Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey.

BACKGROUND: We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO's recommendations. METHODS: HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups. RESULTS: Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz/nevirapine was 8.4% (95% CI 4.6-15.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8-39.5) compared with 4.6% (95% CI 1.6-12.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3-16.6, P = 0.021). PDR to efavirenz/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1-29.4) compared with men (7.0%, 95% CI 3.1-14.7) (P = 0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4-35.4) compared with MSM (3.8%, 95% CI 1.1-12.7) (P = 0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1-12.1) and no PI PDR was observed in the study. CONCLUSIONS: A high prevalence of efavirenz/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.

Salmonella enteritidis brain abscess in a sickle cell disease patient: case report and review of the literature.

BACKGROUND: Focal intracranial abscesses due to Salmonella spp are rarely reported. They tend to occur in patients who are immunosuppressed and in those with other predisposing factors. We present herein the first reported case of Salmonella enteritidis brain abscess in a sickle cell disease (SCD) patient. METHODS: We describe the case of a 29-year-old black African female with SCD who presented to her local hospital with a left frontal abscess. She was treated with emergency burr hole aspiration of the abscess and antibiotics. The aspirate grew S. enteritidis PT 8 on culture. All investigations into the source of the infection proved negative. The patient made a full recovery. We also present a detailed review of S. enteritidis brain abscesses in the medical literature. RESULTS AND CONCLUSIONS: S. enteritidis brain abscesses are very rare and are usually associated with immunocompromised conditions. Our patient appears to be the first reported case associated with SCD, the pathogenesis of which is unclear at present. Further clinical research is suggested in countries with a high prevalence of SCD to determine the association of SCD and the development of Salmonella brain abscesses.

Septic arthritis due to Aeromonas hydrophila: case report and review of the literature.

Aeromonas hydrophila is a rare human pathogen, and worldwide, soft tissue infections following water-related injuries are the most common. However, septic arthritis due to A. hydrophila remains uncommon with only seven cases previously reported in the English literature. In this report, we describe the important clinical features, microbiological findings and management of severe septic arthritis of the knee due to A. hydrophila in a healthy 13-year-old girl following an injury sustained in a private fresh water lake. A review of seven previously reported cases of septic arthritis due to A. hydrophila and the present case suggests that the infection commonly affected the knee and the meta-/intercarpal-phalangeal joint and was frequently rapidly progressive following trauma in fresh water and or associated with leukaemia. Second and third generation cephalosporins, gentamicin, trimethoprim, ciprofloxacin and appropriate orthopaedic management should be promptly instituted. After chemical treatment and chlorination, fresh water becomes free of coliforms, but A. hydrophila persists more compared with the other strains of aeromonas, namely A. sobria and A. caviae. Seawater injuries, unlike freshwater injuries, are not usually associated with aeromonas infections. Further workup on the mechanisms of A. hydrophila resistance to chlorination could probably yield useful information in achieving new procedures of preventing and controlling such infections in public and private fresh water recreational facilities.