Non chylous filarial ascites: A rare case report

Filariasis is a common health problem in tropical and subtropical regions including India. It commonly presents with lymphatic involvement in form of nonpitting pedal edema, chylous ascites, chyluria,hydrocele and lymphocele. Detection of microfilaria in ascitic fluid is an extremely uncommon finding. We present a case of non chylous ascites where microfilaria were detected in the ascitic fluid.

Treatment of methicillin-resistant Staphylococcus aureus infections:Importance of high vancomycin minumum inhibitory concentrations

Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threateningsystemic infections.The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration(MIC)(dubbed the MIC "creep").In this way,the emergence of vancomycinintermediate SA(VISA) strains and heteroresistantVISA has raised concern for the scarcity of alternative treatment options.Equally alarming,though fortunately less frequent,is the emergence of vancomycin-resistant SA.These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach.Ultimately,various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range(i.e.,MIC = 2 μg/mL).These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use,both in methicillin-resistant SA and in methicillin-sensitive SA.The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains,and the different optimal treatment options known.

Platelet indices in neonatal sepsis: A review

Thrombocytopenia is a common hematological abnormality in neonates with sepsis. The autoanalyzers now-a-days readily provide platelet indices along with platelet counts without any additional cost. However these indices are not given proper weightage often.The important platelet indices available for clinical utility include mean platelet volume(MPV), platelet distribution width and plateletcrit that are related to morphology and proliferation kinetics of platelets. Studies in adult patients reported their role in the diagnosis of severe sepsis and prognosis of adverse clinical outcomes including mortality. Abnormal MPV can aid diagnosing the cause of thrombocytopenia. Low MPV associated with thrombocytopenia has been found to result in clinical bleeding.Other indices, however, are less studied. The studies addressing the importance of these platelet indices in neonatal sepsis are limited. The current review gives an overview of potential utility of important platelet indices in neonatal sepsis.

Pathogenesis of Chagas disease cardiomyopathy

Chagas disease, or American trypanosomiasis, is a parasitic infection caused by the flagellate protozoanTrypanosoma cruzi. Chagas disease is mainly affecting rural populations in Mexico and Central and South America. The World Health Organization estimates that 300 000 new cases of Chagas disease occur every year and approximately 20 000 deaths are attributable to Chagas. However, this organisation classified Chagas disease as a neglected tropical disease. The economic burden of this disease is significant. In many Latin American countries, the direct and indirect costs, including the cost of health care in dollars and loss of productivity, attributable to Chagas disease ranges from $40 million to in excess of $800 million per nation per annum. So, it remains a contemporary public health concern. In chronic phase, mortality is primarily due to the rhythm disturbances and congestive heart failure that result from the chronic inflammatory cardiomyopathy(CCC) due to the persistence presence of parasites in the heart tissue. Mechanisms underlying differential progression to CCC are still incompletely understood. In the last decades immunological proteomic genetic approaches lead to significant results which help to disperse the veil covering the knowledge of the pathogenic process. Here, we reported these significant progresses.

Liver transplantation in patients with SARS-CoV-2:Two case reports

BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)causes coronavirus disease 2019(COVID-19).This disease was declared a worldwide health problem with the characteristics of a pandemic.Most patients have mild symptoms and a good prognosis.Information on the evolution and prognosis of COVID-19 in solid organ recipients is scarce.CASE SUMMARY We describe two patients who underwent liver transplantation with a positive test result for detection of the viral sequence for COVID-19,using reversetranscription polymerase chain reaction(RT-PCR),immediately before transplantation.The patients showed good evolution in the postoperative period,without signs of graft dysfunction.The immunosuppressive therapy was not modified.Both patients were discharged for subsequent outpatient follow-up.CONCLUSION In conclusion,it is expected that the experience at this center can be used as an example,aimed at the continuation of transplantations by other services and,thus,the morbidity and mortality of patients with liver disease on the transplantation waiting list can be reduced.Transplant centers must be able to readjust daily to the evolution of the COVID-19 pandemic.

Towards the worldwide eradication of hepatitis B virus infection: A combination of prophylactic and therapeutic factors

Hepatitis B virus(HBV)is still a global health problem,mostly because of the intermediate/high rates of HBV chronic carriers living in most Asian,African and eastern European countries.The universal HBV vaccination of new-borns undertaken in most nations over the last 3 decades and effective HBV antiviral treatments(nucleos(t)ide analogue with high genetic barrier to viral resistance)introduced in the last decade have shown their beneficial effects in inducing a clear reduction of HBV endemicity in the countries where they have been extensively applied.Great hopes are now placed on new antiviral and immunotherapeutic drugs that are now at an advanced stage of study.It is in fact already conceivable that the synergistic use of new drugs targeting more than one HBV-lifecycle steps(covalent closed circular DNA destruction/silencing,HBV entry inhibitors,nucleocapsid assembly modulators targeting viral transcripts)and of some new immunotherapeutic agents might eliminate the intrahepatic covalent closed circular DNA and achieve the eradication of HBV infection.In spite of this,a strong effort should be given to extensive educational and screening programs for the at-risk population and to the implementation of HBV vaccination in developing countries.

Stenotrophomonas maltophilia,an emerging pathogen in newborns:Three case reports and a review of the literature

BACKGROUND Stenotrophomonas maltophilia(S.maltophilia)is a rare cause of neonatal sepsis with significant morbidity and mortality and has extensive resistance to several antibiotics leaving few options for antimicrobial therapy.Only a few cases have been reported in neonates from developing countries.We report three cases of critically ill,extramural babies with neonatal S.maltophilia sepsis.All three babies recovered and were discharged.CASE SUMMARY All three cases were term extramural babies,who were critically ill at the time of presentation at our neonatal intensive care unit.They had features of multiorgan dysfunction at admission.Blood culture was positive for S.maltophilia in two babies and one had a positive tracheal aspirate culture.The babies were treated according to the antibiogram available.They recovered and were subsequently discharged.CONCLUSION Although various authors have reported S.maltophilia in pediatric and adult populations,only a few cases have been reported in the newborn period and this infection is even rarer in developing countries.Although S.maltophilia infection has a grave outcome,our three babies were successfully treated and subsequently discharged.

Primary lymphocutaneous nocardiosis associated with gardening: A case series

Most cases of nocardiosis are seen in immunocompromised patients. Primary lymphocutaneous is a relatively uncommon presentation of this disease that may also occurs in normal hosts. Diagnosing this infection requires a high index of suspicion since cultures can take several days to exhibit growth. The microbiology laboratory must therefore be notified about cases in which this pathogen is suspected. We report four cases of primary lymphocutaneous norcardiosis. Of particular interest is the association of three of these cases with gardening.

Physiological functions and clinical implications of fibrinogen-like 2:A review

Fibrinogen-like 2(FGL2) encompasses a transmembrane(m FGL2) and a soluble(s FGL2) form with differential tertiary structure and biological activities. Typically, m FGL2 functions as prothrombinase that is capable of initiating coagulation in tissue without activation of the blood clotting cascade, whereas s FGL2 largely acts as an immunosuppressor that can repress proliferation of alloreactive T lymphocytes and maturation of bone marrow dendritic cells. Protein sequences of FGL2 exhibit evolutionary conservation across wide variety of species, especially at the carboxyl terminus that contains fibrinogen related domain(FRED). The FRED of FGL2 confers specificity and complexity in the action of FGL2, including receptor recognition, calcium affiliation, and substrate binding. Constitutive expression of FGL2 during embryogenesis and in mature tissues suggests FGL2 might be physiologically important. However, excessive induction of FGL2 under certain medical conditions(e.g. pathogen invasion) could trigger complement activation, inflammatory response,cellular apoptosis, and immune dysfunctions. On the other hand, complete absence of FGL2 is also detrimental as lack of FGL2 can cause autoimmune glomerulonephritis and acute cellular rejection of xenografts. All these roles involve m FGL2, s FGL2, or their combination. Although it is not clear how m FGL2 is cleaved off its host cells and secreted into the blood, circulating s FGL2 has been found correlated with disease severity and viral loading among patients with human hepatitis B virus or hepatitis C virus infection. Further studies are warranted to understand how FGL2 expression is regulated under physiological and pathological conditions. Even more interesting is to determine whether m FGL2 can fulfill an immunoregulatory role through its FRED at carboxyl end of the molecule and, and vice versa, whether s FGL2 is procoagulant upon binding to a target cell. Knowledge in this area should shed light on development of s FGL2 as an alternative immunosuppressive agent for organ transplantation or as a biomarker for predicting disease progression, monitoring therapeutic effects, and targeting FGL2 for repression in ameliorating fulminant viral hepatitis.

Pharmacodynamics for predicting therapeutic outcome and countering resistance spread:The cefditoren case

The relationship between pharmacokinetics and pharmacodynamics is a key instrument to improve antimicrobial stewardship and should be aimed to identification of the drug exposure measure that is closely associated not only with the ability to kill organisms but also to suppress the emergence of resistant subpopulations. This article reviews published studies for efficacy prediction with cefditoren and those aimed to explore its potential for countering resistance spread, focusing on the three most prevalent community-acquired isolates from respiratory infections: Streptococcus pneumoniae(S. pneumoniae), Haemophilus influenzae(H. influenzae) and Streptococcus pyogenes(S. pyogenes). Studies for efficacy prediction include in vitro pharmacodynamic simulations(using physiological concentrations of human albumin) and mice models(taking advantage of the same protein binding rate in mice and humans) to determine the value of the pharmacodynamic indices predicting efficacy, and Monte Carlo simulations to explore population pharmacodynamic coverage, as weapons for establishing breakpoints. Studies exploring the potential of cefditoren(free concentrations obtained with 400 mg cefditoren bid administration) for countering spread of resistance showed itscapability for countering(1) intra-strain spread of resistance linked to fts I gene mutations in H. influenzae;(2) the spread of H. influenzae resistant strains(with fts I gene mutations) in multi-strain H. influenzae niches or of S. pneumoniae strains with multiple resistance traits in multi-strain S. pneumoniae niches; and(3) for overcoming indirect pathogenicity linked to β-lactamase production by H. influenzae that protects S. pyogenes in multibacterial niches. This revision evidences the ecological potential for cefditoren(countering resistance spread among human-adapted commensals) and its adequate pharmacodynamic coverage of respiratory pathogens(including those resistant to previous oral compounds) producing community-acquired infections.

Natural contamination of human hands with enteric parasites in Indian Subcontinent

AIM: To investigate the prevalence of enteric parasite contamination on hands and the potential role naturally contaminated hands may have in their transmission. METHODS: Prior to initiating the survey, the protocol was reviewed and approved by respective Institutional Review Boards of each survey site(Dhaka, Bangladesh and Kolkata, India). Both stool and corresponding hand wash samples collected, were analyzed for the presence of enteric parasitic ova/(oo)cysts employing conventional microscopy coupled with permanent staining techniques. Additionally molecular approachessuch as polymerase chain reaction(PCR) of enteric parasites recovered from both stool and corresponding hand wash samples, were also used to further confirm their identity. RESULTS: A total of 972 stool samples were collected from both sites surveyed(300 volunteers from Kolkata, India and 672 from Dhaka, Bangladesh). Parasitic analysis revealed, 113(38%) from Kolkata, India and 267(40%) of stool samples from Dhaka, Bangladesh were positive for parasitic ova/(oo)cysts. When the corresponding hand wash samples were analyzed, 43(14%) stool-positive volunteers in Kolkata, India and 47(7%) in Dhaka, Bangladesh were positive for enteric parasitic ova/(oo)cysts. Ascaris lumbricoides(A. lumbricoides) ova and Giardia lamblia(G. lamblia) cysts predominated in hands wash samples from both sites surveyed(from India, A. lumbricoides ova, 53%; G. lamblia cysts 31% and from Bangladesh, A. lumbricoides ova, 47%; G. lamblia cysts 19%). Genotypic analysis of enteric parasitic ova/(oo)cysts obtained from both stool and corresponding hand wash samples taken from the same person were found to be identical. CONCLUSION: These results suggest a possible role of hands contaminated with enteric parasites' ova/(oo)cysts in the transmission of these parasites highlighting another role of hand hygiene/proper hand washing in reducing the disease burden in low socioeconomic communities.

DNA methylation in liver diseases

Recently, growing evidences show that the combination of epigenetic and genetic abnormalities contribute together to the development of liver diseases. DNA methylation is a very important epigenetic mechanism in human beings. It refers to addition of the methyl groups to DNA and mainly occurs at cytosine adjacent to guanine. DNA methylation is prevalent across human genome and is essential for the normal human development, while its dysfunction is associated with many human diseases. A deep understanding of DNA methylation may provide us deep insight into the origination of liver diseases. Also, it may provide us new tools for diseases diagnosis and prognosis prediction. This review summarized recent progress of DNA methylation study and provided an overview of DNA methylation and liver diseases. Meanwhile, the association between DNA methylation and liver diseases including hepatocellular carcinoma, liver fibrosis, nonalcoholic steatohepatitis and liver failure were extensively discussed. Finally, we discussed the potential of DNA methylationtherapeutics for liver diseases and the value of DNA methylation as biomarkers for liver diseases diagnosis and prognosis prediction. This review aimed to provide the emerging DNA methylation information about liver diseases. It might provide essential information for managing and care of these patients.

Top ten tips for perfect corona-2 prophylaxis

The current corona-2 pandemic has stimulated wide research for hydroxychloroquine(Quine)therapy and lately,prophylaxis.To optimize prophylaxis proper methods of use are explained.The focus is on tools of assessment and robust comparison;defining infection objectively;loading and maintenance dose designing based on pharmaco-viro-kinetics;confirming Quine threshold-levels and its sufficiency;and Quine side-effects vigilance/amelioration.Attention to statistics to study valid endpoints of goals in appropriately-sized population is essential.Mass interactive quine dose auto designer software is built to simplify,optimize and help collaboration of complex Quine dosing system.A similar chloroquine software can be built.

Interplay between rabies virus and the mammalian immune system

Rabies is a disease caused following infection of the brainby the rabies virus(RABV). The principle mechanism of transmission is through a bite wound. The virus infects peripheral nerves and moves to the central nervous system(CNS). There appears to be little involvement of other organ systems and little detectable immune stimulation prior to infection of the CNS. This failure of the mammalian immune system to respond to rabies virus infection leads, in the overwhelming majority of cases, to death of the host. To some extent, this failure is likely due to the exclusive replication of RABV in neurons and the limited ability to generate, sufficiently rapidly, an anti-viral antibody response in situ. This is reflected in the ability of post-exposure vaccination, when given early after infection, to prevent disease. The lack of immune stimulation during RABV infection preceding neural invasion is the Achilles heel of the immune response. Whilst many viruses infect the brain, causing encephalitis and neuronal deficit, none are as consistently fatal to the host as RABV. This is in part due to prior replication of many viruses in peripheral, non-neural tissue by other viruses that allows timely activation of the immune response before the host is overwhelmed. Our current understanding of the correlates of protection for rabies suggests that it is the action of neutralising antibodies that prevent infection and control spread of RABV. Furthermore, it tells us that the induction of immunity can protect and understanding how and why this happens is critical to controlling infection. However, the paradigm of antibody development suggests that antigen presentation overwhelmingly occurs in lymphoid tissue(germinal and non-germinal centres) and these are external to the CNS. In addition, the blood-brain-barrier may provide a block to the delivery of immune effectors(antibodies/plasma B-cells) entering where they are needed. Alternatively, there may be insufficient antigen exposure after natural infection to mount an effective response or the virus actively suppresses immune function. To improve our ability to treat this fatal infection it is imperative to understand how immunity to RABV develops and functions so that parameters of protectionare better defined.

What is the purpose of launching the World Journal of Clinical Infectious Diseases?

Launching of the World Journal of Clinical Infectious Diseases(WJCID)could have been possible due to efforts of the publisher,members of the editorial board,all the authors and definitely our readers.I congratulate everyone for making it possible.Pathogenic organisms of various origin cause infectious diseases often resulting in symptomatic illness.WJCID is an open access peer reviewed journal that will be published bimonthly.WJCID will primarily emphasize on topics relevant to infections affecting human and animal health yet articles from other diseases and relevant issues will also be encouraged.WJCID welcomes articles from either basic or applied research in different disciplines like Epidemiology of communicable and non-communicable infections,Immunology and Genetics.WJCID covers topics like Host-Parasites interactions,Vector biology,development of advanced tools for diagnosis,genetic susceptibility to diseases,and disease prevention and vector control.WJCID will work as an important resource of basic and applied research in the field of infections.It is widely recommended that clinical implementations of basic and applied research be encouraged for the benefit to each stream.So again I welcome everyone and assure that WJCID will be a great platform where you can feel free to share your valuable results,discuss new hypothesis and research problems and update yourself with the most recent advancements made in the field of infections.

Clinical significance of anti-nucleocapsid-IgG sero-positivity in SARS-CoV-2 infection in hospitalized patients in North Dakota

BACKGROUND During the peak of the coronavirus diseases 2019(COVID-19)pandemic,clinicians actively studied the utility of various epidemiologic-clinical parameters to determine the prognosis for patients hospitalized with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Serum IgG antibody level,DDimer,C-reactive protein and neutrophil to lymphocyte ratio,etc.were studied to assess their association with the clinical course in hospitalized patients and predict who may be at increased risk for poor clinical outcome.However,the influence of SARS-CoV-2-anti-nucleocapsid-IgG antibody(IgG-N)sero-positivity on the clinical outcome of patients with COVID-19 is largely unknown.AIM To study the influence of SARS-CoV-2 anti-nucleocapsid-IgG seropositivity on clinical course and diseases severity in hospitalized COVID-19 patients.METHODS We conducted a retrospective study of adults admitted to a tertiary care community hospital in North Dakota with COVID-19.Included patients had severeCOVID-19 disease or worse and so required supplemental oxygen on admission.They were serologically tested for SARS-CoV-2-anti-nuceocapsid-IgG(IgG-N).The IgG-N positive group were 26 patients and the IgG-N negative group had 33 patients.The groups received similar treatment for COVID-19 as approved by our healthcare system from Day 1 of admission until discharge or death.Measurable parameters for monitoring the patients’clinical course included the following:Length of hospitalization(LOS),use of high flow nasal canula(HFNC),use of noninvasive bilevel positive pressure ventilation(BiPAP),admission into the intensive care unit,need for mechanical ventilation(VENT);and the patient outcome/discharge or death.Other variables included were age,gender and body-mass-index,and duration of symptoms before presentation.For each variable,the outcome was modeled as a function of SARS-CoV-2-IgG-N status(positive or negative)using a generalized linear model.For LOS-days,a negative binomial distribution was used as it had a better fit than a Poisson or Gaussian distribution as evidenced by a Pearson chi-square/df value closer to 1.0.All other outcomes utilized a binary logistic regression model.RESULTS After a thorough examination of patient data,it was found that admission rates to the Intensive Care Unit,as well as the usage of BiPAP,HFNC and VENT support,in conjunction with patient outcomes,were not significantly different across IgG-N status.However,the LOS variable when assessed by IgG-N status was found to be significant(t value=2.16,P value=0.0349).IgG-N negative patients had higher than average LOS in comparison to IgG-N positive patients(15.12 vs 9.35 d).Even when removing the extreme value(an LOS of 158 d),IgG-N negative patients still had slightly higher than average stays(10.66 vs 9.35 d)but the relationship was no longer significant.For patient outcome/death,only age(numerical)was a significant predictor(F value=4.66,P value=0.0352).No other variables for any of the outcomes were significant predictors of clinical course or disease severity.CONCLUSION Our study demonstrated that IgG-N seroconversion had no significant association with clinical outcomes in hospitalized COVID-19 patients.

Current situation of Giardia infection in Spain: Implications for public health

Giardia is an enteric protozoan that infects a wide range of vertebrate hosts, being considered a major causative agent of gastrointestinal disease in humans in both developing and developed countries. Giardia infection has also a significant impact on livestock health, causing diarrhoea and resulting in significant economic lost. Transmission is either direct, through the faecal-oral route, or indirect, through ingestion of contaminated water or food. In this article, we review current knowledge about the epidemiology of giardiasis in different populations in Spain, including humans, livestock, companion animals, and wildlife. Environmental contamination of surface waters and raw foods by Giardia cysts is also addressed. Special relevance has been given to the data available on the molecular characterization of the Giardia isolates obtained from clinical and environmental samples, as determining thespecies/assemblages and subassemblages involved is essential for accurately identifying the parasite and assessing zoonotic transmission. The public health significance of these findings has also been thoroughly discussed.

Osmolyte transport in Staphylococcus aureus and the role in pathogenesis

Osmolyte transport is a pivotal part of bacterial life, particularly in high salt environments. Several low and high affinity osmolyte transport systems have been identified in various bacterial species. A lot of research has centered on characterizing the osmolyte transport systems of Gram-negative bacteria, but less has been done to characterize the same transport systems in Gram-positive bacteria. This review will focus on the previous work that has been done to understand the osmolyte transport systems in the species Staphylococcus aureus and how these transporters may serve dual functions in allowing the bacteria to survive and grow in a variety of environments, including on the surface or within humans or other animals.

New biomarkers for clinical management of hepatitis C virus infected patients

Hepatocellular carcinoma(HCC) is the third most frequent oncological cause of death worldwide, principally a consequence of hepatitis C virus(HCV) infection and its prognosis is mostly poor. For early identification and surveillance of HCV patients with liver disease progression, the availability of suitable diagnostic and prognostic biomarkers is still an unmet clinical need. Alfa-fetoprotein together with imaging techniques is commonly used, however its specificity and sensitivity are not satisfactory. Several clinical and serological data have been proposed to define the risk of disease progression in HCV infected patients and new biomarkers have been proposed, including post-transcriptionally modified molecules and genetic biomarkers. The present editorial article attempts to summarize the current knowledge on the new promising tools for effective early diagnosis of HCV-related liver disease progression and for the surveillance of HCC.

Pericarditis following COVID-19 vaccination:Two case reports

BACKGROUND Coronavirus disease 2019(COVID-19)is a highly contagious viral illness which conventionally manifests with primarily respiratory symptoms and less commonly with cardiac involvement in various forms,such as pericarditis.Myocarditis and pericarditis have been reported in a variety of live and attenuated vaccines,such as smallpox and influenza.As of October 2021,no cases of pericarditis associated with COVID-19 vaccination have been published.We present two healthy male patients who present post COVID-19 vaccination with pericarditis diagnoses.CASE SUMMARY A 21-year-old male with no significant past medical history presented with myalgia,chills,mild headache,and chest pain for two days.Patient received the Moderna COVID-19 vaccine the day prior to symptom onset.On presentation,electrocardiogram(ECG)revealed sinus rhythm with ST elevation,and troponin was elevated.Emergent cardiac catheterization was not significant for abnormalities.The primary diagnosis was acute pericarditis,and the patient was discharged on colchicine and indomethacin.Additionally,a 35-year-old male with no pertinent past medical history presented with fever,chills,weakness,nausea,vomiting,diarrhea,and retrosternal chest pain for three days.He received the Moderna COVID-19 vaccine four days prior to symptom onset.On presentation,troponin was elevated,and ECG revealed mild ST elevation.Left ventricular dysfunction with ejection fraction of 41%was reported on transthoracic echocardiogram.Patient was started on ibuprofen and colchicine for diagnosis of myopericarditis.CONCLUSION These case reports highlight a potential unintended consequence,pericarditis,associated with COVID-19 vaccination that may not warrant invasive cardiac intervention.