Microbiol Infect Research Articles

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

Characterization of SP-T1 Phage for Potential Biological Control of Salmonella Enteritidis

Objectives: Salmonella Enteritidis is a pathogen that causes gastroenteritis and septicemia in humans and animals, causing worldwide health implications. This pathogen often causes fatal foodborne diseases in humans and animals. In recent years, new treatment strategies for bacterial infections have been studied. Bacteriophages might be used as an alternative strategy for battling against bacterial diseases.
 Methods: A novel SP-T1 phage was isolated, and its lytic activity against Salmonella Enteritidis strains and other enteric bacterial species was evaluated. In addition to its kinetic and genetic characteristics, it is in vivo cytotoxicity and ability to inhibit the development of biofilms were investigated. 
 Results: The gene sequence of the major capsid protein confirmed that the SP-T1 phage belonged to the family Siphoviridae. There was no evidence that phage had a lytic effect on bacteria other than the type of Salmonella used in this investigation. The phage exhibited a short latent period of 15 to 20 min and a burst size of 10 plaque forming unit per infected cell. The phage was resistant to temperatures between 15 and 37 °C and pH levels between 5 and 11. The SP-T1 phage exhibited no adverse effects on EPC cell culture and reduced biofilm formation.
 Conclusions: Because of its short latent period, appropriate burst size, ability to inhibit biofilm formation, and sensitivity to various temperatures and pH levels, the phage found in this study would be an excellent candidate for phage therapy. These findings are beneficial for improving the microbiological safety and quality of food and creating efficient bacteriophage-based regulation in the food chain. J Microbiol Infect Dis 2023; 12(4):38-46.

Evaluating The Effectiveness of A Non-Locally Developed Commercial Phage Cocktail on Kenyan Pseudomonas aeruginosa Isolates

Objectives: The use of bacteriophages (phages) as an alternative treatment for multidrug-resistant bacteria has recently gained popularity. Phage cocktails have been proposed for broad-spectrum therapeutic effects against such resistant bacteria. However, the effectiveness of non-locally formulated phage cocktails for therapy on Kenyan isolates has yet to be evaluated and is a subject of investigation. This study aimed to determine the in vitro effectiveness of a non-locally made commercial pyophage cocktail on clinical Pseudomonas aeruginosa isolates from Kenya. 
 Methodology: Forty-nine P. aeruginosa isolates from Kenya were subjected to a pyophage cocktail for efficacy studies using direct spot test (DST) and efficiency of plating (EOP).
 Results: The success rate of the cocktail was observed on 16.3% (8/49) isolates only and ineffective on 83.7% (41/49) isolates. Six of the eight isolates that showed cross-reactivity from DST had complete lysis with a faintly hazy background. Five of these six isolates resulted in successful and high phage progeny production in plaquing efficiency (EOP ≥ 0.5).
 Conclusion: Non-locally made commercial pyophage cocktail was ineffective against the 83.7% endemic clinical strains of the Kenyan P. aeruginosa isolates, demonstrating the importance of locally derived phage cocktails against endemic and multidrug-resistant isolates. J Microbiol Infect Dis 2023; 12(4):25-30.

Role of miRNAs in Immune Regulation And Bacterial Infections

Micro RNAs (miRNAs) are small noncoding RNAs that regulate gene expression at the post-transcriptional level. The miRNA in the RNA-induced silencing complex acts as a guide strand and binds the target mRNA. Subsequently, the gene is silenced either by cleaving the target mRNA or repressing the translation. Since the discovery of the first miRNA three decades ago, more than 2000 human miRNAs have been discovered. It is known to regulate hundreds of genes in various physiological and pathophysiological processes, including the development and function of immunologically essential cells. miR-155 plays a vital role in the function of T helper 1, 17, and T regulatory cells. miR-24 positively regulates the function of T helper 1, 17, and T regulatory cells, whereas miR-23 and 27 have a negative regulatory effect. miR-223 regulates the differentiation of neutrophils and monocytes. The role of miRNAs in bacterial infections came to light in 2006 after discovering miR-163 as a negative regulator of defense response in Arabidopsis thaliana infected with Pseudomonas syringae. During bacterial infection in the host, aberrant expression of several miRNAs was discovered. miR-155 was found to be the most commonly dysregulated miRNA in bacterial infections such as Helicobacter pylori, Staphylococcus aureus, Listeria monocytogenes, Mycobacterium tuberculosis, and Chlamydia trachomatis. Therefore, miRNAs can be utilized as a diagnostic and prognostic tool for bacterial infections. J Microbiol Infect Dis 2022; 12(4):1-7.

Assessment of Quantity and Quality of Multidrug-Resistant Tuberculosis DNA Extracts Stored at Different Temperatures

Objectives: Globally, Multidrug-Resistant Tuberculosis (MDR-TB) remains a public health concern. Rapid identification of MDR-TB using conventional or novel technologies is crucial for effective treatment. Here we assessed the quantity and quality of DNA extracted from MDR-TB isolates, allowing whole-genome sequencing (WGS).
 Methods: This was a retrospective study on MDR-TB isolates from five studies conducted in Zimbabwe between 2011 and 2019. The isolates were stored under ambient 37 oC and -80 oC temperatures, respectively. These isolates were resuscitated and confirmed to be Mycobacterium tuberculosis (MTB). DNA was extracted using the N-Cetyl-N-trimethylammonium-bromide standard protocol. The concentration (A260nm) and purity (A260/280) of the extracted DNA before WGS (concentration ≥20ng/ul) were compared among the different storage conditions on Stata v15.
 Results: A total of 85 samples were successfully recovered from 106 retrieved. The overall recovery rate was 80.2%. We found a significant difference (p=0.005) in the concentration of the DNA samples by storage temperatures, with samples stored at -80 oC having the lowest concentration. Similarly, a significant difference (p=0.018) was found in the purity of the DNA (samples within the optimal range of 1.8 ± 0.2) by storage conditions, with 34/39 (87.2%) stored under ambient temperature, 18/20 (90.0%) stored in a 37 oC incubator and 1/4 (25.0%) stored at -80 oC.
 Conclusions: The better concentration and purity obtained from samples stored at 37 oC and ambient temperatures provide an impetus that such storage conditions could be used in many resource-limited settings where power supplies are a limitation to long storage conditions. J Microbiol Infect Dis 2023; 12(4):31-37.

Effect of Sodium Hypochlorite on Biofilm-Producing Organisms Isolated from A Hospital Drinking Water

Objectives: Providing safe drinking water is essential for maintaining healthcare quality. The presence of biofilms in the water supply protects the organism from the antimicrobial effects of disinfectants leading to the formation of the MDR pathogen pool. Therefore, this study was taken up to determine the prevalence of biofilm formation in the bacteria isolated from the water system of a tertiary health care setup and study the effect of disinfectants on biofilms.
 Methods: Thirty-four drinking water samples were collected in sterile glass stopper bottles and transported to the lab. Standard bacteriological procedures identified isolates. Biofilm detection was carried out by the tissue culture plate (TCP) method. The effect of disinfectant (sodium hypochlorite) at various concentrations (0, 0.25, 0.5, 1, 2, and 4 %) on biofilm-producing organism were studied for 30 minutes and analyzed.
 Results: The culture positivity was 76.4% (26/34). Twenty samples showed monomicrobial growth, while only six samples showed polymicrobial growth of organisms. The most common organism isolated was Pseudomonas aeruginosa. Biofilm production was seen more in polymicrobial organisms, 91.66 % (11/12). A high level of resistance to chlorine compounds was seen in biofilm-producing microorganisms, especially those that produced robust biofilms.
 Conclusion: Resistance of biofilms against high levels of chlorine has implications for the delivery of safe drinking water. Drug resistance was seen in these organisms, which can be transmitted from drinking water sources to humans. Therefore, it is recommended that biofilm production should be evaluated in drinking water samples regularly..J Microbiol Infect Dis 2022; 12(4):17-24.

Predicting infection risk from surveillance cultures: frustrating or foretelling?

The global burden of morbidity and mortality due to multidrug-resistant infections is high, and in-vitro inactive empirical antibiotic therapy is a well known risk factor for poor outcomes. 1 Antimicrobial Resistance CollaboratorsGlobal burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-655 Summary Full Text Full Text PDF PubMed Scopus (1171) Google Scholar , 2 Kadri SS Lai YL Warner S et al. Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals. Lancet Infect Dis. 2021; 21: 241-251 Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar Studies have shown that colonisation with resistant pathogens increases the subsequent risk of infection by those same strains. However, when operationalising this principle, deciding how often to use specific broad-spectrum antibiotics if the patient is colonised with a particular pathogen warrants an improved understanding of the relative size of infection risks across different pathogens, host types, and time. 3 Denkel LA Maechler F Schwab F et al. Infections caused by extended-spectrum beta-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae. Clin Microbiol Infect. 2020; 26: 1046-1051 Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 4 Tseng W-P Chen Y-C Chen S-Y Chen S-Y Chang S-C Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant Gram-negative bacteria colonization or infection. Antimicrob Resist Infect Control. 2018; 7: 93 Crossref PubMed Scopus (33) Google Scholar , 5 Giannella M Bartoletti M Conti M Righi E Carbapenemase-producing Enterobacteriaceae in transplant patients. J Antimicrob Chemother. 2021; 76: i27-i39 Crossref Scopus (6) Google Scholar , 6 Tischendorf J de Avila RA Safdar N Risk of infection following colonization with carbapenem-resistant Enterobactericeae: a systematic review. Am J Infect Control. 2016; 44: 539-543 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar Roel P J Willems and colleagues should be congratulated for their systematic review and meta-analysis establishing the cumulative incidence risk and the incidence density of infection in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) or vancomycin-resistant enterococci (VRE) colonisation of the gastrointestinal or urinary tract. 7 Willems RPJ van Dijk K Vehreschild MJGT et al. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. Lancet Infect Dis. 2022; (published online Jan 30.)https://doi.org/10.1016/S1473-3099(22)00811-8 Google Scholar Willems and colleagues pool aggregate results from 40 observational studies contributing 5015 VRE carriers and 9034 MDR-GNB carriers with a median study duration of 45 days (IQR 28–140). 7 Willems RPJ van Dijk K Vehreschild MJGT et al. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. Lancet Infect Dis. 2022; (published online Jan 30.)https://doi.org/10.1016/S1473-3099(22)00811-8 Google Scholar Infection and colonisation were as defined by the authors of each respective study and varied across studies. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysisThe risk of infection was substantial, with the highest risk for patients colonised with carbapenem-resistant Gram-negative bacteria and the lowest in patients with VRE. These data might help to guide prophylactic and treatment decisions and form a valuable resource for planning clinical trials on targeted prevention. Full-Text PDF

Liposomal Amphotericin-B Infusion-related Reactions and Rate of Infusions: A Single Center Cohort Study

Objectives: Liposomal amphotericin B is a broad-spectrum antifungal treatment used for life-threatening infections, but it commonly induces infusion-related adverse events that may prevent treatment completion. Based on anecdotal evidence, a slow infusion guideline at treatment initiation has been suggested to reduce these reactions. This study aimed to determine if slowing down the infusion rate on treatment initiation would reduce the rate of infusion-related adverse events.
 Methods: A retrospective cohort study was conducted examining the primary outcome of adverse event rates between patients who received slow and standard (2-hour or faster) infusions at a major hospital in Australia. Secondary outcomes were risk factors associated with infusion reactions. The rates of adverse events were analyzed using Fisher’s exact test.
 Results: An 8-year audit identified 47 patients who were administered liposomal amphotericin-B. The average age of the study population was 61.7 years and 28 (59.6%) were male patients. Slower than standard infusions were given to 5 (10.6%) patients on treatment initiation. Infusion-related adverse events occurred in 2 (40.0%) patients with reduced rates and 5 (11.9%) patients with standard infusion rates (p=0.154). Typical reactions were myalgia, dyspnoea, and flushing. Four patients with adverse events had been rechallenged after further rate reductions and prophylactic medications with the completion of treatment. No risk factors for adverse events were identified among demographics, comorbidities, or co-prescribed medications.
 Conclusion: Slowing the infusion rate of liposomal amphotericin-B administration does not appear to reduce the likelihood of infusion-related reactions, however, it can be trialed for adverse-event management. J Microbiol Infect Dis 2022; 12(4): 148-153.

Possibility of COVID-19 Vertical Transmission to Newborns: Case Report

Coronavirus disease 2019 (COVID-19) has impacted people of all ages, including neonates. However, confirmed data on its vertical transmission is still scarce. As a result, displaying various cases of COVID-19 in neonates may assist in understanding the virus's behavior during pregnancy. This report shows a 32-year-old mother with a 5-day history of acute respiratory disease tested positive for COVID-19 by real-time polymerase chain reaction (RT-PCR), presented with labor pain at 34 weeks of gestation, and underwent an emergency cesarean section. She gave birth to a preterm male baby, who tested positive for RT-PCR less than 24 hours after birth and fifth day of life. His outcome was good. J Microbiol Infect Dis 2022; 12(4):160-162.
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Prolonged Scrotal Pain Resulting from Testicular Schistosomiasis: Case Report

Testicular Schistosomiasis causes acute and chronic scrotal pain causes, typically by one or more species of blood flukes of the genus Schistosoma, which are rarely seen. Therefore, specimens for the diagnosis are usually biopsies from the testes and tissue sections from orchidectomy. This case report was aimed to present the diagnosis of testicular Schistosomiasis resulting from orchidectomy due to prolonged scrotal pain. Microscopic examination of a histological specimen stained by hematoxylin and eosin revealed dispersed viable and calcified ova of Schistosoma haematobium. This finding provided a rare case of testicular Schistosomiasis that clinicians and other healthcare professionals should be mindful of when dealing with cases with scrotal involvement, especially in endemic areas, to avoid unnecessary orchidectomy. J Microbiol Infect Dis 2022; 12(4):167-170.

Epidemiological Features and Phylogeny of SARS-CoV-2 Circulating in the Southeast Asia in Early Pandemic

Objectives: This study aims to understand the epidemiological and level of genetic similarity in the SARS-CoV-2 from different geographical areas in The Southeast Asia Region during an early pandemic.
 Methods: The data on COVID-19 cases in Southeast Asia was collected from https://worldometer.info/ and extracted independently. Complete genome SARS-CoV-2 nucleotide sequence data was obtained from GISAID and NCBI online platforms. The sequences were aligned using MEGA X software and identified RdRp and Spike genes using UGENE software. The phylogenetic was constructed using MEGA X software to know the similarity of these genes among isolates in the Southeast Asia region. 
 Results: The result showed that the first case in Southeast Asia was reported in January 2020. The highest number of COVID-19 cases and death were reported from populous and suffering countries. The phylogenetic results showed an identical solid (100%) among isolates, except for the Philippines-5 isolate. The Wuhan-Hu-1 (China) SARS-CoV-2 isolate (Acc. NC_045512) was transmitted to other countries in Southeast Asia regions with various mutations in the spike protein.
 Conclusion: During the early pandemic, all countries in the Southeast Asia regions reported COVID-19 cases. Indonesia became the country with the highest number of COVID-19 cases and deaths. The level of similarity of the RdRp gene in the SARS-CoV-2 in Southeast Asia is higher than the Spike genes. J Microbiol Infect Dis 2022; 12(4):139-148.

Breast Abscess as the Sole Presentation of Salmonella Typhi Infection: Case Report

A breast abscess is a common clinical entity most commonly caused by gram-positive cocci in the lactating breast. Here we present a bilateral breast abscess due to Salmonella Typhi in a young non-lactating female. The patient presented with on and off fever and a painful lump with discharge in the left breast, followed by similar complaints in the right breast after a few days. Incision and drainage were done, and the sample was sent for microbiological analysis. Salmonella Typhi was isolated. The patient had high titers of the Widal test though her blood culture was negative. The infection was successfully treated with a combination of surgical drainage and antibiotics. This case highlights that a systemic Salmonella infection need not always present with the typical symptoms and can solely present in a focal manner (breast abscess) and highlights the importance of microbiological analysis for accurate diagnosis and proper management. J Microbiol Infect Dis 2022; 12(4):163-166.

Poverty and antibiotic misuse: a complex association

Poverty and antibiotic misuse: a complex association

Need for standardized vancomycin dosing for coagulase-negative staphylococci in hospitalized infants

In high-income countries, coagulase-negative staphylococci (CoNS) are the most commonly implicated pathogens in late-onset sepsis (LOS) (sepsis occurring after 72 hours of age) in neonates [ [1] Jean-Baptiste N. Benjamin Jr., D.K. Cohen-Wolkowiez M. Fowler Jr., V.G. Laughon M. Clark R.H. et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2011; 32: 679-686https://doi.org/10.1086/660361 Crossref PubMed Scopus (68) Google Scholar ]. They are responsible for more than 50% of neonatal LOS cases [ [2] Cailes B. Kortsalioudaki C. Buttery J. Pattnayak S. Greenough A. Matthes J. et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018; 103: F547-F553https://doi.org/10.1136/archdischild-2017-313203 Crossref PubMed Scopus (77) Google Scholar ]. Overall mortality rates from LOS caused by CoNS are low; however, low birth-weight and preterm infants carry the highest burden. Morbidity related to LOS caused by CoNS has been associated with poor neurodevelopment, visual impairment, chronic lung disease, and necrotizing enterocolitis and can prolong the length of hospitalization [ [3] Dong Y. Speer C.P. Glaser K. Beyond sepsis: Staphylococcus epidermidis is an underestimated but significant contributor to neonatal morbidity. Virulence. 2018; 9: 621-633https://doi.org/10.1080/21505594.2017.1419117 Crossref PubMed Scopus (47) Google Scholar ]. CoNS are frequently multi-drug resistant, and the emergence of the multi-drug resistant Staphylococcus capitis NRCS-A clone worldwide, found almost exclusively as a pathogen within neonatal units, is concerning [ [4] Laurent F. Butin M. Staphylococcus capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units. Clin Microbiol Infect. 2019; 25: 1081-1085https://doi.org/10.1016/j.cmi.2019.03.009 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ]. A recent survey of French neonatal units demonstrated that S capitis accounted for 14.2% of nosocomial bloodstream infections, with most infections being attributed to the NRCS-A clone [ [5] Decalonne M. Dos Santos S. Gimenes R. Goube F. Abadie G. Aberrane S. et al. Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units. Eur J Clin Microbiol Infect Dis. 2020; 39: 2185-2194https://doi.org/10.1007/s10096-020-03925-5 Crossref PubMed Scopus (1) Google Scholar ].

A RARE CAUSE OF MULTIFOCAL PNEUMONIA AND CONSTRICTIVE PERICARDITIS: COXSACKIEVIRUS A

A RARE CAUSE OF MULTIFOCAL PNEUMONIA AND CONSTRICTIVE PERICARDITIS: COXSACKIEVIRUS A

A RARE CAUSE OF COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN A PATIENT WITH POORLY CONTROLLED DIABETES

A RARE CAUSE OF COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA IN A PATIENT WITH POORLY CONTROLLED DIABETES

GEMELLA MORBILLORUM BIOPROSTHETIC AORTIC VALVE INFECTIVE ENDOCARDITIS WITH SEPTIC SHOCK CAUSING LEAFLET PERFORATION AND AORTIC ROOT ABSCESS

GEMELLA MORBILLORUM BIOPROSTHETIC AORTIC VALVE INFECTIVE ENDOCARDITIS WITH SEPTIC SHOCK CAUSING LEAFLET PERFORATION AND AORTIC ROOT ABSCESS

Comparison of Different Phenotypic Methods of Detection of Methicillin-Resistant Staphylococcus aureus with Polymerase Chain Reaction

Objectives: The objective of the current study was to compare the diagnostic methods of Oxacillin Disk Diffusion, Cefoxitin Disk Diffusion, Oxacillin Resistance Screening Agar Base, and CHROM Agar MRSA with the gold-standard method of Polymerase Chain Reaction for detection of Methicillin-resistant Staphylococcus aureus.
 Methods: Two hundred pus samples were included in the study from which Staphylococcus strains were evaluated. The isolates of Staphylococcus aureus were subjected to the Oxacillin Disk Diffusion test, Cefoxitin Disk Diffusion test, Oxacillin Resistance Screening Agar Base, and CHROM Agar MRSA to detect MRSA with PCR, the reference standard. The diagnostic techniques were compared to their sensitivity, specificity, positive predictive, and negative predictive values.
 Results: The sensitivity of the Cefoxitin Disk Diffusion test was 100%, followed by CHROM Agar MRSA at 96.7%, Oxacillin Disk Diffusion at 90%, and Oxacillin Resistance Screening Agar Base at 86.7%. Most specific was the Cefoxitin Disk Diffusion test (99.4%), followed by Oxacillin Resistance Screening Agar Base (98.8%), CHROM Agar MRSA (97.7%), and the least specific was the Oxacillin Disk Diffusion test (96.5%).
 Conclusion: The Cefoxitin Disk Diffusion test was the most sensitive and specific of all four methods, next to the Polymerase Chain Reaction. However, future multicentric studies are recommended to test this method across all prevalent centers of methicillin resistance. J Microbiol Infect Dis 2022; 12(3):116-126.

Leptotrichia species Bacteremia in Hematological Malignancies

Here we present four clinical cases of immunocompromised patients experiencing bacteremia caused by Leptotrichia species in a few months with no common epidemiological link. Leptotrichia species are thin anaerobic gram-negative rods that inhabit multiple areas in the human body, including the oral microbiota. Many infections with Leptotrichia species occur in immunocompromised individuals classifying Leptotrichia species as opportunistic pathogens. Utilization of standard microbial identification methods of matrix-assisted laser-desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) initially yielded the same identification for all four Leptotrichia isolates as Leptotrichia buccalis. However, 16S ribosomal RNA sequencing confirmed the identification of only one of the four isolates as L. buccalis, while two of the four isolates were identified as Leptotrichia trevisanii. These four cases highlight the clinical importance of considering opportunistic infection in immunocompromised patients with unusual organisms considered members of the normal oral flora. J Microbiol Infect Dis 2022; 12(3):130-135.