Asian Pacific Journal of Tropical Medicine

383-384

Authors: Qazi Syed Muhammad Ali, Mustafa Ashiq Husain

None.

401-409

Authors: Vetriselvan Subramaniyan, Shivkanya Fuloria, Hari Kumar Darnal, Dhanalekshmi Unnikrishnan Meenakshi4, Mahendran Sekar5, Rusli Bin Nordin1, Srikumar Chakravarthi, Kathiresan V. Sathasivam, Shah Alam Khan, Yuan Seng Wu, Usha Kumari, Kalvatala Sudhakar, Rishabha Malviya, Vipin Kumar Sharma, Neeraj Kumar Fuloria

In the current pandemic, COVID-19 patients with predisposing factors are at an increased risk of mucormycosis, an uncommon angioinvasive infection that is caused by fungi with Mucor genus which is mainly found in plants and soil. Mucormycosis development in COVID-19 patient is related to various factors, such as diabetes, immunocompromise and neutropenia. Excessive use of glucocorticoids for the treatment of critically ill COVID-19 patients also leads to opportunistic infections, such as pulmonary aspergillosis. COVID-19 patients with mucormycosis have a very high mortality rate. This review describes the pathogenesis and various treatment approaches for mucormycosis in COVID-19 patients, including medicinal plants, conventional therapies, adjunct and combination therapies.

417-428

Authors: Xiayu Xiang, Chuanyi Liu, Yanchun Zhang, Wei Xiang, Binxing Fang

Objective: To determine the most influential data features and to develop machine learning approaches that best predict hospital readmissions among patients with diabetes. Methods: In this retrospective cohort study, we surveyed patient statistics and performed feature analysis to identify the most influential data features associated with readmissions. Classification of all-cause, 30-day readmission outcomes were modeled using logistic regression, artificial neural network, and EasyEnsemble. F1 statistic, sensitivity, and positive predictive value were used to evaluate the model performance. Results: We identified 14 most influential data features (4 numeric features and 10 categorical features) and evaluated 3 machine learning models with numerous sampling methods (oversampling, undersampling, and hybrid techniques). The deep learning model offered no improvement over traditional models (logistic regression and EasyEnsemble) for predicting readmission, whereas the other two algorithms led to much smaller differences between the training and testing datasets. Conclusions: Machine learning approaches to record electronic health data offer a promising method for improving readmission prediction in patients with diabetes. But more work is needed to construct datasets with more clinical variables beyond the standard risk factors and to fine-tune and optimize machine learning models.

341-349

Authors: Md. Iftakhar Parvej, Samina Sultana, Mimma Tabassum, Seefat E Mannan, Firoz Ahmed

Objective: To identify the acceptance of the vaccine based on factors influencing the vaccination program and the side effects from vaccinated people. Methods: A cross-sectional online survey of 1 529 Bangladeshi adults (≥18 years) was conducted between 17 April, 2021 and 26 April, 2021. Statistical analysis of the data included Chi-square test and multinomial logistic regression analysis. Results: In total, 67.04% of the participants were willing to accept a COVID-19 vaccine, and 45.00% of them in our study had already received. Overall Bangladeshi people were more likely to accept COVID-19 vaccine if the vaccine reduces risk of infectious disease and has no associated health risk after receiving it. Among the respondents, religions, education level, living area (urban), belif that vaccines protect against infectious diseases and vaccines do not have health-related risk and vaccination was significantly associated with the acceptance of COVID-19 vaccines. Conversely, people’s perception on development of natural immunity rather than receiving vaccines was also positively reflected. More than half (57.41%) reported minor side effects such as fever, muscle pain and headache after getting vaccine shots. Conclusions: This study revealed that the acceptance rate was influenced by socio-demographic and health-related characteristics and people are not afraid of this vaccine if they faced minor side effects after receiving it. These findings might help the government and policymakers of Bangladesh to implement necessary steps to accomplish this vaccination program effectively.

356-363

Authors: Kamaruddin Mardhiah, Nadiah Wan-Arfah, Nyi Nyi Naing, Muhammad Radzi Abu Hassan, Huan-Keat Chan

Objective: To identify the predictors of mortality among in-hospital melioidosis patients. Methods: A total of 453 patients in Hospital Sultanah Bahiyah, Kedah, and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis were retrospectively included in the study. Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis. The analysis was performed using STATA/SE 14.0. Results: A total of 50.11% (227/453) of the patients died at the hospital, and a majority (86.75%, 393/453) of cases were bacteremic. The logistic regression estimated that the bacteremic type of melioidosis, low platelet count, abnormal white blood cell counts, and increased urea value were predictors of mortality. The results showed that bacteremic melioidosis increased the risk of death by 4.39 times (OR 4.39, 95% CI 1.83-10.55, P=0.001) compared to non-bacteremic melioidosis. Based on laboratory test, the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease [high white blood cell (>10伊109 /L): OR2.43, 95% CI 1.41-4.17, P<0.001; low white blood cell (<4伊109 /L): OR3.82, 95% CI 1.09-13.34, P=0.036; low platelet (<100伊109 /L): OR4.19, 95% CI 1.89-9.30, P<0.001; high urea (>7 800 µmol/L): OR5.53, 95% CI 2.50-12.30, P<0.001; and low level of urea (<2 500 µmol/L): OR 3.52, 95% CI 1.71-7.23, P=0.001). Conclusions: Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.

375-377

Authors: Vorada Sakulsaengprapha, Mary Kay Alford, Wikrom Karnsakul

Rationale: Hepatitis C in the pediatric population is a large health burden globally. With its diverse genotypes as well as genotypic subtypes, there is a discrepancy in the genotypes used in research compared to their prevalence. HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide, but make up a minority of cases studied in HCV research. Patient concerns: We report a case of HCV-6 seen in an 11-year old Burmese immigrant to the U.S. and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6. Interventions: The patient completed a 12-week course of ledipasvir/sofosbuvir (90 mg/400 mg), per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6, without any complications. Outcomes: The patient was treated successfully with an undetectable HCV viral load one month after treatment completion. Lessons: HCV-6, although previously uncommon in the U.S., is becoming more prevalent. Updated guidelines include the use of direct acting antivirals, which have been proven effective for HCV-6. Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.

299-308

Authors: Surachet Benjathummarak, Atsushi Yamanaka, Thanyaluk Krasae, Chonlatip Pipattanaboon, Subenya Injampa, Pannamthip Pitaksajjakul, Pongrama Ramasoota

Objective: To evaluate the expression of DNA plasmid-harboring modified antibody gene that produces neutralizing human monoclonal antibodies against four serotypes of dengue virus (DENV) without enhancing activity in BALB/c mice. Methods: We constructed pFUSE-based vectors (pFUSE_1G7C2_ hVH and pFUSE_1G7C2_hVL) containing genes encoding the variable domains of the heavy or light chain of the anti-dengue virus antibody 1G7C2, a human IgG1 that has been characterized for its neutralizing activity to DENV-1-4. Leucine (L) at positions 234 and 235 on the Fc CH2 domain in pFUSE_1G7C2_hVH was mutated to alanine (A) (LALA mutation) by site direct mutagenesis, and the new plasmid was termed pFUSE_1G7C2_hVH_LALA. An equal amount of pFUSE_1G7C2_hVL and 1G7C2_hG1-LALA plasmids were co-transfected into Chinese hamster ovary cells (CHO-K1) and a single dose of 100 µg 1G7C2_hG1-LALA plasmid was intramuscularly injected, followed by electroporation in BALB/c mice. The secreted 1G7C2_hG1-LALA antibodies in cell culture supernatant and mouse serum were examined for their biological functions, neutralization and enhancing activity. Results: The co-transfection of heavy- and light-chain 1G7C2_ hG1-LALA plasmids in CHO-K1 cells produced approximately 3 900 ng/mL human IgG and neutralized 90%-100% all four DENV, with no enhancing activity. Furthermore, the modified human IgG was produced more than 1 000 ng/mL in mouse serum on day 7 post plasmid injection and showed cross-neutralization to four DENV serotypes. Subsequently, antibody production and neutralization decreased rapidly. Nevertheless, the secreted neutralizing 1G7C2_ hG1-LALA in mouse serum demonstrated complete absence of enhancing activities to all DENV serotypes. Conclusions: These findings reveal that a new modified 1G7C2_ hG1-LALA expressing plasmid based on gene transfer is a possible therapeutic antibody candidate against DENV infection.

316-322

Authors: Sayed Nassereddin Mostafavi, Soodabeh Rostami, Zary Nokhodian, Behrooz Ataei, Azam Cheraghi, Parisa Ataabadi, Naser Almasi, Zohreh Norouzi, Roya Kelishadi

Objective: To determine the antibiotic resistance patterns of the Acinetobacter (A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source (hospital/ community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS. Results: From 254 patients who had confirmed A. baumannii complex infection, 158 (62.20%) cases were male, 27 (10.63%) were less than 20 years old, 172 (67.72%) had healthcare-associated infections and 96 (37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections (111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics (more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline (20, 44.44%) and colistin (0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance (MDR) were significantly different between males and females. In patients with healthcare associated infection (HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses. Conclusions: In our study, a high level of antibiotic resistance was detected in both community-acquired and healthcare-associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

330-332

Authors: Dhanasekaran Sivaraman, Kagithakara Vajravelu Leela, Venkatesalu Venugopal

None.

254-265

Authors: Mohammad Ali Hamidinejad, Hadi Esmaeili Gouvarchin Ghaleh, Mahdieh Farzanehpour, Masoumeh Bolandian, Ruhollah Dorostkar

Crimean-Congo hemorrhagic fever virus (CCHFV) is responsible for widespread tick-borne zoonotic viral disease CCHF in African, Middle Eastern, Asian, and European countries. CCHFV can be spread to humans through tick bites or contact with infected animals or humans, and it often progresses from asymptomatic to severe/lethal illness, with fatality rates ranging from 10% to 40% in humans. Today, CCHF is growing into a significant public health concern due to its very high prevalence, severity of the condition, and lack of available vaccines and specific treatments. Recent research has been drawn towards a more accurate study of CCHFV characteristics, including the structure, genetic diversity, mechanisms involved in pathogenesis and immunopathogenesis, and clinical features. In addition, the use of animal models (mouse and non-human primates) and advanced diagnostic tools in recent years has resulted in a significant advance in CCHF related studies. In this context, we summarized the latest findings about CCHF research, its health complications, animal models, current diagnosis, vaccination, and CCHF treatments, and therapeutic strategies. Furthermore, we discussed existing deficiencies and problems in CCHFV analysis, as well as areas that still need to yield conclusive answers.

274-280

Authors: Ning Ding, Yang Zhou, Guifang Yang, Xiangping Chai

Objective: To predict the in-hospital incidence of acute respiratory distress syndrome (ARDS) in COVID-19 patients by developing a predictive nomogram. Methods: Patients with COVID-19 admitted to Changsha Public Health Centre between 30 January 2020, and 22 February 2020 were enrolled in this study. Clinical characteristics and laboratory variables were analyzed and compared between patients with or without ARDS. Clinical characteristics and laboratory variables that were risk factors of ARDS were screened by the least absolute shrinkage and selection operator binary logistic regression. Based on risk factors, a prediction model was established by logistic regression and the final nomogram prognostic model was performed. The calibration curve was applied to evaluate the consistency between the nomogram and the ideal observation. Results: A total of 113 patients, including 99 non-ARDS patients and 14 ARDS patients were included in this study. Eight variables including hypertension, chronic obstructive pulmonary disease, cough, lactate dehydrogenase, creatine kinase, white blood count, body temperature, and heart rate were included in the model. The area under receiver operating characteristic curve, specificity, sensitivity, and accuracy of the full model were 0.969, 1.000, 0.857, and 0.875, respectively. The calibration curve also showed good agreement between the predicted and observed values in the model. Conclusions: The nomogram can be used to predict the in-hospital incidence of ARDS in COVID-19 patients.

285-286

Authors: Resat Ozaras, Altan Bayar, Niiar Alioglu, Semiha Baysoy

None.

195-208

Authors: Samar Habib, Manar Azab, Khaled Elmasry, Aya Handoussa

Leishmania donovani is one of the causative agents of visceral leishmaniasis. The immune response against Leishmania depends on CD4+ T helper type 1 cells. The immune system is unable to combat Leishmania because the parasite can exert several immune suppressive mechanisms that facilitate escaping the immune responses. One of these mechanisms is the up-regulation of programmed death-1/programmed death ligand-1 pathway which causes T cells to undergo exhaustion. Autophagy is strongly linked to the immune response, with some research indicating that activating autophagy reduces the immune response to some intracellular pathogens, while others indicate that activating autophagy limits the growth of intracellular pathogens. Leishmania was found to subvert the host defense mechanisms for its own persistence, such as Leishmania-induced autophagy modulation. Leishmania was reported to activate autophagy in different studies, thus getting a dual benefit by evading the immune system and simultaneously utilizing the autophagy byproducts as nutrients. In this review, we introduced different immune evasion/suppressive mechanisms used by Leishmania, and different immunotherapies which were developed accordingly. We focused on the programmed death-1/programmed death ligand-1 pathway as well as autophagy with the potential interplay of both mechanisms.

214-222

Authors: Vipavinee Cheypanya, Pheravut Wongsawad, Chalobol Wongsawad, Nattawadee Nantarat

Objective: To examine and study the morphology, epidemiology, and molecular phylogeny of Anisakis larvae in blue mackerel [Scomber australasicus (Cuvier, 1832)] and Indian mackerel [Rastrelliger kanagurta (Cuvier, 1816)] using light microscope, scanning electron microscope, molecular phylogeny, and species delimitation methods for confirmation and investigation of Anisakis species and their evolutionary relationship. Methods: A total of 90 fish (45 per species) were purchased from a department store in Chiang Mai, Thailand. Anisakis samples were investigated for morphological characteristics using light and scanning electron microscopes. Molecular phylogeny and species delimitation methods based on the cox2 gene were performed. Results: The prevalence, mean intensity (Mean±SEM), and mean abundance of Anisakis larvae (Mean±SEM) in blue mackerel were 77.78%, 6.74±1.320, and 5.24±1.107, respectively, and in Indian mackerel, these values were 13.33%, 2.50±0.764, and 0.33±0.159, respectively. Scanning electron microscopy showed the detail of morphological characteristics and provided the different shapes of mucron and excretory pores in Anisakis larvae congruent with the phylogenetic tree. The species tree was congruent with the phylogenetic tree. Conclusions: The prevalence, mean intensity, and mean abundance of Anisakis larvae were higher in blue mackerel. To the best of our knowledge, this is the first time that Anisakis pegreffii was found in blue mackerel in Thailand. The phylogenetic tree also supported the morphological data of Anisakis larvae. However, species delimitation based on cox2 revealed 1-3 possible cryptic species in this genus. Anisakis spp. contamination of fish products is unpleasant and a health concern considering human infection with larvae (anisakiasis) arises.

231-233

Authors: Sara Iqbal, Humza Thobani, Saulat Fatimi

Rationale: Salmonella (S.) typhi is a rare cause of osteomyelitis in immunocompetent adults. Extensive drug resistance (XDR) may lead to more complicated cases of S. typhi osteomyelitis. Patient concern: A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months. Her symptoms had been unresponsive to previous anti-microbial therapy. Diagnosis: Rib osteomyelitis caused by XDR S. typhi. Interventions: Surgical wound debridement, left 7th-9th rib resection and intravenous 桇 meropenem were done. Outcome: Fever resolved and left-sided swelling resected without recurrence. Lessons: The prevalence of XDR S. typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.

236-237

Authors: Mahadevan Ganesan, Jagannathan Renganathan, Vaithiyanadhaswamy Vasuki, Raj Joseph

None.

239-240

Authors: Giao Huynh, Thien Thuan Tran, Han Thi Ngoc Nguyen, Le An Pham

None.