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Dandapani S, Rajkumari N, Gopichand P. Comparison of Detection of Giardia lamblia and Entamoeba histolytica Using Microscopy and Antigen Detection Rapid Cards in Patients with Diarrhea. J Gastrointest Infect 2020; 10 (1):3-6.
Background and objectives: Intestinal infections by protozoan parasites like Giardia lamblia and Entamoeba histolytica is still much prevalent, more so in developing countries. Microscopy remains the mainstay of its diagnosis despite its limitations. Therefore, we have tried to assess the usefulness of using antigen based rapid card test to that of the routine stool microscopy in this study and see its associated risk factors.
Materials and methods: Stool samples were collected from enrolled patients with history of loose motion. On these, routine stool microscopy was followed by a rapid combo test for antigen detection of Entamoeba, Giardia and Cryptosporidium. The associated risk factors of these patients were then checked and analyzed.
Results: A total of 2,434 stool samples were included in the study without duplication, of which 790 samples were found positive for an intestinal parasite by microscopy and 249 were positive by the rapid triage card test for one of the three intestinal protozoan parasites. Both cysts and trophozoites of G. lamblia and Entamoeba spp. were recovered from these samples. Stool microscopy for Giardia was positive in 17 samples and 60 for Entamoeba spp. However, by rapid card test, 114 samples were found to be positive for G. lamblia, 129 for Entamoeba spp. and 51 for Cryptosporidium spp. The additional detection of these intestinal pathogen by the rapid cards were found to be statistically significant (p<0.005).
Conclusions: The results show that routine screening for intestinal parasitosis is important as many persons can have silent infection. In addition, a combination of another test especially rapid test along with microscopy helps to identify such cases.
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Chhina D, Garg S, Chinna R, Dhiman P, Gupta D. Study of Prevalence of Hepatitis B, Hepatitis C, and Other Opportunistic Coinfections in HIV-infected Patients in a Tertiary Care Hospital of North India. J Gastrointest Infect 2020; 10 (1):7-10.
Background and objectives: There is only limited information on the prevalence of coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus (HIV)-infected individuals, resulting in greater morbidity and mortality. This study was done to evaluate the prevalence of HBV and HCV in HIV-infected individuals attending a tertiary care hospital in north India.
Materials and methods: A total of 104 HIV patients were included in this study of 6-month duration (January–June 2019). Samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by rapid detection method and/or enzyme-linked immunosorbent assay (ELISA). HBsAg positive serum samples and anti-HCV positive samples were further tested for HBV-DNA and HCV-RNA, respectively. Other opportunistic infections were studied along with it.
Results: Among the 104 HIV-positive patients, 11 (10.6%) were anti-HCV positive and 7 of 11 (63.6%) were positive for HCV-RNA. Three (2.8%) suffered from chronic HBV coinfection (HBsAg positive) and 2 of 3 (66.7%) were positive for HBV-DNA. Triple infection with HBV, HCV, and HIV was seen in 0.9% of patients. The most common mode of transmission was sexual promiscuity (76%), followed by infected needle/unknown (13.5%), and a history of intravenous drug abuse (10.5%). The demographic distribution shows the maximum number of patients (38.5%) belonging to the Ludhiana district of Punjab.
Interpretation and conclusions: The findings show a prevalence of 10.6 and 2.8% for HCV and HBV, respectively, in HIV-positive patients. Coinfection with HCV-HIV is more frequent than HBV-HIV. Hence, all HIV patients need to be routinely tested for markers of HBV and HCV.
Biofilms are formed by unicellular bacteria residing on a scaffold of exopolymeric substances and impart survival advantage to microbial communities from adverse environmental conditions. The formation of biofilms is an intricately ordered stepwise process. Biofilms can form on many medical implants where the body fluids supply adequate organic nutrients for the most favorable bacterial growth. The hydrophobicity of the surface influences the strength of adhesion and microorganisms are more likely to attach to non-polar hydrophobic surfaces, which make up stents. In general, the stent diameter, duration of stenting, contour and material determine the susceptibility of stents to biofilm-related occlusion. Occlusion of stents by microcolonies can result in increased rates of complications and therapeutic failure leading to an increased need for repeat procedures and hence cost of treatment. Despite several studies explicating the range of organisms involved in the formation of biofilms, the factors related to their formation in plastic stents have not been adequately elaborated. Biofilms cannot be detected by standard microbial culture techniques. Molecular diagnostics based on nucleic acid amplification techniques are the mainstay for detection and identification. The formation of microbial biofilms in bio prosthesis related to gastroenterology is an under studied arena. In this mini-review, we aim to discuss the formation of biofilms in biliary and pancreatic stents used for the management of biliary and pancreatic ductal obstructions to provide clinicians with information to optimize the safety and efficiency of stents.
Gut microbiota has emerged as an important player in the pathogenesis of various intestinal and extraintestinal diseases. Microbiota-targeted therapies, such as probiotics, prebiotics, antibiotics, dietary interventions, and fecal microbiota transplantation (FMT), are therefore being considered and tested as therapies for such diseases. In this review, we discuss the mechanisms and clinical applications of FMT with focus on Clostridioides difficile infection, inflammatory bowel disease, and irritable bowel syndrome. We also discuss practical issues concerning the clinical use of FMT.
The oral cavity and the gut are distinct organs having specific microbiomes. However, studies in animals and humans have indicated that oral bacteria can overcome the physical and microbial barrier and colonize the gut, especially in the small intestine. The oral microbiome is associated with oral and systemic diseases. The bacteria mainly implicated in causing oral dysbiosis—Porphyromonas gingivalis and Fusobacterium nucleatum—on colonizing the gut alter the intestinal microbiome, creating dysbiosis in the gut microbiome and promoting the immune and inflammatory responses resulting in gastrointestinal diseases. This area of research, although still in its infancy, highlights the need for a coordinated approach to the treatment of periodontitis and development of gastrointestinal disease and also evaluation of emerging microbiome-based therapeutic approaches in the treatment of disease.
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Kannambath R, Samantaray S, Mohan P, Mandal J. Isolation of Plesiomonas shigelloides from a Case of Inflammatory Bowel Disease on Immunosuppressant Therapy. J Gastrointest Infect 2020; 10 (1):29-30.
Plesiomonas shigelloides is a gram-negative, oxidase-positive facultative anaerobe, very rarely encountered in clinical samples. Here we report a case of infective relapse of inflammatory bowel disease (IBD) caused by this organism in a patient on immunosuppressive therapy. Plesiomonas shigelloides is known to be a causative agent of acute gastroenteritis in patients with certain common risk factors which is absent in our case. Through this case report, we intend to discover the role of P. shigelloides as a causative agent of relapse of IBD.
Ajay K Jain,
Amit D Joshi,
An amebic liver abscess (ALA) is a common extraintestinal manifestation of invasive amebiasis. Rupture into the thoracic or peritoneal cavity is a common complication of liver abscess especially, from left lobe abscess. Rupture into the stomach leading to hepatogastric fistula is an extremely rare complication more so spontaneous rupture after a decrease in size of the abscess on treatment. We report a patient with ALA who developed spontaneous hepatogastric fistula on day nine of treatment and was managed successfully with conservative management with the healing of fistula and resolution of the abscess.
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Jain P, Jain M, Kaur R, Joseph M. Herpes Simplex Infection Masquerading as Esophageal Candidiasis in Immunocompetent Individuals: A Series of Two Cases. J Gastrointest Infect 2020; 10 (1):33-35.
Herpes simplex esophagitis (HSE) is usually an autopsy finding in immunosuppressed hosts but is a rare occurrence in immunocompetent individuals. It presents with an acute onset of retrosternal pain, odynophagia, and fever. Clinically, esophageal herpetic infections remain underdiagnosed unless the patient is immunocompromised. HSE is generally a self-limiting condition. The patient may present with complications like perforation and bleeding. Antiviral therapy is useful to provide symptomatic relief and hasten recovery. Treatment with the nucleoside analog acyclovir has been shown to be effective for HSE. Herpes esophagitis must be kept in the differential diagnosis of patients with acute esophageal complaints. We hereby report two cases of herpetic esophagitis in young immunocompetent patients.
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Krishnamurthy S, Mandal J. Salmonella enterica Serotype Choleraesuis var Decatur Gastroenteritis Complicated by Severe Acute Kidney Injury and Neurological Dysfunction. J Gastrointest Infect 2020; 10 (1):36-38.
We herein report a case of gastroenteritis due to Salmonella enterica serotype Choleraesuis var Decatur following ingestion of ground meat. A 10-year-old child presented with diarrhea and vomiting followed by multi-organ dysfunction in the form of severe acute kidney injury requiring multiple sessions of hemodialysis, transaminasemia, thrombocytopenia, and altered sensorium. Stool cultures were positive for Salmonella enterica serotype Choleraesuis var Decatur, and intravenous ceftriaxone was administered for 10 days for the same. She survived with neurological sequelae. Nontyphoidal Salmonella is one of the most frequently identified causes of foodborne illness in developing countries. An increased level of awareness is needed to understand the association of severe foodborne illnesses, especially given the prevalence of consumption of such foods in the local cuisine. This case also adds to the spectrum of clinical manifestations associated with this entity. Vaccination of farm animals on a routine basis with live attenuated Salmonella vaccine is needed to diminish the transmission of Salmonella through the food chain to humans and increased awareness should be created about the preparation of ground meat products to reduce the transmission of infection.