GERMS

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Open AccessCase Report

A Febrile Old Man with Xanthochromic Hypoglycorrhachia

by Nai-Hui Lin and Yu-Jang Su

GERMS 2020, 10(1), 55-57; https://doi.org/10.18683/germs.2020.1186 - 2 Mar 2020

Cited by 1 | Viewed by 26

Introduction: Meningitis is a commonly seen disease in the daily practice of emergency departments. Cerebrospinal fluid (CSF) examination including Gram stain and culture are crucial for identifying between bacterial and viral meningitis and should be completed prior to antibiotic administration. Hypoglycorrhachia is one [...] Read more.

Introduction: Meningitis is a commonly seen disease in the daily practice of emergency departments. Cerebrospinal fluid (CSF) examination including Gram stain and culture are crucial for identifying between bacterial and viral meningitis and should be completed prior to antibiotic administration. Hypoglycorrhachia is one of the certain independent predictors of bacterial meningitis. Case report: A 69-year-old male having a past medical history of alcoholism and liver cirrhosis presented to the emergency department with intermittent fever and chills for one day. Sudden onset of a tonic-clonic seizure for a few minutes with agitation, and neck stiffness on physical examination were noted. Lumbar puncture was performed and xanthochromic turbid cerebrospinal fluid (CSF) was retrieved. CSF analysis showed pleocytosis with a white blood cell count of 4608/cm²; the neutrophil-to-lymphocyte ratio was 96:4. The CSF also showed extreme hypoglycorrhachia (4 mg/dL) and high protein levels (865 mg/dL) were noted. Bacterial meningitis was diagnosed. The CSF yielded Klebsiella pneumoniae on the third day of admission. After 4 weeks of meropenem complete treatment, the patient recovered uneventfully without any neurological deficit and was discharged one1 month later. Discussion: Hypoglycorrhachia is one of the certain independent predictors of bacterial meningitis. Elevated CSF protein over 150 mg/dL may turn normal crystal-clear CSF into yellowish or turbid CSF. Aerobic Gram-negative bacteria like Klebsiella species are uncommon community-acquired pathogens and are more likely to occur after neurosurgical procedures complicated with pyogenic liver abscess and septic endophthalmitis. The appropriate antibiotic should be monitored and adjusted clinically. Conclusions: In febrile patients, epileptic episodes may hint towards an inflammatory process in the central nervous system. Grossly turbid and xanthochromic CSF with hypoglycorrhachia raise the concern for bacterial meningitis. Adequate antibiotic adjustment according to CSF culture results can also lead to the successful outcome without neurologic deficits. Full article

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Open AccessCase Report

An Unusual Case of Fulminant Generalized Peritonitis Secondary to Purulent Salpingitis Caused by Prevotella bivia – Case Report with Literature Review

by Stoyan Kostov, Stanislav Slavchev, Deyan Dzhenkov, Strahil Strashilov and Angel Yordanov

GERMS 2020, 10(1), 51-54; https://doi.org/10.18683/germs.2020.1185 - 2 Mar 2020

Cited by 3 | Viewed by 29

Abstract

Introduction: Prevotella bacilli are prevalent in the body as members of the normal flora and in some cases they can be involved in infections throughout the body. Prevotella bivia is a member of a nonpigment group found in the resident flora of the [...] Read more.

Introduction: Prevotella bacilli are prevalent in the body as members of the normal flora and in some cases they can be involved in infections throughout the body. Prevotella bivia is a member of a nonpigment group found in the resident flora of the female genital tract and it is occasionally seen in the oral cavity. Case report: We describe the very rare case of a 39-year-old woman with fulminant generalized peritonitis secondary to purulent salpingitis caused by Prevotella bivia. Discussion: In most cases described in the literature, Prevotella bivia was mixed with aerobes and caused bacterial vaginosis and pelvic inflammatory disease, whereas in our case study Prevotella bivia was the only microbe that was isolated. The infection was fulminant and caused generalized peritonitis. Rapid and systemic infections typically occur in immunocompromised hosts, however our patient was in good health condition and immunocompetent. Conclusions: Prevotella bivia may cause rapid and systemic infections, even in immunocompetent hosts. Multidisciplinary team management is mandatory in order to estimate the optimal treatment regimen. Full article

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Open AccessArticle

Prevalence of Asymptomatic Malaria in HIV-Infected Subjects on Cotrimoxazole Antimalarial Prophylaxis Attending a Tertiary Health Care Center in Southern Nigeria: A Cross-Sectional Study

by Ekerette Friday Ekere, Tatfeng Youtchou Mirabeau and Henshaw Uchechi Okoroiwu

GERMS 2020, 10(1), 44-50; https://doi.org/10.18683/germs.2020.1184 - 2 Mar 2020

Cited by 5 | Viewed by 35

Abstract

Introduction: Co-infection has become a major contributor to increased burden of morbidity and mortality in HIV infection. The aim of this study was to assess the prevalence of asymptomatic malaria in the HIV-infected subjects on antimalarial prophylaxis and provide information to improve management [...] Read more.

Introduction: Co-infection has become a major contributor to increased burden of morbidity and mortality in HIV infection. The aim of this study was to assess the prevalence of asymptomatic malaria in the HIV-infected subjects on antimalarial prophylaxis and provide information to improve management of HIV subjects. Methods: This was a cross-sectional study with a purposive sampling. Microscopy method was used for the confirmation of malaria parasitemia status. The study was performed in University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria, a major tertiary health institution within the period of January to June 2016 involving 100 participants. Results: The majority (65%) of the study participants were females. The majority of the studied population belonged to the age range 33-38 years old. Most (45%) of the patients had CD4 count ≥500 cells/µL. The prevalence of asymptomatic malaria was found to be 13% (13/100). The distribution of asymptomatic malaria based on gender and age were found not to be statistically significant (P > 0.05). Subjects with CD4 count in the range of 200-499 cells/µL had the highest prevalence (24.39%) of asymptomatic malaria. Conclusions: Considering that all the studied participants were on antimalarial prophylaxis, it signals a public health concern to employ more intensive preventive methods in addition to antimalaria prophylaxis. Full article

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Open AccessArticle

The Relationship Between the Exposure to Healthcare Settings and Colonization with Methicillin-Resistant Staphylococcus aureus Among Medical Students

by Jayaweera Arachchige Asela Sampath Jayaweera, Senaka Pilapitiya and Widuranga Kumbukgolla

GERMS 2020, 10(1), 34-43; https://doi.org/10.18683/germs.2020.1183 - 2 Mar 2020

Cited by 5 | Viewed by 33

Abstract

Introduction: Medical students who engage in clinical learning in healthcare settings can be potential methicillin-resistant Staphylococcus aureus (MRSA) carriers. Methods: This is a descriptive cross-sectional study having a follow-up approach. Three batches of medical students who were studying at the Faculty of Medicine [...] Read more.

Introduction: Medical students who engage in clinical learning in healthcare settings can be potential methicillin-resistant Staphylococcus aureus (MRSA) carriers. Methods: This is a descriptive cross-sectional study having a follow-up approach. Three batches of medical students who were studying at the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (1^st, 3^rd and 5^th study years of MBBS course) were screened for nasal and axillary MRSA colonization. The first-year students were screened before and 6 months after clinical learning. The knowledge of the students about infection control was scored (percentage) using a questionnaire in the one week before and later one year after the hospital exposure. Data was compared using two-sample t test. Results: The percentage of MRSA colonization was 6.36% (7/110) and 49.57% (59/119) before clinical exposure and after 2.5 years of exposure, respectively (p < 0.012). The percentage of correct responses obtained by the students for the questionnaire about infection control was 28% and 66.9% one week before the exposure to the hospitals and one year after the exposure to the hospitals, consecutively. Conclusions: MRSA carriage was significantly associated with the time duration of the clinical training of the medical students. The knowledge of students about infection control was significantly inadequate one week before the hospital exposure and they have gained the knowledge only after being exposed to the hospitals. Full article

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Open AccessArticle

Study of the Diagnostic Value of Interleukin-6 and Interleukin-8 in Children with Acute Gastroenteritis

by Maysaa El Sayed Zaki, Mona Abdel Latif Alsayed and Raghdaa Shrief

GERMS 2020, 10(1), 27-33; https://doi.org/10.18683/germs.2020.1182 - 2 Mar 2020

Cited by 9 | Viewed by 38

Abstract

Introduction: Gastroenteritis in children is responsible for high morbidity and mortality. Our aim was to determine the serum and fecal levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in children with acute gastroenteritis of viral and bacterial etiology to assess their utility as [...] Read more.

Introduction: Gastroenteritis in children is responsible for high morbidity and mortality. Our aim was to determine the serum and fecal levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in children with acute gastroenteritis of viral and bacterial etiology to assess their utility as diagnostic biomarkers for these infections. Methods: In this case-control study, the children were classified according to the pathogen recovered from the stool by bacterial culture or by direct viral antigen detection by enzyme immunoassay (EIA) into 50 children with acute bacterial gastroenteritis and 50 children with acute viral gastroenteritis. In addition, 50 apparently healthy children were included as a control group. Blood and stool samples were subjected to detection of IL-6 and IL-8. Results: There were statistically significant elevations of total leucocytes counts, absolute neutrophils count, C-reactive protein, serum IL-6 and serum IL-8 in children with gastroenteritis compared to healthy children (p < 0.001). CRP, serum IL-6 and IL-8 had significantly elevated levels in children with bacterial gastroenteritis compared to viral gastroenteritis. Fecal IL-6 and IL-8 had significantly elevated levels in children with acute gastroenteritis than in healthy control (p < 0.001). The area under the curve (AUC) showed that CRP and serum IL-6 could be used as discriminative markers for acute bacterial gastroenteritis in children, in comparison to serum IL-8. Conclusions: Elevated serum IL-6 and CRP can aid in differentiation between viral and bacterial gastroenteritis. Serum IL-8 had limited discrimination ability between viral and bacterial gastroenteritis. Stool levels of IL-6 and IL-8 were elevated in children with viral and bacterial gastroenteritis, however, their assessment by enzyme linked immunosorbent assay had technical limitations to be used as differentiation biomarkers. Full article

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Open AccessArticle

First Report of Vim Metallo-β-Lactamase Production in Escherichia coli and Klebsiella pneumoniae Clinical Isolates from Gaza Strip, Palestine

by Ghassan Tayh, Daram Nagarjuna, Rym Ben Sallem, Vivek Verma, Sarra Chairat, Abdellatif Boudabous, Manisha Yadav and Karim Ben Slama

GERMS 2020, 10(1), 18-26; https://doi.org/10.18683/germs.2020.1181 - 2 Mar 2020

Cited by 7 | Viewed by 43

Abstract

Introduction: Even though the increasing incidence of VIM-producing E. coli and K. pneumoniae has been reported worldwide, studies are still lacking in Palestine. The aim of this study was to screen carbapenem-resistant E. coli and K. pneumoniae bacteria in the Gaza Strip, [...] Read more.

Introduction: Even though the increasing incidence of VIM-producing E. coli and K. pneumoniae has been reported worldwide, studies are still lacking in Palestine. The aim of this study was to screen carbapenem-resistant E. coli and K. pneumoniae bacteria in the Gaza Strip, Palestine and further to characterize carbapenemase-producing isolates. Methods: A total of 69 E. coli and 27 K. pneumoniae isolates were obtained from three Gaza hospitals and recovered from urine, wound swabs, blood and ear discharge. The screening for metallo-β-lactamases (MBLs) was performed by using the imipenem-EDTA disc synergy test. The detection of β-lactamases genes, detection of non-β-lactam genes and the characterization of integrons were performed by PCR and sequencing. The clonal relationship among the isolates was determined by pulsed-field gel electrophoresis (PFGE). Results: Our study showed that 4 E. coli (5.8%) and 5 K. pneumoniae (18.5%) were positive by the imipenem-EDTA disc synergy test. Bla_VIM-4 was detected in six isolates and bla_VIM-28 was identified in three isolates. The β-lactamases genes in the VIM-producing K. pneumoniae isolates were bla_CTX-M-15 (n = 3), bla_CTX-M-14 (n = 1), bla_SHV-1 (n = 3), bla_SHV-12 (n = 1), bla_TEM-1 (n = 1) and bla_OXA-1 (n = 1). Aac(6′)-Ib-cr gene was confirmed in four E. coli and in two K. pneumoniae isolates. QnrS1 was identified in two K. pneumoniae isolates. The class 1 integron was identified with the different gene cassette; dfrA17-aadA5, dfrA5, dfrA12-orf-aadA2 and dfrA17-aadA5 were identified. Conclusions: Our study indicated for the first time the emergence of multidrug-resistant VIM-containing K. pneumoniae and E. coli isolates of clinical origin in Gaza Strip hospitals. Full article

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Open AccessArticle

Exploring Knowledge on Danger Signs of Common Childhood Illnesses and Associated Factors Among Mothers of Under-Five Children in Central Tigrai, Ethiopia: A Cross-Sectional Study

by Senait Gebreslasie, Guesh Welu, Betiel Berhane, Birhanu Gebresilassie, Berhane Fseha, Tesfay Tsegay and Hadush Negash

GERMS 2020, 10(1), 9-17; https://doi.org/10.18683/germs.2019.1175 - 2 Mar 2020

Cited by 4 | Viewed by 41

Abstract

Introduction: Globally, a large number of under-five deaths have occurred from preventable and treatable common childhood illnesses. Therefore, early identification of general danger signs of common childhood illnesses and adhering to appropriate treatment helps to reduce morbidity and mortality. This study aimed to [...] Read more.

Introduction: Globally, a large number of under-five deaths have occurred from preventable and treatable common childhood illnesses. Therefore, early identification of general danger signs of common childhood illnesses and adhering to appropriate treatment helps to reduce morbidity and mortality. This study aimed to assess the knowledge of mothers and associated factors on general danger signs of common childhood illnesses of under-five children in Central Tigrai, Ethiopia. Methods: A community-based cross-sectional study design was employed from February to March 2017. A total of 416 study participants were finally enrolled in the study using simple random sampling technique. A pretested and structured interviewer-based questionnaire was used. Data were entered, coded and analysed using SPSS 22.0. Multivariable logistic regression was used to control the effect of confounders. Results: In this study, 44.7% of the mothers had good knowledge of the general danger signs of common childhood illnesses. Mothers’ educational status (AOR = 1.93, 95%CI = 1.09-3.44, p = 0.025), occupation of mothers (AOR = 5.94, 95%CI = 3.17-11.12, p ≤ 0.001), childbirth order (AOR = 1.85, 95%CI = 1.00-3.40, p = 0.005) and source of information (AOR = 2.19, 95%CI = 1.23-3.87, p = 0.007) were significantly associated with knowledge of mothers on general danger signs of common childhood illnesses. Conclusions: Maternal knowledge of general danger signs of common childhood illnesses was low. Therefore, intervention modalities focusing on improving the educational level, behavioural change communication activities, and access of mothers to health visits are needed. Full article

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Open AccessEditorial

SARS-CoV-2 in Romania – Situation Update and Containment Strategies

by Adrian Streinu-Cercel

GERMS 2020, 10(1), 8; https://doi.org/10.18683/germs.2020.1179 - 2 Mar 2020

Cited by 8 | Viewed by 31

Abstract

With the rapidly changing outbreak of SARS-CoV-2 [...] Full article

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GERMS, Volume 10, Issue 1 (03 2020) – 8 articles

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