Irrational use of azithromycin in typhoid endemic areas: A challenge on multidrug-resistant typhoid treatment

Typhoid is a food-borne fatal disease caused by Salmonella typhi. It causes inflammation of the intestine, resulting in diarrhoea, fever, headache, cough, and muscle pain. Improved hygiene has resulted in a marked decline in typhoid fever cases in many developed countries. However, significant typhoid cases emerge in low and middle-income countries annually, including Pakistan. Typhoid fever accounts for a larger percentage of acute febrile illnesses in Pakistan. Azithromycin is the only effective drug used in multidrug-resistant typhoid. The emergence of drug resistance typhoid has been of more significant concern in recent years due to its irrational use of azithromycin. It is considered the last antibiotic to eradicate multidrug-resistant typhoid fever from Pakistan. In this article, we express our concern of the irrational use of azithromycin in Pakistan and its effect on typhoid in the country.

Chronic lymphocytic leukemia in a farmer and vegetable seller: Associated with exposure of multiple work-related hazards?

There are several risk factors associated with the incidence of chronic lymphocytic leukaemia (CLL), namely genetic factors, smoking, and occupational exposure to chemicals. We highlight a possible association of a CLL case and the occupational. We reported a case of CLL patient, a 69-year-old man, who had been working as a vegetable seller and a chili farmer since 15 and 4 years ago, respectively. The patient was diagnosed with CLL three months prior to admission and had a history of three times blood transfusions. The patient only complained of paleness and weakness without any specific symptoms. No swelling of the lymph nodes, hepatomegaly, or splenomegaly was found. As a vegetable seller and chili farmer, the patient was exposed to five hazards, physical, chemical, biological, ergonomic to psychosocial. Therefore, it is necessary to analyse whether there was an association between the patient's work and the current CLL. To diagnose occupational diseases, several steps are needed. In this patient, one of the risk factors that could lead to CLL was exposure to chemicals such as pesticides. However, information regarding the content of pesticides used was unclear and there were no results obtained from pesticides biomarker examination that might cause the disease, making it difficult to establish a definitive diagnosis of work-related cause. The patient could be advised to have biomarkers of pesticide substances checked, which requires control of farmers and vegetable sellers who might have been exposed to pesticides. The control mechanism might be started from elimination, substitution, engineering, administration, and use of personal protective equipment. A control mechanism is necessary to prevent the entry of contaminants into the body, especially through inhalation, oral, and dermal pathways. It is recommended to examine for biomarkers of pesticides containing organophosphates, organochlorines, or carbamates to determine the chronic effects on the accumulation of these chemicals that might cause CLL.

Pregnancy in a patient with dilated cardiomyopathy (DCM)

Pregnancy in dilated cardiomyopathy (DCM) has an extremely high risk. However, DCM is usually asymptomatic at a young age. In pregnancy with DCM, it appears progressive and becomes symptomatic. and mimicking with peripartum cardiomyopathy (PPCM). We reported a case of a 23-year-old woman who was 20 weeks pregnant with her first child complained of chest palpitations and severe faintness. These progressive symptoms have happened and started during pregnancy. This case report suggests that physiological and emotional burdens are greater during pregnancy, especially for dilated cardiomyopathy (DCM) patients. This condition often leads to the progression of the DCM. The DCM often headways from the asymptomatic phase upturn to the symptomatic stage.

The pandemic of COVID-19 decreased adherence to treatment among hypertension patients at Dr. Zainoel Abidin Hospital

Hypertension is one of the leading causes of mortality and morbidity worldwide. Treatment adherence is an essential factor in controlling blood pressure among hypertensive patients. This study aimed to evaluate the effect of the Coronavirus disease 2019 (COVID-19) pandemic on treatment adherence among hypertensive patients at Dr. Zainoel Abidin Hospital, Aceh, Indonesia, as well as to determine its associated factors. A cross-sectional study was conducted at the Cardiac Center by utilizing medical records of hypertensive patients visiting during the period of April-July 2019 and December 2020-March 2021. Bivariate analysis using the Kruskal-Wallis test was employed to examine the effect of the COVID-19 pandemic on patients’ adherence. The results showed that the number of patients adhering to treatment significantly decreased (p=0.000) by 22.7%, from 179 patients in 2019 to 64 patients in 2020. The data also suggested a significant positive association between residential and patient adherence before the pandemic (p=0.006); however, no significant difference was observed between residential and patients’ adherence after the pandemic (p=0.282). Furthermore, our study found no association between age and adherence before and after the pandemic (p=0.690 in 2019 and p=0.125 in 2020). In conclusion, the pandemic of COVID-19 significantly affected treatment adherence among patients with hypertension at Aceh provincial hospital, with a decreased number in patient visits up to 22.7%.

Coinciding SARS-CoV-2 infection in HIV patients with cerebral toxoplasma

A massive and notorious impact of coronavirus disease 2019 (COVID-19) pandemic has affected communities worldwide, urging extra preventive measure, especially for individuals with comorbidities including those who are suffering from human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). We reported a case of a 45-year-old man with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV infection as well as toxoplasmosis. The patient presented to the hospital with decreased consciousness and stiffness on both hands and feet accompanied with loss of appetite, fever, and coughing. Since 2014, he had been diagnosed with HIV and undergone combined antiretroviral therapies. Toxoplasmosis was revealed by multislice computed tomography (MSCT) showing multiple rim-like lesion in cortex-subcortex of left temporal lobe along with surrounding perifocal oedema. Furthermore, the finding was corroborated by the contrasted image exhibiting rim enhancement patterns. The patient was also RT-PCR confirmed Covid-19. Following examinations, the patient received pyrimethamine with a loading dose of 200 mg. The management was continued with oral intake of pyrimethamine, clindamycin, folic acid, and vitamin B6 for maintenance dose. This case report suggests that HIV patient suffering from COVID-19 can be treated with antiretroviral therapies since the specific antivirus for SARS-CoV-2 has not yet available. We believe that this case report could contribute to more understanding on the development of clinical management for COVID-19 in HIV-positive patients.

Prevalence of shigellosis and associated risk factors among undergraduate students of a private university in Ogun State, Nigeria

This cross-sectional, institutional-based study aimed to determine the prevalence of shigellosis and associated risk factors among Babcock University students in Ogun State, Nigeria. One hundred and twenty (120) undergraduate students, 80 females and 40 males, were asked to provide stool specimen in a sterile leak-proof single-use universal bottle with a screw-capped lid. Standard microbiological techniques were used to analyse the stool samples. A questionnaire was designed to collect demographic and clinical information from participants. The data obtained were statistically analysed using the SPSS Statistics software (version 18.0). The study showed that there was no occurrence of shigellosis among the study participants (0%), but other enteric pathogens infection were present in all participants (100%). The three most common mono-infections found among the study participants included Staphylococcus aureus (40%), followed by Escherichia coli (16.7%), and Salmonella typhi and Bacillus spp. (3.3%, each). While the most common prevalence of dual-infections included Staphylococcus aureus and Escherichia coli (33.3%), followed by Staphylococcus aureus and Salmonella typhi (3.3%). The proportion of participants who were asymptomatic (66.7%) was significantly higher than the symptomatic ones (33.3%). Identified risk factors of non-Shigella enteric infection included consumption of beef, vegetables, fruits, poultry/poultry products, as well as street foods, poor hand hygiene before eating, anal cleaning, and poor hand hygiene after toileting. Although shigellosis did not exist among undergraduate students of Babcock University, this study highlighted the existence of other enteric infections among the study participants. Therefore, the necessary preventive measures should be ensured and sustained.

Early transmission dynamics of SARS-CoV-2 in Indonesia

The objective of this study was to determine the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to evaluate the vigilance of the health system during the early phase of coronavirus disease 2019 (COVID-19) outbreak in Indonesia. The early epidemiology and transmission chains of COVID-19 were analyzed based on data from the Directorate General of Disease Prevention and Control of the Indonesian Ministry of Health. The results of this study shown although Indonesia is a country with a high relative importation risk of SARS-CoV-2, the first two cases of COVID-19 were identified on March 2, 2020. This relatively late date by regional standards raises the possibility of undetected cases beforehand. The first case was a foreigner citizen who visited the capital city of Jakarta and later was diagnosed COVID-19 after returning from Indonesia. One week later after the first case, 27 confirmed COVID-19 cases had been reported in Indonesia, and the majority of the cases were clustered together. Apart from the possibility of underdetection of COVID-19 cases in the country, the government has strengthened the disease surveillance system and established an outbreak preparedness system to diagnose and control COVID-19.

A rare case of varicella zoster virus encephalitis in a 16 years old unvaccinated girl

We reported a 16-year-old girl, with diffuse vesicular rashes all over the body, presented to the emergency department with altered mental status, irritability, persistent fever and one episode of a generalized tonic-clonic seizure. After thorough evaluation and investigations, the case was a varicella zoster-associated encephalitis in an unvaccinated patient. Appropriate treatment was initiated, the patient was then shifted to the critical care and subsequently discharged with no sequelae. Early diagnosis and treatment should be emphasized as they play an important role in the clinical outcome of chickenpox-associated encephalitis.

Ramadan and Eid al-Fitr: Population movement, mass gathering and escalating of COVID-19 – A perspective from Indonesia

In Indonesia, the most populous Moslem-majority country, despite the possibility of underreported coronavirus disease (COVID-19) cases, 6,248 confirmed cases and 535 deaths have been recorded. With upcoming Ramadan and Eid al-Fitr, between 18-23 million of Indonesians may move from urban locations (with high counts of COVDI-19) to rural areas with fewer cases currently but less laboratory capacity to diagnose cases. This review summaries the current situation of CO.VID-19 in Indonesia and discusses the possible impacts of mass population movement, Ramadan-related activities, and Eid al-Fitr celebration days on COVID-19 transmission in the country.

COVID-19 with acute hepatitis A virus co-infection in a fully-vaccinated individual: a case report

In a developing country with varying degree of public hygiene and sanitation, prevalent infectious diseases such as hepatitis A (HAV) could add to the burden of infection during coronavirus disease 2019 (COVID-19) pandemic and complicate its gastrointestinal and hepatic manifestation. Here we present a case COVID-19 with acute hepatitis A virus co-infection in a young female with fever, joint pain, non-productive cough, loss of smell, abdominal discomfort, darkened urine, and pale loose stool before admission. The significant finding was slightly icteric sclera, hepatomegaly with tenderness in the epigastrium and right upper quadrant, increase in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, C-reactive protein and, D-dimer. A naso-oropharyngeal swab examination for SARS-CoV-2 infection was positive, and IgM anti-HAV was reactive with a total anti-HAV titer 60 mIU/mL. Subsequently, she was hospitalized for 14 days, successfully recovered; her symptoms resolved and her level of liver enzymes back to normal, and she was discharged for self-isolation at home. RT-PCR for SARS-CoV-2 infection came back negative 7 days later. In light of the pandemic, physicians need to raise suspicion of co-infection of COVID-19 with other hepatitis viruses in cases with gastrointestinal and hepatic manifestation. A marked increase in liver enzyme may warrant further testing for hepatitis viruses where such infection should be suspected.