- Email: [email protected]
Snippets
Current Medicine Research and Practice 6 (2016) 213–214
Contents lists available at ScienceDirect
Current Medicine Research and Practice journal homepage: www.elsevier.com/locate/cmrp
Snippets
1. One health: people, animals and the environment
3. Antimicrobial resistance in Neisseria gonorrhoea
One health approach is an interdisciplinary approach relating human, animal and environment worldwide to look at the prevailing public health issues. The human–animal–ecosystem interface discussions can have the highest impact on improving and achieving our ‘‘Millennium Development Goals’’ and ‘‘Health for All Mission’’. The interconnectedness of human and animal pathogens, the emergence of influenza viruses, foodborne diseases, zoonotic diseases (rabies, brucellosis), environmental changes and cholera and emergence of antimicrobial drug resistance related to animal and poultry farming practices are all too well documented. Emerging and re-emerging diseases such as hantavirus, Lyme disease, leptospirosis, SARS and MERS-COV are clear examples. Investigating foodborne diseases require collaboration of agriculturists, food-processing industry, consumers and public health regulatory bodies. More than 250 microbial agents are today related to the cause of food-borne diseases.
Gonorrhoea is a global public health problem with more than 100 million annual cases.1 Gonococci have acquired resistance to various antibiotics over the time. Extended spectrum cephalosporins (ESCs) are the drugs of choice these days. However, decreased susceptibility and even therapeutic failures to ESCs have been reported in many countries. Gonococci have TEM-1 b-lactamases which may mutate to develop even ESBL and thus complete resistance to cephalosporins. The current CDC guidelines recommend Cefriaxone 250 mg plus azithromycin 1 g orally. Azithromycin also provides cover for Chlamydia trachomatis. However, emergence of resistance to azithromycin is also reported in various countries. USA reported it in 0.5%, 0.3% and 0.4% in 2010, 2011 and 2012 respectively. United Kingdom reported it in 0.8% in 2012 and 1.6% in 2013. Australia reported it in 2.1% in 2013. Canada reported it in 3.3% in 2016.2 There is thus a need for monitoring the resistance in India regularly and research into alternate combination therapies.
Reference 1. Centres for Disease Control and Prevention. Food Safety (Cited Feb 8). http://www.cdc.gov/foodsafety/.
2. Microsporidiosis in renal transplant patients Intestinal microsporidia (IM) are known to cause diarrhoea usually in immunocompromised hosts, frequently in HIV patients (0.1–50%). IM are emerging parasitic opportunistic infections. However, its prevalence in patients of renal transplants have been reported only in 31 cases till date. Ghoshal et al. have reported the first largest case-control study from Lucknow, India.1 IM was reported in 5.8% of 272 RT recipients. IM patients were often younger in age, had frequent and longer bouts of diarrhoea, and had associated giardiasis. E. bieneusi was the commonest species seen. Albendazole is the drug of choice. Strong clinical suspicion and a good laboratory support are essential for early diagnosis and treatment.2 References 1. Ghoshal U, Khanduja S, Pant P, et al. Intestinal microsporidiosis in renal transplant recipients: prevalence, predictors of occurrence and genetic characterisation. Indian J Med Microbial. 2015;33:357–363. 2. Saigal K, Sharma A, Sehgal R, Sharma P, Malla N, Khurana S. Intestinal microsporidiosis in India: a two year study. Parasital Int. 2013;62:53–56. http://dx.doi.org/10.1016/j.cmrp.2016.09.001 2352-0817/
References 1. Sood S. Gonococcal antimicrobial resistance. Indian J Med Microbial. 2015;33:341–342. 2. Decline in decreased cephalosporin susceptibility and increase in azithromycin resistance in Neisseria gonorrhoea, Canada. Emerg Infect Dis. 2016;22:65–67.
4. Meningococcal disease in India Indian data on meningococcal disease is scanty though occasional epidemics have been reported since over 100 years. Serogroup A causes highly invasive disease and has been reported to be the cause of such epidemics.2–4 We require a good laboratory support and a surveillance program to pre-empt and contain the future epidemics. We do not have a vaccine policy for this disease in our country as yet. A recent multicentric (Delhi, Mumbai, Bangalore), non-randomised, open label phase III trials using quadravalent conjugated vaccine (Men ACWY-DT) has shown reassuring results regarding safety and efficacy in children (2 yr or above) and adults. However, duration of protection, impact on carriage rate and herd immunity have still to be determined.5 References 1. Sinclair D, Preziosi MP, Jacob John T, Greenwood B. The epidemiology of meningococcal disease in India. Trop Med Int Health. 2010;15:1421–1435.
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Snippets / Current Medicine Research and Practice 6 (2016) 213–214
2. Pollard AJ. Meningococcal disease prevention in India. Indian Pediatr. 2014;51:445. 3. Mittal SK, Manchanda V. Preventing meningococcal infections in India. Indian Pediatr. 2014;51:446–448. 4. Jafri RZ, Ali A, Messonnier NE, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr. 2013;11:17. 5. Yadav S, Manglani MV, Narayan DA, et al. Safety and immunogenicity of a quadrivalent meningococcal conjugate vaccine (MenACYW-DT): a multicenter, open-label, non-randomized, phase III clinical trial. Indian Pediatr. 2014;51:451–456. 5. Assessing role of gram stain in clinical practice Gram stain is an important rapid and simple test in early diagnosis and guides empirical treatment of microbial diseases. With the advent of rapid tests, its role has now become less significant. Its role in countries with limited resources for early diagnosis, evaluation of quality of specimens and antimicrobial stewardship program is useful and critical. However, the quality of reporting of this procedure is poorly standardised. Poor specimen quality, limited skills of technologists in preparation of smears and interpretation of microscopic findings are sources of errors. This has been a matter of concern. There are various observations made in some countries. In a study of respiratory, fluid, wound, and biopsy cultures in four major US hospitals, 976–1864 specimens per site (with a total of 6115 specimens) were analysed. 5% Gram stain reports were not compatible with culture reports. 24% discrepant reports were due to errors of a technician.1 Other have also stated that this is a poorly controlled procedure and requires standardisation.2,3 There are no such objective studies from India, where Gram stain can play an important role in guiding the clinicians in early diagnosis and empiric antibiotic therapy. References 1. Samuel LP. Multicenter assessment of gram stain error rates. J Clin Microbiol. 2016;54:1442–1447. 2. Thomson RB Jr. One small step for the gram stain, one giant leap for clinical microbiology. J Clin Microbiol. 2016;54:1416–1417.
3. Su R-J, Wang P. Role of Gram stain in microbiological laboratories with limited resources. Rev Med Microbiol. 2011;22:41–44. 6. Host gene expression and infectious diseases Various microbes elicit host gene expression differently in the infected blood cells. In a study of 205 patients suffering from cold, influenza or respiratory syncitial viral infection, 161 genes overexpressed while 235 genes were identified to express specifically in influenza and well before the symptoms appeared. The host gene expression once refined in due course of time, may be able to differentiate viral from bacterial infections and may become a part of antimicrobial stewardship program.1 Tuberculosis kills 1.5 million persons per year in the world. Rapid and accurate diagnosis still remains a challenge. The detection of Mycobacteria (by microscopy, culture, molecular, assays) and host immune response (tuberculin skin test and IGRAs) have been the current approaches in clinical practice. A study of 2572 samples from pediatric and adult patients from 10 countries has shown three genes: GBP5, DUSP3 and KLF2 to be highly diagnostic of active tuberculosis. Their expression declines with treatment. Also bacterial drug resistance, prior BCG vaccination or HIV status has no influence on the expression of these three genes.2 Thus host gene expression in infectious diseases may be the future diagnostic tool. Reference 1. Andres-Terre M, McGuire HM, Pouliot Y, et al. Integrated, multi-cohort analysis identifies conserved transcriptional signatures across multiple respiratory viruses. Immunity 2015;43:1199– 1211. 2. Sweeney TE, Braviak L, Tato CM, Khatri P. Genome-wide expression for diagnosis of pulmonary tuberculosis: a multicohort analysis. Lancet Respir Med. 2016;4:213–224. T.D. Chugh National Emeritus Professor, National Academy of Medical Sciences (NAMS), Ansari Nagar, Mahatma Gandhi Marg, India E-mail address: [email protected]
Contents lists available at ScienceDirect
Current Medicine Research and Practice journal homepage: www.elsevier.com/locate/cmrp
Snippets
1. One health: people, animals and the environment
3. Antimicrobial resistance in Neisseria gonorrhoea
One health approach is an interdisciplinary approach relating human, animal and environment worldwide to look at the prevailing public health issues. The human–animal–ecosystem interface discussions can have the highest impact on improving and achieving our ‘‘Millennium Development Goals’’ and ‘‘Health for All Mission’’. The interconnectedness of human and animal pathogens, the emergence of influenza viruses, foodborne diseases, zoonotic diseases (rabies, brucellosis), environmental changes and cholera and emergence of antimicrobial drug resistance related to animal and poultry farming practices are all too well documented. Emerging and re-emerging diseases such as hantavirus, Lyme disease, leptospirosis, SARS and MERS-COV are clear examples. Investigating foodborne diseases require collaboration of agriculturists, food-processing industry, consumers and public health regulatory bodies. More than 250 microbial agents are today related to the cause of food-borne diseases.
Gonorrhoea is a global public health problem with more than 100 million annual cases.1 Gonococci have acquired resistance to various antibiotics over the time. Extended spectrum cephalosporins (ESCs) are the drugs of choice these days. However, decreased susceptibility and even therapeutic failures to ESCs have been reported in many countries. Gonococci have TEM-1 b-lactamases which may mutate to develop even ESBL and thus complete resistance to cephalosporins. The current CDC guidelines recommend Cefriaxone 250 mg plus azithromycin 1 g orally. Azithromycin also provides cover for Chlamydia trachomatis. However, emergence of resistance to azithromycin is also reported in various countries. USA reported it in 0.5%, 0.3% and 0.4% in 2010, 2011 and 2012 respectively. United Kingdom reported it in 0.8% in 2012 and 1.6% in 2013. Australia reported it in 2.1% in 2013. Canada reported it in 3.3% in 2016.2 There is thus a need for monitoring the resistance in India regularly and research into alternate combination therapies.
Reference 1. Centres for Disease Control and Prevention. Food Safety (Cited Feb 8). http://www.cdc.gov/foodsafety/.
2. Microsporidiosis in renal transplant patients Intestinal microsporidia (IM) are known to cause diarrhoea usually in immunocompromised hosts, frequently in HIV patients (0.1–50%). IM are emerging parasitic opportunistic infections. However, its prevalence in patients of renal transplants have been reported only in 31 cases till date. Ghoshal et al. have reported the first largest case-control study from Lucknow, India.1 IM was reported in 5.8% of 272 RT recipients. IM patients were often younger in age, had frequent and longer bouts of diarrhoea, and had associated giardiasis. E. bieneusi was the commonest species seen. Albendazole is the drug of choice. Strong clinical suspicion and a good laboratory support are essential for early diagnosis and treatment.2 References 1. Ghoshal U, Khanduja S, Pant P, et al. Intestinal microsporidiosis in renal transplant recipients: prevalence, predictors of occurrence and genetic characterisation. Indian J Med Microbial. 2015;33:357–363. 2. Saigal K, Sharma A, Sehgal R, Sharma P, Malla N, Khurana S. Intestinal microsporidiosis in India: a two year study. Parasital Int. 2013;62:53–56. http://dx.doi.org/10.1016/j.cmrp.2016.09.001 2352-0817/
References 1. Sood S. Gonococcal antimicrobial resistance. Indian J Med Microbial. 2015;33:341–342. 2. Decline in decreased cephalosporin susceptibility and increase in azithromycin resistance in Neisseria gonorrhoea, Canada. Emerg Infect Dis. 2016;22:65–67.
4. Meningococcal disease in India Indian data on meningococcal disease is scanty though occasional epidemics have been reported since over 100 years. Serogroup A causes highly invasive disease and has been reported to be the cause of such epidemics.2–4 We require a good laboratory support and a surveillance program to pre-empt and contain the future epidemics. We do not have a vaccine policy for this disease in our country as yet. A recent multicentric (Delhi, Mumbai, Bangalore), non-randomised, open label phase III trials using quadravalent conjugated vaccine (Men ACWY-DT) has shown reassuring results regarding safety and efficacy in children (2 yr or above) and adults. However, duration of protection, impact on carriage rate and herd immunity have still to be determined.5 References 1. Sinclair D, Preziosi MP, Jacob John T, Greenwood B. The epidemiology of meningococcal disease in India. Trop Med Int Health. 2010;15:1421–1435.
214
Snippets / Current Medicine Research and Practice 6 (2016) 213–214
2. Pollard AJ. Meningococcal disease prevention in India. Indian Pediatr. 2014;51:445. 3. Mittal SK, Manchanda V. Preventing meningococcal infections in India. Indian Pediatr. 2014;51:446–448. 4. Jafri RZ, Ali A, Messonnier NE, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr. 2013;11:17. 5. Yadav S, Manglani MV, Narayan DA, et al. Safety and immunogenicity of a quadrivalent meningococcal conjugate vaccine (MenACYW-DT): a multicenter, open-label, non-randomized, phase III clinical trial. Indian Pediatr. 2014;51:451–456. 5. Assessing role of gram stain in clinical practice Gram stain is an important rapid and simple test in early diagnosis and guides empirical treatment of microbial diseases. With the advent of rapid tests, its role has now become less significant. Its role in countries with limited resources for early diagnosis, evaluation of quality of specimens and antimicrobial stewardship program is useful and critical. However, the quality of reporting of this procedure is poorly standardised. Poor specimen quality, limited skills of technologists in preparation of smears and interpretation of microscopic findings are sources of errors. This has been a matter of concern. There are various observations made in some countries. In a study of respiratory, fluid, wound, and biopsy cultures in four major US hospitals, 976–1864 specimens per site (with a total of 6115 specimens) were analysed. 5% Gram stain reports were not compatible with culture reports. 24% discrepant reports were due to errors of a technician.1 Other have also stated that this is a poorly controlled procedure and requires standardisation.2,3 There are no such objective studies from India, where Gram stain can play an important role in guiding the clinicians in early diagnosis and empiric antibiotic therapy. References 1. Samuel LP. Multicenter assessment of gram stain error rates. J Clin Microbiol. 2016;54:1442–1447. 2. Thomson RB Jr. One small step for the gram stain, one giant leap for clinical microbiology. J Clin Microbiol. 2016;54:1416–1417.
3. Su R-J, Wang P. Role of Gram stain in microbiological laboratories with limited resources. Rev Med Microbiol. 2011;22:41–44. 6. Host gene expression and infectious diseases Various microbes elicit host gene expression differently in the infected blood cells. In a study of 205 patients suffering from cold, influenza or respiratory syncitial viral infection, 161 genes overexpressed while 235 genes were identified to express specifically in influenza and well before the symptoms appeared. The host gene expression once refined in due course of time, may be able to differentiate viral from bacterial infections and may become a part of antimicrobial stewardship program.1 Tuberculosis kills 1.5 million persons per year in the world. Rapid and accurate diagnosis still remains a challenge. The detection of Mycobacteria (by microscopy, culture, molecular, assays) and host immune response (tuberculin skin test and IGRAs) have been the current approaches in clinical practice. A study of 2572 samples from pediatric and adult patients from 10 countries has shown three genes: GBP5, DUSP3 and KLF2 to be highly diagnostic of active tuberculosis. Their expression declines with treatment. Also bacterial drug resistance, prior BCG vaccination or HIV status has no influence on the expression of these three genes.2 Thus host gene expression in infectious diseases may be the future diagnostic tool. Reference 1. Andres-Terre M, McGuire HM, Pouliot Y, et al. Integrated, multi-cohort analysis identifies conserved transcriptional signatures across multiple respiratory viruses. Immunity 2015;43:1199– 1211. 2. Sweeney TE, Braviak L, Tato CM, Khatri P. Genome-wide expression for diagnosis of pulmonary tuberculosis: a multicohort analysis. Lancet Respir Med. 2016;4:213–224. T.D. Chugh National Emeritus Professor, National Academy of Medical Sciences (NAMS), Ansari Nagar, Mahatma Gandhi Marg, India E-mail address: [email protected]