Asian Pacific Journal of Tropical Medicine

385-399

Authors: Aashna Sinha, Sudhashekhar Kumar, Deen Dayal, Vaishali Yadav, Atreyi Pramanik, Kundan Kumar Chaubey, Sanjay Kumar

Lymphatic filariasis (LF), an asymptomatic, acute, and chronic condition in human beings, is the second most common vector-borne disease after malaria. According to the World Health Organization, there are 120 million LF cases detected in 81 tropical and subtropical countries, and one billion people are at risk. Therefore, the Global Program to Eliminate Lymphatic Filariasis was launched in 2000, with the primary objective of stopping LF transmission among all at-risk groups using mass drug administration (MDA), managing morbidities, and preventing LF-related impairments using a minimum treatment package. Additionally, other programs such as epidemiological assessment including National Filaria Control Program and World Health Organization recommended routine and pre-MDA microfilaremia surveys also implemented to stop the LF transmission. The routine filaria surveys were also carried out in around 2 000-4 000 individuals/month throughout the year whereas pre-MDA surveys were also conducted every year in approximately 4 000 individuals in four fixed and four random sites. Furthermore, the Transmission Assessment Survey was also conducted to check the risk of LF among primary school children. Moreover, potential diagnostic methods, systematic surveillance regimes, the Direct Network Report system, and regular trainings and awareness may be also effective in preventing the recurrence of LF. Hence, this review emphasizes the potential advocacy tools and various strategies as well as procedures for monitoring, which could be impactful in eliminating LF.

409-417

Authors: Zainul Khaqiqi Nantabah, Rofingatul Mubasyiroh, Antonius Yudi Kristanto, Lely Indrawati, Astridya Paramita,Dwi Hapsari Tjandrarini, Agung Dwi Laksono

Objective: To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services (FHFS) in Indonesia. Methods: This cross-sectional study analyzes national representation data. Meanwhile, the study involved 9 846 representative respondents in 2019. Respondent’s satisfaction with FHFS based on the five dimensions of service quality (SERVQUAL) is a dependent variable. Independent variables consist of sex, marital status, age, education, employment, insurance ownership, and economics. The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality. Results: 77.3% Respondents were satisfied with FHFS, with the highest order of satisfaction dimensions being assurance (59.4%), empathy (57.3%), reliability (53.6%), responsiveness (52.7%), and then tangibility (49.1%). Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied (95% CI 1.17-1.87). Employees were 0.77 less likely than the unemployed to get satisfied (95% CI 0.70-0.86). Respondents with higher education was 0.82 less likely than those with primary education to be satisfied (95% CI 0.67-0.99). Meanwhile, respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied (95% CI 1.42-1.80). Moreover, the rich were 0.82 less likely than the poor to get satisfied (95% CI 0.73-0.92). Conclusions: Community satisfaction with FHFS is generally high, though some areas could be improved. Demographic factors are still strongly related to satisfaction ratings. The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society, ensuring that service satisfaction is rated as good by all groups.

425-427

Authors: Harpreet Singh Pawar, Itu Singh, Harish Kumar Sagar

Rationale: Leprosy, a chronic granulomatous disease often present clinically as erythema nodosum leprosum, a type 2 reaction. The involvement of cochlear part of audiovestibular system is a rarity. Patient concerns: A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss (SNHL) during type 2 reactional episode. Diagnosis: Recurrent erythema nodosum leprosum in rifampicin- resistant lepromatous leprosy. Interventions: Corticosteroids and second-line multidrug therapy. Outcomes: The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss. Lessons: The hearing impairment is a rare complication of type 2 reaction. Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required. All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.

337-346

Authors: Yasser Ali Kamal, Seham Abdelwakeel Abdel-Gaber

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

354-362

Authors: Nurhayat Yakut, Zeynep Ergenc, Sevgi Aslan Tuncay, Sezin Bayraktar, Elvan Sayin, Arzu Ilki, Eda Kepenekli

Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility of S. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573- 18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.

371-378

Authors: J. Y. Kumari, L.D. Amarasinghe, H.A.K. Ranasinghe

Objective: To determine the prevalence of tick-borne pathogens with a particular focus on Rickettsia spp. in ticks collected from cattle in Gauteng and Limpopo Provinces, South Africa. Methods: A total of 200 ticks were collected from cattle within the Madala livestock, Pretoria, Gauteng Province and in Mankweng Township, Polokwane, Limpopo Province in 2019. The ticks were morphologically identified and processed individually for a total genomic DNA extraction. Specific primers targetting ompA, ompB, and the 17KDa genes were used for a molecular screening and delineation of Rickettsia from the extracted genetic materials using polymerase chain reaction (PCR) technique. PCR amplicons of positive samples were sequenced bidirectionally using the Sanger sequencing method. Sequences generated were processed and analysed using appropriate bioinformatics software. Results: The ticks were morphologically identified as Amblyomma spp. PCR profiling of the genomic DNA samples revealed the presence of the Rickettsia pathogen in 42 (21%) of the ticks collected from both Provinces. Out of the genes profiled, 14 (7%) were positive for 17KDa, 42 (21%) for ompA and 32 (16%) were positive for ompB genes respectively. The nucleotide blast of the sequenced genomes showed high similarity, as high as 100% with other reference Rickettsia (R.) africae in the GenBank. The phylogenetic analysis of the sequences further validated them as R. africae with their characteristic clustering pattern with related reference sequences. Conclusions: There is an abundance of R. africae in Amblyomma ticks collected from cattle in the study areas. This has serious public health implications as individuals who accidentally get infested with the ticks could acquire R. africae. Hence, adequate precautions in terms of sensitization of farmers about the risk and mass mobilization drive to control the vectors in the areas are highly recommended to safeguard public health.

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.