Infectious human diseases: Regions, habitats, threats, and mitigation strategies: The issues—Part II

Globally, vaccines against 47 infectious etiologic agents are approved by at least one regulatory authority as of December 2022. The numbers of viral diseases, infections caused by mycoplasma, bacterial and protozoal diseases, mycoses, diseases caused by parasitic worms, and other infectious diseases of unknown etiology run into thousands. Therefore, more vaccines are required to be developed to keep more populations disease free. Climate change and global increase in temperature may promote sea level rises and an increase in the intensity of rains, causing an upsurge in certain infectious diseases in regions of the human population and even causing movement of habitats. In societies where the expenditure on health as a percentage of gross domestic product is higher, people are more capacitated to tackle the treatment and spread of infectious diseases. As several of such conditions are zoonotic, well-planned strategies for controlling the spread would go a long way in the proper direction. Poverty and contagious diseases are infallibly linked. Major infectious diseases of poverty include tuberculosis, human immunodeficiency virus (HIV)/ acquired immuno deficiency syndrome (AIDS), malaria, measles, pneumonia, diarrheal diseases, and several neglected tropical diseases. The world is not yet unified in action to jointly work to contain the global problem of infectious diseases in every human habitat. There was a visible divide between and among the rich countries versus the developing countries regarding accessibility and deployment of vaccines against COVID-19 flu. To contain the spread of infectious diseases in the future, the whole world would have to work together, raising funds, strengthening epidemiological surveys, inventing effective vaccines, and vaccinating the eligible population, as also treating the infected with therapy in time, besides resorting to other preventive measures for overall human progress. The developmental efforts are to be pursued jointly and together to benefit all people, respecting the world as one.

Infectious human diseases: Regions, habitats, threats, and mitigation strategies: The actors—Part I

Infectious diseases are a significant burden on the global economy and public health. The major factors attributed to the rise in infectious diseases are thought to be the unstructured rise in the human population with expanding poverty, unplanned urbanization, fast urban migration, unplanned human habitats in thickly populated urban pockets that are the residence of poor people, insufficient healthcare infrastructure, inadequate vaccination, and neglect in effectively containing the zoonotic diseases, among others. Certain global regions such as China, India, Bangladesh, Pakistan, and Indonesia among the other Asian countries, sections of South America, and vast parts of Sub-Saharan Africa harbor more infectious human diseases. To contain the infectious disease burden, the health infrastructure especially in poor countries needs to be improved. With the assistance of rich countries monetarily as well as technologically, the situation can be improved. International institutions and large philanthropic organizations are working to improve human health globally. More monetary assistance to these organizations would positively contribute to the cause and would go a long way in diffusing the infectious agents.

Healthcare-associated Infections in a Neonatal Intensive Care Unit in Turkey.

Objective: To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcareassociated infections (HAIs) in the Neonatal Intensive Care Unit. Design: Prospective, cohort. Setting: A 38-bed, teaching, referral, neonatal intensive-care unit. Participants: All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. Methods: The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. Results: The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral R E S E A R C H P A P E R INDIAN PEDIATRICS 951 VOLUME 49__DECEMBER 16, 2012 nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. Conclusions: Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.

Clinical Features and Identification of Etiologic Agents in Onychomycosis (1999-2002) / 대한피부과학회지

BACKGROUND: Although there have been many studies about tinea unguium, few studies about etiologic agents including nondermatophytic molds and yeasts in onychomycosis have been reported in Korea. OBJECTIVE: The purpose of the study was to investigate the recent clinical features and identification of etiologic agents in onychomycosis. METHODS: In the 3-year period 1999-2002, we reviewed five hundred ninty nine patients with onychomycosis in retrospectively. The etiologic agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. The identification of yeasts based on the results of culture, germ tube test, and biochemical API system tests. Nondermatophytic molds or yeasts isolated were considered as pathogens when the presence of fungal elements was identified at direct microscopy and follow-up specimen yielding cultures showed the same fungi. RESULTS: Of the five hundred ninty nine patients presenting with onychomycosis, 92.5% were toenail onychomycosis, 5.5% fingernail onychomycosis, and 2.0% onychomycosis in both toenails and fingernails. Among the age groups, the incidence rate was highest in the fifth decade(22.0%). The ratio of male to female patients was 1.1:1. Distal subungual onychomycosis(96.1%) was the most common clinical type of onychomycosis. In the toenail onychomycosis, dermatophytes were most frequently isolated(81.9%), followed by yeasts(11.7%), and nondermatophytic molds(6.4%). Trichophyton rubrum was the most frequently isolated agent. In the fingernail onychomycosis, yeasts were mostly isolated(48.2%), followed by dermatophytes(44.4%), and nondermatophytic molds(7.4%). CONCLUSION: Because of the increase in onychomycosis by nondermatophytic molds and yeasts, we suggest the need of a careful mycological examination in patients with onychomycosis.

Etiologic agents of cutaneous infectious granuloma: 2 year-experience from granuloma clinic, Siriraj Hospital.

Etiological diagnosis of cutaneous infectious granuloma is difficult to achieve and leads to difficult in patient management. We proposed to search for etiologic agents by special stain of histologic sections, cultural method and PCR technique for tuberculous and non-tuberculous mycobacteria. The skin biopsy specimens were obtained from dermatologic patients who attended Granuloma Clinic, Siriraj Hospital from January 1994 to December 1996. Sixty-nine cases of mixed cell granuloma were found during the 2-year-period. The causative agents had been found in 45 cases (65.22%). Mycobacterial infections were documented in 25 cases. Five cases of tuberculous infection were diagnosed by PCR method. Non-tuberculous mycobacterial infections were diagnosed by cultural method in 14 cases and the other 6 cases were diagnosed by acid-fast stain in histologic section alone. Actinomycotic mycetoma were diagnosed in 4cases. Fungal infections were documented in 16 cases, which caused by hyaline fungi 7 cases and dematiaceous fungi 9 cases. About one-third of all cases (24 cases) the etiologic agent could not be identified.