Asian Pacific Journal of Tropical Medicine

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  • 1  Epitope finding in 2019 novel coronavirus (2019-nCoV): The first world report
    Beuy Joob Viroj Wiwanitkit
    . DOI: 10.4103/1995-7645.277515
    [Abstract](435) [HTML](0) [PDF 610.35 K](2558)
    2  Imported cases of 2019-novel coronavirus (2019-nCoV) infections in Thailand: Mathematical modelling of the outbreak
    Pathum Sookaromdee Viroj Wiwanitkit
    . DOI: 10.4103/1995-7645.277516
    [Abstract](277) [HTML](0) [PDF 608.76 K](2438)
    3  Evaluation of in vitro and in vivo immunostimulatory activities of poly (lactic-co-glycolic acid) nanoparticles loaded with soluble and autoclaved Leishmania infantum antigens: A novel vaccine candidate against visceral leishmaniasis
    Emrah Sefik Abamor Adil Allahverdiyev Ozlem Ayse Tosyali Melahat Bagirova Tayfun Acar Zeynep Mustafaeva Serap Derman
    2019, 12(8):353-364. DOI: 10.4103/1995-7645.262564
    [Abstract](149) [HTML](0) [PDF 1.09 M](1940)
    Objective: To prepare and characterize poly lactic-co-glycolic acid (PLGA) nanoparticles loaded with soluble leishmanial antigen or autoclaved leishmanial antigen and explore in vitro and in vivo immunogenicity of antigen encapsulated nanoparticles. Methods: Water/oil/water double emulsion technique was employed to synthesize PLGA nanoparticles, and scanning electron microscopy, Fourier transform infrared spectroscopy and Zeta-potential measurements were used to identify the characteristics of nanoparticles. Cytotoxicity of synthetized nanoparticles on J774 macrophage were investigated by MTT assays. To determine the in vitro immunostimulatory efficacies of nanoparticles, griess reaction and ELISA was used to measure the amounts of NO and cytokines. During the in vivo analysis, Balb/c mice were immunized with vaccine formulations, and protective properties of nanoparticles were measured by Leishman Donovan unit in the liver following the infection. Cytokine levels in spleens of mice were determined by ELISA. Results: MTT assay showed that neither soluble leishmanial antigen nor autoclaved leishmanial antigen encapsulated nanoparticles showed cytotoxicity against J774 macrophage cells. Contrary to free antigens, both autoclaved leishmanial antigen-nanoparticle and soluble leishmanial antigen-nanoparticle formulations led to a 10 and 16-fold increase in NO amounts by macrophages, respectively. Leishman Donovan unit calculations revealed that soluble leishmanial antigen-nanoparticles and autoclaved leishmanial antigen-nanoparticles yielded 52% and 64% protection against visceral leishmaniasis in mouse models. Besides, in vitro and in vivo tests demonstrated that by increasing IFN-γand IL-12 levels and inhibiting IL-4 and IL- 10 secretions, autoclaved leishmanial antigen-nanoparticles and soluble leishmanial antigennanoparticles triggered Th1 immune response. Conclusions: Both autoclaved leishmanial antigen-nanoparticles and soluble leishmanial antigen-nanoparticles formulations provide exceptional in vitro and in vivo immunostimulatory activities. Hence, PLGA-based antigen delivery systems are recommended as potential vaccine candidates against visceral leishmaniasis.
    4  Molecular identification of hemoplasmas in free ranging non-human primates in Thailand
    Parut Suksai Supakarn Kaewchot Piya Sereerak Sirinan Boonnan Bongkotchamat Phimsin Taksina Jaruwattananon Kacharin Raschasin Mutchamon Kaewparuehaschai Sorraya Siriphet Benjaporn Bhusri
    2019, 12(8):375-379. DOI: 10.4103/1995-7645.262566
    [Abstract](166) [HTML](0) [PDF 822.10 K](1387)
    Objective: To survey hemoplasmas infection in free ranging non-human primates from 8 provinces in Thailand. Methods: DNA from ethylenediaminetetraacetic acid blood of 262 free ranging non-human primates were identified as hemoplasmas using PCR and phylogenetic analysis based on 16S rRNA and rnpB genes. Results: A total of 148 non-human primates (56.49%) were determined positive for Candidatus Mycoplasma haemomacaque, including 125 Macaca fascicularis and 23 Macaca mulatta. Hemoplasmas can cause anemia in monkey but all positive samples were healthy. The positive rates in male and female non-human primates were not significantly different. Conclusions: Candidatus Mycoplasma infection is prevalent in free ranging Macaca fascicularis and Macaca mulatta in Thailand.
    5  Laboratory diagnosis of schistosomiasis mansoni: Current status and future trends
    Amira Taman Samar N. El-Beshbishi
    2019, 12(6):243-249. DOI: 10.4103/1995-7645.261270
    [Abstract](162) [HTML](0) [PDF 687.99 K](1371)
    Schistosomiasis is a neglected tropical disease that affects about 290 million patients worldwide. Children aged between 5 and 14 years represent 45.8% of the affected patients, in addition, schistosomiasis has been reported in Schistosoma-free areas, mostly because of tourism and immigration from endemic countries. Intestinal schistosomiasis caused by Schistosoma mansoni is mainly diagnosed via direct stool examination for egg detection. Immunological methods are favoured for disease monitoring and preliminary checking for communities in areas with low infection rates, and for patients with light and chronic infections where parasitological tests are negative. PCR-based diagnostic techniques are more sensitive, but expensive. Tegument proteins and miRNAs are promising markers for diagnosis of schistosomiasis. Here we review the diagnostic methods for schistosomiasis mansoni aiming to reach a standardized technique for diagnosis of early infection to help better control of the disease.
    6  An update on the 2014 Ebola outbreak in western Africa
    Haaris A. Shiwani Rebabonye B. Pharithi Barkat Khan Christian Binoun-A-Egom Peter Kruzliak Vincent Maher Emmanuel Eroume-A Egom
    2017, 10(1):6-10. DOI: 10.1016/j.apjtm.2016.12.008
    [Abstract](86) [HTML](0) [PDF 260.82 K](1244)
    The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times. There have been remarkable local and international efforts to control the crisis. Ebola Virus Disease is the focus of immense research activity. The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation. Over 28 000 people were inflicted with the condition, over 11 000 have died. Novel data has emerged regarding modes of transmission, providing rationale for recent flare-ups. Similarly, studies on survivors are elucidating the later stages of the disease recovery process. Novel techniques for diagnosis are also discussed. Finally, the current research regarding treatment and vaccine development is reviewed, particularly the implementation of rVSV-ZEBOV vaccination programs.
    7  Potential of herbal constituents as new natural leads against helminthiasis: A neglected tropical disease
    Kiran D. Patil Shashikant B. Bagade Sanjay R. Sharma Ketan V. Hatware
    2019, 12(7):291-299. DOI: 10.4103/1995-7645.262072
    [Abstract](118) [HTML](0) [PDF 818.29 K](1187)
    The WHO reports that billions of people and animals in tropical and subtropical regions are affected by helminthiasis as neglected tropical disease. It is predominant in underdeveloped areas; nevertheless, the increase in the number of travelers and migrants has made this infection more common. The current mass drug treatment produces severe side effects and many strains of helminths are resistant to them. None of the chemotherapeutic drugs meets the ideal requirements of anthelmintics, such as broad spectrum of activity, single dose cure, free from side effect and cost-effectiveness. Today, many researchers are screening the traditional herbal system in search of the anthelmintic herbal constituents which overcome all the problems of synthetic drugs. Several researchers proclaim anthelmintic activity of herbal medicines by using different experimental models. The present review demonstrates natural product drug discovery, outlining potential of herbal constituents from natural sources as natural leads against helminthiasis.
    8  Chlamydoconidium-producing Trichophyton tonsurans: Atypical morphological features of strains causing tinea capitis in Ceará, Brazil
    Raimunda Samia Nogueira Brilhante Germana Costa Paixao Jonathas Sales de Oliveira Vandbergue Santos Pereira Marcos Fábio Gadelha Rocha Reginaldo Goncalves de LimaNeto Débora de Souza Collares Maia Castelo-Branco Rossana de Aguiar Cordeiro José Júlio Costa Sidrim
    2019, 12(8):380-384. DOI: 10.4103/1995-7645.262567
    [Abstract](111) [HTML](0) [PDF 946.61 K](1148)
    Objective: To report atypical morphological features of Trichophyton (T.) tonsurans strains associated with tinea capitis. Methods: Eighty-two T. tonsurans strains isolated in Ceará, Brazil, were analyzed regarding macro and micromorphological features and nutritional patterns. Results: Fifty-two samples presented abundant chlamydoconidia, which were produced in chains. Macroscopically, these strains developed small glabrous colonies that were firmly attached to the surface of the culture medium, with few or no aerial mycelia and intense rusty yellow pigmentation. Seven strains did not grow with stimulus from thiamine. Samples were heterogeneous regarding urease production and none presented in vitro hair perforation. Conclusions: The observation of T. tonsurans strains with distinct phenotypic features indicates the need to revise the taxonomic criteria for routine identification of this dermatophyte.
    9  Annona muricata fruit extract protects against diethylnitrosamineinduced hepatocellular cancer in rats
    Ines Sifaoui Carmen M Martín-Navarro Atteneri López-Arencibia María Reyes-Batlle Basilio Valladares José E. Pi?ero Sutherland K Maciver Jacob Lorenzo-Morales
    2019, 12(6):283-287. DOI: 10.4103/1995-7645.261287
    [Abstract](206) [HTML](0) [PDF 823.36 K](1146)
    Objective: To evaluate the combination of several statins (atorvastatin, fluvastatin and simvastatin) and azoles (voriconazole, posaconazole and itraconazole) against Acanthamoeba spp. Methods: The efficiency of the different drug combinations against the trophozoite stage of different Acanthamoeba strains were evaluated by Alamar Blue assay. Effect on the cyst stage was observed by inverted microscope. Cytotoxicity of combinations of azoles and statins was evaluated by measuring the release of lactate dehydrogenase from a murine macrophage cell line. Results: Combinations of any of the tested statins and voriconazole or posaconazole were more efficient in inhibiting Acanthamoeba compared to statins or azoles individually. The drug combinations at the combined inhibitory concentrations 50% showed lower toxicity compared to that of the compounds alone. Conclusions: The combinations of statins together with voriconazole and posaconazole are more efficient than these drugs alone, and these combinations have lower cytotoxicity in mammalian cell lines.
    10  Annona muricata fruit extract protects against diethylnitrosamineinduced hepatocellular cancer in rats
    Subin Varghese Thomas John Paul Akhila Hosur Shrungeswara Subhankar Biswas AartiAbhishek Shah Chandrashekar Kodangala Subraya Yogendra Nayak
    2019, 12(6):272-282. DOI: 10.4103/1995-7645.261273
    [Abstract](364) [HTML](0) [PDF 1.33 M](1132)
    Objective: To evaluate the anticancer potentials of Annona muricata fruit by in vitro and in vivo methods. Methods: The ethanolic extract of Annona muricata fruit was prepared by Soxhlet extraction method and further fractionated with petroleum ether, ethyl acetate and chloroform. The fractions were tested for cytotoxicity, apoptosis, scratch wound assay, and cell cycle analysis. IC50, apoptotic index and percentage cell migration were determined using HepG2 cells. For the in vivo studies, hepatocellular carcinoma was induced by administering 0.01% diethylnitrosamine (DEN) in drinking water in Wistar rats. In pre-treatment, rats were co-administered 200 mg/kg of fruit extract with DEN for 14 weeks. In post-treatment, the extract was co-administered after 8-weeks of DEN-induction for 14 weeks. Liver function test, haematological test, oxidative stress markers, relative liver weight, number of cancer nodules and histopathological parameters were determined. Results: Annona muricata fruit extract =significantly lowered cell proliferation counts. The chloroform-fraction possessed higher activity [IC50=(53.7±4.3) μg/mL]. The chloroform fraction inhibited cell migration, which was significant compared to curcumin. Further investigations regarding the mode of anticancer activity revealed that the chloroform fraction induced apoptosis. The cell cycle analysis indicated that cells were being arrested at G0/G1. In the in vivo studies, the DEN-control group showed a significant decrease in body weights with increased mortality rate, hepatic nodules, and impairment of liver function compared to normal rats. The rats pre-treated and post-treated with the extract showed positive results with significant improvement in the parameters that were adversely affected by DEN. In addition, other adverse effects of DEN, such as blood dyscrasias and hepatic endogenous antioxidant, were significantly attenuated by Annona muricata fruit extract. Conclusions: The Annona muricata fruit extract has anticancer activity when tested by in vitro and in vivo hepatocellular cancer models.
    11  Tioxolone niosomes exert antileishmanial effects on Leishmania tropica by promoting promastigote apoptosis and immunomodulation
    Maryam Hakimi Parizi Iraj Sharifi Saeedeh Farajzadeh Abbas Pardakhty Mohammad Hossein Daie Parizi Hamid Sharifi Ali Reza Keyhani Mahshid Mostafavi Mehdi Bamorovat Ahmad Khosravi Daryoush Ghaffari
    2019, 12(8):365-374. DOI: 10.4103/1995-7645.262565
    [Abstract](133) [HTML](0) [PDF 1.62 M](1095)
    Objective: To explore the antileishmanial effect of tioxolone and its niosomal form against Leishmania tropica. Methods: Tioxolone niosomes were prepared by the hydration method and were evaluated for morphology, size, release study, and encapsulation efficiency. The cytotoxicity of tioxolone and its niosomal form was measured by MTT assay, leishmanicidal activity against promastigote and amastigote by MTT assay, apoptosis by flow cytometry, IL-12, IL-10 and metacaspase gene expression levels by q-PCR. Results: Span/Tween 40 and Span/Tween 60 niosomes had good physical stability as depicted in their size distribution curves and high encapsulation efficiency (>99%). The release profile of the entrapped compounds showed Fickian’s model of tioxolone delivery based on diffusion through lipid bilayers. With the IC50 value for amastigote as (24.5±2.1) μg/mL and selectivity index as 10.5, the Span/Tween 60 niosome (NT2) had a superior effect to other drugs. The CC50 value and IC50 of promastigote value for NT2 were (257.5±24.5) μg/mL and (164.8±20.6) μg/ mL, respectively. The flow cytometric analysis showed that tioxolone and niosomal forms induced apoptosis of Leishmania tropica promastigotes in a dose-dependent manner. NT2 increased the expression level of IL-12 and metacaspase genes and decreased the expression level of the IL-10 gene. Conclusions: Niosomes of tioxolone play an immunomodulatory role in increasing Th1 cytokine profile and inhibiting the Th2 cytokine profile. It could be used for treatment of anthroponotic cutaneous leishmaniasis.
    12  The phytochemical and pharmacological properties of artocarpin from Artocarpus heterophyllus
    Nik Nurul Najihah Nik Mat Daud Abdi Wira Septama Nordin Simbak Eldiza Puji Rahmi
    2020, 13(1):1-7. DOI: 10.4103/1995-7645.273567
    [Abstract](163) [HTML](0) [PDF 1.07 M](1087)
    Artocarpus heterophyllus Lam. (Moraceae) has been traditionally used in treating various diseases such as diabetes, diarrhea, malarial fever, inflammation, wound healing and other diseases. Since various bioactive compounds have been found in this plant, this review focuses on the phytochemical and pharmacological properties of a potent bioactive compound artocarpin. Despite its various functions, a mechanistic review on this compound has not been reviewed specifically. Here, pharmacological studies in vitro and in vivo on artocarpin are discussed thoroughly stressing on anticancer, antimicrobial, anti-tyrosinase, antioxidant and antiinflammatory aspects of artocarpin. This review would be beneficial for future study to show the competency of natural products for their therapeutic characteristics.
    13  Anticancer activity of Mahonia leschenaultii methanolic root extract and berberine on Dalton’s ascitic lymphoma in mice Western Province, Sri Lanka: A cross-sectional study
    R Latha TM Chozhavel Rajanathan Ameer Khusro N Chidambaranathan Paul Agastian Sankaranarayanan Nagarajan
    2019, 12(6):264-271. DOI: 10.4103/1995-7645.261273
    [Abstract](119) [HTML](0) [PDF 1.68 M](1038)
    Objective:To evaluate the effects of methanol root extract of Mahonia leschenaultii and berberine of Mahonia leschenaultii on Dalton’s ascitic lymphoma in Swiss Albino mice. Methods: The methanol root extracts of Mahonia leschenaultia (200 and 400 mg/kg) were given orally, and berberines (10 and 20 mg/kg) were injected intra-peritoneally for 14 successive days in tumor bearing mice. Hematological parameters (white and red blood cells, haemoglobin level, granulocytes, and agranulocytes), lipid parameters (total cholesterol and triglycerides), serum enzymes (serum glutamate pyruvate transaminases, serum glutamate oxaloacetate transaminases, and alkaline phosphatise) and mean survival and solid tumor growth were determined and compared with untreated mice. 5-fluorouracil (20 mg/kg) was used as a reference standard drug. Results: Mahonia leschenaultii and berberine reduced the hematocrit significantly. Furthermore, Mahonia leschenaultii and berberine improved the survival of mice significantly and restored the affected hematological and lipid parameters similar to the normal levels. Conclusions: These observations show a strong anticancer effect of methanol root extract of Mahonia leschenaultii and berberine in suppressing Dalton’s ascitic lymphoma cancer cell growth in a mouse model by controlling haematological, lipid, serum enzymes, and other derived parameters effectively.
    14  Impact of seasonality on the prevalence and risk factors of Giardia lamblia infections among the aborigines
    Samseh Abdullah Noradilah Norhayati Moktar Ii Li Lee Fatmah Md Salleh Tengku Shahrul Anuar
    2019, 12(7):315-320. DOI: 10.4103/1995-7645.262075
    [Abstract](145) [HTML](0) [PDF 656.99 K](1033)
    Objective: To determine the prevalence and risk factors of Giardia (G.) lamblia infections among the aboriginal community during the wet and dry seasons. Methods: A total of 473 stool samples from the aborigines in Temerloh, Pahang, Malaysia were collected during wet (n=256) and dry seasons (n=217). Smear of all the PVA-preserved stool samples were subjected to Trichrome staining and microscopic examination under 1 000 × magnification (Nikon eclipse E100) for the detection of G. lamblia. Positivity was recorded based on the presence of G. lamblia in trophozoite and/or cyst forms. Results: The prevalence of giardiasis was 12.10% and 8.29% during the wet and dry season, respectively. Age of less or equal to 15 years old and presence of other family members with G. lamblia infection were found to be the significant risk factors to acquire G. lamblia infections during both seasons. Untreated water supply was the significant risk factor of giardiasis during the dry season. This study highlighted the possibility of anthroponotic transmission of G. lamblia during both seasons and waterborne transmission during the dry season in the aboriginal community. Conclusions: This study suggests that seasonal variation plays an important role in the prevalence and risk factor of G. lamblia infection in the aboriginal community. Therefore, close contact with Giardia-infected family members and water-related activities or usage of untreated water must be avoided to reduce the burden of G. lamblia infection in this community.
    15  Pharmacological and analytical aspects of artemisinin for malaria: Advances and challenges
    Sravani Karri Sanjay Sharma Ginpreet Kaur
    2019, 12(8):339-346. DOI: 10.4103/1995-7645.262562
    [Abstract](120) [HTML](0) [PDF 369.97 K](1016)
    Malaria remains a major tropical health burden owing to the development of resistance and decreased sensitivity to the frequently used conventional antimalarial drugs. The drug like artemisinin possesses potent antimalarial activities, but has some limitations. Therefore, new strategies are to be implemented for optimal utilization of artemisinin to improve its therapeutic effectiveness and to overcome its limitations. The present review focuses on present scenario of malaria and pharmacological as well as analytical aspects of artemisinin. Data from 2000 to 2018 were collected from NCBI for understanding the various analytical techniques used for estimation of artemisinin. This review will reveal the facts about artemisinin which can be utilized to develop novel drug delivery system either in a combination or as alone for the well being of the patients suffering from malaria.
    16  Ebola virus disease: Recent advances in diagnostics and therapeutics
    Supriya Jagga Ashish Ranjan Sharma Chiranjib Chakraborty Sang-Soo Lee
    2019, 12(9):385-395. DOI: 10.4103/1995-7645.267581
    [Abstract](141) [HTML](0) [PDF 834.93 K](1010)
    Ebola virus disease (EVD) is associated with haemorrhagic fever in humans and nonhuman primates, with a high rate of fatality (up to 90%). Some outbreaks in human history have proven the lethality of EVD. The recent epidemic of 2014 and 2015 in West Africa was the deadliest of all time (11 284 deaths). To understand the transmission dynamics, we have reviewed the epidemiology of EVD to date. The absence of any licensed vaccines or approved drugs against Ebola virus (EBOV) further highlights the severity and crisis level of EVD. Some organizations (public and private) are making considerable efforts to develop novel therapeutic approaches or vaccines to contain the outbreak of EBOV shortly. Here, we summarized the various potential drugs and vaccines (undergoing multiple phases of clinical trials) that have arisen as an alternative against EBOV, and we highlighted the numerous issues and limitations hindering this process. Alternatively, an increasing focus on strengthening the medical and civic health structure could provide speedy benefits in containing the spread of EVD, as well as offer a resilient foundation for the deployment of novel drugs and vaccines to the affected countries, once such drugs and vaccines become available.
    17  Visceral leishmaniasis among children in an endemic area of northwestern Iran between 2016 and 2017: An epidemiological study
    Hamed Behniafar Vahideh Moin-Vaziri Mehdi Mohebali Seyyed Javad Seyyed Tabaei Zabih Zarei Elham Kazemirad Behnaz Akhoundi Mohammad Kazem Saharifi-Yazdi Alireza Zahraei-Ramazani
    2019, 12(7):306-314. DOI: 10.4103/1995-7645.262074
    [Abstract](91) [HTML](0) [PDF 853.14 K](1002)
    Objective: To clarify the epidemiological aspects of visceral leishmaniasis in Kaleybar and Khoda-Afarin districts, north-west of Iran. Methods: A total of 1 420 human (children under 12 years) samples, 101 domestic dogs samples (Canis familiaris), and 577 female sand fly samples were collected. Sera of human and dogs were tested using the direct agglutination test, and sand flies were identified at species level using the microscopic method. Furthermore, a structured questionnaire was applied to evaluate the correlation between the potential risk factors and the related clinical signs/ symptoms with the human and dogs' seropositivity. Results: Totally, 2.18% of human samples were positive at titers ≥ 1: 800; among them, 13 cases (41.94%) were above 1:3 200, and clinical symptoms were observed in all of them except for an 11-year old girl. Anti-Leishmania infantum antibodies were found at titer ≥ 1: 320 in 9.90% of dogs' samples, half of them had at least one sign of canine visceral leishmaniasis. Moreover, 10 Phlebotomus species were identified in the study areas, and Phlebotomus (Larroussius) major group was the predominant species. There are significant correlations between the presence of anti-Leishmania infantum antibodies and the fever (P<0.001), anemia (P=0.001) and weight loss (P=0.016) in children. On the other hand, significant correlations were revealed between the Leishmania infection and the shelter (P=0.039), cutaneous lesion (P=0.005), lymphadenopathy (P=0.001) and weight loss (P<0.001) in the infected dogs. Conclusions: Visceral Leishmania infection is prevalent in rural areas of Kaleybar and Khoda- Afar districts located in East-Azerbaijan province, therefore active detection and treatment of visceral leishmaniasis cases should not be neglected.
    18  Symptoms of dengue at the acute and post-infection stage in theWestern Province, Sri Lanka: A cross-sectional study
    Chrishantha Abeysena Sharika Peiris Indrakantha Welgama Upul Gunasekara Kolitha Wickramage
    2019, 12(6):258-263. DOI: 10.4103/1995-7645.261272
    [Abstract](95) [HTML](0) [PDF 651.62 K](963)
    Objective: To describe the symptoms of dengue at acute and post-infection stage and to identify preventive strategies adopted by the patients in the Western Province, Sri Lanka. Methods: This was a descriptive cross-sectional study conducted in the Western Province of Sri Lanka in November 2017. The study population consisted of 473 confirmed dengue patients aged from 18 to 64 years who were hospitalized between June and August 2017. A stratified random sampling technique was applied to select the participants. Data collection was done by trained interviewers, using a structured, pre-tested interviewer-administered questionnaire. Results: The most common symptoms of dengue fever at the acute stage was body ache (81.81%, n=387), followed by headache (71.67%, n=339), loss of appetite (66.80%, n=316), tiredness (53.06 %, n=251) and vomiting (41.86%, n=198). The most common symptom during the post-infection stage was body ache (48.62%, n=230), followed by fatigue (39.74%, n=188), and loss of appetite (28.75%, n=136). Adding sand to the water in places where water accumulates (41.64%, n=197) was the most common method used to prevent transmission of dengue followed by removing/draining stagnant water regularly (36.15%, n=177). Use of mosquito nets (83.08%, n=393) was the most common method in preventing mosquito bites followed by the use of fans among dengue patients (56.02%, n=265). Conclusions: The study shows a prolonged persistence of clinical symptoms during the postinfection period.
    19  Cryptococcal meningitis with pulmonary cryptococcoma in an immunocompetent patient: A case report
    Kee Tat Lee Kar Ying Yong Hock Hin Chua
    2020, 13(1):46-48. DOI: 10.4103/1995-7645.273574
    [Abstract](126) [HTML](0) [PDF 791.14 K](924)
    Rationale: Cryptococcal infections commonly occur in immunosuppressed patients and are uncommon in immunocompetent persons. Patient concerns: A 32 year old lady, active smoker presented with right chest pain, dry cough and loss of weight. Initial chest radiograph showed a lobulated lung mass in the right lower lobe. She developed headache and right cranial nerve palsy during admission. Various investigations were done including lumbar puncture, brain and chest imaging. Diagnosis: Cryptococcal meningitis with pulmonary cryptococcoma. Interventions: She received five months of effective antifungal treatment; however, the patient did not respond well. Subsequently, removal of pulmonary cryptococcoma was done. Outcomes: Her condition improved and she no longer had any headache. Lessons: Disseminated cryptococcosis is rare in immunocompetent patient. Our case highlights the importance of high index of suspicion and we postulate that lobectomy helped in reducing the cryptococcal burden in her body, thus facilitating better response to antifungal therapy.
    20  Community-acquired pneumonia with Acinetobacter radioresistens bacteremia in an immunocompetent host: A case report
    Yi Hern Tan Lishan Jessica Quah Humaira Shafi
    2019, 12(6):288-290. DOI: 10.4103/1995-7645.261308
    [Abstract](118) [HTML](0) [PDF 821.86 K](881)
    Rationale: Acinetobacter radioresistens is a non-fermentative Gram-negative coccobacillus that is environmentally ubiquitous and is an uncommon cause of pneumonia in an immunocompetent patient with no known chronic medical illness. Patient concerns: A middle-aged Asian male with a smoking history presented with fever and cough. Physical examination was unremarkable. Chest imaging was consistent with pulmonary parenchymal infection and blood culture grew Acinetobacter radioresistens. Diagnosis: Community acquired pneumonia with Acinetobacter radioresistens bacteremia. Interventions: The patient received a combination of intravenous and oral ampicillinsulbactam over 2 weeks. Outcomes: Repeat blood cultures showed resolution of bacteremia. Completion of antimicrobial treatment saw resolution of respiratory symptoms and radiological pneumonic changes. Lessons: Acinetobacter radioresistens causing community-acquired pneumonia in an immunocompetent host has never been described before. It may be a novel emerging infectious agent in pulmonary infections. Its clinical course in this immunocompetent patient appears to be relatively benign.

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