Journal of Infection

Title page - Editorial Board

2012-06-01

Bacillus Calmette-Guérin (BCG) complications associated with primary immunodeficiency diseases

2012-03-19

Summary: Primary immunodeficiency diseases (PIDs) are a group of inherited disorders, characterized by defects of the immune system predisposing individuals to variety of manifestations, including recurrent infections and unusual vaccine complications. There are a number of PIDs prone to Bacillus Calmette-Guérin (BCG) complications. This review presents an update on our understanding about the BCGosis-susceptible PIDs, including severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial diseases.

Completeness of infectious disease notification in the United Kingdom: A systematic review

Maria Keramarou, Meirion R. Evans — 2012-03-14

Summary: Objectives: Infectious disease legislation in the United Kingdom has recently changed. Our aim was to provide a baseline against which to assess the impact of these changes by synthesising current knowledge on completeness of notification and on factors associated with better reporting rates.Methods: We systematically reviewed the literature for studies reporting completeness of reporting of notifiable infectious diseases in the United Kingdom over the past 35 years.Results: Altogether, 46 studies met our search criteria. Reporting completeness varied from 3% to 95% and was most strongly correlated with the disease being reported. Median reporting completeness was 73% (range 6%–93%) for tuberculosis, 65% (range 40%–95%) for meningococcal disease, and 40% (range 3%–87%) for other diseases (Kruskal–Wallis test, p < 0.05). Reporting completeness did not change for either tuberculosis or meningococcal disease over the period studied. In multivariate analysis, none of the factors examined (study size, study time period, number of data sources used to assess completeness, uncorrected or corrected study design) were significantly associated with reporting completeness.Conclusion: Reporting completeness has not improved over the past three decades. It remains sub-optimal even for diseases which are under enhanced surveillance or are of significant public health importance.

Computed tomography angiography in patients with tuberculous meningitis

2012-03-26

Summary: Background: Strokes in tuberculous meningitis are important determinant of prognosis. Strokes are caused by tuberculosis-related vasculopathy. In this study, we aimed to demonstrate the value of computed tomography angiography. We also assessed value of angiographic findings in determining the prognosis.Methods: We included consecutive patients of tuberculous meningitis and prospectively followed them for 6 months. Computed tomography angiography was performed at inclusion. Follow-up angiography, after 6 months, was done in the patients, who had given consent. Angiographic findings were evaluated by experienced neuroradiologists.Results: Initial computed tomography angiography revealed arterial narrowing or occlusion in 33 patients. In 30 patients the anterior cerebral circulation and in 9 patients posterior cerebral circulation was involved. Six (18.2%) patients had lesions in both the territories. The most frequently involved arteries were supraclinoid portion of the internal carotid artery, and proximal portions of the anterior cerebral and middle cerebral arteries. On univariate analysis, predictors of angiographic abnormalities were impaired vision (p = 0.019), hemiparesis (p = 0.002), hydrocephalous (p < 0.001), basal exudates (p < 0.001), meningeal enhancement (p = 0.026) and infarcts (p < 0.001). On multivariate analysis basal exudates was a significant predictor. Angiographic abnormalities were associated with insignificantly poorer prognosis. On follow-up angiograms, 3 patients showed resolution in vascular abnormalities. Two patients had developed new angiographic abnormalities.Conclusion: Arterial narrowing and occlusion is seen in majority of patients with tuberculous meningitis. Angiographic abnormalities may be associated with poor prognosis.

Interferon gamma and interferon gamma inducible protein-10 in detecting tuberculosis infection

Basirudeen Syed Ahamed Kabeer, Paulkumaran Paramasivam, Alamelu Raja — 2012-02-29

Summary: Objective: This study aimed to compare the levels of TB-antigen specific Interferon gamma (IFN-γ) and IFN-γ inducible protein (IP)-10 in culture of whole blood samples from healthy controls (HC) and healthy household contacts (HHC).Methodology: A total of 386 study subjects, which included 186 HC and 200 HHC, were recruited. QuantiFERON-TB Gold in-tube (QFT-IT) assay was employed to measure IFN-γ levels. IP-10 levels were measured in the supernatants collected from QFT-IT tubes. Tuberculin skin test was also performed.Results: The levels of TB antigen specific IFN-γ and IP-10 were significantly higher in HHC compared to HC. There was no significant difference observed between positivity of QFT-IT and IP-10 in HC and HHC. The positivity of TST was significantly lower in subjects <17 year, when compared to IP-10 (p<0.005). The reduced cut-off point 0.22IU/ml significantly increased the positivity of QFT-IT among children with high risk for latent TB infection (LTBI).Conclusions: Measurement of TB antigen specific IFN-γ and IP-10 can be potential markers for the detection of LTBI.

Rapid and effective diagnosis of tuberculosis and rifampicin resistance with Xpert MTB/RIF assay: A meta-analysis

2012-02-29

Summary: Objectives: Xpert MTB/RIF (Cepheid) assay has been introduced for the diagnosis of tuberculosis (TB) and RIF-resistance. The meta-analysis was used to establish the overall accuracy of Xpert MTB/RIF assay for diagnosing TB and RIF-resistance.Methods: Based on comprehensive searches of the Pubmed and Embase, we identified outcome data from all articles estimating diagnostic accuracy with Xpert MTB/RIF assay. A summary estimation for sensitivity, specificity, diagnostic odds ratios (DOR) and the area under the summary ROC curve (AUC) was calculated by using the bivariate random-effects approach.Results: The meta-analysis included 18 studies (10,224 suspected specimens). The summary estimate was 90.4% (95%CI 89.2%–91.4%) for sensitivity, 98.4% (95%CI 98.0%–98.7%) for specificity and 328.3/0.9822 for DOR/AUC in pulmonary tuberculosis (PTB). The sensitivity, specificity and DOR/AUC of detecting RIF-resistance were 94.1%, 97.0% and 177.8/0.9832, respectively. For extrapulmonary tuberculosis, the overall pooled sensitivity was 80.4% and specificity was 86.1%. The findings in subgroup analysis were as follows: the accuracy of Xpert MTB/RIF assay is higher in smear-positive specimens and the sensitivity of diagnosing PTB in adults was higher than that in children (90.8% versus 74.3%).Conclusions: TB and RIF-resistance can be rapidly and effectively diagnosed with Xpert MTB/RIF assay.

Increase in primary drug resistance of Mycobacterium tuberculosis in younger birth cohorts in France

2012-02-03

Summary: Background: Monitoring of primary drug resistance is of interest for long-term evaluation of the efficacy of a national tuberculosis program. The objective was to describe changes over time in primary drug resistance among new tuberculosis patients.Methods: Stratified analysis by birth cohorts, region of birth, HIV-coinfection of data from 14,610 culture-positive new tuberculosis patients diagnosed by a network of university hospitals between 1995 and 2008.Results: Half of the patients were foreign-born, and 9% HIV-coinfected. For foreign-born and French-born patients, there was an upward trend in resistance rates to streptomycin, isoniazid, and rifampicin from the oldest to the youngest cohorts. For a same age at tuberculosis diagnosis, the risk of isoniazid resistance was higher in younger cohorts, revealing a cohort effect. Among French-born patients, the only factor independently associated with primary resistance to streptomycin, or isoniazid was birth after 1950, and particularly after 1980. Risk of streptomycin resistance increased in youngest cohorts among European-born patients. HIV-coinfection was associated to rifampicin resistance among foreign-born and French-born patients,Conclusions: Theses results indicate that among French-born patients, isoniazid-resistant strains are currently circulating in younger patients that are more likely to be infected recently, and that among foreign-born patients, HIV-coinfection is a strong risk factor for primary resistance.

Transmission of tuberculosis within family-households

2012-02-03

Summary: Objective: The introduction of molecular typing methods in the 1990s to study the epidemiology of tuberculosis (TB) has significantly improved the possibilities of quantifying transmission of Mycobacterium tuberculosis in different human settings. The purpose of this study was to investigate transmission of TB in 35 family-households in Poland.Methods: Two PCR-based genotyping methods: spoligotyping and mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) typing were used.Results: Of 78 patients, 49 (63%), could be assigned to intra-household transmission on the basis of identical DNA fingerprints upon a combined typing approach. However, if a single spoligotype spacer or a single MIRU-VNTR locus variation was tolerated in the cluster definition, the intra-household transmission raised to 85% of all patients. For 12 patients in 6 households, the M. tuberculosis isolates were clearly distinct in either spoligotyping or VNTR typing or in both genotyping methods, suggesting that these patients were infected by the sources in the community.Conclusions: This study is the first to provide the results of a molecular epidemiological investigation performed within family-households in Poland. It shows the household setting as an important reservoir of M. tuberculosis transmission, and thus argues in favor of routine and extensive screening of the family contacts of TB patients.

Pulmonary Mycobacterium abscessus: A canary in the cystic fibrosis coalmine

2012-02-27

Summary: We present a case of pulmonary nontuberculous mycobacterial infection (PNTM) with M. abscessus. After exclusion of genetic immune disorders known to cause NTM susceptibility, we found compound heterozygosity of two mutations, F508del and R117H in CFTR. The combination of F508del with a hypomorphic CFTR mutation can cause a mild Cystic Fibrosis (CF) phenotype with delayed CF symptoms in adulthood. Although the patient was continuously treated for her lung infection by different physicians for more than twenty years, the diagnosis CF had been missed. The forme fruste of CF should be considered in the analysis of host factors predisposing for PNTM.

Recurrent Mycobacterium avium infection after seven years of latency in a HIV-infected patient receiving efficient antiretroviral therapy

2012-01-05

Summary: We report the first case of Mycobacterium avium reactivation, after prolonged latency, in a HIV-infected patient receiving highly active antiretroviral therapy with undetectable viral replication and normal CD4 cell count. The patient presented with a painful swollen shoulder seven years after initial M. avium bacteriaemia. Articular puncture grew M. avium. The isolates of the first and second infection were identical using repetitive-sequence-based Polymerase Chain Reaction analyses.

Fluoroquinolone use and resistance of Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2008

2012-02-10

Recently, Liu et al. investigated the relationship between the consumption of fluoroquinolones (FQ), including ciprofloxacin, levofloxacin, and moxifloxacin, and the susceptibility of Pseudomonas aeruginosa to fluoroquinolones (FQ). They demonstrated positive correlations between the use of ciprofloxacin and other FQ and the prevalence of ciprofloxacin resistant-P. aeruginosa after a one-year lag. In our previous study, FQ resistance of P. aeruginosa did not correlate with prescription of ciprofloxacin, levofloxacin or total FQ. However FQ prescription did correlate with the rate of ciprofloxacin-resistant Escherichia coli. Therefore, due to the observed species to species variability in the associations between FQ exposure and FQ resistance, we sought to clarify whether this intuitive relationship can in fact be generalized to all gram-negative organisms (GNO). We investigated the correlations between consumptions of FQ and FQ resistance for GNO associated with healthcare-associated infection (HCAI) from 2000 to 2008 at a medical center in Taiwan.

Susceptibility of global intra-abdominal Enterobacteriaceae isolates to tigecycline (TEST 2007–2010)

S.P. Hawser, S. Lob, D. Hoban, S. Bouchillon, R. Badal — 2012-02-10

Intra-abdominal infections are considered one of the most difficult infections to treat. In 2010, the Infectious Disease Society of America (IDSA) and the Surgical Infection Society (SIS) published revised guidelines for management of complicated intra-abdominal infections (IAI). Tigecycline is indicated for the treatment of complicated IAI in adults.

Prevalence and molecular characterization of serotype K1 Klebsiella pneumoniae strains from various clinical specimen sources in 11 Asian countries

2012-02-17

Klebsiella pneumoniae is an important pathogen causing liver abscess in Taiwan and Korea, and K1 has been reported to be the predominant serotype among those isolates, accounting for around 60% of cases. However, serotype K1 had not been common among the clinical isolates from Western countries before the 1990s. Further studies revealed that most K1 strains isolated from liver abscess cases or feces of healthy adults belonged to sequence type (ST) 23 in Korea. A recent report also showed that ST23 was most frequent among K. pneumoniae liver abscess isolates from Taiwan, Hong Kong, and Singapore. Furthermore, the investigation of the K. pneumoniae isolates with serotype K1 collected from the UK, Hong Kong, Israel, Taiwan, and Australia showed that most of those belonged to ST23, suggesting the possibility that this genotype was geographically widespread. Recently, there was a report of seven liver abscess cases caused by K1 K. pneumoniae strains of ST23 in France.

Man’s best friend? – First report of prosthetic joint infection with Streptococcus pyogenes from a canine source

H. Sprot, A. Efstratiou, M. Hubble, M. Morgan — 2012-02-17

We read with interest the report by Sendi et al regarding the comparatively high incidence of prosthetic joint infection (PJI) following Staphylococcus aureus bacteraemia. Streptococcus pyogenes prosthetic joint infection (PJI) is extremely rare, with very few case reports in the literature. Zoonotic PJI are rare, except for Pasteurella multocida which mainly affects elderly women with rheumatoid arthritis and follows cat- related bites or trauma.

Estimation of the reproductive number for A(H1N1)pdm09 influenza among the French armed forces, September 2009–March 2010

2012-02-16

We were interested to read the article by Lee and Wong describing the spatio-temporal spread of the influenza A(H1N1)pdm09 outbreak in Hong Kong using a geographical information system. We used a different approach to model the extension of the outbreak in the French armed forces. The effective reproductive number R (average number of secondary infections that arise from a typical primary case) is a mathematical tool enabling the evaluation of the spread of an outbreak prior to the implementation of control measures. An R-value >1 reflects the fact that each case is potentially able to infect more than one new person, which is likely to lead to the extension of the outbreak. Conversely, an R < 1 reflects the fact that each case infects less than one new person, which reflects the decline of the outbreak. For A(H1N1)pdm09 influenza, the R-value was estimated to be between 2.2 and 3.1 by the preliminary Mexican studies conducted from March to April 2009, at the onset of the pandemic. The aim of this work was to estimate the reproductive number R for A(H1N1)pdm09 influenza in the French armed forces.

Kidney transplantation in an elite HIV controller: Limited impact of immunosuppressive therapy on viro-immunological status

2012-03-09

Rare HIV-1-infected patients, termed HIV controllers (HIC) or elite controllers, maintain plasma HIV RNA levels below the detection limit for long periods without treatment. This spontaneous control could be due to several genetic and/or immune mechanisms. In particular, the protective HLA allele B*5701 is overrepresented in these patients. Immune control of viral replication is further supported by the presence of a fully functional HIV-specific CD8+ T cell response. In a large fraction of HIC patients, CD8+ T cells exhibit unique HIV-suppressive activity, with rapid production of perforin, release of several cytokines and strong proliferative capacity. Interestingly, however, some HIC patients have weak or even undetectable HIV-specific CD8+ T cell responses, pointing to a role of other mechanisms. Central memory CD4+ T cells are preserved in HIC patients and antibody-dependent cytotoxicity could play a role in limiting viral replication. In addition, recent publications suggest that restriction factors may limit HIV replication in CD4+ T cells and macrophages in some HIC patients.

Diverse human rhinoviruses A and C from children with respiratory infections in Kuala Lumpur, Malaysia

2012-03-16

We read with interest the recent paper by Xiang and colleagues describing the molecular epidemiology of human rhinovirus in China. Human rhinoviruses (HRVs) were first discovered more than 50 years ago. HRVs are a common cause of upper respiratory tract infections, but are also associated with asthma exacerbations and more severe respiratory infections. HRVs can be divided into three groups, A, B and C, with the latter, HRV-C, only reported in 2007. There are more than 100 types of HRV-A and B, while discovery of new HRV-C still continues. The high genetic and antigenic heterogeneity amongst the HRV results in lack of protective immunity and repeated infections. With the wider availability of molecular diagnostic methods, there is great interest in determining the global range of HRV variants, for subsequent development of antivirals and vaccines. As data from tropical Asian countries is relatively lacking, we report here the clinical manifestations of HRV infection and the molecular typing of HRV detected at the University Malaya Medical Centre, a major 900-bed referral and teaching hospital in Kuala Lumpur, Malaysia.

Screening of healthcare workers in response to a group A streptococcal outbreak in a maternity setting

Marie Whitley, Claire F. Haill, Nicola Phillips, Alison Williams, Peter J. Jenks — 2012-03-14

The recently published guideline for the management and control of group A streptococcal (GAS) infection provides welcome guidance on the management of cases potentially acquired through contact with healthcare or maternity services. Because of the number of reported cases of staff-to-patient transmission of GAS, the guideline recommends that screening of epidemiologically linked healthcare workers (HCWs) should be considered where no alternative source is readily identified. The few studies of GAS throat carriage in healthy adults and vaginal or rectal colonisation in pregnant women, generally report carriage rates of 1% or less (summarized in Ref. ). Although one Canadian study linked symptomatic HCWs with 8.2% of outbreaks and colonised, asymptomatic HCWs with 34%, there is limited data on rates of GAS carriage in staff working in the healthcare environment. We report our experience of investigating an outbreak of GAS on our maternity unit, which included screening of epidemiologically linked HCWs.