Journal of Gastrointestinal Infections

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2021 | January-December | Volume 11 | Issue 1

EDITORIAL

Navneet Kaur, Ashwini Agarwal, Guduru Gopal Rao

Role of 16S Ribosomal RNA in Etiological Diagnosis of Pyogenic Liver Abscess

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:2] [Pages No:1 - 2]

Keywords: 16S rRNA, Diagnosis, Liver abscess

   DOI: 10.5005/jp-journals-10068-3045  |  Open Access |  How to cite  | 

ORIGINAL RESEARCH

Gopal Nath, Shweta Singh, Rajesh Kumar

Does Over-colonization of Klebsiella pneumoniae in the Gut Cause Obesity?

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:6] [Pages No:3 - 8]

Keywords: Bacteriophage therapy, Charles Foster rats, Klebsiella pneumoniae, Obesity

   DOI: 10.5005/jp-journals-10068-3048  |  Open Access |  How to cite  | 

Abstract

Background and objectives: Gut microbes have been implicated in human weight gain and involve a few species of the Enterobacteriaceae family such as Klebsiella pneumoniae. We have tried to explore the effect of early colonization of the K. pneumoniae and subsequent eradication through bacteriophage therapy in rat pups on weight gain and loss. Materials and methods: Three pairs of rats selected for mating were grouped separately. Group I having five pups were kept on a sterile diet. Five pups each belonging to group II and III were fed with K. pneumoniae. At the end of 10th week, the pups belonging to the group III were fed with K. pneumoniae-specific phages for 8 weeks. At the end of 30th week, group III were again fed with the bacterium, while group II received bacteriophage therapy for the next 8 weeks. The weight of each of the pups was noted every Monday of the week till the completion of the study. Results: There was significantly higher weight gain (p <0.001) in the rats colonized by the bacterium (50% higher) than those without the colonization by K. pneumoniae by the end of the seventh week. When the bacterium was eradicated using a specific bacteriophage cocktail orally, the mean weight decreased and became almost similar to that of the control rats in about 12 weeks. Conclusion: The bacterial species K. pneumoniae, which is a saprophyte with voracious metabolic activities, may lead to more harvesting of energy from the food and in turn lead to obesity.

ORIGINAL RESEARCH

Lakshmi Shanmugam, Jharna Mandal, Niranjan Biswal, Noyal M Joseph

Study of Prevalence of Campylobacter Gastroenteritis among Pediatric Population Using a Multiplex PCR in a Tertiary Care Hospital in Puducherry, South India

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:6] [Pages No:9 - 14]

Keywords: Campylobacter, Children, Gastroenteritis, Multiplex PCR

   DOI: 10.5005/jp-journals-10068-3050  |  Open Access |  How to cite  | 

Abstract

Background and objectives: Campylobacter is one of the four common causes of diarrheal illness worldwide. Campylobacter infection is more common in developing than in developed countries. As conventional methods pose a great difficulty for the isolation and identification of this organism, molecular methods are much preferred. Materials and methods: A total of 133 stool samples were collected from children less than 13 years presenting to pediatric outpatient department and the emergency department in a tertiary care hospital in Puducherry. The stool samples were extracted, and the DNA was subjected to multiplex PCR to detect Campylobacter species, followed by sequencing. Results: Campylobacter species was detected in 13 children (9.7% of the study population) (95% CI: 5.5–16.4), with Campylobacter jejuni (11 of 13) being the predominant species. The prevalence was higher in children less than 24 months (18.18%) with a higher predisposition to girls (14.29%). The most common clinical presentation was found to be acute watery diarrhea (10%). Campylobacter detection was higher from August to November (62%), with the highest incidence in October (22.3%). Campylobacter was detected in six (21.4%) children who had contact with pets. Conclusion: The study reveals that the prevalence of Campylobacter infection was high in Puducherry. There is an increased need to implement molecular assays for the routine detection of Campylobacter in all clinical pediatric stool samples.

REVIEW ARTICLE

Varsha Gupta, Meenakshi Singh, Aditi , Ritu Garg

New Insights into Molecular Diagnostics for Common Gastrointestinal Infections

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:9] [Pages No:15 - 23]

Keywords: Culture, Diarrhea, Enteropathogens, Gastrointestinal infections, Real-time PCR

   DOI: 10.5005/jp-journals-10068-3044  |  Open Access |  How to cite  | 

Abstract

Gastrointestinal (GI) infections are a major health problem all over the world, causing an increase in hospitalization, morbidity, and mortality. The etiological agents of infectious gastroenteritis are viruses, bacteria, and parasites. A precise identification of GI pathogens is crucial for proper treatment and/or isolation, management, and further investigations like designing specific prevention modalities, vaccination strategies, and empiric treatment regimens to prevent the spread of the infectious agents. Routinely, the laboratory diagnosis of GI infections depends on microscopy, culture, and antigen detection. The drawbacks of conventional method are its low sensitivity and 3–5 days of turnaround time in the finalization of report. Quick turnaround time is of paramount value in diagnosis, clinical management, and infection control. From the last decade, molecular-based diagnostic tools have emerged for GI infections in the microbiological laboratory analyses. Culture-independent diagnostic tests typically involve nucleic acid amplification of the genetic material of several bacteria, viruses, and parasites simultaneously. Even whole-genome next-generation sequencing is important for symptomatic patients that remain negative by both routine and multiplex PCR-based diagnostic methods. Therefore, the use of proficient methods for pathogen detection is necessary to ensure prompt turnaround time. This review includes various conventional and molecular tools in identifying various enteropathogens and also analyzes the advantages and drawbacks of all methods.

REVIEW ARTICLE

Chetana Vaishnavi

Virulence Factors Associated with Clostridiodes difficile: An Overview

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:6] [Pages No:24 - 29]

Keywords: Binary toxin, Clostridiodes difficile infection, Flagella, Spores, Surface layer proteins, Toxin A, Toxin B, Virulence factors

   DOI: 10.5005/jp-journals-10068-3047  |  Open Access |  How to cite  | 

Abstract

Clostridiodes difficile is a health threat mainly acquired via the feco-oral route and colonizes the human gut. There is a wide range of clinical presentation of C. difficile infection (CDI). C. difficile can be accountable for 15–25% of antibiotic-related diarrhea and up to 100% of pseudo-membranous colitis. Clinically important C. difficile are evolving and increasingly being reported globally. The pathogenesis of C. difficile is associated with many established and potential virulence factors. They include toxins, surface layer proteins, cell wall proteins, flagella, fimbriae, spores, etc. The main virulent factors of CDI are toxin A and toxin B, both of which share a high structural and functional resemblance between them. Both these toxins are responsible for neutrophil infiltration marked by mucosal insult and colitis which is a significant feature of CDI. These toxins also influence the cytoskeletal features, despite the difference in activity potency. A third toxin, produced by some C. difficile strains, contains components of both toxin A and toxin B and is referred to as the binary toxin. The role of this toxin in CDI virulence is not clear. Besides the above described virulence features there are other probable factors that could be involved in C. difficile colonization. They are flagella, surface layer protein, production of tissue degradative exoenzymes, and sporulation. In this overview, the virulence factors associated with C. difficile shall be discussed to highlight their potential role in the disease.

REVIEW ARTICLE

Jagdish Chander

Gastrointestinal Mucormycosis: A Challenge during COVID-19 Pandemic

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:6] [Pages No:30 - 35]

Keywords: Amphotericin B, CAM, COVID-19, Gastrointestinal mucormycosis, Pandemic

   DOI: 10.5005/jp-journals-10068-3052  |  Open Access |  How to cite  | 

Abstract

In India, the second wave of COVID-19 pandemic came with unprecedented number of patients in the months of April, May, and June, 2021. This time correspondingly there was a record number (~50,000) of mucormycosis, which was popularized by the mainstream media as “black fungus.” The most common presentation was rhino-orbital mucormycosis followed by pulmonary and gastrointestinal mucormycosis. Scientifically this disease should be termed as COVID-19-associated mucormycosis (CAM). The Government of India had to declare it as an emergency situation under the Epidemic Diseases Act, 1897, on May 20, 2021. A large number of professional bodies in medical sciences, particularly in the field of microbiology, came out with various guidelines to tackle the challenging issue. The most common species involved is Rhizopus arrhizus, which is found in our surroundings, food material, and different places. Sometimes it is taken as a contaminant or “bread-mold” in houses or “lid-lifter” in the laboratory. But when there is an underlying background of any disease like diabetic mellitus, the same very fungus also becomes life-threatening. During this intervening period of second and looming third wave, patients are presenting with recurrence of the disease. The diagnosis is not very difficult when the index of suspicion is high. The direct finding of nonseptate hyphae with right-angle branching followed by cultural confirmation on Sabouraud Dextrose Agar clinch the final diagnosis. As far as the treatment is concerned, it is mainly surgical intervention of the necrotic tissue followed by antifungals like amphotericin B (conventional/liposomal), posaconazole, isavuconazole, apart from taking care simultaneously of the underlying risk factors like diabetes mellitus. With timely management the patient can be saved easily otherwise it can prove fatal.

REVIEW ARTICLE

Virendra Bahadur Yadav, Gopal Nath, Sudhir Kumar Singh

Biofilm and Chronic Typhoid Carriers with Special Reference to Bacteriophage Therapy

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:6] [Pages No:36 - 41]

Keywords: Antibiotics, Bacteriophage therapy, Biofilm, Chronic carrier, Typhoid fever

   DOI: 10.5005/jp-journals-10068-3053  |  Open Access |  How to cite  | 

Abstract

Salmonella enterica serovar Typhi is a human-restricted pathogen and the primary etiologic agent of typhoid fever with an incidence of 21 million cases each year, resulting in 200,000 deaths annually. About 3–5% of the individuals with an acute clinical or subclinical infection ultimately develop a chronic asymptomatic carrier state. These new chronic carriers are being added to the existing pool every year. This chronic carriage state not only serves as a reservoir for further spread of the disease via bacterial shedding in feces but is also being reported to be associated with malignant transformations in the biliary system. The acute and chronic carrier states are also becoming challenging to resolve with antibiotics due to the emergence of multiple drug-resistant strains. Moreover, biofilm formation is another hindrance in eliminating the infection. It is crucial to understand the development of each of these states to design and test targeted approaches to resolve the more recalcitrant chronic carriage. Bacteriophage therapy is emerging as one of the potential alternatives to deal with acute and chronic infection associated with biofilm formation. In this review, we have discussed the natural process of biofilm formation along with the intelligent role of bacteriophages to resolve such complicated infections, particularly in relation to typhoid.

CASE REPORT

Arup Choudhury, Deepak Kumar, Pankaj Gupta, Aman Sharma, Vishal Sharma

Forme Fruste of Septic Arthritis in a Patient with Ulcerative Colitis

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:2] [Pages No:42 - 43]

Keywords: Arthritis, Inflammatory bowel disease, Septic arthritis, Ulcerative colitis

   DOI: 10.5005/jp-journals-10068-3051  |  Open Access |  How to cite  | 

Abstract

Musculoskeletal involvement is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Typically, peripheral joint involvement in IBD is classified into two types depending upon involvement of joint pattern. Apart from IBD associated arthritis, patient of IBD is also at risk of developing non-IBD related arthritis. Patients with IBD are on immunosuppressive medication and are at risk of developing septic arthritis, which is a medical emergency and needs emergent drainage and antibiotic therapy. Here we report a case of ulcerative colitis in a woman who was on azathioprine, presenting with unilateral pain and swelling of knee joint where a diagnosis of septic arthritis was established. The case highlights difficulties in diagnosis especially in patients on immunosuppression.

CASE REPORT

Rama Gupta, Veenu Gupta, Deepak Bhat, Reetu Goyal, Jyoti Chaudhary, Menal Gupta

Shigella flexneri Sepsis in a Well-nourished Immunocompetent Child: A Rare Case Report

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:3] [Pages No:44 - 46]

Keywords: Bacteremia, Intravenous antibiotics, Shigella flexneri, Stool culture, Well-nourished child

   DOI: 10.5005/jp-journals-10068-3046  |  Open Access |  How to cite  | 

Abstract

Shigella infections are usually restricted to the intestine. There are a few reports of Shigella isolated from the blood and most of these are from children, usually the neonates and the malnourished. In the small number of adult cases of Shigella bacteremia which have been reported, there appears to be an association with underlying disease and immunosuppression including acquired immunodeficiency syndrome. We report a rare case of septicemia with Shigella flexneri in a well-nourished, obese child, with no other predisposing underlying condition. With the prompt and aggressive symptomatic treatment along with administration of appropriate antibiotics based upon the antimicrobial susceptibility pattern of the isolate, the patient's recovery was uneventful.

CASE REPORT

Rachana Kannambath, Pheba Stanley, Pazhanivel Mohan, Jharna Mandal

Isolation of Comamonas Species from the Stool Samples of Patients with Underlying Gastrointestinal Pathology

[Year:2021] [Month:January-December] [Volume:11] [Number:1] [Pages:4] [Pages No:47 - 50]

Keywords: Comamonas aquatica, Comamonas testosteroni, Gastrointestinal infection

   DOI: 10.5005/jp-journals-10068-3049  |  Open Access |  How to cite  | 

Abstract

Comamonas species are saprophytes, thought to be rarely associated with clinical infections. We report five cases of Comamonas species associated with gastrointestinal (GI) manifestations isolated over a period of 2 years. All these patients had underlying GI pathologies like malignancy or inflammatory bowel disease. This report tends to introspect on the clinical significance of such rare pathogens in stool samples and emphasize its possible role in causing GI infections.

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