Asian Pacific Journal of Tropical Medicine

1019–1029

Authors: Rodrigo Siqueira Batista, Andréia Patrícia Gomes, Jorge Luiz Dutra Gazineo, Paulo Sérgio Balbino Miguel, ... Mauro Geller

Meningococcal disease is the acute infection caused by Neisseria meningitidis, which has humans as the only natural host. The disease is widespread around the globe and is known for its epidemical potential and high rates of lethality and morbidity. The highest number of cases of the disease is registered in the semi-arid regions of sub-Saharan Africa. In Brazil, it is endemic with occasional outbreaks, epidemics and sporadic cases occurring throughout the year, especially in the winter. The major epidemics of the disease occurred in Brazil in the 70's caused by serogroups A and C. Serogroups B, C and Y represent the majority of cases in Europe, the Americas and Australia. However, there has been a growing increase in serogroup W in some areas. The pathogen transmission happens for respiratory route (droplets) and clinically can lead to meningitis and sepsis (meningococcemia). The treatment is made with antimicrobial and supportive care. For successful prevention, we have some measures like vaccination, chemoprophylaxis and droplets' precautions. In this review, we have described and clarify clinical features of the disease caused by N. meningitidis regarding its relevance for healthcare professionals.

1037-1042

Authors: Abdul Waheed Khan, Sadia Nawab, Zeeshan Nasim, Abdul Haleem Khan, Syed Ishfaq Ahmad, Fazli Zahir, Israr Ud Din

Infection due to hepatitis C virus (HCV) is a major cause of fibrosis and hepatocellular carcinoma in Pakistan. In the current review, pattern of HCV genotypes and subtypes in Khyber Pakhtunkhwa province was ascertained in light of the available literature. After thorough analysis, genotype 3 (58.27%) was determined to be the leading HCV genotype, followed by genotypes 2 (12.39%), 1 (9.54%) and 4 (0.86%). The proportions of genotypes 5 and 6 were recorded as 0.09% and 0.22% respectively. Subtype wise, 3a accounted for 48.67%, followed by subtype 2a (10.91%), 3b (9.43%), 1a (5.84%), 1b (3.66%), 2b (1.45%) and genotype 4 with its undefined subtypes contributed a portion of 0.86%. The cumulative share of subtypes 1c, 2c, 3c, 5a and 6a was less than 1%. In 11.51% cases, the subtype was untypeable while in 7.17% cases mixed subtypes were recorded. Gender wise, proportions of most HCV subtypes were marginally higher among males as compared to females. On the basis of studied groups, 3a was pervasive among all groups except in intravenous drug users where 2a was the major HCV subtype. Similarly, based on various geographical locations (provincial divisions), subtype 3a revealed a ubiquitous distribution. Conclusively, HCV 3a persists to be the principal subtype across the province of Khyber Pakhtunkhwa. The considerable number of untypeable subtypes in most studies urges for an improved genotyping system on the basis of local sequence data and practice of sequencing for determination of underlying subtype in untypeable cases. Further, studies on identification of subtypes transmission pattern are imperative for assessment of transmission origin and reinforcement of efficient control strategies. In addition, the current review emphasizes the need of attention toward HCV risk groups and ignored southern side of Khyber Pakhtunkhwa province for better holistic understanding of HCV genotype distribution pattern in the province.

1047–1053

Authors: Claudia V. Moreno-Quirós, Alberto Sánchez-Medina, Maribel Vázquez-Hernández, Ana G. Hernández Reyes, Rosa V. García-Rodríguez

Objective To evaluate the anti-inflammatory, analgesic, antioxidant and acute toxicity of extracts obtained from a successive extraction with solvents of ascending polarity [hexane, hex; chloroform, CHCl3 and ethanol (EtOH)] of Ternstroemia sylvatica Schltdl. & Cham. Methods The antioxidant potential was evaluated by 2,2 diphenyl-1-picrylhydrazyl, the ferric reducing/antioxidant power assays and by determining the total phenolic content. The anti-inflammatory and antinociceptive effects were evaluated using the in vivo croton oil-induced ear edema, phorbol 12-myristate 13-acetate induced ear edema, carrageenan-induced paw edema, acetic acid-induced writhing and formalin murine models. The acute toxicity was tested using the Lorke's method in mice. Results The EtOH extract was the most active for the antioxidant potential tests diphenyl-1-picrylhydrazyl (68.70% inhibition), ferric reducing/antioxidant power [(2 431.30 ± 102.10) mmol Fe2+ and total polyphenols content (215.80 ± 8.50) meqAG/g]. The anti-inflammatory activity was evaluated by topical application of croton oil (2 mg/ear dose) where the EtOH extract showed the strongest activity compared to the control group (45.13% inhibition), whereas in the phorbol 12-myristate 13-acetate model, at the same dose, the CHCl3 extract showed the highest inhibition (42.88%). In the carrageenan induced edema model, the EtOH extract showed a stronger inhibition compared to indomethacin (56.34% and 50.70% at doses of 250 and 500 mg/kg of extract, respectively) during the first hour. Similarly, the same extract showed the highest analgesic activity (30.60% inhibition) in the acetic acid contortion assay, and in the formalin test it showed a greater effect with respect to the control group in both phases. Conclusions Our work confirms the value of Ternstroemia sylvatica as an important anti-inflammatory and analgesic plant, whose mechanism seems to be associated to its antioxidant effects, and supports its uses in the Mexican traditional medicine.

1059–1064

Authors: Ebru Şebnem Yılmaz, Özkan Aslantaş

Objective To investigate the antimicrobial susceptibility of 97 clinical Staphylococcus aureus (S. aureus) strains against 14 antimicrobials and corresponding resistance mechanisms. Methods The antimicrobial susceptibility of the isolates was determined using a disk diffusion method and antimicrobial resistance genes were screened by polymerase chain reaction. Mutations responsible for ciprofloxacin and rifampicin resistance were investigated by polymerase chain reaction and DNA sequencing. Results All isolates were found to be susceptible to vancomycin. Various rates of resistance to penicillin (83.5%), ampicillin (77.3%), erythromycin (63.9%), tetracycline (16.5%), amoxicillin/clavulanic acid (16.5%), ciprofloxacin (15.5%), trimethoprim/sulfamethoxazole (15.5%), oxacillin (13.4%), fusidic acid (12.4%), rifampin (6.2%), clindamycin (6.2%), gentamicin (6.2%) and mupirocin (5.2%) were determined. In addition, different combinations of resistance genes were identified among resistant isolates. Ciprofloxacin resistant isolates had mutations in codon 84 (Ser84Leu) and 106 (Gly106Asp) in the gyrA gene. Mutations in grlA were mostly related to Ser80Phe substitution. Leu466Ser mutation in the rpoB gene was detected in all rifampin resistant isolates. All methicillin resistant S. aureus isolates were SCCmec type V. Conclusions In conclusion, it was determined that the isolates were resistant to different classes of antimicrobials at varying rates and resistance was mediated by different genetic mechanisms. Therefore, continuous monitoring of resistance in S. aureus strains is necessary to control their resistance for clinically important antimicrobials.

1072–1076

Authors: Mojtaba Shahnazi, Abbas Azadmehr, Moazzam Dosti Jondabeh, Reza Hajiaghaee, Reza Norian, Hamidreza Aghaei, Mehrzad Saraei, Mahmood Alipour

Objective To evaluate the possible involvement of programmed cell death strategy in hydatid cyst protoscolices following treatment with Myrtus communis (M. communis) as an herbal medicine. Methods Protoscolices were aseptically collected from sheep liver hydatid cysts. Evaluating the effect of M. communis extract on programmed cell death and increased activity of caspases 3, 8, and 9 in hydatid cyst protoscolices was conducted by treating the protoscolices with different concentration (5, 50, and 100 mg/mL) of M. communis extract at 37 °C and 5% CO2 for 4 h by using the Bradford test and ELISA commercial kits. Results The extract of M. communis at all concentrations led to initiation of programmed cell death in protoscolices and this effect, was only significant at 50 and 100 mg/mL concentrations, compared to the negative control (P < 0.05). Also, the activity of caspases 3, 8, and 9 in hydatid cyst protoscolices, was shown that the extract at all 3 concentrations could only increase the activity of caspases 3 and 9. Moreover, a significant increase in the activity of caspase 3 was only observed at concentrations 50 and 100 mg/mL by 37.00% and 66.19% while a significant increase in the activity of caspase 9 at the same concentrations was observed by 20.89% and 63.67%, respectively (P < 0.05). Conclusions The extract of M. communis at different concentrations could increase the activity of caspases 3 and 9 and caused programmed cell death in hydatid cyst protoscolices however, this effect was significant at high concentrations of the extract.

1080–1083

Authors: Clarissade Albuquerque Botura, Bruno Ambrósioda Rocha, Thiely Balensiefer, Franciele Queiroz Ames, Ciomar Aparecida Bersani-Amado, Roberto Kenji Nakamura Cuman

Objective To evaluate the efficacy of oral indomethacin, ibuprofen, and paracetamol in oral dosage form on patent ductus arteriosus (PDA) in premature neonates with significant clinical and hemodynamic repercussions (CHRs) and to determine the effect of these respective treatments on renal function. Methods A retrospective study of cases of PDA in premature neonates in the Neonatal Intensive Care Unit was conducted. The treatments consisted of indomethacin [0.2 mg/(kg·d), 3-day cycle], ibuprofen [10 mg/(kg·d) followed by 5 mg/(kg·d), 3-day cycle], and paracetamol (15 mg/kg every 6 h, 5-day cycle). The drugs were administered as an oral solution. The following variables were considered: gestational age, newborn weight at birth, Apgar score, diuresis, serum creatinine and urea levels, and serum electrolyte levels (sodium and potassium). Results Treatment with indomethacin presented efficacy of 87.5% in closure of the ductus with a mean outcome period of 3.5 d. In premature neonates with CHRs and contraindications for indomethacin, the initial treatment with either ibuprofen or paracetamol failed to close the ductus. However, when this treatment was followed by indomethacin, closure occurred in 66.7% of the neonates, with an outcome period of 9.66 d. The initial treatment with one cycle of ibuprofen followed by one or two cycles of paracetamol failed to close the ductus. Conclusions Oral indomethacin was effective for closure of the PDA in premature neonates with severe CHRs. Oral paracetamol or ibuprofen for PDA closure in premature neonates with severe CHRs and contraindications for indomethacin was ineffective. However, results in clinical improvements of neonates allowed the subsequent use of indomethacin and successful closure of the ductus. A significant reduction of diuresis occurred in neonates who were treated with indomethacin, either as a first-line treatment or after the failure of ibuprofen or paracetamol.

1090–1094

Authors: Jin-Feng Dong, Xiao-Qiang Zheng, Hong-Bing Rui

Objective To observe the effect of taurine on immune function in mice with T-cell lymphoma during chemotherapy. Methods A total of 40 C57BL/6 mice were selected and randomly divided into 4 groups, namely model group, chemotherapy group, taurine group and chemotherapy + taurine group, each containing 10 mice. Hypodermic injection was adopted to inoculate EL-4 cells in order to establish model of T-cell lymphoma. When the tumor achieved the size of 1 cm3, intervention treatments were given to the groups respectively. Mice in model group received 0.2 mL of normal saline which was intraperitoneally injected on Days 1, 8 and 15 with 3 weeks as a cycle; mice in chemotherapy group were administered with 80 mg/kg body weight of gemcitabine which was also intraperitoneally injected on Days 1, 8 and 15 with 3 weeks as a cycle; mice in taurine group were administered with 80 mg/kg body weight of taurine intraperitoneally injected daily for consecutive 8 d; mice in chemotherapy + taurine group were treated in the same manner as the mice in taurine group and chemotherapy group. Five mice were sacrificed at 2 and 3 weeks after intervention respectively, and the tumor tissues were collected and weighted after removal of auxiliary tissue, then the tumor inhibition rate was calculated. The thymus and spleen of mice sacrificed at 3 weeks after intervention were collected and weighted, and thymus and spleen indexes were calculated. Enzyme linked immunosorbent assay was used to detect the serum levels of IL-4, IL-10, IL-12 and IFN-γ in mice of each group. Results The tumor weights in chemotherapy group, taurine group and chemotherapy + taurine group after 2 and 3 weeks of treatment were significantly lower than that in model group (P < 0.05); the tumor weight in chemotherapy + taurine group after 2 and 3 weeks of treatment was significantly lower than that in chemotherapy group (P < 0.05); the tumor inhibition rate in chemotherapy + taurine group was significantly higher than that in chemotherapy group and taurine group (P < 0.05); the thymus and spleen indexes in taurine group and chemotherapy + taurine group were significantly higher than those in chemotherapy group and model group (P < 0.05); the thymus and spleen indexes in chemotherapy group were significantly lower than those in model group (P < 0.05); after 3 weeks of treatment, the serum levels of IL-4, IL-12 and IFN-γ in chemotherapy group, taurine group and chemotherapy + taurine group were significantly lower than those in model group (P < 0.05); the IL-4 level in taurine group and chemotherapy + taurine group was significantly lower than that in chemotherapy group (P < 0.05); the serum level of IL-10 in chemotherapy group and chemotherapy + taurine group was significantly higher than that in model group and taurine group (P < 0.05); the serum level of IFN-γ in taurine group and chemotherapy + taurine group was significantly lower than that in model group and chemotherapy group (P < 0.05); after treatment of 3 weeks, the serum levels of IL-4 and IL-10 in chemotherapy group, taurine group and chemotherapy + taurine group were significantly lower than those in model group (P < 0.05), and IL-12 level was significantly higher than that in model group (P < 0.05); the level of IFN-γ in taurine group and chemotherapy + taurine group was significantly higher than that in model group (P < 0.05), while the level of IFN-γ in chemotherapy group was significantly lower than that in the other 3 groups (P < 0.05). Conclusions Taurine can effectively enhance the immune function of mice with T-cell lymphoma during chemotherapy, reduce the toxicity of chemotherapy.

1101–1103

Authors: Diego Espinoza-Morales, Aldo Lucchetti Rodríguez, Wilmer Silva-Caso, Luis Suarez-Ognio, María J.Pons, Juanadel Valle Mendoza

We present an atypical case of disseminated cutaneous leishmaniasis in the Sihuas district, located in the Andean valleys of Ancash-Peru. A 62-year-old man with no particular medical history presented multiple lesions located on the inferior abdomen, lumbar region and the right anterior thigh. Histological analysis found leishmanial amastigotes in the lesion sample, the Montenegro reaction was positive for Leishmania spp, and the polymerase chain reaction was positive for Leishmania peruviana. In conclusion, the atypical presentation of this disease may be related to the presence of an uncommon parasite strain or host immune deficiencies. The molecular identification of the etiology for disseminated leishmaniasis, will allow a better understanding of the presentation and proper treatment, as well as associated risk factors.