State of the globe: Antimicrobial resistance: Need for de-compartmentalization of action Sunil Kumar Raina Journal of Global Infectious Diseases 2019 11(4):133-134

Costing of febrile illness among under five children, a study in a tertiary care teaching hospital in Odisha, India Himanshu Sekhar Pradhan, Nirmal Kumar Mohakud, Rishab Pugalia, Sudhir Kumar Satpathy Journal of Global Infectious Diseases 2019 11(4):135-139 Objective: The objective of this study was to determine the cost of treatment, both direct and indirect costs, of febrile illness among under-five children in Odisha, India. Methods: This was a cross-sectional study of thirty under-five children with febrile illness reporting to the pediatric outpatient (OP) department and thirty more under-five children admitted to the pediatric ward who were included in the study during January–April 2018. The parents/caretakers of the ailing children were interviewed using the WHO questionnaire contextualized to the local situation. Both direct (medicine, diagnostics, registration/doctor's fees, bed charges, and cost of personal medical appliances) and indirect (transportation, food, loss of income, and lodging) costs of febrile illness and pre-, during, and posthospital visit cost were estimated. Results: The median direct and indirect costs for OP cases were Rs. 1201.00 and Rs. 1375.00, respectively. For the hospitalization (indoor patients), direct and indirect costs were Rs. 7015.00 and Rs. 5190.00, respectively. People also spent money in pre-, during, and posthospital visits for the same episode of febrile illness. Only four OP cases had some kind of medical insurance. Conclusion: High expenditure on both OP and indoor patients calls for appropriate policy for provision of financial protection while seeking health-care services. Health facilities should be tuned to do cost analysis enabling comparison among health facilities.

Socioeconomic factors associated with diarrhea among under-five children in Manado Coastal Area, Indonesia Oksfriani Jufri Sumampouw, Jeini Ester Nelwan, Adisti Aldegonda Rumayar Journal of Global Infectious Diseases 2019 11(4):140-146 Background: Diarrhea is a condition where individuals experience defecation as much as 3 or more per day with a soft consistency. Diarrhea in children is one of the environmentally-based diseases, and Manado is one of the cities faced with this environmental lead diarrhea problems. The purpose of this study is to analyze the influence of socioeconomic factors on the occurrence of diarrhea among under-five children in the coastal area of Manado city. Materials and Methods: A cross-sectional study design was conducted in August 2017. The numbers of respondents were a total of 120 mothers or caregivers with children under five who suffered from diarrhea in the coastal area of Manado. The respondent candidates were selected from the community health center's records of the diarrhea program and further selected by the inclusion/exclusion criteria. The characteristics of mothers and family income were used as indicators of socioeconomic factors. All of the respondents were questioned about the occurrence of their child's diarrhea that they had experienced in the previous 6 months. A structured and well-designed questionnaire was used to obtain data, which were related to sociodemographic, economic, and diarrhea. Generalized structured component analysis in GeSCA software was applied for data analysis. Results: The findings of this study showed significant influence from socioeconomic factors on diarrhea incidence in under-five children (critical ratio = 2.74). In other words, as socioeconomic factors improve, the incidence of diarrhea decreases (B = −0.246). The characteristics of the mother are the indicator of the highest influence (loading value = 0.846). Conclusions: This study identified that the socioeconomic factors are influencing the diarrhea incidence among children under five in the coastal area of Manado city. Thus, to minimize a childhood diarrheal disease, socioeconomic factors are considered when promoting health and community empowerment among the coastal communities of Manado city.

Burden and molecular epidemiology of Rotavirus causing diarrhea among under-five children: A hospital-based study from Eastern India Arpit Kumar Shrivastava, N Samarasimha Reddy, Sidhartha Giri, Priyadarshi Soumyaranjan Sahu, Mirabai Das, Nirmal Kumar Mohakud, Rashmi Ranjan Das Journal of Global Infectious Diseases 2019 11(4):147-152 Background: Rotavirus (RVA) causes severe gastroenteritis in under-five children, and there are many diverse strains of the virus that are localized to different parts of the world. Objectives: To study the burden and molecular epidemiology of RVA causing gastroenteritis among children from Eastern India. Materials and Methods: This hospital-based cross-sectional study included children under-five with gastroenteritis. Demographic and clinical parameters were recorded in a predesigned pro forma. Stool samples collected from these children were initially screened for RVA VP6 antigen by enzyme immunoassay (EIA). Each EIA-positive sample was then subjected to RNA extraction, followed by reverse transcription, and heminested multiplex polymerase chain reaction for genotyping of RVA strains. Results: Of 320 included children, RVA was detected in 30.62% (98/320) cases by EIA. The highest incidence for RVA-positive cases (34.61%) was observed among children in the age group of 24–36 months, followed by 0–12 months (33.04%). Of the 97 completely typed samples, single genotype was detected in 85 (87.62%) samples with either G (VP7) or P (VP4) types. However, mixed genotypes were detected in 12 (11.21%) samples. G3P[8] (44.09%) was the most common genotype, followed by G1P[8] (32.65%), G2[P4] (5.10%), G1[P6] (3.06%), and G9[P4] (1.02%). Conclusions: The present study found RVA positivity in 30.62% of children with gastroenteritis, with the highest burden among 24–36 months old. The predominant genotypes were G1, G3, and P[8]. Further large-scale/multicentric studies should be conducted to document the diversity of circulating RVA genotypes in this region for giving inputs for vaccination strategy.

Antimicrobial resistance surveillance in typhoidal Salmonella in Ahmedabad in an era of global antimicrobial resistance surveillance systems Veena Iyer, Anal Ravalia, Kankshi Bhavsar, Susanna Abraham Cottagiri, Ayushi Sharma, Mahendra Vegad, Parul Shah, Bhavini Shah, Bhavin Solanki, Sumeeta Soni, Dileep Mavalankar Journal of Global Infectious Diseases 2019 11(4):153-159 Introduction: India possibly carries the highest burden of antimicrobial resistant typhoidal salmonellae in the world. We report on the health-care ecosystem that produces data on antimicrobial resistance (AMR) testing and the resistance patterns of typhoidal Salmonella isolates in the city of Ahmedabad. Materials and Methods: Through municipality records and internet searches, we identified 1696 private and 83 public laboratories in the city; 4 medical colleges, 4 health-care institution attached laboratories, and 4 corporate laboratories (CLs) were performing culture and antibiotic sensitivity testing (AST), but only 2 medical colleges and 1 CL shared their data with us. There was considerable variation in culturing and sensitivity testing methodology across laboratories. Results: Out of 51,260 blood cultures, Salmonella isolates were detected in only 146 (0.28%). AST was conducted on 124 isolates, of which 67 (54%) were found resistant. Multidrug resistance was absent. Concurrent resistance to more than one antibiotic was very high, 88%, among the 67 resistant isolates. Ciprofloxacin resistance varied widely between the private and public sector laboratories. Notably, isolates from the private sector laboratory showed complete resistance to azithromycin. Conclusions: High resistance to ciprofloxacin and azithromycin observed in Ahmedabad may be due to the increased use of these two antibiotics in the public and private sectors, respectively. The need of the hour is to identify a representative sample of laboratories from both the public and the private sectors and encourage them to participate in the national AMR surveillance network.

An unusual case of suspected lyme neuroborreliosis in a patient presenting with ear pain Michael Anthony Ramada, Saman Kannangara, Hany Eskarous Journal of Global Infectious Diseases 2019 11(4):160-162 We report a case of suspected Lyme neuroborreliosis (LNB) where the patient's sole symptom was chronic, intermittent episodes of unilateral ear pain. This case was unusual because this patient did not show any other neurological or extraneurological symptoms of Lyme disease. LNB is a manifestation of infection by Borrelia burgdorferi spirochetes that can manifest in a number of different clinical presentations depending on the nervous system dissemination of the bacteria. Most commonly, these neurological findings present as peripheral nerve radiculopathies, but rarer involvement of the central nervous system (CNS) can occur if a patient goes untreated. Most often, CNS involvement presents as meningitis with increased lymphocytes but can, in rarer cases, involve the spinal cord or brain parenchyma. The diagnosis of LNB was made after the patient was found to have suspicious lesions in the spinal cord and brain parenchyma on magnetic resonance imaging as well as cerebrospinal fluid Borrelia antibody index was consistent with CNS Lyme disease. We discuss this case as a unique clinical presentation of suspected LNB and the diagnostic findings associated with this infection.

Key factors in antibiotic resistance Vikas Yellapu, Nicholas Roma, Victoria Ngo, Parampreet Kaur, Richard Snyder Journal of Global Infectious Diseases 2019 11(4):163-165

Adjuvant maggot debridement therapy for deep wound infection due to methicillin-resistant Staphylococcus aureus Olga Kaplun, Magdalena Pupiales, George Psevdos Journal of Global Infectious Diseases 2019 11(4):165-167