Factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals.

This study was conducted to assess factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. A total of 800 swab samples from 200 participants including 100 diabetics and 100 non-diabetics were collected from four different body sites: (1) the forehead, (2) nasal cavity, (3) hands and (4) feet. Fungal isolation, fungal identification and antibiotic sensitivity tests were performed on the isolates. Overall, 12.0 % of the participants showed Mucormycetes colonization while the commonest fungal isolates were Mucor Species (Spp.). followed by Rhizopus spp. Diabetics had a 11 times higher odds of colonization compared to non-diabetics. The majority of the isolates were resistant to itraconazole; however, all isolates were sensitive to amphotericin B. A significant association was observed between profession and Mucormycetes (P=0.03) with significantly higher colonization in retired people compared to business people. Higher odds of colonization were demonstrated among older ages, lower class status and individuals with prolonged contact time with soil.

Lead levels in drinking water from point-of-use dispensers: a case study of elementary schools in Taichung, Taiwan.

Drinking water contaminated with lead has adverse health consequences, particularly in young children. Water dispensed from point-of-use dispensers is generally regarded as drinking water instead of conventional tap water in Taiwan, and such dispensers are installed in all public facilities, including elementary schools. However, studies on drinking water quality are mainly focused on tap water, while dispenser water quality is less known. Hence, this study investigated lead concentrations in drinking water from point-of-use dispensers in elementary schools of Taichung, Taiwan. Water samples were collected between September 2019 and February 2021 from 86 schools across 24 districts utilizing a modified first draw sampling protocol to collect ten 100-mL sequential samples. Approximately 26% of the schools had at least one sample exceeding 10 µg/L (Taiwan EPA standard), with the highest level reaching 99.2 µg/L. Exceedance tendency varied with water use, seasons, and age of the schools. Samples collected over the weekends and during summer showed higher levels and frequencies of contamination. Lead levels surpassing the standard were observed in 14% of weekend and 17% of summer samples, compared to only 4% of weekday and 4% of winter samples. Similarly, while older schools (age > 40 years) exhibited higher contamination, young schools (age < 20 years) were also not entirely safe. This study reveals that point-of-use dispensers do not always provide safe drinking water. Findings also indicate the susceptibility of children in elementary schools to lead exposure through their drinking water. Therefore, a routine monitoring program for heavy metals, including lead, in drinking water is urgently needed.

Anti-SARS-CoV-2 Antibody Level among Renal Transplant Recipients: A Case Report from Nepal.

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them against severe illness.

Widespread nickel contamination in drinking water supplies of elementary schools in Taichung, Taiwan.

Owing to the limited information regarding potential sources of nickel (Ni) in drinking water, incidences of Ni contamination have not been well elucidated in the literature. However, in recent decades, Ni-containing plumbing materials such as stainless steel pipes, brass fittings, and chrome faucets have gained popularity in drinking water distribution systems. As a result of increased use of such materials, Ni levels in drinking water are expected to rise over time, posing long-term exposure risks to consumers. For the first time, this study employed an intensive sequential sampling, from October 2019 to July 2020, to assess Ni levels in drinking water samples collected from dispensers of elementary schools in Taichung, Taiwan. Of the total 580 sequential samples collected from 58 elementary schools, 45 samples from 17 schools exceeded the Taiwan Environmental Protection Administration (EPA) standard value of 20 µg/L for Ni. Total Ni concentration in 1 L sample, an average of the total Ni concentrations in 10 sequential samples, exceeded in 4 schools. This finding suggests minor Ni contamination in drinking water supplies across the city. The highest Ni concentration was measured in the 1st sequential sample reaching 154 µg/L. Weekend and summer samples exhibited a higher tendency to exceed the standard. Older schools with age above 50 years and schools with a higher student population (≥ 500) were more likely to have Ni contamination. This study showed that drinking water is a potential source of Ni. However, the identification of Ni source, whether within the dispenser or in the distribution system, warrants further research.

Status of rpoB gene mutation associated with rifampicin-resistant Mycobacterium tuberculosis isolated in a rural setting in Nepal.

Mycobacterium tuberculosis ranks among the top 10 causes of deaths in Nepal despite the country having a long history of national tuberculosis prevention programmes that have proved very successful in the control of tuberculosis. Several cases of active or latent tuberculosis are still missing despite that the number of infected individuals is increasing each year. Microscopy has its own limitations and factors like low bacterial load, quality of sample, quality of smear, experience of microscopist etc. influence the overall sensitivity of the test. The implementation of a molecular technique-based rapid, point-of-care testing system offers higher sensitivity in the early diagnosis of tuberculosis. Cepheid GeneXpert is the most commonly used molecular technology in Nepal. It is a cartridge-based semi-quantitative, nested real-time PCR-based diagnostic system. It detects mutations in the beta-subunit of RNA polymerase (rpoB) gene that lead to rifampicin resistance (RR) in M. tuberculosis complex. The present study aims to increase our understanding of the epidemiology of mutations in the rpoB gene in tuberculosis-positive patients by using the Xpert MTB/RIF assay in a rural setting in Pyuthan Hospital, Nepal. Sputum from 2733 patients was tested for the diagnosis of tuberculosis using the Cepheid GeneXpert system between July 2018 and January 2020 at Pyuthan Hospital. Two hundred and ninety-seven of these samples (10.86 %) were positive for M. tuberculosis , of which 3.3 % (10/297) were rifampicin-resistant. Among rifampicin-resistant tuberculosis (RR-TB) patients, 50.0 % (5/10) showed mutations located in codons 529-533 (probe E) of the rpoB gene, followed by others. The GeneXpert system can be a convenient, highly sensitive, rapid and accurate tool for the diagnosis of tuberculosis, also identifying RR-TB and at the same time determining the molecular epidemiology of rifampin resistance-associated mutations in rural and/or resource-limited laboratory settings.

Fungal Infection among Diabetic and Nondiabetic Individuals in Nepal.

BACKGROUND: Low immunity, comorbid clinical conditions, and metabolic disorders may be the underlying factors that determine the severity of infection. Diabetes increases the risk of infection and multiple organ damage. In Nepal, the actual burden of fungal infections has not been estimated or is in a limited progress. This study aimed to investigate the status of fungal infection in diabetic and nondiabetic individuals in Bhaktapur, Nepal. MATERIALS AND METHODS: A total of 670 samples were collected from 134 participants. From each participant, five samples were collected from different sites like an oral wash, toe swab, midstream urine, hair shaft, and nail scrapings. All samples were cultured on Sabouraud dextrose agar. Gram stain was used to observe yeast cells and lactophenol cotton blue stain was used for hyphae. Chlamydospore production by Candida species was observed in cornmeal agar medium by Dalmau Plate method. Candida species isolated were characterized by germ-tube test and differentiated using CHROM agar Candida medium. Candida species isolates were tested for antibiotic susceptibility. RESULTS: Overall, 19.4% of the samples showed fungal growth. The prevalence of fungal infection was higher in diabetic (34.0%) than nondiabetic individuals (4.7%). Fungal growth was found to be higher in oral wash followed by toe, urine, hair, and nail samples. Predominant fungi were Candida species (57.5%), Aspergillus species (28.4%), and Trichophyton species (10.7%). Oral wash, toe, and urine samples in diabetics had a significantly higher fungal prevalence when compared between both groups, p value < 0.05. In Candida isolates, higher resistance was seen against fluconazole 36.8% and ketoconazole 28.9%, whereas other drugs showed low resistance. CONCLUSION: Diabetic participants are more susceptible to fungal infection than the nondiabetics. Overall, Candida species and Aspergillus species are highly predominant fungi. Candida species are highly resistant to fluconazole and ketoconazole.