Asian Pacific Journal of Tropical Medicine

296-304

Authors: Praneetha Kumar Nair, Kai Ern Koh, Christine Yvonne Bede, Lee Ai Ren Natasha, Mevuni Dinethma Mahanama, Thin Mon Kyaw, Htoo Htoo Kyaw Soe, Soe Moe, Kazi Majidur Rahaman, Mila Nu Nu Htay

Objective: To determine the frequency and severity of the breakthrough infections and the associated factors in Malaysia. Methods: This cross-sectional study was conducted among the adult general population in Malaysia who completed at least one dose of vaccination. The validated online questionnaires were used for data collection between December 2022 to February 2023. The participants were recruited by a convenient sampling method. The data were analysed by descriptive statistics, and logistic regression by using SPSS (Version 27). Qualitative data from open-ended questions were analysed as thematic analysis by using RQDA software. Results: A total of 524 participants' data were analyzed and 77.5% of them completed three doses of COVID-19 vaccination. Breakthrough infections after vaccination were reported in 57.3% of the participants. Age group of 18 and 30 years (aOR 2.32, 95% CI 1.01-5.32) and other ethnicities (aOR 2.00, 95% CI 1.02- 3.93) significantly associated with the occurrence of breakthrough infections. A total of 35.5% of the participants were not willing to take another booster dose in the future because of their attitudes towards fear of long-term side effects, lack of trust to the vaccine, less susceptibility to severe infection, belief in natural immunity, and myths. Conclusions: Future public health policies and interventions should be focused on disseminating the information about safety of booster doses of vaccine, management and re-assurance of side effects, and targeted vaccination to the working (younger age group) and ethnic minorities.

313-320

Authors: J. I. Abeynayake, G. P. Chathuranga, M.A.Y. Fernando, M. K. Sahoo

Objective: To surveill emerging variants by nanopore technology-based genome sequencing in different COVID-19 waves in Sri Lanka and to examine the association with the sample characteristics, and vaccination status. Methods: The study analyzed 207 RNA positive swab samples received to sequence laboratory during different waves. The N gene cut-off threshold of less than 30 was considered as the major inclusion criteria. Viral RNA was extracted, and elutes were subjected to nanopore sequencing. All the sequencing data were uploaded in the publicly accessible database, GISAID. Results: The Omicron, Delta and Alpha variants accounted for 58%, 22% and 4% of the variants throughout the period. Less than 1% were Kappa variant and 16% of the study samples remained unassigned. Omicron variant was circulated among all age groups and in all the provinces. Ct value and variants assigned percentage was 100% in Ct values of 10-15 while only 45% assigned Ct value over 25. Conclusions: The present study examined the emergence, prevalence, and distribution of SARS-CoV-2 variants locally and has shown that nanopore technology-based genome sequencing enables whole genome sequencing in a low resource setting country.

329-331

Authors: Sourav Kundu, Sambudhya Chakraborty

Rationale: Fungal rhinosinusitis is a rare entity in immunocompetent patients and is a diagnostic challenge. Conidiobolomycosis is a rare cause of fungal rhinosinusitis which happens to affect immunocompetent patients. Patient concerns: A 30-year-old male patient complained of painless progressive swelling of nose for 5 years and painless progressive swelling of upper lip for 4 years associated with nasal obstruction for 5 years. Diagnosis: Rhinofacial conidiobolomycosis. Interventions: Systemic anti-fungals and saturated solution of potassium iodide. Outcomes: Swelling initially reduced but again increased eventually as he discontinued treatment. Lessons: Proper adherence to drugs and need for facial reconstructive surgery may need to be considered in such cases of conidiobolomycosis.

243-244

Authors: Nitika Nitika, Shrikant Nema, Praveen Kumar Bharti

None.

253-260

Authors: Burak Mete, Tarik Salcan, Hakan Demirhindi

Objective: To investigate the perception of antibiotics, the frequency of inappropriate antibiotic use, and the factors that lead to inappropriate antibiotic use by parents who apply to primary healthcare organizations. Methods: This cross-sectional study included 973 parents who applied to primary healthcare centers. We analyzed basic concepts related to antibiotics prescribed for their children, antibiotic administration, and antibiotic resistance, as well as parents' knowledge and attitudes towards antibiotic use, and their experiences, practices, and perceptions related to purchasing antibiotics without prescription. Results: In the past one year, 78.9% of the parents gave antibiotics to their children at least once, and 39.1% gave antibiotics three or more times. Some of the participants (7.1%) reported having forced the physician to prescribe antibiotics and purchased antibiotics without a prescription (13.2%). The knowledge about antibiotics and awareness about antibiotic resistance were found to be more frequent; among parents who had university degrees, higher income levels, two or fewer children, social insurance and negative behaviours were lower in those who received information about antibiotics from healthcare professionals. The probability of taking antibiotics without prescription was lower in that of with higher income level (OR 0.460; 95% CI 0.219-0.965), and the probability of forcing antibiotic prescription was higher in those with 3 or more children (OR 6.94; 95% CI 2.37-20.26). The score obtained from the awareness of antibiotic resistance sub-dimension was found to negatively affect the behavior of forcing antibiotic prescription (OR 0.852; 95% CI 0.732-0.993) but the score obtained from the behaviour sub-dimension was positively affect this behaviour (OR 1.136; 95% CI 1.011-1.276). Conclusions: Inappropriate antibiotic use appears to be a problem with negative perception, lack of knowledge and socioeconomic dimension. Studies should be conducted to increase antibiotic knowledge in parents and to expand the scope of social insurance.

268-275

Authors: Aysun Yahşi, Gülsüm İclal Bayhan, Tuğba Erat, Ahmet Yasin Güney, Seval Özen, Kübra Konca, Belgin Gülhan, Saliha Kanık Yüksek, Aslınur Özkaya Parlakay

Objective: To investigate the clinical and epidemiological features and outcome of Chryseobacterium and Elizabethkingia spp. infections in children, together with antimicrobial susceptibilities. Methods: This retrospective study was conducted at a tertiary pediatric hospital in Turkey. All patients infected with Chryseobacterium/Elizabethkingia spp. among those presenting to Ankara City Hospital between March 2014 and March 2022 were included. Results: A total of 49 cases were included and 29 cases were identified as Elizabethkingia. The median age was 14 (0.2-185.0) months. The majority (89.8%) of these patients had an underlying disease, including malignancy (42.9%). Bacteremia (46.9%) and central line-associated bloodstream infection (28.6%) were the most common infections. The thirty-day all-cause mortality rate was 12.2%. The most commonly used antibiotics were ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Forty-five (91.8%) isolates were susceptible to ciprofloxacin, 44 (91.6%) to TMP-SMX, and 21 (87.5%) to levofloxacin. Conclusions: Chryseobacterium and Elizabethkingia spp. are emergent, nosocomial pathogens and the majority of cases were older than the neonatal period. They were mainly seen in patients with long hospital stays, indwelling devices, and those who have received antibiotics within the last month, especially carbapenems. In addition, they were associated with bloodstream infection and malignancy. The most commonly useful antibiotics according to the resistance patterns were ciprofloxacin and TMP-SMX.

284-286

Authors: Jeyapraniya Arumugam, Shamila De Silva

Rationale: Disseminated tuberculosis involves the central nervous system in up to a third of cases. However, meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together, particularly in the immuno-competent population. Patient concerns: A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month. Examination revealed spastic paraplegia and left hemiparesis. Diagnosis: Disseminated tuberculosis presenting with meningitis and spondylodiscitis. Interventions: Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered. Outcomes: There was clinical improvement after nine months of treatment. Lessons: Tuberculosis may present with atypical clinical manifestations. Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features, a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence, especially in extrapulmonary tuberculosis.

204-212

Authors: Changtai Wang, Huiqin Yang, Jielan Xu, Jian Wang, Lingzhai Zhao, Wenxin Hong, Fuchun Zhang

Objective: To identify the association between serum albumin levels and disease severity among adult patients with dengue in mainland China. Methods: This retrospective cohort study analyzed the data of adult patients (aged ≥ 18 years) hospitalized with laboratory-confirmed dengue in a tertiary center for infectious diseases from 2013 to 2019 in mainland China. Serum albumin levels were estimated and compared between patients with severe dengue and non-severe dengue. Additionally, the association between serum albumin levels and severe dengue was evaluated using a generalized linear model [relative risks (RR)]. Multivariate logistic regression analysis was performed to identify the potential predictors of severe dengue. Results: Overall, 1 568 patients were included in this study. Of these patients, 34 (2.17%) developed severe dengue. The median serum albumin levels were significantly lower in patients with severe dengue than that in those with non-severe dengue (33 g/L vs. 37 g/L, P<0.001). After adjustment for age, sex, and comorbidities, hypoalbuminemia (RR 4.877, 95% CI 2.193-11.461, P<0.001) was found to be a predictor of severe dengue. Serum albumin levels (OR 1.303, 95% CI 1.161-1.462, P<0.001)] and age (OR 1.038, 95% CI 1.017-1.061, P<0.001) were significant risk factors for severe dengue. The area under the curve for serum albumin levels to distinguish severe dengue was 0.787. Conclusions: Lower serum albumin levels were significantly associated with disease severity in adult patients with dengue. Hypoalbuminemia on admission resulted in at least a four-fold increased risk of severe dengue.

220-231

Authors: Nor Syaza Syahirah Amat Junaidi, Nik Noorul Shakira Mohamed Shakrin, Mohammad Fahmi Daman Huri, Ahmad Zakwan Kamarudin, Mohd Nasir Mohd Desa, Wan Mohd Zin Wan Yunus

Objective: To determine the antibiotic resistance profile (ARP) of Staphylococcus (S.) aureus isolates and molecular typing of the methicillin-resistant S. aureus (MRSA) isolates from Tuanku Mizan Armed Forces Hospital (TMAFH), Kuala Lumpur. Methods: The ARP and presence of the pvl gene were determined for 209 S. aureus isolates from clinical specimens. Of these, 123 were methicillin-susceptible S. aureus (MSSA) isolates and 86 were MRSA isolates. All MRSA isolates were characterized using SCCmec typing and spa typing. Descriptive analysis was performed to compare the demographic data with the phenotypic and genotypic variables of the S. aureus isolates. Results: No vancomycin-intermediate and -resistant S. aureus (VISA and VRSA, respectively) were detected among the study isolates. The MSSA isolates showed low resistance rates to all tested antibiotics, were commonly invasive (28/42, 66.7%), and mostly harboured pvl (35/42, 83.3%). Meanwhile, MRSA isolates showed high resistance to penicillin (86/86, 100%), ampicillin (86/86, 100%), sulbactam/ampicillin (86/86, 100%), cefuroxime (81/86, 94.19%), cefoperazone (76/86, 88.37%), azithromycin (56/86, 65.12%), and erythromycin (54/86, 62.79%). The majority of MRSA isolates were of SCCmec type IVh (65/86, 75.58%), spa type t032 (55/85, 63.95%), and grouped into spaCC-t022 (66/85, 77.65%). The t032 type was found to be associated with resistance traits to azithromycin and erythromycin (P<0.05). We also found several spa types that are typically associated with hospital-, community-, and livestock-associated MRSA co-existing in our MRSA population. Conclusions: This study reflected the consistent absence of VISA and VRSA and corroborated the clonal shifting of MRSA isolates in the Malaysian MRSA isolates.

239-240

Authors: Rupak Chatterjee, Dolonchampa Modak, Kumkum Sarkar, Shambo Samrat Samajdar, Netai Pramanik, Shatavisa Mukherjee, Bibhuti Saha

None.

148-161

Authors: Manish Thakur, Ranbir Sobti, Tejinder Kaur

There is considerable evidence from a wide range of sources, including written texts, preserved monuments, and natural plant medicines, that demonstrate the long history of humankind's search for medicinal substances in the natural world. The purpose of this article was to compare the performance of medicinal plant Thuja (T.) occidentalis in a variety of disease-relieving conditions. The current review draws on the work of nearly two hundred original research papers indexed in Google Scholar, ScienceDirect, and the NCBI Library. The authors gatherd all the accessible data on the therapeutic effects of T. occidentalis. Although there are no published randomized controlled trials of T. occidentalis alone so far, multiple clinical investigations have validated the therapeutic efficacy of a combination herbal medication including the extract of T. occidentalis and additional immune stimulants. T. occidentalis is a plant with great potential as it is widely used in both traditional homoe¬opathy and modern, evidence-based phytotherapy. In vitro and in vivo models have shown its immunopharmacological potential, including its immunostimulatory, anti-cancer, anti-bacterial, anti-fungal, and antivi¬ral activities. More researches into these plants might be done to find out if any of them have the potential to be implemented as a novel drug to treat a wide range of conditions.

169-175

Authors: Oki Nugraha Putra, Yulistiani Yulistiani, Soedarsono Soedarsono, Susi Subay

Objective: To evaluate early efficacy of sputum conversion within 6 months of individual regimens containing bedaquiline in patients with drug resistant tuberculosis. Methods: We conducted a retrospective study among patients with drug resistant tuberculosis who were receiving individual regimens containing bedaquiline. The primary outcome was sputum conversion of both smear and culture within 6 months of treatment. We used medical records of drug resistant tuberculosis patients from January 2020 to December 2021. The study was conducted at Dr. Soetomo Hospital, Indonesia from August to October 2022. Results: In this study, 44 eligible drug resistant tuberculosis patients were initiated on regimens containing bedaquiline. There were 52.3% males and the median age was 45.5 years. The rates of previous treatment (70.5%) and lung cavity (36.4%) were high. The most common companion drugs included clofazimine, cycloserine, levofloxacin, and linezolid. Sputum smear and culture conversion was seen in 79.4% and 82.1% at the 2nd month, respectively. More than 97% patients had smear and culture conversion at the end of 6 months. Conclusions: Among drug resistant tuberculosis patients, individual regimens containing bedaquiline were associated with high rates of smear and culture conversion at the end of 6 months. Early efficacy of regimens containing bedaquiline can be used to predict cure rate at the end of treatment.

187-189

Authors: Tukaram Bolla, Sushmita Bhattarai, Harpreet Singh, Vikas Suri, Ashish Bhalla, Debajyoti Chatterjee

Rationale: Fever with myositis and rhabdomyolysis is a medical emergency requiring prompt diagnosis and management. Scrub typhus associated myositis with rhabdomyolysis is rare. Patient concerns: A 36-year-old female presented with intermittent fever up to 38.6 ℃, jaundice and progressive weakness of all four limbs. Diagnosis: Scrub typhus associated myositis and rhabdomyolysis. Intervention: Doxycycline 100 mg twice daily and injection of ceftriaxone 1 gm twice daily along with continuous intravenous fluids. Outcome: Fever resolved with normalization of liver function and recovery of muscle power. Lessons: Presence of myositis and rhabdomyolysis is uncommon in scrub typhus; high clinical suspicion should be kept in patients with atypical manifestations of scrub typhus.

99-101

Authors: Eunice A Owino

None.

110-118

Authors: Abdulsamet Sandal, Aylin Güngör Cifci, Peri M Arbak

Objective: To evaluate the COVID-19 vaccination status and related characteristics of Turkish healthcare workers practicing chest medicine. Methods: A cross-sectional online survey was conducted among the Turkish Thoracic Society members. The survey was started on May 17, 2021, and kept open for seven weeks. The 39-item survey included the COVID-19 vaccination status and demographic, clinical, and occupational characteristics. Results: Of 378 healthcare workers participated in the survey, 354 (93.7%) reported receiving at least one dose of the COVID-19 vaccine. A total of 323 (91.2%) healthcare workers received CoronaVac vs. BioNTech/Pfizer in 31 (8.8%). In the CoronaVac group, 77 (23.8%) contracted COVID-19 when not fully vaccinated, and 13 (4.0%) when fully vaccinated; however, 16 (51.6%) healthcare workers in the BioNTech/Pfizer group got COVID-19 when not fully vaccinated, but any fully vaccinated participants did not contract COVID-19 (P=0.003). Regarding vaccine dosing, 328 (86.8%) were fully vaccinated, while 50 (13.2%) were not. Multiple regression analysis for being a non-fully vaccinated healthcare worker demonstrated a significant relationship with having any SARS-CoV-2 infection history (adjusted OR 9.57, 95% CI 3.93- 23.26, P<0.001) and being a non-physician healthcare worker (adjusted OR 5.86, 95% CI 2.11-16.26, P=0.001), but a significant negative relationship with full-time working at the time of survey (adjusted OR 0.13, 95% CI 0.03-0.56, P=0.006). Conclusions: Although a majority of healthcare workers were fully vaccinated, occupational and non-occupational characteristics were related to being non-fully vaccinated. Active surveillance regarding the COVID-19 vaccination in healthcare workers is necessary to address specific parameters as barriers to vaccination.

129-138

Authors: Ishrat Rahman, Afrah Mohammed, Manal A. AlSheddi, Alanoud Algazlan, Alanoud Alwably, Mamata Hebbal, Maha Galal Omar

Objective: To assess the clinical anti-inflammatory and antimicrobial efficacy of Nigella sativa oil compared with chlorhexidine in patients with gingivitis. Methods: A double-blind, randomized clinical trial was conducted in patients having chronic generalized gingivitis. Patients were randomly assigned to receive Nigella sativa oil (n=18) or chlorhexidine (n=19). The following assessments were made on day 0 and day 15: plaque index, gingival index, gingival IL-6 and IL-18 levels were measured using ELISA, plaque colony-forming units, and alpha-hemolytic Streptococcus strains. Data were analyzed using parametric and non-parametric tests and Fisher's exact test. Results: Both interventions reduced plaque index and gingival index scores (P<0.000 1). The Nigella sativa oil group was better at lowering IL-6 (P=0.007 6) than the chlorhexidine group (P=0.145), although there was no change in IL-18 levels (P>0.05). The post-intervention plaque index and gingival index scores and inflammatory cytokine levels between the two groups were not significantly different. Both interventions caused a significant reduction in the plaque colony-forming units (P<0.000 1), reducing pathogenic bacteria: Streptococcus mitis, Streptococcus oralis, Streptococcus sanguinis, and Streptococcus parasanguinis in the chlorhexidine group (50%) (P=0.103 1), and the Nigella sativa oil group (20%) (P=0.739 5). Conclusions: Nigella sativa oil had anti-inflammatory and antibacterial activities, reducing biofilm formation and disrupting the colonization of pathogenic bacteria essential for the progression of periodontal disease. Nigella sativa oil could offer an alternative therapy for treating gingivitis and may prevent associated systemic diseases and improve overall health outcomes.

143-144

Authors: Abdullah, Riaz Muhammad, Muhammad Salman, Abid Hussain, Amin Ullah, Muddasir Khan

None.