The Journal of Infection in Developing Countries <p>A peer-reviewed open access medical journal, focusing on global health.</p> The Journal of Infection in Developing Countries en-US The Journal of Infection in Developing Countries 1972-2680 <p>Authors who publish with this journal agree to the following terms:</p> <ol type="a"> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="Creative Commons Attribution License" href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a title="The Effect of Open Access" href="" target="_new">The Effect of Open Access</a>).</li> </ol> Examining the incubation period distributions of COVID-19 on Chinese patients with different travel histories <p>Introduction: Current studies estimated a general incubation period distribution of COVID-19 based on early-confirmed cases in Wuhan, and have not examined whether the incubation period distribution varies across population segments with different travel histories. We aimed to examine whether patients infected by community transmission had extended incubation periods than the early generation patients who had direct exposures to Wuhan.</p> <p>Methodology: Based on 4741 patient case reports from municipal centers of disease control by February 21, 2020, we calculated the incubation periods of 2555 patients with clear epidemiological survey information and illness development timeline. All patients were categorized into five groups by their travel histories. Incubation period distributions were modeled for each group by the method of the posterior Weibull distribution estimation.</p> <p>Results: Adults aged 30 to 59 years had the most substantial proportion of confirmed cases in China. The incubation period distribution varied slightly across patient groups with different travel histories. Patients who regularly lived in Wuhan and left to other locations before January 23, 2020 had the shortest posterior median value of 7.57 days for the incubation period, while the incubation periods for persons affected by local community transmission had the largest posterior median of incubation periods, 9.31 days.</p> <p>Conclusions: The median incubation period for all patients infected outside Wuhan was 9 days, a bit of more extended than the early estimated 5-day incubation period that was based on patients in Wuhan. Our findings may imply the decreases of virulence of the COVID-19 virus along with intergenerational transmission.</p> Zuopeng Xiao Xi Xie Wenbo Guo Zhiqiang Luo Jianxiang Liao Feiqiu Wen Qingfeng Zhou Laiwei Han Te Zheng Copyright (c) 2020 Zuopeng Xiao, Xi Xie, Wenbo Guo, Zhiqiang Luo, Jianxiang Liao, Feiqiu Liang, Qingfeng Zhou, Te Zheng, Laiwei Han 2020-04-30 2020-04-30 14 04 323 327 10.3855/jidc.12718 Sustainable health promotion for the seniors during COVID-19 outbreak: a lesson from Tokyo <p>The COVID-19 pandemic is novel corona virus infection outbreak that has gone global in 2020. Current prevention policies consist of hand hygiene and social distancing. Emergencies overloaded health services and shocked the logistics chains in many countries, especially Italy and China. Having more than a quarter of its population being elderly, Japan is at high risk for COVID-19 induced morbidity and mortality.</p> <p>This situation cancelled schedules of all routine group exercise activities for the seniors in Japan. While the outbreak is ongoing, staying at home is safe. However, successive days of being house-ridden and limited movement can lead to excessive physical inactivity. Some elderly who are not moving much can lose a significant amount of muscle strength, flexibility and aerobic capacity. It can accelerate the frailty and dependency of the seniors, and subsequently, claiming of care and health services. Moreover, existing and new evidences showed that physical activity can promote antiviral immunity.</p> <p>An alternative to usual group exercise activities is crucial to keep seniors active without affecting social distancing. While staying at home for long, functional exercises maintaining basic level of physical activity and movements are urgently required to be introduced to the seniors in Tokyo and around the world to prevent functional decline.</p> <p>Home exercise is a practical option. Therefore, we made a home-version of the functional training exercise video with different sets of 10-minutes exercise for 7 days a week. This breakthrough alternative may sustain health promotion for the elderly persons to preserve their active aging and maintain optimal health.</p> Myo Nyein Aung Motoyuki Yuasa Yuka Koyanagi Thin Nyein Nyein Aung Saiyud Moolphate Hiromichi Matsumoto Takashi Yoshioka Copyright (c) 2020 Myo Nyein Aung, Motoyuki Yuasa, Yuka Koyanagi, Thin Nyein Nyein Aung, Saiyud Moolphate, Hiromichi Matsumoto, Takashi Yoshioka 2020-04-30 2020-04-30 14 04 328 331 10.3855/jidc.12684 Streptococcus agalactiae colonization and screening approach in high-risk pregnant women in southern Brazil <p>Introduction: Considering that Group B Streptococcus (GBS) persists as an important cause of neonatal morbidity and mortality, the objective of this study was to evaluate the frequency of maternal colonization by GBS, comparing the culture by the Granada broth with the GeneXpert real-time PCR diagnostic methods and the impact of chemoprophylaxis in high-risk pregnant women.</p> <p>Methodology: A prospective cohort of 110 pregnant women hospitalized for gestational complications was formed and recruited following interview and collection of rectovaginal swabs.</p> <p>Results: The frequency of maternal colonization was 28.2% and statistically associated with Capurro&gt; 37 weeks (p = 0.030) and neonatal infection (p = 0.008). Chemoprophylaxis was offered to 80% of those colonized. Among the pregnant women treated, a fivefold reduction in the rate of prematurity and rate of neonatal infection was observed. The sensitivity was 76.6% and 86.6% in culture and PCR, respectively, with an optimal index of agreement between the methods (K = 0.877). Grenade culture was considered an easy and low-cost method, while GeneXpert presented higher cost and error rate of 10%. However, 23.3% of the pregnant women were diagnosed exclusively by GeneXpert and the results were obtained in two hours.</p> <p>Conclusions: This study showed a significant prevalence of maternal colonization for GBS and that both culture and molecular methods had peculiarities that allow different applicability, with the culture being feasible for antenatal screening and in the hospital for high-risk pregnant women with no sign of imminent delivery and GeneXpert being prioritized for situations of preterm birth.</p> Jeane Zanini da Rocha Jéssica Feltraco Vanessa Radin Carla Vitola Gonçalves Pedro Eduardo Almeida da Silva Andrea von Groll Copyright (c) 2020 Jeane Zanini da Rocha , Jéssica Feltraco, Vanessa Radin, Carla Vitola Gonçalves, Pedro Eduardo Almeida da Silva, Andrea von Groll 2020-04-30 2020-04-30 14 04 332 340 10.3855/jidc.12025 Assessment of STI screening in Romania using a multiplex PCR technique <p>Introduction: Most sexually transmitted infections (STIs) are curable, but inappropriate treatment can lead to serious complications. The importance of setting up STI screening programs has been highlighted in various studies, the absence of such national programs accounting for the lack of STI statistics in Romania. The purpose of our study was to evaluate multiplex PCR as a screening method for the most common 6 STIs and establish their frequency in a group of symptomatic and asymptomatic patients. We aimed to highlight STI associations and correlations between STI pathogens and symptomatology, demographic status, antecedents or sexual partners.</p> <p>Methodology: A total of 249 patients, both symptomatic and asymptomatic, were included in this study. <em>Chlamydia trachomatis </em>(CT), <em>Neisseia gonorrhoeae </em>(NG), <em>Trichomonas vaginalis </em>(TV), <em>Ureaplasma urealyticum </em>(UU), <em>Mycoplasma hominis </em>(MH) and <em>Mycoplasma genitalium</em> (MG) were all identified in urine samples via multiplex Polymerase Chain Reaction (PCR). The SPSS IBM program was employed for statistical analysis.</p> <p>Results: 32.12% of the patients were found positive, some presenting multiple infections. The results are representative for the Romanian male population. 107 STI pathogens were identified, most frequent being CT, UU and NG. Several statistical correlations between patient characteristics and the presence of STIs have been demonstrated.</p> <p>Conclusions: The results suggest that multiplex PCR meets all the prerequisites for a screening method, allowing the use of multiple specimens and enabling simultaneous detection of multiple pathogens in a short period of time. STI identification via multiplex PCR proved to be an effective method for quantifying their frequency in Romania.</p> Alecsandra Iulia Grad Mihaela Laura Vica Loredana Ungureanu Costel Vasile Siserman Alexandru Dumitru Tătaru Horea Vladi Matei Copyright (c) 2020 Alecsandra Iulia Grad, Mihaela Laura Vica, Loredana Ungureanu, Costel Vasile Siserman, Alexandru Dumitru Tătaru, Horea Vladi Matei 2020-04-30 2020-04-30 14 04 341 348 10.3855/jidc.11989 An exploration of disease awareness among tuberculosis patients: The empirical link between attitude and self-preventive care <p>Introduction: The prevalence of tuberculosis (TB) remains alarmingly high in developing countries, including Malaysia. Recognised as the leading global infectious disease, untreated TB can be fatal. TB is easily spread through the air, and any close contact with a TB patient can put others at risk. This study therefore aimed to investigate the level of awareness of TB among TB patients and how their attitudes affect self-preventive healthcare.</p> <p>Methodology: This cross-sectional study was conducted using a validated self-administered questionnaire at 18 hospitals in six states of Malaysia, namely, Selangor, Kuala Lumpur, Penang, Kelantan, Sabah, and Sarawak in 2015. The study sample comprised 1600 TB patients who were randomly selected using data obtained from the Disease Control Division, Ministry of Health Malaysia. A total of 1368 of the completed questionnaires were considered usable and included in the statistical analysis.</p> <p>Results: Overall, the level of TB awareness was found to be high, and the respondents possessed positive attitudes towards TB and health-seeking behaviours. Self-preventive care among the TB patients was determined as being at a moderate level. With regard to contact with others, the patients were more comfortable around their families than their friends and neighbours.</p> <p>Conclusions: More health education programmes are recommended to cultivate positive attitudes towards TB, to encourage communities to have a better understanding of TB, and to create awareness among patients of the proper ways to practice self-preventive care.</p> Khairiah Salwa Mokhtar Nurulhasanah Abdul Rahman Mahmod Sabri Haron Nur Hairani Abd Rahman Copyright (c) 2020 Khairiah Salwa Mokhtar, Nurulhasanah Abdul Rahman, Nur Hairani Abd Rahman 2020-04-30 2020-04-30 14 04 349 359 10.3855/jidc.11583 Comparison of Quantiferon-TB Gold and TST tests in the diagnosis of latent tuberculosis infection among HIV infected patients in Hamadan, west of Iran <p>Introduction: Human immunodeficiency virus (HIV) infection increases the susceptibility of patients for latent tuberculosis infection (LTBI) and reactivtion tuberculosis. This study aimed to compare the Quantiferon-TB gold-in tube test (QFT) with tuberculin skin test (TST) in the diagnosis of LTBI in HIV infected patients.</p> <p>Methodology: This comparative study of 89 patients with HIV in the Behavioral Diseases Counseling Center in Hamadan was carried out from July 2015 to November 2016. After obtaining consent from the patients, all demographic data, clinical manifestations, and laboratory results (CD4 count, TST and QFT) were entered into the questionnaires. The CD4 count is usually routinely performed using flow cytometry at the Behavioral Counselling Center. Quantiferon-TB test was done by using Qiagen – Quantiferon-2 plate kit ELISA.</p> <p>Results: Totally, 89 HIV infected patients with the mean age of 39.55 ± 10.31 years old were enrolled in the study. Sixty patients (67.42%) were male. The mean duration of HIV infection was 4.44 ± 3.88 years and the mean of CD4 count was 388.65 ± 260.66 cells/µL . Twenty patients had LTBI based on TST. Considering the QFT intermediate results as a positive test, the percent agreement of QFT and TST was 59.55%, which was not statistically significant (P = 0.2387).</p> <p>Conclusions: According to the results, there was no significant percent agreement between QFT and TST for detecting LTBI in HIV infected patients. However, by decreasing CD4 counts, there was a significant relation between TST positive and LTBI in HIV patients.</p> Fariba Keramat Benyamin Bagheri Delavar Alireza Zamani Jalal Poorolajal Elham Lajevardi Ali Saadatmand Copyright (c) 2020 Fariba Keramat, Benyamin Bagheri Delavar, Alireza Zamani, Jalal Poorolajal, Elham Lajevardi, Ali Saadatmand 2020-04-30 2020-04-30 14 04 360 365 10.3855/jidc.12139 Evaluation of inhibitory activity of domestic probiotics for against invasion and infection by Proteus mirabilis in the urinary tract <p>Introduction: Approximately 5% of men and 40%–50% of women have experienced urinary tract infections (UTI), which are the most common infectious diseases and nosocomial infections in humans. <em>Proteus mirabilis</em> is susceptible to most antibiotics, but antibiotic treatment usually causes side effects. In this research<em>, </em>lactic acid bacteria (LAB) was assessed for its inhibitory activity against a urinary tract pathogen.</p> <p>Methodology: We studied the effect of pH adjustment, heat, and enzyme treatments on the inhibitory activity of LAB strains and their supernatants, using well-diffusion and co-culture assays. In the cell culture assay, anti-adhesion and anti-invasion activities against <em>P. mirabilis</em> were tested with SV-HUC-1 urothelial cells.</p> <p>Results: LAB were able to adhere to the urothelial cells and inhibited <em>P. mirabilis</em> growth. LAB were also able to inhibit <em>P. mirabilis</em> adhesion to or invasion of SV-HUC-1 urothelial cells. Finally, in the competition assay, LAB showed inhibitory effects against <em>P. mirabilis</em>. LAB could also inhibit the invasion of <em>P. mirabilis</em> into urothelial cells<em>.</em></p> <p>Conclusions: Two LAB strains (PM206 and 229) exhibited antagonistic activity against <em>P. mirabilis</em> adhesion or invasion of urothelial cells in culture. In the future, probiotics may be used in food or urinary tract cleansing and could replace antibiotic treatments.</p> Tzu-Min Lai Pei-Pei Lin You-Miin Hsieh Cheng-Chih Tsai Copyright (c) 2020 Tzu-Min Lai, Pei-Pei Lin, You-Miin Hsieh, Cheng-Chih Tsai 2020-04-30 2020-04-30 14 04 366 372 10.3855/jidc.12203 The High mortality and antimicrobial resistance of Klebsiella pneumoniae bacteremia in northern Taiwan <p>Introduction: <em>Klebsiella pneumoniae</em>, a common hospital- and community-acquired pathogen, is notorious for multidrug resistance. This study aimed to better understand the correlation of clinical presentation and microbiological characteristics of the isolates causing bloodstream infections (BSIs) in Taiwan.</p> <p>Methodology: We retrospectively collected 150 isolates derived from <em>K. pneumoniae </em>bacteremia patients in Taiwan in both 2014 and 2016. Clinical data, bacterial serotyping and drug susceptibility tests were comparatively analyzed.</p> <p>Results: Demographic data showed that diabetes mellitus (DM) was the most common underlying disease (44.0%). The overall 30-day mortality rate was 19.3%, and higher mortality was found in patients with malignancy than others (P = 0.023). Serotype distribution was diverse. The major isolates belonged to non-PCR-typeable serotypes (58.7%) associated with hospital-acquired infections (P = 0.007) and in non-DM patients (P &lt; 0.001), while K2 and K20 significantly caused infections and in DM patients (P = 0.046 and P = 0.006, respectively); however, only K2 showed more community-acquired infection (P = 0.022) than other typeable serotypes. Resistance to antibiotics in clinical isolates in the year 2016 was &gt; 24%, including cefazolin (54%), ampicillin-sulbactam (25%) and cefuroxime (25%). Susceptibility to gentamicin, flomoxef, and tigecycline reduced between the two time periods (2014 and 2016). However, the isolates remained highly susceptible to amikacin and ertapenem (&gt; 95%).</p> <p>Conclusions: Patients with cancer had a higher 30-day mortality rate than others. Amikacin and ertapenem are the drugs of choice for the treatment of multidrug-resistant <em>K. pneumoniae </em>BSIs in Taiwan.</p> Chyi-Liang Chen Pin-Chun Hou Yun-Ting Wang Hao-Yuan Lee Ying-Li Zhou Ting-Shu Wu Rajendra-Prasad Janapatla Chien-Chang Yang Copyright (c) 2020 Chyi-Liang Chen, Pin-Chun Hou, Yun-Ting Wang, Hao-Yuan Lee, Ying-Li Zhou, Ting-Shu Wu, Rajendra-Prasad Janapatla, Chien-Chang Yang 2020-04-30 2020-04-30 14 04 373 379 10.3855/jidc.11524 A cross-sectional study of real life data of HCV from Turkey south region <p>Introduction: This study investigated demographic characteristics and the prevalence of viremia among anti-HCV-positive patients.</p> <p>Methodology: Hospital records of adult patients with anti-HCV positivity between June 2016 and October 2018 were screened retrospectively. Demographic characteristics, genotype distribution, history of injection drug use (IDU), treatment data of HCV RNA-positive patients were investigated.</p> <p>Results: The rate of anti-HCV seropositivity was 1.7% and 54.5% of these were viremic. 69.5% of the 869 viremic patients were male. The mean age was 62 ± 15 (18–95) years for women and 42 ± 19 (18-90) years for men (p &lt; 0.0001). 42.7% of these patients had IDU history. Regarding age, patients with IDU history accounted for 95% of the 18–29 age group. The most common genotype in patients younger than 40 was genotype 3, and genotype 1b in those older than 40. Only 52% of viremic patients had received DAA therapy. Also, 62.2% of patients aged &lt; 40 and 36% of patients &gt; 40 did not receive treatment (p &lt; 0.0001). The SVR12 rate in patients receiving DAA treatment and follow-up was 100%; SVR24 was 99.5%.</p> <p>Conclusions: A shift in the demographic structure of HCV-infected patients due to the changing trends of the HCV transmission mode was observed in this study. On the other hand, the proportion of patients who received DAA therapy was low. A substantial proportion of untreated patients were young with a history of IDU. This indicates that without strategies targeting the patients, the patient load due to HCV-related cirrhosis and hepatocellular carcinoma may persist in the future.</p> Bedia Mutay Suntur Hava Kaya Halime Betül Şahin Eker Banu Kara Taylan Bozok Nevzat Unal Copyright (c) 2020 bedia mutay suntur, Hava Kaya, Halime Betül Şahin Eker, Banu Kara, Taylan Bozok, Nevzat Ünal 2020-04-30 2020-04-30 14 04 380 386 10.3855/jidc.11983 Use of ovitraps for the seasonal and spatial monitoring of Aedes spp. in an area endemic for arboviruses in Northeast Brazil <p>Introduction: Due to recent outbreaks of Dengue and Chikungunya and an absence of effective monitoring of the mosquito <em>Aedes</em> spp. in the municipality of São Raimundo das Mangabeiras, State of Maranhão, we aimed to demonstrate the potential of ovitraps used together with mathematical models and geotechnology to improve control of this mosquito.</p> <p>Methodology: From January to December of 2017, ovitraps were set up in five different neighborhoods (Centro, Vila Cardoso, Nazaré, São José e São Francisco). Positivity indices were calculated for each ovitraps, besides the egg density and average number of eggs. Some of the eggs were used for species identification. Mathematical models of correlation and logistic regression were used to evaluate the influence of abiotic factors on egg distribution during each month. Spatial analysis was carried out using georeferencing.</p> <p>Results: A total of 4,453 eggs were counted, with <em>A. aegypti</em> and <em>A. albopictus</em> present in each month and neighborhood. The mathematical models show that rainfall can result in a significant increase in the number of eggs. Entomological calculation indicates that there is a high risk of dissemination of arboviruses in the area. Spatially, it was possible to indicate sites with the largest number of collected eggs, which may facilitate future interventions.</p> <p>Conclusions: As such, ovitraps have proven to be an effective and low cost method for the monitoring of <em>Aedes</em> spp., and that its use may help in arboviruses prevention campaigns.</p> João Victor Oliveira Noleto Hevilem Letícia Moura do Nascimento Moraes Tamires de Moura Lima João Gustavo Mendes Rodrigues Diogo Tavares Cardoso Kalyl Chaves Lima Richardson Soares de Souza Melo Guilherme Silva Miranda Copyright (c) 2020 João Victor Oliveira Noleto, Hevilem Letícia Moura do Nascimento Moraes, Tamires de Moura Lima, João Gustavo Mendes Rodrigues, Diogo Tavares Cardoso, Kalyl Chaves Lima, Richardson Soares de Souza Melo, Guilherme Silva Miranda 2020-04-30 2020-04-30 14 04 387 393 10.3855/jidc.12245 In vitro susceptibility of OXA-48, NDM, VIM and IMP enzyme- producing Klebsiella spp. and Escherichia coli to fosfomycin <p>Introduction: Infections caused by Carbapenemase-producing Enterobacterales (CPE) are an important public health issue. Intravenous fosfomycin can be considered as an alternative for the treatment of serious infections caused by CPE. In this study, <em>in vitro</em> activity of fosfomycin was investigated among CPE isolates.</p> <p>Methodology: Overall, 158 clinically relevant isolates obtained from 18 hospitals of 13 cities in Turkey with predetermined carbapenemase types were evaluated in the study, including <em>Escherichia coli</em> (n = 19) and <em>Klebsiella</em> spp. (n = 139). <em>In vitro</em> activity of fosfomycin was determined with agar dilution method. Among <em>Klebsiella </em>spp., 104 harbored <em>bla<sub>OXA-48</sub></em>, 15 isolates carried both <em>bla<sub>OXA-48 </sub></em>and <em>bla<sub>NDM</sub></em>; three had both <em>bla<sub>OXA-48 </sub></em>and <em>bla<sub>VIM</sub></em> and nine isolates had <em>bla<sub>NDM</sub></em> alone. Four isolates carried only <em>bla<sub>VIM</sub></em> and two isolates harbored <em>bla<sub>IMP</sub></em> alone. One isolate co-harbored <em>bla<sub>VIM</sub></em> and <em>bla<sub>NDM</sub></em>. Among <em>E. coli</em> isolates, <em>bla<sub>OXA-48</sub></em> and <em>bla<sub>NDM</sub></em> were carried by 18 and one isolates, respectively.</p> <p>Results: Resistance to fosfomycin was detected in 43.7% of the isolates. Among <em>Klebsiella</em> spp. and <em>E. coli</em>, these rates were 46.8% and 21.1%, respectively. In <em>Klebsiella </em>spp. resistance to fosfomycin was 49.5% in <em>bla<sub>OXA-48</sub></em> carriers; 26.7% in isolates co-harbouring <em>bla<sub>OXA-48</sub></em> and <em>bla<sub>NDM</sub></em> and 66.7% in <em>bla<sub>NDM</sub></em> carriers. In <em>E. coli</em>, fosfomycin resistance was detected among 16.7% of the <em>bla<sub>OXA-48</sub></em> carriers.</p> <p>Conclusions: High level of fosfomycin resistance in these isolates may be attributable to the fact that these isolates are multidrug resistant. The genetic background of resistance should also be investigated in order to understand the co-occurrence and transfer of resistance among the CPE.</p> Selay Demirci-Duarte Tugce Unalan-Altintop Zeynep Gulay Ayse Nur Sari Kaygisiz Asli Cakar Deniz Gur Copyright (c) 2020 Selay Demirci Duarte, Tugce Unalan Altintop, Zeynep Gulay, Ayse Nur Sari Kaygisiz, Asli Cakar, Deniz Gur 2020-04-30 2020-04-30 14 04 394 397 10.3855/jidc.12456 Herpes Simplex virus type 2 seroprevalence and risk factors among adolescents and youth with HIV-1 in Northern, Tanzania <p>Introduction: Herpes Simplex virus type 2 (HSV-2) infection is associated with an increased risk of human immunodeficiency virus type 1 (HIV-1) acquisition and transmission. Individuals co-infected with HIV-1 and HSV-2 may have longer lasting, more frequent and severe outbreaks of herpes symptoms. Previous studies have assessed HSV-2 seroprevalence and associated risk factors in adult populations. However, there is limited data on the HSV-2 seroprevalence among adolescents and youth living with HIV-1. The study aimed to determine the HSV-2 seroprevalence and associated risk factors among adolescents and youth living with HIV-1 at referral hospital setting in Northern Tanzania.</p> <p>Methodology: A cross-sectional survey was conducted between February and July 2017 among HIV-1-infected individuals aged 10-24 years attending the Child -Centred Family Care Clinic at Kilimanjaro Christian Medical Centre. Blood specimens from 180 individuals were collected for ELISA-based detection of HSV-2 antibodies. Associations between risk factors and HSV-2 seroprevalence were analysed by univariate and multivariate logistic regression models.</p> <p>Results: The overall HSV-2 seroprevalence was 18% (32/180). A significant HSV-2 seroprevalence was noted among adolescents and youth, who reported having had sexual intercourse than those who never had sexual intercourse (28.9%<em> vs </em>13.3%, p = 0.02). Youths aged 20-24 had six folds higher risk of HSV-2 seroprevalence compared to those aged 10-14 years (AOR = 5.97 95% CI 1.31 – 27.19, p = 0.02).</p> <p>Conclusions: Our study found that HSV-2 seroprevalence increased by age among adolescents and youth living with HIV-1. Age-specific approaches might play an important role in interventions targeting HSV-2 infection.</p> Rashid Madebe Ireen Kiwelu Arnold Ndaro Filbert Francis Vito Baraka Zahra Theilgaard Terese Katzenstein Copyright (c) 2020 Rashid Madebe, Ireen Kiwelu, Arnold Ndaro, Filbert Francis, Vito Baraka, Zahra Theilgaard, Terese Katzenstein 2020-04-30 2020-04-30 14 04 398 403 10.3855/jidc.11599 Molecular characterization of adenovirus from an ongoingmulti-centric keratoconjunctivitis study in India Ferdinamarie Sharmila Philomenadin Mini Pritam Singh Jayanti Shastry Anil Chandra Phukan Muruganandam Nagarajan Subashini Kaliaperumal Radha Kanta Ratho Jagat Ram Madhav Jagannath Sathe Avinash Ingole Darshana Babubhai Rathod Benjamin Nongrum Rehnuma Parvez Vineeta Malik Rahul Dhodapkar Copyright (c) 2020 Ferdinamarie Sharmila Philomenadin, Mini Pritam Singh, Jayanti Shastry, Anil Chandra Phukan, Muruganandam Nagarajan, Subashini Kaliaperumal, Radha Kanta Ratho, Jagat Ram, Madhav Jagannath Sathe, Avinash Ingole, Darshana Babubhai Rathod, Benjamin Nongrum, Rehnuma Parvez, Vineeta Malik, Rahul Dhodapkar 2020-04-30 2020-04-30 14 04 404 407 10.3855/jidc.12093 Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant <p>Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, <em>Acinetobacter baumannii</em> infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation.</p> <p>The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. <em>A. baumannii</em> was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery.</p> <p>The duration of a transplant patient’s hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) <em>A. baumannii</em> infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.</p> Muhammed Rasid Aykota Tugba Sari Sevda Yilmaz Copyright (c) 2020 Muhammed Rasid Aykota, Tugba SARI, Sevda Yilmaz 2020-04-30 2020-04-30 14 04 408 410 10.3855/jidc.11842 KPC-2 producing Pseudomonas putida as an unexpected pathogen of catheter-associated bloodstream infection <p>Infections due to multidrug resistant Gram-negative pathogens are of great concern worldwide, as they are frequently associated with high mortality and morbidity rates. The occurrence of <em>Pseudomonas</em> spp. producing <em>Klebsiella pneumoniae</em> carbapenemases (KPCs) imposes a great challenge through treatment course of bloodstream infections (BSIs). <em>Pseudomonas putida</em> has been recognized as an emerging pathogen of healthcare associated infections (HAIs). Therefore, we aimed to report a case of a non-fatal case of peripheral line associated BSI (PLA-BSI) in an immunocompromised host due to <em>P. putida</em> harboring bla<sub>KPC-2</sub> gene in Brazil. A <em>P. putida</em> isolate was recovered from a blood culture of a 72-year-old man admitted at a University Hospital, identified by BD Phoenix™ 100 (Becton, Dickinson and Company), causing PLA-BSI. The species identification was confirmed by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) and resistance to carbapenems were confirmed by Epsilometer test (E-test®). Additionally, the presence of important carbapenemases genes (<em>bla<sub>KPC</sub></em>, <em>bla<sub>NDM</sub></em>, <em>bla<sub>OXA-48-like</sub></em>, <em>bla<sub>SPM</sub></em>, <em>bla<sub>IMP</sub></em>, <em>bla<sub>VIM</sub></em>) was investigated by Polymerase Chain Reaction. The bacterial isolate was confirmed as meropenem resistant <em>P. putida</em> harboring bla<sub>KPC-2 </sub>gene.Thereofre, these fidings suggest that <em>P. putida</em> can work as a reservoir for resistance genes as this bacterium has the ability to disseminate through water-fluids inside hospital and community settings. Moreover, this paper highlights that a frequent and worldwide disseminated mechanism of resistance (<em>bla<sub>KPC-2</sub></em>) is currently occurring among uncommon agents of BSI.</p> Raiane Cardoso Chamon Jaqueline Abel da Rocha Isabella Araujo Martins Laís Lopes Pires Breno Macêdo de Almeida Nahara Souza Leite Cláudia Rezende Vieira de Mendonça Souza Viviane Zahner Rachel Leite Ribeiro Thiago Pavoni Gomes Chagas Ianick Souto Martins Copyright (c) 2020 Raiane Cardoso Chamon, Jaqueline Abel da Rocha, Isabella Araujo Martins, Laís Lopes Pires, Breno Macêdo de Almeida, Nahara Souza Leite, Cláudia Rezende Vieira de Mendonça Souza1, Viviane Zahner, Rachel Leite Ribeiro, Thiago Pavoni Gomes Chagas, Ianick Souto Martins 2020-04-30 2020-04-30 14 04 411 414 10.3855/jidc.12145 Purpureocillium lilacinum as unusual cause of pulmonary infection in immunocompromised hosts <p><em>Purpureocillium lilacinum (P. lilacinum) </em>is an emergent pathogenic mold that presents more commonly as an ocular infection, cutaneous and/or subcutaneous infections in patients that are usually immunocompromised. A pulmonary presentation is rare, the clinical presentation is fever and cough with radiographic presentation as pleural effusion, single-lung consolidation, and cavitary pulmonary disease. We present a case of a patient with hematologic malignancy with febrile neutropenia; after receiving chemotherapy, the patient developed a pulmonary infection with multiple bilateral consolidations shown in the thoracic computed tomography scan. Fever persisted in spite of the use of wide-spectrum antibiotics and amphotericin. Bronchoalveolar lavage was performed and the samples were cultured, isolating in the Sabouraud Dextrous Agar a filamentous fungi growth with purple colonies that were identified morphologically as <em>P. lilacinum</em> and later it was confirmed by molecular methods. Once the infectious agent was identified, we continued amphotericin and oral voriconazole was added to the treatment with complete resolution of the infection. The report aims to create awareness of this emerging infectious disease, as there is little information concerning the treatment and the prognosis of patients infected by <em>P. lilacinum</em> with a pulmonary presentation.</p> Manuel A Salazar-González Jorge R Violante-Cumpa Christian G Alfaro-Rivera Hiram Villanueva-Lozano Rogelio de Jesús Treviño-Rangel Gloria M González Copyright (c) 2020 Manuel A. Salazar-González, Jorge R. Violante-Cumpa, Christian G. Alfaro-Rivera, Hiram Villanueva-Lozano, Rogelio de Jesús Treviño-Rangel, Gloria M. González 2020-04-30 2020-04-30 14 04 415 419 10.3855/jidc.12235