multidrug-resistant <em>P. aeruginosa</em> has remarkably increased. Thus, we wanted to investigate the carbapenem resistance mechanisms and clonal relationship among 80 carbapenem-resistant<em> P. aeruginosa </em>strains<em>.</em></p> <p>Methodology: Carbapenemase production was detected using the Modified Hodge Test (MHT), EDTA combined disc method (ECD), and PCR. Expression levels of efflux and porin genes were mesured by real-time reverse transcription PCR. Clonal relationship of the isolates was investigated by pulsed-field gel electrophoresis (PFGE).</p> <p>Results: Carbapenemase production was detected in 7.5% of the isolates with MHT/ECD tests and in 11.3% of the isolates with PCR. Although the specificity of MHT/ECD was high, the sensitivitivity was low. <em>oprD</em> downregulation and <em>mexB</em>, <em>mexY</em>, and <em>mexD</em> overexpression were demonstrated in 55%, 16.3%, 2.5%, and 2.5% of the isolates, respectively. Multiple carbapenem resistance mechanisms were found in nearly a quarter of the isolates. PFGE typing of the 80 <em>P. aeruginosa</em> isolates yielded 61 different patterns. A total of 29 isolates (36.3%) were classified in 10 clusters, containing 2 to 7 strains. We could not find a strict relationship between PFGE profile and carbapenem resistance mechanisms.</p> <p>Conclusions: Although <em>oprD</em> downregulation and MexAB-OprM overexpression were the most common mechanisms, carbapenem resistance was associated with multiple mechanisms in the study<em>. </em>MHT/ECD tests should not be used alone for investigation of carbapenemase production in <em>P. aeruginosa</em>. Rapid tests with high sensitivity and specificity should be developed for the detection of carbapenemase production in <em>P. aeruginosa</em>.</p> Tuba Muderris, Rıza Durmaz, Birsen Ozdem, Tuba Dal, Ozlem Unaldı, Sibel Aydogan, Nevreste Celikbilek, Ziya Cibali Acıkgoz ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 In vitro activity of hybrid lavender essential oils against multidrug resistant strains of Pseudomonas aeruginosa <p>Introduction: Lavender is an evergreen shrub native to Northern Africa and other mountainous Mediterranean regions. It grows throughout Southern Europe, the United States, and Australia.<a name="_ednref2"></a> Lavender essential oil has been used since ancient times and is known for its anti-inflammatory, antidepressant, antiseptic, antifungal and antimicrobial properties.</p> <p>Methodology: in this study, the antimicrobial activity of two Lavender essential oils (<em>Lavanda sumian</em> and <em>Lavanda grosso</em>) against 16 multidrug-resistant <em>P. aeruginosa</em> strains from clinical ocular samples taken from migrant patients has been investigated. The <em>in vitro</em> cytotoxic activity on human Wong-Kilbourne derivative (WKD) conjunctiva cells from healthy patients and nitric oxide synthase (NOS) activity on murine macrophage (J774.1A) were also evaluated.</p> <p>Results: <em>L. sumian</em> showed lower antimicrobial activity when compared to <em>L. grosso</em>. Both lavender oils tested had no cytotoxic effect at very low concentrations, mostly <em>L. grosso</em>. The essential oils extracted from <em>L. sumian</em> and <em>L. grosso</em> significantly reduced NOS in a cell model.</p> <p>Conclusion: Increase in drug resistance and lack of new antibiotics may encourage the development of natural antimicrobial treatments.</p> Matthew Donadu, Donatella Usai, Antonio Pinna, Tiziana Porcu, Vittorio Mazzarello, Maura Fiamma, Mauro Marchetti, Sara Cannas, Giovanni Delogu, Stefania Zanetti, Paola Molicotti ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 First molecular characterisation and PCR ribotyping of Clostridium difficile strains isolated in two Algerian Hospitals <p>Introduction: <em>Clostridium difficile</em> is the major etiological agent of nosocomial antibiotics associated diarrhoea. <em>C. difficile</em> infection is associated with considerable morbidity and mortality among hospitalized patients worldwide. Despite its known importance, there is no study on this important pathogen in Algeria.</p> <p>Methodology: In this prospective study, undertaken between 2013 and 2015, faecal specimens were collected from 159 hospitalized patients with antibiotic-associated diarrhoea in two tertiary health care hospitals in Chlef, Algeria. Faecal samples were cultured on CLO plates Agar with cefoxitin, cycloserine antibiotics and sodium taurocholate. <em>C. difficile</em> suspected colonies were analysed by multiplex PCR for the detection of the toxin genes. <em>C. difficile</em> isolates were analysed by PCR ribotyping and multi-locus tandem repeat analysis. Antimicrobial susceptibility was determined by the E-test method, according to the Clinical and Laboratory Standards Institute protocol.</p> <p>Results: <em>C. difficile</em> was cultured from 11 of 159 stool specimen (6.9%). Seven strains were toxigenic, mainly represented by the 020 and 014 PCR ribotypes and four non toxigenic belong to PCR ribotype 084. All 11 isolates were susceptible to both vancomycin and metronidazole and resistant to ciprofloxacin.</p> <p>Conclusions: This study, which reported for the first time <em>C. difficile </em>ribotypes circulating in Algerian health care facilities, could paves the way for further more comprehensive studies on this important pathogen, and could be useful to the local health authorities to implement a surveillance program of <em>C. difficile</em> in Algeria.</p> Mohammed Sebaihia, Abla Djebbar, Ed Kuijper, Celine harmanus, Ingrid Sanders, Nadia Benbraham, Hocine Hacène ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Protective immunity of recombinant LipL21 and I-LipL21 against Leptospira interrogans serovar Autumnalis N2 infection <p>Introduction: Leptospirosis is a zoonotic disease caused by the spirochete of genus <em>Leptospira</em> with widespread distribution in tropical, subtropical and temperate zones. Leptospirosis is often confused with other febrile illnesses including jaundice, dengue, and malaria. Generally, the disease is often underdiagnosed or misdiagnosed. Though leptospirosis is curable with antibiotic treatment, the laboratory diagnosis of the disease is specialized and open to interpretation with multiple kits available to detect the different serological markers of <em>Leptospira</em>. Moreover, when leptospirosis is misdiagnosed, the disease can lead to multi-organ failure and may have fatal effects. There is a need for strategies to develop vaccines and prevent leptospirosis. In the present study, the immunogenic potential of leptospiral recombinant protein LipL21 (rLipL21) and its truncated form I-LipL21 (rI-LipL21) was evaluated.</p> <p>Methodology: The recombinant proteins were established in cyclophosphamide treated BALB/c mice model infected with <em>L. interrogans</em> serovar Autumnalis strain N2.</p> <p>Results: The vaccination study showed 66% and 83% survivability among mice immunized with rLipL21 and rI-LipL21 respectively and post-challenge with leptospiral strain N2 compared to control groups that showed 100% lethality. Additionally, a significant increase in antibody levels and cytokine levels (TNF-a, IFN-γ and IL-10) was observed evidencing a marked stimulation of both humoral and cell-mediated immune response in mice immunized with rLipL21/rI-LipL21 compared to whole cell leptospiral lysate (WCL).</p> <p>Conclusions: This study evidenced protective immunization against leptospirosis with rLipL21 and rI-LipL21 recombinant proteins and are potential candidates for the development of leptospiral vaccine.</p> Anita Kumari, Mallela Martha Premlatha, Veerapandian Raja, Charles Solomon Akino Mercy, Kalimuthusamy Sumathi, Malini Shariff, Kalimuthusamy Natarajaseenivasan ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Seroprevalence of transfusion transmissible infections among blood donors by chemiluminescent assay in a tertiary care centre <p>Introduction: Blood transfusion is a life saving measure, but also carries risk of transfusion transmitted infections (TTIs). In spite of improved donor screening, risk of transmission of TTIs still remains a major concern. Stringent screening of blood not only ensures safe supply of blood and blood products, but also gives us an idea about prevalence of TTIs among general population.</p> <p>Methodology: Blood donors (voluntary and replacement), fulfilling national and regional blood bank criteria, attended our blood bank, during Jan 2015-Dec 2016 (included). Retrospective data analysis was performed by a structured database. After obtaining informed consent, venous blood was collected and analysed for HBsAg, anti-HCV and Anti-HIV1&amp;2 (Chemiluminescent assay -OrthoVitrosECi/ECiQ), Malaria (ICT–pf/pan-Alere) and Syphilis (RPR-Labcare Dignotics).</p> <p>Results: A total of 9027 donors were screened; Males and females were 99.23% and 0.76% respectively with the mean age of 27.4 ± 2years (19-58years). Voluntary donors were 68.7%; replacement donors 31.3%. Voluntary donation increased by 3% in 2016 (69.7%) vs 2015 (67.1%). TTI prevalence was 1.12% (102/9027). Surprisingly prevalence was higher among voluntary donors, females and 21-30 years. Seroprevalence of HBV (0.42%), HIV (0.13%), and Malaria (0.01%), in our region was relatively inferior than other parts of country. Nonetheless, HCV (0.56%) infections were on the rise. No syphilis case was reported. Low seropositivity rate is believed to be attributed to improved counselling of blood donors, adherence to standard donor selection criteria and rational use of blood.</p> <p>Conclusion: Even though low prevalence, effective control strategies including stringent screening, implementation of more sensitive tests and health education are urgently needed to prevent those TTIs.</p> Raja Sundaramoorthy, Ramesh Arunagiri, Vithiya Ganesan, Sethuammal Perumal, Rajendran Tiruvanamalai, Jhansi Charles ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Molecular epidemiology of coronavirus in faeces of Brazilian calves and Peruvian camelid herds <p>Introduction: The enteric disorders represent a serious hazard for bovine and camelid breeding. The aim of this study was to examine the frequency of detection and molecular characteristics of enteric coronavirus (CoV) infections in cattle, alpaca, and llama herds bred in family-based farms in Brazil and Peru.</p> <p>Methodology: Stool samples were collected from calves from Brazil and camelids from Peru for detection and characterization of CoV by reverse transcription polymerase chain reaction (RT-PCR) and sequence analysis.</p> <p>Results: 46.5% (47/101) samples from calves and 26.8% (70/261) from alpaca tested positive for CoV. All strains belong to lineage A1 of the <em>Betacoronavirus</em> genus. Phylogenetic analysis showed high identity between CoV strains detected in calves and alpacas.</p> <p>Conclusions: This study characterised CoV strains from dairy cattle herds in the state of Rio de Janeiro, Brazil, and indicated that this virus is spread among the state herds. The results also indicate widespread circulation of CoV among the alpacas of Cuzco, Peru.</p> Camila B Rocha, Luz Alba A.M.G. Fornells, Miguel Rojas, Maíra Libetal, Alberto Manchego, Danilo Pezo, Norma Santos ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Investigational approach to adenoviral conjunctivitis: comparison of three diagnostic tests using a Bayesian latent class model <p>Introduction: Highly contagious adenoviral conjunctivitis represents 15-70% of all conjunctivitis worldwide. Human adenovirus (hAdV) serotypes 3,4,7,8,19 and 37 contributes to 89% of all adenoviral conjunctivitis. Accurate and rapid diagnosis of adenoviral infections at serotype level could prevent misdiagnosis, spread of disease, unnecessary antibiotic use and increased treatment costs.</p> <p>Methodology: Sixty-two suspected viral conjunctivitis cases were recruited from November2013-January2015. Swabs collected from inferior palpebral conjunctiva and processed for viral culture (Hep2 cell line), immunofluorescence assay (IFA) and polymerase chain reaction (PCR) (targeting hexon gene). Serotype 3,4,7,8,19 and 37 identification was carried out with an optimized multiplex-PCR (based on hypervariable region of hexon gene) and confirmed by sequence analysis. Bayesian Latent Class Model (LCM) analysis was used to compare sensitivity and specificity of three tests.</p> <p>Results: Adenovirus was detected in 54.8% (34/62) of cases by combination of all three methods. Culture was positive in 23/34 cases (67.6%). PCR and IFA detected adenovirus in 24 (70.5%) and 21 (61.7%) cases respectively. LCM analysis revealed, sensitivity and specificity of PCR, Culture and IFA was 77.8% and 92.4%; 72.2% and 90.8%; 67.6% and 92.9% respectively. Serotyping by multiplex-PCR showed, two cases each were hAdV3 and hAdV4, 18 hAdV8 and two remained unidentified. Results of Multiplex-PCR and sequence analysis showed 100% concordance</p> <p>Conclusion: LCM analysis revealed, PCR is the most appropriate method for identification. Multiplex-PCR is a simple and rapid method (serotypes identification within two days); owing its short turnaround time and accuracy, it can be used as a diagnostic tool for surveillance of adenoviral keratoconjunctivitis.</p> Raja Sundaramurthy, Rahul Dhodapkar, Subashini Kaliaperumal, Belgode Narasimha Harish ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Dientamoeba fragilis diagnosis by fecal screening: relative effectiveness of traditional techniques and molecular methods <p>Introduction: <em>Dientamoeba fragilis,</em> an intestinal trichomonad, occurs in humans with and without gastrointestinal symptoms. Its presence was investigated in individuals referred to Milad Hospital, Tehran.</p> <p>Methodology: In a cross-sectional study, three time-separated fecal samples were collected from 200 participants from March through June 2011. Specimens were examined using traditional techniques for detecting <em>D. fragilis</em> and other gastrointestinal parasites: direct smear, culture, formalin-ether concentration, and iron-hematoxylin staining. The presence of <em>D. fragilis</em> was determined using PCR assays targeting 5.8S rRNA or small subunit ribosomal RNA.</p> <p>Results: <em>Dientamoeba fragilis</em>, <em>Blastocystis </em>sp.<em>, Giardia lamblia, Entamoeba coli</em>, and<em> Iodamoeba butschlii</em> were detected by one or more traditional and molecular methods, with an overall prevalence of 56.5%. <em>Dientamoeba </em>was not detected by direct smear or formalin-ether concentration but was identified in 1% and 5% of cases by culture and iron-hematoxylin staining, respectively. PCR amplification of SSU rRNA and 5.8S rRNA genes diagnosed <em>D. fragilis</em> in 6% and 13.5%, respectively. Prevalence of <em>D. fragilis</em> was unrelated to participant gender, age, or gastrointestinal symptoms.</p> <p>Conclusions: This is the first report of molecular assays to screen for <em>D. fragilis</em> in Iran. The frequent finding of <em>D. fragilis</em> via fecal analysis indicated the need to include this parasite in routine stool examination in diagnostic laboratories. As the length of amplification target correlates to the sensitivity of PCR, this assay targeting the <em>D. fragilis </em>5.8S rRNA gene seems optimal for parasite detection and is recommended in combination with conventional microscopy for diagnosing intestinal parasites.</p> Negin Hamidi, Ahmad Reza Meamar, Lameh Akhlaghi, Zahra Rampisheh, Elham Razmjou ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 A large pulmonary cavity replaced by a tuberculosis granuloma and healed during treatment of a patient with tuberculosis <p>In the early stages of <em>M. tuberculosis</em> infection, lung tuberculosis (TB) granulomas are often formed at sites of infection to constrain the infection and can undergo healing in most cases or enlarge as the disease progresses in some cases. We present here an unusual case of TB in which a large previously existing pulmonary cavity was replaced by a TB granuloma and then healed during treatment of a patient with poly-resistant TB. This case indicates that the disease process from TB granuloma formation to pulmonary cavities and progression or healing is more diverse than previously thought and could be reversed. An in-depth understanding of the disease process from initiation and maintenance of the TB granuloma to pulmonary cavities and progression or healing will provide new ways to combat mycobacterial infections.</p> Ling Chen, Jianyong Zhang, Hong Zhang ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800 Knowledge, attitudes and practices of hand hygiene among Pakistani health professionals: A cross-sectional study Muhammad Salman, Muhammad Hussnain Raza, Zia Ul Mustafa, Surendra Shrestha, Mudasir Ali, hanzalah Faham, Noman Asif, Naureen Shehzadi, Khalid Hussain ##submission.copyrightStatement## Wed, 31 Jan 2018 00:00:00 -0800