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 Tech Support) Thu, 08 Nov 2018 14:08:10 -0800 OJS 60 Negative immunomodulation by parasitic infections in the human response to vaccines <p>Parasitic infections are an important cause of global morbidity and mortality and are highly prevalent in "underdeveloped" countries. The presence of parasitic infections is associated with modulation of the immune system and changes in the response to bacterial and viral vaccines. The objective of this review was to compile, summarize and analyze information about immunomodulation by parasitic infections and its effects on the immune response to vaccines. We also identified the parasites most associated with immunomodulation of vaccine responses and those vaccines most affected. In addition, articles evaluating the effect of chemoprophylaxis for malaria on the immune response against vaccines were considered. The most affected vaccines are Bacillus Calmette-Guérin and bacterial polysaccharide vaccines. Malaria is the infection most associated with decreased response to vaccines; however, there are discordant results. Chemoprophylaxis for malaria did not change the immune response to vaccination. While parasitic infections can alter the immune response to vaccination, it is important to clarify the discrepancies and establish the mechanisms.</p> Catalina Alvarez-Larrotta, Eliana María Arango, Jaime Carmona-Fonseca ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients – an update <p>Introduction:<em> Pneumocystis jirovecii</em> (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients.</p> <p>Methodology: We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017.</p> <p>Results: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell &lt; 200 cells/mL or &lt; 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial.</p> <p>Conclusions: Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.</p> Yuan-Ti Lee, Ming-Lung Chuang ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Characterization of clinical extensively drug resistant Pseudomonas aeruginosa from a Chinese teaching hospital <p>Introduction: <em>Pseudomonas aeruginosa</em>, an important opportunistic pathogen, carries multiple virulence factors which contribute to its adaptation and pathogenicity. The goal of this study was to characterize the virulence factors among extensively drug-resistant <em>P. aeruginosa</em>.</p> <p>Methodology: In this study, 63 non-duplicated extensively drug-resistant <em>P. aeruginosa</em> clinical isolates were collected from December 2013 to July 2015. Polymerase chain reaction (PCR) was used to analyze the homogeneity and the type III secretion system. Microtiter plate method was performed to evaluate the ability to form biofilms associated to twitching and swimming motilities.</p> <p>Results: High percentage (96.8%) of isolates was sensitive to polymyxin B, while the resistance rate to</p> <p>other antibiotics (amikacin, aztreonam, ceftazidime, ciprofloxacin, gentamicin, imipenem, levofloxacin, meropenem, piperacillin-tazobactam) ranged from 80.9% to 100%. Enterobacterial repetitive intergenic consensus-PCR detected seven major groups with minimal genetic variation. All the isolates carried <em>exoT</em> gene, 96.8% carried <em>exoY</em>, 69.8% carried <em>exoS</em>, and 31.7% carried <em>exoU</em> gene. Biofilm formation was confirmed in all strains, out of which 41.3% formed strong biofilm. Motilities analysis showed heterogeneous diameters ranging from 6.02 to 26.09 mm for swimming and from 7.60 to 23.34 mm for twitching motilities.</p> <p>Conclusions: Our findings revealed that the clinical <em>P. aeruginosa</em> isolates tested are the major invasive types in nature and multiple virulence factors were commonly carried in the extensively drug-resistant strains.</p> Mingxiang Zou, Haichen Wang, Jian Shui, Jun Li, Yongmei Hu, Qingya Dou, Qun Yan, Wen' en Liu ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Aerobic bacteriological profile and antimicrobial susceptibility pattern of pus isolates from tertiary care hospital in India <p>Introduction: Pyogenic infections are an important cause of sepsis. These infections are difficult to treat because of the pathogens with increasing antibiotic resistance. It is important to know the pathogens causing the infections and its antibiotic susceptibility for proper management of the patients.</p> <p>Methodology: A retrospective analysis of 1428 culture positive pus and tissue samples received in the department of microbiology from various departments in the hospital between January 2012 to 2017 was performed. Data regarding the pathogen isolated and its antimicrobial susceptibility were collected and analyzed. The specimens were primarily processed, as per standard methods. Identification and susceptibility testing was done using the Vitek-2C system.</p> <p>Results: Among the samples males outnumbered females (M: F-2.5:1) and the median age was 47 years. The total number of patients were 1428 with total number of isolates being 1525 as in our study monomicrobial infections were seen in 93.2% (1331/1428) patients whereas combined infections with growth of two pathogens in 6.8% (97/1428). Gram-negative bacilli were isolated in 68.3% (1042/1525). Among the Gram-negative bacilli <em>Escherichia coli</em> was the major pathogen isolated (38.6%, 403/1042). Gram positive organisms were isolated in 31.6% (483/1525) of cases and <em>Staphylococcus aureus</em> was the predominant organism isolated (91.7%, 443/483). Rare pathogens like <em>Burkholderia pseudomallei</em> in 3 patients and <em>Nocardia</em> in one patient were also isolated.</p> <p>Conclusion: This study emphasizes to understand the common organisms isolated from wound infections and it helps in empirical treatment of patients based on antibiotic susceptibility patterns.</p> Sukanya Sudhaharan, Padmaja Kanne, Padmasri Chavali, Lakshmi Vemu ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Leptospira in the different ecological niches of the tribal union territory of India <p>Introduction: Leptospirosis is a widespread zoonotic disease, which has a medical and veterinary importance, and also a commonly re-emerging infectious disease. The main causes of transmission are known; however, the respective prominence of each of the components and the respective environmental risk factors are obscure.</p> <p>Methodology: Present study was conducted in the different locations (urban/rural/tribal) of the union territory of Dadra and Nagar Haveli (UT of Dadra and Nagar Haveli). Periodical sample collection approach was used to collect the samples from May 2016 to April 2017, to determine the persistence of leptospiral contamination of the environmental sources.</p> <p>Results: The PCR detection and isolation of <em>Leptospira</em> revealed that pathogenic leptospires were present in water, soil and animal urine. The highest positivity was reported from the water of household drainage in urban areas and in the water from rice field of rural areas.</p> <p>Conclusions: The data obtained from the present study may help and guiding in developing preventive measures for leptospirosis in the UT of Dadra and Nagar Haveli.</p> Dolatsinh Zala, Vikram Khan, Ankush A Sanghai, Sarat K Dalai, V K Das ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Antibiotic consumption and healthcare-associated infections in a tertiary hospital in Belgrade, Serbia from 2011 to 2016 <p>Introduction: Healthcare-associated infections (HAIs) and irrational use of antibiotics in healthcare settings are major global public health concerns. Surveillance of HAIs in intensive care units (ICU), surgical-site infections (SSIs), and <em>Clostridium difficile </em>infections (CDIs), together with implementation of antibiotic stewardship, are cornerstones of hospital infection prevention programs. The aim of this study was to evaluate antibiotic consumption, especially of broad spectrum antibiotics, in relation to HAI incidence density (ID).</p> <p>Methodology: The study was conducted from 2011 to 2016 in a tertiary hospital, the Military Medical Academy (MMA), in Belgrade, Serbia. Through regular hospital surveillance we identified all patients with a new HAI. Data on consumption of antibacterials for systemic use were expressed as defined daily dose per 100 bed days (DDD/100 BD).</p> <p>Results: The highest incidence density (ID) of HAI was observed among patients in surgical ICUs (47.2 per 1000 patient-days), while the highest incidence rate among SSI was 3.7%. Moreover, the highest ID of CDI in medical patients was 6.2 per 10,000 patient-days, while in surgical patients it was 4.3 per 10,000 patient-days. The most frequently used antibiotics were cephalosporins, aminoglycosides and carbapenems (16.0 ± 2.3, 4.8 ± 0.7, 4.3 ± 0.7 DDD/100 BD, respectively). There was no significant correlation between consumption of any groups of antibiotics and ID of CDI in medical and surgical patients.</p> <p>Conclusion: The multidisciplinary healthcare team would have crucial importance in the implementation of the antibiotic stewardship program in order to decrease unnecessary exposures of patients treated in healthcare settings.</p> Aneta Perić, Viktorija Dragojević-Simić, Bojana Milenković, Sandra Vezmar Kovačević, Vesna Šuljagić ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Knowledge, attitudes and practice survey on blood-borne diseases among dental health care workers in Georgia <p>Introduction: In Georgia limited data exists about awareness of blood borne-diseases among dental health care workers (DHCW).</p> <p>Methodology<em>: </em>To assess DHCW knowledge, attitudes and practices related to infection control practice guidelines designed to limit transmission of blood-borne diseases, a cross-sectional study was conducted. All respondents were asked to voluntarily complete a self-administered questionnaire. Doctors of Dental Medicine, nurses, and dental residents were recruited from 13 private and governmental dental units in three large Georgian cities: Tbilisi (the capital city), Batumi (Western Georgia) and Rustavi (Eastern Georgia).</p> <p>Results: Of 244 DHCWs recruited, 196 (80%) agreed to participate. Nearly 42% DHCWs did not know the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Georgia. Knowledge about risk factors for transmission of human immunodeficiency virus (HIV), HCV and HBV was low; correct response proportions among all DHCWs were 45.3%, 37.9% and 34.2% for these pathogens, respectively. The 59.7% of DHCWs were uninformed about post-exposure prophylaxis for HIV. Only 37.3% reported being well informed on infection control guidelines. Nearly all (95.6%) DHCWs expressed interest in receiving additional education on occupational transmission of blood-borne pathogens.</p> <p>Conclusions: Overall, the study suggests DHCWs are aware they have insufficient knowledge of universal precautions. There is a need for developing a continuous education program that is accessible to practicing DHCWs.</p> Marika Kochlamazashvili, George Kamkamidze, Louise-Anne McNutt, Jack DeHovitz, Olga Chubinishvili, Maia Butsashvili ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Cost effectiveness of dressing in the prevention of catheter-related infection in critically ill patients <p>Introduction: Catheter-related infection is a complication of high morbimortality. The aim was to perform a cost-effectiveness analysis of gauze and medical tape, transparent semi–permeable and chlorhexidine-impregnated dressings for short-term central venous catheter, within the Brazilian Public Healthcare System (Sistema Único de Saúde – SUS) scenario.</p> <p>Methodology: a decision tree was elaborated in order to evaluate the cost-effectiveness of dressings in the prevention of catheter-related infection in critically ill patients. The outcome was the probability of catheter-related infections prevention. Moreover, only direct medical expenses were considered. Sensitivity analyses were performed to evaluate the model uncertainties.</p> <p>Results: Chlorhexidine-impregnated dressing presented higher cost-effectiveness when the base case was analyzed (cost of US$ 655 per case prevented, 99% of effectiveness), in comparison to gauze and medical tape dressing (US$ 696, effectiveness of 96%). Dressing changes performed before the recommended period, treatment performed exclusively in inpatient units and high effectiveness of gauze and medical tape dressing were variables that interfered with the results. The probability of death has also demonstrated to have a major impact on cost-effectiveness.</p> <p>Conclusion: In the context of a Brazilian public hospital, the chlorhexidine-impregnated dressing presented higher cost-effectiveness when compared to the gauze and medical tape dressing or the transparent semi-permeable dressing.</p> Edivane Pedrolo, Mitzy Tannia Reichembach Danski, Astrid Wiens, Radamés Boostel ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Speed of recovery in adult patients with community-acquired pneumonia; moxifloxacin versus levofloxacin <p>Introduction: To evaluate the speed of recovery in CAP-treated adults with Moxifloxacin versus levofloxacin.</p> <p>Methodology:A retrospective multicenter study between January 14, 2010 - March 23, 2017. Patients' records with the diagnosis of community-acquired pneumonia (CAP), age ≥ 18 and ≤ 60 years old, susceptible bacteria to the prescribed fluoroquinolone, completed three days of antimicrobial therapy and who were switched from parenteral to the oral form for the same antimicrobial agent were included.</p> <p>Results: 701 charts were reviewed, 367 were excluded; not on respiratory fluoroquinolones (RFQ), age &gt; 60 or &lt; 18 years old, not enough data, prior antimicrobials, hospital-associated pneumonia, &lt; 3 days of therapy, and one pregnant woman. 334 patients were Included; 167 levofloxacin and 167 moxifloxacin, with 68.5% males (P = 0.259), no significant difference in comorbidities (P &gt; .05), but increased diabetes mellitus in moxifloxacin-treated patients (P = 0.012). No significant difference in Pneumonia Severity Index (PSI). Multivariate and univariate analysis demonstrated that day 3 rate of improvement; levofloxacin-treated patients 75.9% (95% CI, 69.9 to 81.8), and 84.0% (95% CI, 78.1 to 89.9) for Moxifloxacin (difference -8.1%, 95% CI, -16.5 - .003, P = 0.058). And day 5 rates of improvement in Levofloxacin-treated patients was 91.9%, (95% CI, 88.3 – 95.6), and 95.5% (95% CI, 91.8 - 99.2) for moxifloxacin (difference -3.5%, 95% CI, -8.7 - 1.7, P = 0.184). There was no significant difference for patients with radiological diagnoses for day 3 (P = 0.832) and 5 (P = 0.929).</p> <p>Conclusions: Our uni-and-multivariate analyses demonstrated that moxifloxacin exhibited no significant differences in the rates of improvement on days 3 and 5.</p> Jamal Wadi Al Ramahi, Mustafa Ramadan, Waad Jaber, Lamya Abushanab, Mohammad Mughrabi, Noor Alshamayleh, Ahmad Mulhem, Dania Momani, Mohammad Obaidat, Ghayda Haddad, Basma Khalil, Anas Zahran, Esraa Odat, Nadeen Kufoof, Haneen Arabiat, Amr Diab, Antonio Anzueto ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Stethoscope, “the friendly foe” – A study to evaluate bacterial contamination of stethoscopes and disinfection practices <p>Introduction: Stethoscope is used to assess the health of patients but can also act as a potential source of disease transmission. The study was aimed to find out the contamination rate of stethoscopes, evaluate awareness and attitude of healthcare workers (HCWs) about stethoscope cleaning, and determine the efficacy of 70% alcohol as cleaning agent.</p> <p>Methodology: This hospital based cross-sectional study was conducted in a tertiary care hospital in October 2015 among healthcare workers. They were asked to fill a questionnaire followed by culturing the diaphragm and bell surfaces of their stethoscopes before and after cleaning with 70% isopropyl alcohol.</p> <p>Results: Out of 100 stethoscopes cultured, 56 were found to be contaminated at least with one microorganism. <em>Acinetobacter cbc</em> was the commonest contaminant followed by <em>Klebsiella</em> <em>pneumoniae</em>. Three out of twelve <em>S. aureus</em> strains showed methicillin resistance. Stethoscopes used in emergency areas were more contaminated when compared to wards and out-patient departments. Despite 100% awareness among HCWs, the importance of stethoscope cleaning is realized by only 70% who practice it regularly.</p> <p>Conclusion: Stethoscope is a potential vector for transmission of healthcare associated infections. Hence it is vital to clean it after each use to reduce the load of iatrogenic infections.</p> Priya Datta, Mandeep Kaur, Sangeeta Rawat, Varsha Gupta, Jagdish Chander ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Neutrophil phagocytosis and respiratory burst activity of dairy cows during the transition period and early lactation <p>Introduction: Hormonal and metabolic changes, as well as energy imbalance, can affect health, production and reproductive performance of dairy cows. In the present study, we evaluated phagocytosis and respiratory burst neutrophil activity during the transition period and early lactation and compared it with biochemical and hematological parameters in dairy cows.</p> <p>Methodology: Simmental cows (n = 21) were enrolled in the study. Whole blood samples were collected weekly from 3 weeks pre- calving until 6 weeks post calving. Basic metabolic and blood parameters were assessed by routine laboratory analyses, while neutrophil functions were analyzed by commercial test kits.</p> <p>Results: Optimal neutrophil response was observed pre and post calving. The highest value was recorded in the 6th week after calving (89.54 ± 7.61%) and being significantly higher (p &lt; 0.01) as compared to values recorded at two and one week before and one week after calving. The percentage of activated neutrophils was high during the entire study period: from 70.80 ± 5.22% at the beginning of the study to 89.54 ± 7.61% at the end of the study. During the study period, production of Reactive Oxidative Species by neutrophils was positively correlated with β-hydroxybutyrat and non-esterified fatty acids values (0.454<sup>**</sup> and 0.423<sup>**</sup>, respectively) and calcium levels (0.164<sup>*</sup> and 0.212<sup>**</sup>, respectively).</p> <p>Conclusions: The most prominent changes in all parameters had no influence on phagocytic and respiratory burst activity of neutrophils. Neutrophil function is preserved at the optimal level during the transition period and early lactation in Simmental cows.</p> Marina Žekić-Stošić, Zdenko Kanački, Dragica Stojanović, Dejan Bugarski, Miodrag Lazarević, Aleksandar Milovanovic, Aleksandar Masic ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women <p>Introduction: Hepatitis B infection is a serious global public health problem. The aim of the study was to assess the seroprevalance of hepatitis B surface antigen (HBsAg), as well as the risk factors associated with hepatitis B virus (HBV) infection among pregnant women attending antenatal care clinics of the University Hospital in Antioch, Turkey.</p> <p>Methodology: This descriptive cross-sectional study was carried out between May 2016 and December 2016. The Chi-squared was utilized to estimate the statistical significance of the association between socio-demographic variables and HBsAg status. The results were generated as proportions odds ratio (OR) with their 95% confidence intervals (Cl) and calculated by using both univariate and multivariate logistic regression analysis.</p> <p>Results: The seroprevalence of HBsAg was found to be 2.1%. A significant association was observed between age and HBsAg seropositivity (p = 0.027). History of blood transfusion (AOR = 9.51, 95% CI = 1.92-46.80, p = 0.006), history of hepatitis (AOR = 11.13, 95% CI = 2.02-61.28, p = 0.006), tattooing (AOR = 13.64, 95% CI = 2.52-73.76, p = 0.002) and a history of household/close contact (AOR = 11.10, 95% CI = 1.56-78.65, p = 0.016) were significantly associated with the risk of HBV infection.</p> <p>Conclusions: Data regarding the seroprevalence of HBsAg and risk factors associated with HBV infection in pregnant women plays a crucial role in evaluating the effectiveness of the public health protection policies and the strategies to control the disease.</p> Sirin Cetin, Meryem Cetin, Ebru Turhan, Kenan Dolapcioglu ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Burden of fungal infections in Iran <p>Introduction: The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of different type of fungal diseases on populations, we have estimated the burden of fungal diseases in Iran.</p> <p>Methodology: We estimated the burden of human fungal diseases based on the specific populations at risk, existing epidemiological data in both local and international databases, and modelling previously described by the LIFE program (</p> <p>Results: Among the population of Iran (79,926,270 in 2016), 6,670,813 (8.3%) individuals are estimated to suffer from a fungal infection each year. A total of 2,791,568 women aged between 15 and 50 years are estimated to suffer from recurrent vulvovaginal candidiasis, annually. In addition, considering the 13.3% prevalence rate of tinea capitis in children, a total of 2,552,624 cases per year are estimated. The estimated burden of invasive aspergillosis in the 3 groups of patients with hematologic malignancy, lung cancer and chronic pulmonary obstructive disease was 6394 (8.0 per 100,000). The estimate for the burden of allergic disease related to fungi including allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization and allergic fungal rhinosinusitis was 272,095 (340 per 100,000). Based on the 28,663 cases of HIV infection reported, an estimated 900 and 113 cases with pneumocystosis and cryptococcal meningitis are annually anticipated, respectively.</p> <p>Conclusion: Our estimates indicate that the importance of fungal infections is high but overlooked in Iran, which warrants further actions by health care authorities.</p> Mohammad T Hedayati, Mojtaba Tagizadeh Armaki, Jamshid Yazdani Charati, Newsha Hedayati, Seyedmojtaba Seyedmousavi, David W Denning ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Brucellar terminal ileitis and epididymo-orchitis in an adolescent; case report and review of the literature <p>Although brucellosis is a multi-systemic illness, terminal ileitis or colitis due to brucellosis is reported anecdotal in literature. Genitourinary manifestations of Brucella, namely epididymo-orchitis is very rare in childhood brucellosis. Herein, we present a case of brucellosis in a child with a rare combination of terminal ileitis and epididymo-orchitis not reported previously in the literature.</p> Melahat Melek Oguz, Fatma Zehra Oztek-Celebi ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Moxifloxacin-induced neutropenia in 26-year-old man <p>Moxifloxacin is a fourth generation widely used fluoroquinolone antibiotic. There are three cases of moxifloxacin-induced neutropenia reported in the literature and we report the fourth case.</p> <p>A 26-year-old man with pneumonia was treated with moxifloxacin because of penicillin allergy. On the second day of therapy, leukopenia [White blood cell (WBC) count 2.7×10³/μL] and neutropenia (neutrophils 1.21×10³/μL) occurred. <em>Rothia</em><em> mucilaginosa</em> was isolated in sputum culture. On the fourth day of hospitalization moxifloxacin treatment was stopped and clarithromycin 500 mg PO twice daily was started. Leukopenia and neutropenia resolved one day after discontinuation of moxifloxacin that WBC and neutrophil count rose 4.5×10³/μL and 1.97×10³/μL, respectively. On the sixth day of hospitalization, WBC and neutrophil count was 4.3×10³/μL and 2.29×10³/μL, respectively.</p> <p>The immunomodulatory effects of moxifloxacin may result in the changes of WBC count like leukopenia with neutropenia. Moxifloxacin induced neutropenia may be more common and is an important adverse effect. More observational studies about safety profiles of moxifloxacin are needed.</p> Tuğba Kula Atik, Emre Ispir, Aykut Aytekin, Ufuk Turhan, Esma Yeniiz, Dilaver Tas, Orhan Bedir ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700 Tuberculosis reactivation related with ruxolitinib in a patient with primary myelofibrosis <p>Primary myelofibrosis (PMF) is a clonal stem cell disease, characterized by bone marrow fibrosis. Ruxolitinib is a selective inhibitor of JAK-1 and JAK-2 used to treat PMF. Its mechanism of action is based on the reduction of signal transduction and cytokine levels; including IL-6 and tumor necrosis factor alpha. Increased infection risk related to Ruxolutinib is rarely reported. Here we describe a case of tuberculosis infection ractivation in a female patient treated with Ruxolitinib. During the treatment, she complained of night sweats, weight loss and enlarged mass in the neck. Excisional mass biopsy revealed a necrotizing granulomatous lymphadenitis. QuantiFERON-TB and PPD tests were not able to diagnose the tuberculosis infection. Therapy with Ruxolitinib was interrupted due to possible immunsuppressive effects and the patient was treated with the standard antituberculosis regimen. After six months, the patient’s symptoms had resolved and there was no lymphoadenopathy. In conclusion, it is important to assess the risk of tuberculosis activation before Ruxolitinib treatment. In addition, the diagnosis of tuberculosis using QuantiFERON-TB and PPD may be misleading in patients treated with Ruxolutinib.</p> Mehmet S Pepeler, Zübeyde N Özkurt, Özlem T Güzel, Nalan Akyürek ##submission.copyrightStatement## Wed, 31 Oct 2018 00:00:00 -0700