Current Issue Volume 7, Number 1 , January-December 2017

EDITORIAL
Chetana Vaishnavi

Editorial

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:iv]



It gives me immense pleasure to announce that the Journal of Gastrointestinal Infections, the official publication of the Gastrointestinal Infection Society of India, has been assigned to M/s Jaypee Brothers Medical Publishers, New Delhi, for publishing and distributing the journal worldwide, both in print and electronic media. Every issue of the journal will be hosted online at www.jaypeejournals.com by the Publishers.


ORIGINAL ARTICLE
Velmurugan Anitharaj, Dhandapany Gunasekaran, Jothimani Pradeep, Selvaraj Stephen

Gastrointestinal Manifestations of Scrub Typhus in Children and Adults from Puducherry and Neighboring Tamil Nadu State, India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:1-4]



Scrub typhus (ST) is reported from almost every Indian state. In our tertiary care teaching hospital at Puducherry, we looked for gastrointestinal (GI) manifestations of ST in children as well as adults and correlated with laboratory findings. We examined 588 serum samples for immunoglobulin M (IgM) antibody against Orientia tsutsugamushi by enzyme-linked immunosorbent assay (ELISA) and observed that 335 (56.97%) of these clinically suspected ST patients were positive, comprising 134 children and 201 adults. Statistically significant (p ≤ 0.05) number of adults had nausea (p = 0.000) and abdominal pain (p = 0.020) than children. Similar trend was observed in adults with reference to increased liver enzymes (aspartate aminotransferase/ alanine aminotransferase/alkaline phosphatase; p = 0.000), creatinine (>1.0 mg/dL; p = 0.007), and platelet count (.1.5 lakhs/mm3; p = 0.026). Rash in children is the only statistically significant manifestation than adults (p = 0.03). More number of children were positive than adults, but without any statistical significance, with reference to other parameters like cough/expectoration (p = 0.735), hepatomegaly (p = 0.730), and eschar (p = 0.721).

Keywords: Gastrointestinal symptoms, Orientia tsutsugamushi, Scrub typhus, Scrub typhus immunoglobulin M enzyme-linked immunosorbent assay.

How to cite this article: Anitharaj V, Gunasekaran D, Pradeep J, Stephen S. Gastrointestinal Manifestations of Scrub Typhus in Children and Adults from Puducherry and Neighboring Tamil Nadu State, India. J Gastrointest Infect 2017;7(1):1-4.

Source of support: Indian Council of Medical Research (ICMR) New Delhi (Iris Id No. 2008-08180, File no 30/3/41/2008/ECD-II) and Mahatma Gandhi Medical College & Research Institute, Puducherry, Sri Balaji Vidyapeeth University, Puducherry, India.

Conflict of interest: None


ORIGINAL ARTICLE
Shweta Chitkara, Deepinder Chhina, Veenu Gupta, Rajesh Mahajan

A Clinical and Epidemiological Profile of Seropositive Cases of Leptospirosis in a Tertiary Care Hospital in Ludhiana City, India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:5-8]



Introduction: Leptospirosis, an infectious disease caused by spirochetes Leptospira, is the most widespread zoonosis in the world. Humans acquire infection through contact with the urine of infected or carrier animals, either directly or through contaminated water or soil. There are only few reports documenting the serological evidence of leptospirosis in northern India.

Aims and objectives: To determine the seroprevalence of leptospirosis among febrile patients and to study their clinical and laboratory profile.

Materials and methods: It is a prospective study conducted over a period of 1 year from April 2015 to March 2016. Febrile patients with clinical suspicion of leptospirosis admitted in the hospital were included in the study. Leptospira immunoglobulin M (IgM) antibodies in the serum samples were detected by enzyme-linked immunosorbent assay (ELISA) to confirm the diagnosis. Serologically confirmed patients of leptospirosis were studied for their clinical presentation and laboratory parameters.

Results: The seroprevalence of leptospirosis in this study was 4% (147/3,661). Leptospirosis was most prevalent in the age group of 46 to 55 years. Male predominance was seen. Maximum number of cases was seen in the months of August and September. Common clinical manifestations were jaundice (57.1%), abdominal pain (40.1%), abdominal distension (27.2%), and myalgia (28.5%). Hepatomegaly (53%) was the predominant clinical sign observed. Laboratory parameters revealed leukocytosis (68.7%), thrombocytopenia (52.3%), and transaminitis (78.2%). Hepatic failure (20.4%) was the most common complication.

Conclusion: Seroprevalence of leptospirosis among febrile cases was 4%, indicating male predominance and seasonal variation. There is the need to review the importance of adding leptospirosis to differential diagnosis of febrile illness.

Keywords: Clinical profile, Enzyme-linked immunosorbent assay, Leptospirosis, Seroprevalence.

How to cite this article: Chitkara S, Chhina D, Gupta V, Mahajan R. A Clinical and Epidemiological Profile of Seropositive Cases of Leptospirosis in a Tertiary Care Hospital in Ludhiana City, India. J Gastrointest Infect 2017;7(1):5-8.

Source of support: Institutional funds

Conflict of interest: None


ORIGINAL ARTICLE
Monika Sharma, Shelly Sehgal, Shashi S Sudhan, Konika Razdan, Bharti Pandita, Mamta Sharma

Epidemiology and Genotypes of Hepatitis C Virus: A First Study from Jammu (J&K), India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:9-14]



Background and objectives: Globally, around 200 million people are infected with hepatitis C virus (HCV). India contributes a big proportion of HCV burden with the prevalence estimated between 0.5 and 1.5%. Northeastern tribal populations and areas of Punjab represent the HCV infection hotspots, while in Western and Southern parts of the country, the prevalence is lower. The distribution of HCV genotypes is highly variable. This study was particularly planned to attain knowledge of the prevalent HCV genotypes in Jammu province of Jammu and Kashmir (J&K) state.

Materials and methods: Blood samples of patients attending the Department of Medicine, Government Medical College (GMC), Jammu and Kashmir, India, for HCV testing were subjected to serological test at Department of Microbiology, GMC, Jammu. The serum samples were tested for anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA) and positive samples were subjected to genotyping.

Conclusion: Of the 396 samples tested, 33 (8.33%) were found to be HCV positive and 23 of these were included for genotyping. Genotypes 3 and 1 were detected in this region and this was in accordance with other national studies. There is a need for larger field studies to better understand the HCV epidemiology and identify higher prevalence areas and also the distribution of genotypes of HCV. This, being a maiden study from this region, will shed light to allow apposite choice and target efforts for better management of the disease and reduce the burden of chronic liver disease due to HCV.

Keywords: Chronic liver disease, Genotyping, Hepatitis C virus, Seroprevalence.

How to cite this article: Sharma M, Sehgal S, Sudhan SS, Razdan K, Pandita B, Sharma M. Epidemiology and Genotypes of Hepatitis C Virus: A First Study from Jammu (J&K), India. J Gastrointest Infect 2017;7(1):9-14.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Piyush Harchand, Veenu Gupta, Gautam Ahluwalia, Rajoo S Chhina

Clinical and Bacteriological Profile of Spontaneous Bacterial Peritonitis in Cirrhotic Patients

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:15-20]



Background and objectives: Spontaneous bacterial peritonitis (SBP) is a frequent complication in patients with chronic liver disease and ascites. This can develop slowly and insidiously or remain clinically unrecognized until the appearance of symptoms. The mortality rate after a single episode ranges from 20 to 40%, and early diagnosis is required for adequate treatment and prevention of new episodes. The aim was to study the clinicobacteriological profile of SBP and its variants in patients of cirrhosis.

Materials and methods: This prospective study was conducted on cirrhotic patients with ascites admitted in a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done for ascitic fluid cytology and culture. Identification and antimicrobial susceptibility of the isolates was done in VITEK system.

Results: Of a total of 113 cirrhotic patients, 58 (51.3%) were diagnosed with SBP. Culture-negative neutrocytic ascites (CNNA) was the commonest presentation. The most common symptoms were abdominal distension followed by fatigue, anorexia, and jaundice. Majority of patients belonged to Child- Pugh’s Grade C. Of 58 cases of SBP, 22 were culture positive. Gram-negative isolates were predominant (77.3%). Escherichia coli was the commonest isolate. Gram-negative isolates were highly susceptible to colistin followed by tigecycline, amikacin, and carbapenems; 59% of the isolates were multidrug resistant (MDR) and 13.6% were extensively drug resistant (XDR).

Interpretation and conclusion: Prevalence of SBP in cirrhotic patients was 51.3% and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotic is common.

Keywords: Bacterascites, Cirrhosis, Culture-negative neutrocytic ascites, Serum ascites albumin gradient, Spontaneous bacterial peritonitis.

How to cite this article: Harchand P, Gupta V, Ahluwalia G, Chhina RS. Clinical and Bacteriological Profile of Spontaneous Bacterial Peritonitis in Cirrhotic Patients. J Gastrointest Infect 2017;7(1):15-20.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Ritu Garg, Varsha A Singh

Bacteriological Profile and Antimicrobial Susceptibility Pattern of Intra-abdominal Infections: A Study from a Tertiary Care Hospital of North India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:21-25]



Background and objectives: Intra-abdominal infections (IAIs) are associated with significant morbidity and mortality. Pathogenic isolates and emerging resistance to commonly used antimicrobials have been a matter of concern in IAIs. In the present study, bacteriological profile and antimicrobial susceptibility of isolates from IAIs were investigated.

Materials and methods: A total of 145 samples (ascitic fluids, n = 56; bile, n = 20; and pus, n = 36) were collected from suspected IAI of patients reporting to the hospital and cultured. Identification of the isolates was done using standard identification protocol. Antimicrobial susceptibility was performed by Kirby-Bauer disk diffusion method and interpretation was done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Of 145 samples, 112 were culture positive and 33 were sterile. Gram-negative organisms (n = 85) outnumbered the Gram-positive organisms (n = 27). Among the Gramnegative organisms, Escherichia coli (n = 31) was the most commonly isolated organism followed by Klebsiella sp. (n = 19), Acinetobacter sp. (n = 14), Pseudomonas sp. (n = 10), Proteus sp. (n = 5), Citrobacter sp. (n = 3), and Enterobacter sp. (n = 3). Among the Gram-positive bacteria, the most common organism was Staphylococcus aureus (n = 19) followed by Enterococcus faecalis (n = 8). Gram-negative bacilli showed significant resistance to almost all of the commonly used antibiotics. The rate of methicillin-resistant S. aureus (MRSA) was 36.84%.

Conclusion: Prompt starting of empirical antimicrobials based on the local susceptibility pattern, followed by modification of treatment in accordance with the antimicrobial susceptibility report can significantly reduce the morbidity and the mortality associated with IAIs.

Keywords: Emerging resistance, Empirical antimicrobials, Intra-abdominal infections.

How to cite this article: Garg R, Singh VA. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Intra-abdominal Infections: A Study from a Tertiary Care Hospital of North India. J Gastrointest Infect 2017;7(1):21-25.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Vishwa M Katoch

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:26-31]



Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn’s disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.

Keywords: Crohn’s disease, Diagnostic methods, Immunohistochemistry, In situ hybridization, In situ polymerase chain reaction, Intestinal tuberculosis, Probes.

How to cite this article: Katoch VM. Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract. J Gastrointest Infect 2017;7(1):26-31.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Alisha Chaubal, Nirav Pipaliya, Prabha Sawant

Amebic Abscess—Is it still a Common Entity?

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:32-35]



Amebic liver abscess is the most common extraintestinal manifestation of amebiasis. It is seen most frequently in the fourth and fifth decades of life and is more common among adult men and alcoholics. The infection is primarily transmitted by food and water contamination. It presents commonly with fever and right hypochondriac pain but can present with complications like rupture into the pleural and peritoneal cavity or with abdominal vein thrombosis. The infection still responds well to nitroimidazoles, which remain the mainstay of treatment. In India, the epidemiology and presentation of amebic abscess have not changed over the years and it still is the major cause of liver abscesses.

Keywords: Amebic, Liver abscess, Metronidazole.

How to cite this article: Chaubal A, Pipaliya N, Sawant P. Amebic Abscess—Is it still a Common Entity? J Gastrointest Infect 2017; 7(1):32-35.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Rumpa Saha, Stuti Kaushik, Kavita Gupta, Shukla Das

Human Infection with Hymenolepis diminuta: First Case Report from North India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:36-37]



The parasite Hymenolepis diminuta commonly infests rodents, and human cases have been reported from all corners of India, save North India. There is a need to create awareness about its association with human disease as it is completely curable after treatment. We describe two cases of human infection due to H. diminuta in a 24-year-old woman and her son. These two cases were diagnosed on routine microscopy wet mount preparation and subsequently were successfully treated with medication. A detailed description of this disease in terms of epidemiology, clinical presentation, and effective treatment is dependent upon prompt diagnosis and reporting of all such cases.

Keywords: Diarrhea, Hymenolepis diminuta, Praziquantel, Rat tapeworm.

How to cite this article: Saha R, Kaushik S, Gupta K, Das S. Human Infection with Hymenolepis diminuta: First Case Report from North India. J Gastrointest Infect 2017;7(1):36-37.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Ramya Raghavan, Jharna Mandal, Chanaveerappa Bammigatti, Gangadhar Rao

Vibrio vulnificus: An Unusual Isolate from a Case of Eosinophilic Enteritis

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:38-40]



The report describe a case of Vibrio vulnificus isolated from a patient with eosinophilic enteritis and hence convey the importance of vibriosis and its transmission.

Keywords: Diarrhea, Shellfish, Vibrio vulnificus

How to cite this article: Raghavan R, Mandal J, Bammigatti C, Rao G. Vibrio vulnificus: An Unusual Isolate from a Case of Eosinophilic Enteritis. J Gastrointest Infect 2017;7(1):38-40.

Source of support: Nil

Conflict of interest: None


RESEARCH NEWS SCAN
Anshul Sood

Databases for Antimicrobial Resistance Genes and Mobile Genetic Elements in Gut Microbiome

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:41-42]



The human gut microbiota forms a large reservoir of antimicrobial resistance (AMR) genes. Also a number of these bacteria are endowed with metabolic potentials and added advantages which are often provided by mobile genetic elements (MGE). MGEs carry out extensive horizontal gene transfer (HGT) in gut and are believed to be agents of open source evolution. Regardless of their medical importance and biological significance, MGEs from the gut microbiome have not been methodically characterized. This research news scan highlights the Intestinal microbiome mobile element database (ImmeDB) associated with the collection, classification, and annotation of MGEs from gut microbiome using a novel “deletion-based” Split Read Insertion Detection (SRID) method. The database can help us screen already identified genomes for the validation and detection of new MGEs

Keywords: Antimicrobial resistance, Intestinal microbiome mobile element database, Mobile genetic elements, Split read insertion detection.

How to cite this article: Sood A. Databases for Antimicrobial Resistance Genes and Mobile Genetic Elements in Gut Microbiome. J Gastrointest Infect 2017;7(1):41-42.

Source of support: Nil

Conflict of interest: None


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