Infections In Asia Research Articles

How helminths trump diabetes

Parasitology The prevalence of type 2 diabetes mellitus (T2DM) is inversely correlated with helminth infections in Asia. This may be because helminths have an immunomodulatory effect and thus dampen the type 1 (allergic type) immune responses underlying the proinflammatory state of T2DM. To test this idea, Rajamanickam et al. measured plasma levels of cytokines in 60 individuals living in rural India infected with Strongyloides stercoralis , a persistent nematode gut parasite, which in most people is symptomless. They compared these results with plasma cytokine concentrations from 58 T2DM patients showing no worm infection. Parasitized individuals showed significantly increased levels of interleukin-1 receptor alpha (IL-1Rα), which is typical of type 2 immune responses, and low levels of a wide range of proinflammatory cytokines and chemokines. When diabetic subjects were treated for parasites, their proinflammatory state, typically marked by increased IL-1β and IL-6, partially rebounded. PLOS Neg. Trop. Dis. 14 , e0008101 (2020).

Chytrid infection in Asia: How much do we know and what else do we need to know?

We conducted a systematic review to evaluate the knowledge base for amphibian chytrid Batrachochytrium dendrobatidis (Bd) infection in the continent of Asia. Despite an indication of geographic bias in terms of studying chytrid fungus distribution in Asia, 167 amphibian species (145 spp. native to Asia) from 16 countries have been reported as infected with Bd. Our meta-analysis shows that overall prevalence is 8.19 % (out of 28,433 samples), and Bd-positive rate in amphibia significantly varies among sampling sources (χ2= 380.57, DF= 6, P< 0.001) and age categories (χ2= 22.09, DF= 2, P< 0.001). We used Kernel Density analysis to produce a hotspot map for chytrid infection, and Digital Elevation Model to understand the distribution of chytrid positive locations across different elevations. In our meta-analysis, most of the Bd-positive sites range between 4.45–27.49 °C, 167–4,353 mm rainfall, 10–40°N, and at lower elevations (<500 m). Using land cover analysis, we did not find a statistically significant difference among six different land cover categories in relation to the prevalence of Bd across Asia. Although no mass die-off events have been reported so far, Maximum Entropy modelling shows that Bd distribution and infection may potentially occur across a vast region of south-east Asia. In conclusion, we call for more systematic research and monitoring strategies in place for countries with little to no information, but have a moderately higher risk of chytrid distribution and infection.

Investigation into the presence of Hepatitis E Virus in commercially available venison charcuterie in Scotland

Hepatitis E Virus is an RNA virus of the Hepeviridae family that affects hepatocytes and seriously impacts the health of immunocompromised patients. Genotypes 3 and 4 have been circulating in animal populations such as swine and deer in developed countries, causing food borne infections associated with consumption of contaminated animal food products. While HEV has been circulating in European deer populations and causing food borne infections in Asia, its presence in Scottish venison food products has not been investigated. This study assesses 4 ready-to-eat venison charcuterie products for HEV by performing RNA extraction on duplicate samples with a Qiagen RNeasy Midi kit and using Mengovirus as a process control to determine virus recovery by RT-qPCR. This was followed by RT-PCR with previously described HEV primers, and ligation of the suspected positive fragments in a recombinant pGEMT Easy Vector system which was then cloned in competent E. coli cells for propagation. Recombinant plasmids were isolated and subjected to Sanger sequencing. An average RNA extraction efficiency of 5.02% was achieved across all samples, but large deviations between duplicates suggests that further optimisation is necessary in RNA extraction from food products with complex matrices. HEV-sized PCR fragments were detected in 3 out of 4 food products, but the sequencing data showed inefficient ligation of the fragments in the vector, possibly due to low RNA amount and excess of dimerised primers. The likelihood of HEV presence in Scottish venison needs to be investigated further for the detection of transmission routes and the implementation of improved surveillance policies.

A review: microbiology perspective of zika virus

The aim of review is to increase a quality of information about zika virus in microbiology perspective. Zika virus is an emerging-mosquio borne that was founded in Uganda 1947. Zika virus was transmitted to human in 1954 in Nigeria and first human infection in Asia were reported in Indonesia, Central Java in 1977. WHO was declared that zika virus was a global health emergency in 2016. Zika virus is flavivirus that was brought by mosquito (Aedes aegypti and Aedes albopictus). Zika virus had a several fatal effect like microencephaly and Guillain-Barre syndrome. Recently there is no medicine or vaccine for zika virus. Early diagnostic will help HCP (Health Care Professional) to provide early treatment for human infected. There was several rapid diagnotic for zika virus like ZnO nanostructure and paper disc.

From awareness to action: NIPD's engagement in the control of food-borne clonorchiasis.

Clonorchiasis is caused by ingestion of raw freshwater fish containing infective larvae of Clonorchis sinensis. China harbours the largest number of people with C. sinensis infection. During the past three decades, the National Institute of Parasitic Diseases, affiliated to the Chinese Center for Disease Control and Prevention (NIPD) conducted many studies to facilitate the control on clonorchiasis. Three national surveys have shown the updated epidemiology of clonorchiasis in China. Recently, a national surveillance system has also been established, which will enable the production of high-resolution map. The evaluation of the disease burden has enhanced the awareness on clonorchiasis. Diverse diagnosis techniques including rapid screening by questionnaire, serological tests, faecal examination and a molecular method have been developed or evaluated. The NIPD also participated in the early evaluation of praziquantel against clonorchiasis, which enhanced its application in China. Also, the NIPD has verified the efficacy of tribendimidine against clonorchiasis. A new sustainable strategy is also being explored. However, more research is expected to further facilitate control of clonorchiasis in China, as well as international cooperation in fighting human liver fluke infections in Asia.

Pulmonary Nocardiosis in Pemphigus Vulgaris Patients from Tehran, Iran.

Nocardiosis is an opportunistic infection in individuals who had organ transplants and in patients with immunosuppressive diseases such as pemphigus Vulgaris (PV), diabetes mellitus, and HIV. Nocardiosis rate has not been assessed in Iranian PV patients, and this was the first study to estimate nocardiosis rate in these patients. In this study, 103 patients with PV were examined. BAL samples were obtained and direct smear was prepared and visualized by microscopy after PAS staining. Samples were cultured on antibiotic-containing blood and chocolate agar media. DNA extraction and PCR were performed on positive cultures, and final identification was done by 16S rRNA gene sequencing. Drug susceptibility testing was done by microbroth dilution method. Four positive cultures (3.88%) were found in the samples (n = 103). According to sequence analysis, 2 isolates were identified as Nocardia cyriacigeorgica and 2 as Nocardia otitidiscaviarum and Nocardia cerradoensis. Nocardia cerradoensis was isolated from an invasive brain infection. Isolated bacteria were susceptible to majority of the tested antibiotics, except for 2 strains of Nocardia cyriacigeorgica and Nocardia cerradoensis. This was the first isolation of Nocardia cerradoensis of human infection in Asia. Patients with PV are susceptible to nocardiosis, similar to other immunocompromised patients. Pemphigus Vulgaris is a severe autoimmune disease which is treated by a high dosage of corticosteroids. Opportunistic infections are one of the greatest challenges of these patients. One of the neglected agents of opportunistic infection in this disorder is Nocardiosis which can cause a high mortality rate in PV patients.

Asian consensus recommendations on optimizing the diagnosis and initiation of treatment of hepatitis B virus infection in resource-limited settings.

Asia has an intermediate-to-high prevalence of and high morbidity and mortality from hepatitis B virus (HBV) infection. Optimization of diagnosis and initiation of treatment is one of the crucial strategies for lowering disease burden in this region. Therefore, a panel of 24 experts from 10 Asian countries convened, and reviewed the literature, to develop consensus guidance on diagnosis and initiation of treatment of HBV infection in resource-limited Asian settings. The panel proposed 11 recommendations related to diagnosis, pre-treatment assessment, and indications of therapy of HBV infection, and management of HBV-infected patients with co-infections. In resource-limited Asian settings, testing for hepatitis B surface antigen may be considered as the primary test for diagnosis of HBV infection. Pre-treatment assessments should include tests for complete blood count, liver and renal function, hepatitis B e-antigen (HBeAg), anti-HBe, HBV DNA, co-infection markers and assessment of severity of liver disease. Noninvasive tests such as AST-to-platelet ratio index, fibrosis score 4 or transient elastography may be used as alternatives to liver biopsy for assessing disease severity. Considering the high burden of HBV infection in Asia, the panel adopted an aggressive approach, and recommended initiation of antiviral therapy in all HBV-infected, compensated or decompensated cirrhotic individuals with detectable HBV DNA levels, regardless of HBeAg status or alanine transaminase levels. The panel also developed a simple algorithm for guiding the initiation of treatment in noncirrhotic, HBV-infected individuals. The recommendations proposed herein, may help guide clinicians, to optimize the diagnosis and improvise the treatment rates for HBV infection in Asia.

Epidemic situation of malaria in Jiangsu Province in 2018

To analyze the epidemic situation of malaria in Jiangsu Province in 2018, so as to provide scientific evidence for formulating post-elimination malaria surveillance schemes and technical measures in Jiangsu Province. The malaria case report cards, epidemiological individual investigation forms of malaria cases and foci data were collected from Jiangsu Province in 2018, and the epidemic situation of malaria was descriptively analyzed. A total of 243 malaria cases were reported in Jiangsu Province in 2018, which increased by 1.67% in relative to in 2017 (239 cases), and these cases included 171 cases with falciparum malaria, 14 cases with vivax malaria, 15 cases with quartan malaria, 42 cases with ovale malaria and a case with mixed infection of P. vivax and P. ovale. All cases were overseas imported, and no local secondary cases were found. The malaria cases were predominantly workers (76.54%). Nantong City (48 cases), Yangzhou City (33 cases) and Taizhou City (22 cases) were the most 3 cities with the largest number of malaria cases across Jiangsu Province. The malaria infections predominantly occurred in African areas (96.30%), and the other 9 cases had infections in Asia (8 cases) and Central America (1 case). There were 125 cases (51.44%) and 91 cases (37.45%) with definitive diagnosis at the day of admission and within 1 to 3 days post-admission, respectively. The percentages of definitive diagnosis at initial diagnosis were 48.27%, 88.76% and 97.30% at township-, county- and city-level medical institutions, respectively, and the percentage of definitive diagnosis at initial diagnosis was significantly lower in township-level medical institutions than in county- (χ2 = 21.47, P < 0.01) and city-level medical institutions (χ2 = 32.86, P < 0.01). There are no local malaria cases in Jiangsu Province; however, the number of overseas imported malaria cases remains high in China. In the future, improving the post-elimination malaria surveillance system, enhancing the awareness of malaria prevention and control knowledge among high-risk populations, increasing the diagnostic capability of malaria in medical institutions, and improving the management of imported malaria cases should be performed to consolidate the achievements of malaria elimination.

Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia

PurposeAntiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. MethodsRegional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. ResultsOf 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. ConclusionsUntil challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.

A mini outbreak of human metapneumovirus infection with severe acute respiratory symptoms in a selected group of children presented to a teaching hospital in Sri Lanka.

Human metapneumovirus (hMPV) of the family Paramyxoviridae is a relatively new virus causing severe acute respiratory tract infections (SARI) in children. Data on hMPV infection in Asia including Sri Lanka is limited. We aimed to detect respiratory viruses including hMPV in a selected group of children affected by a small outbreak of SARI presented to the Teaching Hospital, Peradeniya (THP), Sri Lanka in 2014. Nasopharyngeal aspirates (NPA) were obtained from 21 children with SARI and tested for hMPV, influenza A and B, parainfluenza 1, 2 and 3 (PIV 1–3), adenovirus and respiratory syncytial virus (RSV) antigens using an immunofluorescence assay (IFA). In addition, a one step RT-PCR was done for the detection of hMPV from the viral RNA extracts. Of the 21 NPA samples tested for respiratory viral antigens by IFA, two were positive for RSV (9.5%), one was positive for influenza A (4.8%) and one was positive for both adenovirus and PIV-2 (4.8%). Of the 21 NPA viral RNA extracts tested by RT-PCR, 18 (86%) were positive for hMPV, in which 2 were co-infected with RSV and influenza A virus, respectively. hMPV was the predominant cause of SARI outbreak (2014) in children presented to the THP, Sri Lanka.

International Liver Transplantation Society Asian Consensus on the Management of Hepatitis C Virus Infection in Resource Limited Setting-From Noncirrhotic to Decompensated Disease and After Liver Transplantation.

The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in Asia is characterized by specific distribution of genotypes, lack of access to specific therapeutic agents, relatively high cost of treatment, and lack of experienced healthcare providers. Clear consensus on the diagnosis, management, and monitoring of HCV infection specific to the Asian region is a major unmet need. The consensus guidelines documents that have been published to date by major medical societies presume access to an array of direct acting antiviral agents and diagnostic tests that are not broadly applicable to resource limited settings, including Asia. To address the lack of an Asia-specific set of HCV treatment guidelines, we assembled a panel of 15 HCV experts in the field of hepatology from India, Indonesia, Myanmar, Vietnam, Pakistan, Philippines, and Mongolia convened in April 2017 to review the updated literature and provide recommendations on the diagnosis and management of chronic HCV infection that reflects local conditions. An evidence-based comprehensive compilation of the literature supported by the graded recommendations from the expert panel for the optimization of the diagnosis, pretreatment, on treatment, and posttreatment assessments, and management of chronic HCV infection has been presented in this article. With the evolving treatment landscape and addition of several new direct-acting antiviral agents and combination regimens into the therapeutic armamentarium, the current article may serve as a guide to the clinicians in optimizing the diagnosis and treatment selection for the management of chronic HCV infection in resource-limited settings.

High prevalence and diversity of tcdA-negative and tcdB-positive, and non-toxigenic, Clostridium difficile in Thailand

Studies on the prevalence and diversity of Clostridium difficile in Thailand have been limited to those derived from a few tertiary hospitals in Central Thailand. In this study, 145 C. difficile isolates collected in 13 provinces in Thailand during 2006–2018 were characterized by ribotyping and detection of toxin genes. Minimum inhibitory concentrations of eight antimicrobial agents were determined also for all 100 C. difficile strains collected from 2006 until 2015. Of the 145 strains of C. difficile, 71 (49%) were non-toxigenic, 46 (32%) were toxin A-negative, toxin B-positive (A-B+) and 28 (19%) were A+B+. No binary toxin-positive strain was found. The most common ribotype (RT) was RT 017 (A-B+CDT-, 19%, 28/145). Besides RT 017, 20 novel non-toxigenic and A-B+ ribotyping profiles, which may be related to RT 017 by the similarity of ribotyping profile, were identified. All C. difficile strains remained susceptible to metronidazole and vancomycin, however, a slight increase in MIC for metronidazole was seen in both toxigenic and non-toxigenic strains (overall MIC50/90 0.25/0.25 mg/L during 2006–2010 compared to overall MIC50/90 1.0/2.0 mg/L during 2011–2015). There was a high rate of fluoroquinolone resistance among RT 017 strains (77%), but there was little resistance among non-toxigenic strains. These results suggest that RT 017 is endemic in Thailand, and that the misuse of fluoroquinolones may lead to outbreaks of RT 017 infection in this country. Further studies on non-toxigenic C. difficile are needed to understand whether they have a role in the pathogenesis of C. difficile infection in Asia.

Disease- and Treatment-related Morbidity in Adolescents With Perinatal HIV Infection in Asia.

Perinatally HIV-infected adolescents (PHIVA) are exposed to a chronic systemic infection and long-term antiretroviral therapy (ART), leaving them susceptible to morbidities associated with inflammation, immunodeficiency and drug toxicity. Data collected 2001 to 2016 from PHIVA 10-19 years of age within a regional Asian cohort were analyzed using competing risk time-to-event and Poisson regression analyses to describe the nature and incidence of morbidity events and hospitalizations and identify factors associated with disease-related, treatment-related and overall morbidity. Morbidity was defined according to World Health Organization clinical staging criteria and U.S. National Institutes of Health Division of AIDS criteria. A total 3,448 PHIVA contributed 17,778 person-years. Median age at HIV diagnosis was 5.5 years, and ART initiation was 6.9 years. There were 2,562 morbidity events and 307 hospitalizations. Cumulative incidence for any morbidity was 51.7%, and hospitalization was 10.0%. Early adolescence was dominated by disease-related infectious morbidity, with a trend toward noninfectious and treatment-related morbidity in later adolescence. Higher overall morbidity rates were associated with a CD4 count <350 cells/µL, HIV viral load ≥10,000 copies/mL and experiencing prior morbidity at age <10 years. Lower overall morbidity rates were found for those 15-19 years of age compared with 10-14 years and those who initiated ART at age 5-9 years compared with <5 or ≥10 years. Half of our PHIVA cohort experienced a morbidity event, with a trend from disease-related infectious events to treatment-related and noninfectious events as PHIVA age. ART initiation to prevent immune system damage, optimize virologic control and minimize childhood morbidity are key to limiting adolescent morbidity.

Viral RNA Degradation Makes Urine a Challenging Specimen for Detection of Japanese Encephalitis Virus in Patients With Suspected CNS Infection.

BackgroundJapanese encephalitis virus (JEV) is a leading cause of central nervous system (CNS) infections in Asia and results in significant morbidity and mortality. JEV RNA is rarely detected in serum or cerebrospinal fluid (CSF), and diagnosis of JEV infection is usually based on serological tests that are frequently difficult to interpret. Unlike serum or CSF, urine is relatively easy to obtain, but, to date, there has been minimal work on the feasibility of testing urine for JEV RNA.MethodsWe investigated the use of lysis buffer and a Microsep device to optimize urine storage for detection of JEV RNA by reverse transcription real-time polymerase chain reaction (RT-qPCR). The best of the studied methods was then evaluated in consecutive patients admitted to the hospital with suspected CNS infections in Laos.ResultsWe demonstrated degradation of JEV RNA in urine after even short storage periods at 4°C or –80°C. Although there was no advantage in using a Microsep concentration device alone, immediate addition of lysis buffer to fresh urine improved the detection of JEV RNA at the limit of detection.ConclusionsIn 2 studies of 41 patients with acute encephalitis syndrome, 11 (27%) were positive for JEV IgM in CSF and/or serum, and 2 (4.9%) were JEV RT-qPCR positive from throat swabs. JEV RNA was not detected in any of these patients’ urine samples. However, lysis buffer was only used during a prospective study, that is, for only 17/41 (41%) patient urine samples. Our findings suggest a need for larger studies testing urine for JEV RNA, with urine collected at different times from symptom onset, and using lysis buffer, which stabilizes RNA, for storage.

Senecavirus A: An emerging pathogen causing vesicular disease in pigs

Senecavirus A (SVA) is a single representative species of the Senecavirus genus within the family Picornaviridae. This review presents the current knowledge regarding SVA epidemiology, transmission, pathogenesis, clinical signs, differential diagnosis and control measures. SVA is not debilitating, but significant because of its resemblance to acute, highly contagious and economically devastating viral diseases, such as FMD. The incubation period of SVA is 4-5 days, the viremia period is short, lasting 3 to 10 days post infection (dpi). SVA shedding lasts up to 28 days. SVA can be shed by oral and nasal secretions and by faeces. The virus excretion peak occurs between 1 and 5 dpi, especially in oral secretions, which contain higher virus loads relative to nasal secretions and faeces. SVA lesions are found most frequently on the snout, lips and tongue, as well as on hooves, specifically, on coronary bands, dewclaws, hoof pads and in interdigital space. The vesicles quickly rupture to form ulcers that may be covered by serofibrinous exudates. The ulcers begin to repair in 7 days, and the regeneration of epithelium is usually complete within 2 weeks. Since clinical lesions induced by SVA are indistinguishable from those observed in other vesicular diseases of swine, accurate and reliable laboratory differential diagnosis is critical to the precise identification of the infectious agent. SVA has potential cytolytic activity and high selectivity for tumour cell lines with neuroendocrine properties versus adult normal cells. Because of its potential oncolytic activity, the virus can be useful in human cancer therapy. The example of SVA shows that the risk of emerging infectious diseases in swine populations is high and that emerging diseases of swine have significant potential impact on the productivity and economics of the pork industry. The SVA infection is currently limited to the United States, Canada, Brazil, China and Thailand. However, descriptions of the SVA infection in Asia suggest that the virus is not restricted to a specific geographic region and may be distributed on a global scale in the future.

Sofosbuvir–velpatasvir for treatment of chronic hepatitis C virus infection in Asia: a single-arm, open-label, phase 3 trial

Treatment with combined sofosbuvir and velpatasvir has resulted in high sustained virological response rates in patients chronically infected with hepatitis C virus (HCV) with genotypes 1-6 in clinical trials and real-world settings, but its efficacy and safety has not been assessed in Asia, a region with diverse HCV genotypes. In this single-arm, open-label, phase 3 trial, we recruited patients from 38 sites across China, Thailand, Vietnam, Singapore, and Malaysia, who were chronically infected with HCV genotypes 1-6, and were HCV treatment-naive or treatment-experienced, either without cirrhosis or with compensated cirrhosis. Patients self-administered a combined sofosbuvir (400 mg) and velpatasvir (100 mg) tablet once daily for 12 weeks. The primary efficacy endpoint was sustained virological response, defined as HCV RNA less than 15 IU/mL at 12 weeks after completion of treatment (SVR12), assessed in all patients who received at least one dose of study drug. The primary safety endpoint was the proportion of adverse events leading to premature discontinuation of study drug. This trial is registered with ClinicalTrials.gov, number NCT02671500, and is completed. Between April 14, 2016, and June 30, 2017, 375 patients were enrolled in the study, of whom 374 completed the full treatment course and one discontinued treatment. Overall, 362 (97% [95% CI 94-98]) of 375 patients achieved SVR12. Among 42 patients with HCV genotype 3b, all of whom had baseline resistance-associated substitutions in NS5A, 25 (89% [95% CI 72-98]) of 28 patients without cirrhosis and seven (50% [23-77]) of 14 patients with cirrhosis achieved SVR12. The most common adverse events were upper respiratory tract infection (36 [10%] patients) and headache (18 [5%] patients). There were no discontinuations due to adverse events. Serious adverse events were reported in three (1%) patients, none of which was judged to be related to sofosbuvir-velpatasvir treatment. Consistent with data from other phase 3 studies, single-tablet sofosbuvir-velpatasvir for 12 weeks is an efficacious and safe treatment for Asian patients with chronic HCV infection, but might have lower efficacy in those infected with HCV genotype 3b and with cirrhosis. Gilead Sciences.

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.

Cancers Attributable to Infectious Agents: an Ecological Study in Asia

Infections are a major contributor to cancer, especially in developing countries. Infections through the virus, bacteria and parasites are the most and most preventable causes of cancer in the world. The aim of the current study was to investigate the epidemiology of cancer-related infections in Asia. We considered 4 infectious agents classified as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with the estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases for the infection (for some sites). According to data registered in 2012, about 14 million new cases of cancer were detected worldwide of which 2. 2 million people (15.4%) diagnosed with cancer due to infection. The highest incidence of infectious cancers related to the African continent with a prevalence of 27.6% followed by Asian continents (21.4%), America (7.9%), Europe (7.3%) and Oceania (4.8%), respectively. In the Asian continent, of all cancers associated with infection in males, 48.1% were related to Helicobacter pylori infection, 33.2% of hepatitis B virus, 8% of hepatitis C and 3.3% of HPV and in women 47.4% HPV, 28.7% Helicobacter pylori, 15.3% Hepatitis B and 4.5% Hepatitis C, respectively. India (230,000 cases) and Japan (140,000 cases) were the most affected, while Bahrain (86 cases) and Brunei (88 cases) had the least cases of infection-related cancer. in Asia, the most common cancer-related infection in males and females were reported for Helicobacter pylori and HPV, respectively. Therefore, with preventive interventions aimed at reducing these infections, the burden of cancers can be reduced.

Cancers Attributable to Infectious Agents: an Ecological Study in Asia

Infections are a major contributor to cancer, especially in developing countries. Infections through the virus, bacteria and parasites are the most and most preventable causes of cancer in the world. The aim of the current study was to investigate the epidemiology of cancer-related infections in Asia. We considered 4 infectious agents classified as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with the estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases for the infection (for some sites). According to data registered in 2012, about 14 million new cases of cancer were detected worldwide of which 2. 2 million people (15.4%) diagnosed with cancer due to infection. The highest incidence of infectious cancers related to the African continent with a prevalence of 27.6% followed by Asian continents (21.4%), America (7.9%), Europe (7.3%) and Oceania (4.8%), respectively. In the Asian continent, of all cancers associated with infection in males, 48.1% were related to Helicobacter pylori infection, 33.2% of hepatitis B virus, 8% of hepatitis C and 3.3% of HPV and in women 47.4% HPV, 28.7% Helicobacter pylori, 15.3% Hepatitis B and 4.5% Hepatitis C, respectively. India (230,000 cases) and Japan (140,000 cases) were the most affected, while Bahrain (86 cases) and Brunei (88 cases) had the least cases of infection-related cancer. in Asia, the most common cancer-related infection in males and females were reported for Helicobacter pylori and HPV, respectively. Therefore, with preventive interventions aimed at reducing these infections, the burden of cancers can be reduced.

Lipopolysaccharide Structural Differences between Western and Asian Helicobacter pylori Strains.

Recent structural analysis of the lipopolysaccharide (LPS) isolated from Helicobacter pylori G27 wild-type and O-antigen ligase mutant resulted in the redefinition of the core-oligosaccharide and O-antigen domains. The short core-oligosaccharide (Glc–Gal–Hep-III–Hep-II–Hep-I–KDO) and its attached trisaccharide (Trio, GlcNAc–Fuc–Hep) appear to be highly conserved structures among H. pylori strains. The G27 LPS contains a linear glucan–heptan linker between the core-Trio and distal Lewis antigens. This linker domain was commonly identified in Western strains. In contrast, out of 12 partial LPS structures of Asian strains, none displayed the heptan moiety, despite the presence of Lewis antigens. This raises the question of how Lewis antigens are attached to the Trio, and whether the LPS structure of Asian strains contain another linker. Of note, a riban was identified as a linker in LPS of the mouse-adapted SS1 strain, suggesting that alternative linker structures can occur. In summary, additional full structural analyses of LPS in Asian strains are required to assess the presence or absence of an alternative linker in these strains. It will also be interesting to study the glucan-heptan linker moieties in pathogenesis as H. pylori infections in Asia are usually more symptomatic than the ones presented in the Western world.