Asian Pacific Journal of Tropical Medicine

241-253

Authors: Wei Song, Jie Wei, Xiangdong Jian, Deren Wang, Yanhong Ouyang, Yuanshui Liu, Xianjin Du, Ying Chen, Yingqi Zhang, Heping Xu, Shuming Xianyu, Qiong Ning, Xiang Li, Xiaotong Han, Feng Zhan, Tao Yu, Wenteng Chen, Jun Zhang, Wenwei Cai, Sheng’ang Zhou, Shengyang Yi, Yu Cao, Xiaobei Chen, Shunjiang Xu, Zong’an Liang, Duohu Wu, Fen Ai, Zhong Wang, Qingyi Meng, Yuhong Mi, Sisen Zhang, Rongjia Yang, Shouchun Yan, Wenbin Han, Yong Lin, Chuanyun Qian, Wenwu Zhang, Yan Xiong, Jun Lv, Baochi Liu, Yan Cao, Xiaojun He, Xuelian Sun, Yufang Cao, Tian’en Zhou

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID- 19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

266-273

Authors: Morteza Shakhsi Niaee, Peyman Namdar, Abbas Allami, Leila Zolghadr, Amir Javadi5 , Amin Karampour3 , Mehran Varnaseri6 , Behzad Bijani7 , Fatemeh Cheraghi1 , Yazdan Naderi8 , Fatemeh Amini9 , Masoumeh Karamyan, Mohammad Jafar YadYad, Ramin Jamshidian, Nematollah Gheibi

Objective: To evaluate different doses of ivermectin in adult patients with mild COVID-19 and to evaluate the effect of ivermectin on mortality and clinical consequences. Methods: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed at five hospitals. A total of 180 mild hospitalized patients with COVID-19 confirmed by PCR or chest image tests were enrolled and allocated to six arms including hydroxychloroquine 200 mg twice per day, placebo plus hydroxychloroquine 200 mg twice per day, single dose ivermectin (200 µg/kg), three low interval doses of ivermectin (200, 200, 200 µg/kg), single dose ivermectin (400 µg/kg), and three high interval doses of ivermectin (400, 200, 200 µg/kg). The primary endpoint of this trial was all-cause of mortality or clinical recovery. The radiographic findings, hospitalization and low O2 saturation duration, and hematological variables of blood samples were analyzed. Results: A total of 16.7% (5/30) and 20.0% (6/30) patients died in arms treated with hydroxychloroquine 200 mg twice per day and placebo plus hydroxychloroquine 200 mg twice per day, respectively, and a reduction in mortality rate in patients receiving ivermectin treatment to 0%, 10%, 0% and 3.3% for arms 1-4 were observed. Risk of mortality was also decreased about 15% in the ivermectin treated arms. Conclusions: Ivermectin as an adjunct reduces the rate of mortality, time of low O2 saturation, and duration of hospitalization in adult COVID-19 patients. The improvement of other clinical parameters shows that ivermectin, with a wide margin of safety, had a high therapeutic effect on COVID-19.

281-284

Authors: Camila F Araújo, Iara B N Oliveira, Murilo B Silveira, Fátima Ribeiro-Dias

Rationale: Co-infection of human immunodeficiency virus (HIV) and Leishmania spp. has impact on clinical and therapeutic outcomes of leishmaniases. Most studies do not present the identification of Leishmania species causing American tegumentary leishmaniasis in co-infections. In the Americas, Leishmania (L.) Viannia (V.) braziliensis and L. (V.) guyanensis have been identified. Patient concerns: In this study, two cases of American tegumentary leishmaniasis in patients infected with HIV are described. Patients presented several lesions with rapid dissemination and mucosal involvement. Diagnosis: Disseminated cutaneous leishmaniasis caused by L. amazonensis was identified by molecular test. Interventions: The patients were treated with conventional therapies for HIV infection and American tegumentary leishmaniasis. Outcomes: In co-infection, the clinical manifestations are atypical and the treatment response can be impaired. Lessons: These cases show that HIV infection impacts L. amazonensis infection and point to the relevance of identifying Leishmania species, which can lead to a better patient management.

193-194

Authors: Simi Thankappan, Sherin Nedumpillil

None.

209-213

Authors: Ashok Kumar Pannu, Atul Saroch, Saurabh Chandrabhan Sharda, Manoj Kumar Debnath, Manisha Biswal, Navneet Sharma

Objective: To study the spectrum and outcome of severe scrub typhus in adult patients and to predict the hospital mortality by organ failure on admission. Methods: This was a prospective observational cohort study conducted between July 2017 and October 2020 at the medical emergency centre of PGIMER, Chandigarh, India. One hundred and twenty-six patients aged ≥13 years were diagnosed with scrub typhus. Severe disease was defined as the presence of organ failure based on the Sequential Organ Failure Assessment (SOFA) score on admission. Results: About two-thirds of the patients were from geographic regions outside the endemic sub-Himalayan belt. Fever (99.21%) and dyspnea (79.36%) were the most frequent complaints. Respiratory failure (81.75%) was the most common organ failure, followed by hepatic (52.38%), coagulative (47.62%), circulatory (33.33%), renal (21.43%), and cerebral dysfunction (13.49%). The median (Q1, Q3) SOFA score was 8 (6, 9), and 48.41% of the patients had a quick-SOFA score ≥2. Organ supports with invasive ventilation (40.48%), vasopressors (36.51%), and renal replacement therapy (7.14%) were frequently required. The in-hospital mortality was 11.90% and was independently predicted by circulatory and hepatic failures on multivariate logistic regression (OR 11.12, 95% CI 1.73-71.31 and OR 8.49, 95% CI 1.18-61.41, respectively). Conclusions: Most patients had pulmonary dysfunction; circulatory or hepatic failure on admission strongly predicts death.

223-230

Authors: Rahimeh Abdoli, Hasan Bakhshi, Sedigheh Kheirandish, Faezeh Faghihi, Asadollah Hosseini-Chegeni, Mohammad Ali Oshaghi, Zakkyeh Telmadarraiy, Mohammad Mehdi Sedaghat

Objective: To estimate the infection of ticks to Anaplasma, Ehrlichia, Babesia, Theileria, and Brucellaceae using molecular methods in borderline of Iran, Azerbaijan, and Armenia. Methods: Totally, 2 022 ticks were collected from different livestock. Then, species were diagnosed under stereomicroscope according to valid morphological keys. Tick DNA was extracted followed by PCR to detect Anaplasma, Ehrlichia, Theileria, Babesia and Brucellaceae infection in ticks. Results: A total of 498 males [24.62% (95% CI 22.76%-26.57%)], 741 females [36.64% (95% CI 34.54%-38.79%)], 782 nymphs [38.67% (95% CI 36.55%-40.84%)] and 1 larva [0.04% (95% CI 0.00%-0.28%)] were identified. Among identified samples, we found four genera including Hyalomma, Rhipicephalus, Haemaphysalis, and Dermacentor. Molecular assay revealed that the prevalence of ticks to Anaplasma or Ehrlichia, and Brucellaceae was 22.02% (95% CI 16.01%-29.06%) and 15.03% (95% CI 9.43%- 22.26%), respectively. Phylogenetic analysis showed that the identified Anaplasma sp. had the most similarity with Anaplasma centrale, Anaplasma platys, Anaplasma camelii, and Anaplasma phagocytophilum, submitted in GenBank. Furthermore, the detected Ehrlichia sp. and Brucellaceae bacterium had the most similarity with Ehrlichia ruminantium and Mycoplana peli, respectively. However, no sign of the presence of Theileria and Babesia spp. was seen in the studied samples. Conclusions: Anaplasmosis, ehrlichiosis and brucellosis should be considered as important health threats in northwestern Iran and consistent monitoring on infection of ticks and livestock should be performed regularly.

234-235

Authors: Van Minh Hoang, Thi Phuong Thao Tran, Thi Ngoc Phuong Nguyen, Thi Hai Yen Nguyen, Quang Tuan Nguyen

None.

238

Authors: Sanjana Kathiravan, Nikhil Singhania, Ashok Kumar Pannu

None.

145-156

Authors: Weiyong Sheng, Biao Chen, Shanjie Fan, Zhuanglin Zeng, Ying Zhou, Kunpeng Huang, Xing Cheng, Chunyan Cao, Banghong Da, Ning Zhou, Qidi Zhou, Qinghua Wang, Jun Guo, Peng Sun, Chuanzhu Lv, Xiaoling Fu, Jinxiang Zhang

The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety.

159-164

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

Objective: To assess the acceptance of coronavirus disease (COVID-19) vaccine among healthcare workers at two general hospitals in Vietnam when it is available. Methods: A cross-sectional study was conducted using a convenience sampling from January to February 2021 among 410 healthcare workers at two general hospitals in Vietnam via a selfadministered questionnaire. A multivariable regression analysis was performed to determine predictors of vaccine acceptance including the demographic factors, COVID-19 knowledge, and vaccine beliefs based on the domains of Health Belief Model. Results: Among 410 healthcare workers, 76.10% showed vaccination willingness. Predictors of acceptance were determined that the group reporting as “vaccine acceptance” was more likely to be positive towards the perceived susceptibility and severity of COVID-19 (OR 2.45; 95% CI 1.48-4.06, P<0.05), perceived benefits of vaccination, and cues to action (OR 4.36; 95% CI 2.35- 8.09, and OR 5.49; 95% CI 2.84-10.61, respectively, all P<0.001), but less likely to have the perceived barriers to vaccination (OR 0.19; 95% CI 0.09-0.38; P<0.001) compared with the no acceptance group. Besides, people who had a good knowledge regarding the severity of illness were 3.37 times more likely to have identified as vaccine acceptance (OR 3.37; 95% CI 1.04-10.86, P<0.05). The demographic factors were also associated with willingness to receive the vaccine, with participants who were staff and received COVID-19 information from relatives were less likely to accept the vaccine over those who were doctors and not receiving information from relatives (OR 0.36; 95% CI 0.13-0.96, and OR 0.37; 95% CI 0.17-0.78, respectively, all P<0.05). Conclusions: A rate of willingness to get vaccinated against COVID-19 was relatively high with discrepancies between occupation, receiving information from relatives, knowledge toward the severity of illness, and the elements of Health Belief Model. The findings will provide information for the management authorities to develop relevant interventions to promote COVID-19 vaccination uptake.

176-182

Authors: Zubia Jamil, Samreen Khalid, Shahid Mumtaz Abbasi, Yasir Waheed, Jamal Ahmed

Objective: To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit (HDU) in relation to invasive vs. non-invasive mode of ventilation. Methods: In this study, the patients required either non-invasive [oxygen ≤10 L/min or >10 L/min through mask or nasal prongs, rebreather masks and bilevel positive airway pressure (BiPAP)] or invasive ventilation. For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen, Kaplan Meier and log rank analyses were used. In the end, independent predictors of survival were determined by Cox regression analysis. Results: Invasive ventilation was required by 15.1% patients while 84.9% patients needed non-invasive ventilation. Patients with evidence of thromboembolism, high inflammatory markers and hypoxemia mainly required invasive ventilation. The 30- day in hospital mortality was 72.7% for the invasive group and 12.9% for the non-invasive group (1.8% oxygen <10 L/min, 0.9% oxygen >10 L/min, 3.6% rebreather mask and 4.5% BiPAP). The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group (P<0.05). Age, presence of co-morbidities, number of days requiring oxygen, rebreather, BiPAP and invasive ventilation were independent predictors of outcome. Conclusions: Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury. Thus, protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.

187-190

Authors: Renan GM Diniz, Elaine C dos Santos, Gabriel CL Chagas, Elizabeth F Daher

Rationale: Dengue is the most important human arboviral disease. Neurological manifestations occur rarely in dengue. To the best of our knowledge, there is only one reported case of dengue-associated sudden sensorineural hearing loss (SSNHL) in Brazil untill now. Patient concerns: A 42-year-old man was presented to the emergency department with unconsciousness and generalized tonicclonic seizures. Diagnosis: Dengue-associated aseptic meningitis, acute kidney injury, and SSNHL. Interventions: The patient was treated with anticonvulsants and thiamine and underwent mechanical ventilation. He received combined ceftriaxone and acyclovir, which were later switched to meropenem, acyclovir and ampicillin empirically until culture results became available. He also required hemodialysis and plasmapheresis sessions and fresh frozen plasma and buffy coat transfusions until definitive diagnosis. Outcomes: The patient was discharged after improvement of his general condition and of his blood test results, but hearing loss remained. A six-month follow-up visit showed persistent deafness. Lessons: Dengue should be included in the differential diagnosis of patients from dengue-endemic areas presenting an acute febrile disease with neurological manifestations. To the best of our knowledge, this is the second reported case of dengueassociated SSNHL, suggesting an association between dengue and development of SSNHL.

97-98

Authors: Rina Tilak, Sajal Bhattacharya, Shakya Sinha

None.

113-121

Authors: Ryan V. Labana, Vimar A. Romero, Analette M. Guinto, Alvin N. Caril, Kimberly D. Untalan, Alejandro Jose C. Reboa, Khristine L. Sandoval, Kristel Joy S. Cada, Gary Antonio C. Lirio, Iris Rowena A. Bernardo, Lanieleen Jerah Mae Arocha, Julieta Z. Dungca

Objective: To identify the prevalence of soil-transmitted helminthiasis (STH) among school-age children in the Cagayan Valley, the Philippines, assess their level of awareness on the disease, and determine predisposing factors of the disease. Methods: A total of 478 Grades Ⅲ-Ⅴschool-age children in Pamplona and Sanchez-Mira School Districts in the Cagayan Valley answered the questionnaire assessing their knowledge, attitude, and practices on STH, subjected to anthropometric measurements, and provided faecal samples for parasitologic assessment (direct smear, Kato-Katz, and formol-ether concentration techniques). Results: The participants of the study, with 55.86% females, were 8 to 14 years old. Their nutritional status was assessed ‘normal’ (84.31%), ‘severely wasted’ (6.49%), ‘wasted’ (5.23%), ‘overweight’ (2.72%), and ‘obese’ (1.26%). The prevalence of infection with at least 1 STH species was 25.99% in Pamplona and 19.40% in Sanchez- Mira. Overall, the prevalence of heavy intensity was 7.11% for Ascaris lumbricoides and 1.67% for Trichuris trichiura. All hookworm infections had light intensities. The majority of the school-age children had a low score in the KAP test. In knowledge of STH, ‘stunted growth as a symptom of infection’ was associated with a lower risk of Ascaris lumbricoides infection (OR 0.448; 95% CI 0.212, 0.945; P=0.035) while ‘playing with soil as a mode of transmission’ was associated with an increased risk of Ascaris lumbricoides infection (OR 2.067; 95% CI 1.014, 4.212; P=0.046). In attitude towards STH, ‘I think I have intestinal worm now’ was associated with a higher risk of Ascaris lumbricoides infection (OR 1.681; 95% CI 1.061, 2.662; P=0.027). Conclusions: The prevalence rate of Ascaris lumbricoides among the school-age children in the Cagayan Valley shows the need to further intensify intervention in the area to meet the threshold set by the World Health Organization. The identified predictors of infection, which concerns the school-age children’s knowledge and attitude toward STH, can be used in augmenting intervention programs in the future.

128-138

Authors: Azar Tahghighi, Akram Abouie Mehrizi, Sedigheh Zakeri

Objective: To evaluate new compounds synthesized by integrating quinoline, quinazoline, and acridine rings with the active moiety of (5-nitroheteroaryl) methylene hydrazine. Methods: A new series of compounds (1a, 1b, 2a, 2b, 3a, and 3b) were synthesized and evaluated for cytotoxicity against COS-7 cells using the MTT assay. In vitro anti-plasmodial activity of the compounds was measured against CQ-sensitive (3D7) and CQresistant (K1) Plasmodium (P.) falciparum strains. β-hematin assay was performed to assess the inhibitory effects of β-hematin formation for new compounds. Results: The synthetic compounds had anti-plasmodial activity against blood-stage of 3D7 [IC50=(0.328-5.483) μM] and K1 [IC50=(0.622-7.746) μM] strains of P. falciparum, with no cytotoxicity against COS-7 cells in effective doses. Compounds 1a, 1b, and 2b were the most effective derivatives against P. falciparum 3D7 and K1 strains. Based on the β-hematin assay, the inhibition of β-hematin formation is the main mechanism of the inhibitory effect of these compounds. Conclusions: The synthetic compounds could inhibit the erythrocytic stages of CQ-sensitive and resistant P. falciparum strains without toxicity towards mammalian cells. Compounds 1b, 2a, and 2b had comparable anti-plasmodial activity against both CQ-sensitive (3D7) and resistant (K1) P. falciparum strains. These compounds may be promising lead structures for the development of new anti-malarial drugs.

143-144

Authors: Qiu-Ran Wang

None.

49-51

Authors: Balamurugan Shanmugaraj, Waranyoo Phoolcharoen

None.

64-72

Authors: Muhammad Zubair Shabbir, Ruth Helmus Nissly, Abdul Ahad, Masood Rabbani, Levina Lim2, Shubhada K. Chothe2, Murugan Subbiah2, Aswathy Sebastian, Istvan Albert, Aziz Ul-Rahman, Bhushan M Jayarao, Suresh V. Kuchipudi

Objective: To carry out the genetic characterization and evolutionary analysis of three avian orthoavulavirus 1 (AOAV-1) isolates from poultry workers with respiratory symptoms. Methods: Using Illumina MiSeq, whole-genome sequencing was carried out to assess the evolutionary dynamics of three AOAV-1 isolates. A phylogenetic and comparative analysis of all coding genes was done using bioinformatics tools. Results: Phylogenetic analysis and genetic distance estimation suggested a close relationship among human- and avian-originated velogenic strains of genotype ⅩⅢ, sub-genotype ⅩⅢ.2.1. Several substitutions in the significant structural and biological motifs were exclusively identified in the human-originated strains. Conclusions: To our knowledge, this is the first report of a velogenic AOAV-1 isolate from natural infection of the human upper respiratory tract. Our findings highlight the evolution and zoonotic potential of velogenic AOAV-1 in a disease endemic setting.

78-82

Authors: Nabi Jomehzadeh, Maryam Afzali, Khadijeh Ahmadi, Shokrollah Salmanzadeh, Fateme Jahangiri Mehr

Objective: To investigate the antimicrobial resistance patterns and prevalence of integrons in Shigella species isolated from children with diarrhea in southwest Iran. Methods: In this study, 1 530 stool samples were collected from children under 15 years with diarrhea referred to teaching hospitals in Ahvaz and Abadan, southwest Iran. Shigella spp. were identified by standard biochemical tests and PCR. The antibiotic resistance pattern of all Shigella isolates was determined by the disk diffusion method and minimum inhibitory concentration (MIC) by E-test. Results: Of 1 530 stool samples, 91 (5.9%, 91/1 530) were positive for Shigella spp. the most common Shigella isolates were Shigella flexneri 47 (51.6%, 47/1 530). Antibiotic susceptibility tests showed that the highest antibiotic resistance was related to trimethoprimsulfamethoxazole (87.9%, 80/91) and ampicillin (86.8%, 79/91). Multiplex PCR results revealed that 56% and 86.9% of Shigella isolates carried integron classⅠand integron classⅡ genes, respectively. None of the isolates included the integron class Ⅲ gene. Conclusions: The high prevalence of multi-drug resistance in Shigella isolates in our area increases the concerns about dissemination of the antibiotic-resistant isolates in this bacterium.

94-96

Authors: Lakshmi Krishnasamy, Jayasankari Senthilganesh, Chitralekha Saikumar, Paramasivam Nithyanand

Rationale: Candida auris is a potential emerging pathogen among Candida and causes serious health threats globally. Patient concerns: We reported a case of vulvovaginal candidiasis caused by Candida auris. A 26-year-old female presented with complaints of vaginal discharge, itching and low back pain. Diagnosis: High vaginal swab culture yielded Candida. The strain was confirmed as Candida auris by amplification and sequencing the internal transcribed spacer region. Antifungal susceptibility testing revealed that the isolate was resistant to fluconazole, amphotericin B and clotrimazole and susceptible to ketoconazole and nystatin. The isolate also exhibited biofilm forming ability. Interventions: Her symptoms did not subside with initial management with fluconazole and clotrimazole. Later, she was started on ketoconazole therapy. The patient responded well to ketoconazole. Outcome and lessons: To the best of our knowledge, this is the first report about the presence of a drug resistant biofilm forming Candida auris strain isolated from a vaginal swab sample from Chennai area. Biofilm forming ability might contribute to its drug resistance. Nucleic acid analysis helps in rapid and accurate identification of such rare species.