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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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On Aug 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : DD01 - DD03 Full Version

Aerococcus viridans Bacteraemia in a COVID-19 Positive Patient: A Rare Case Report from Northern India


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58755.17148
Mitra Kar, Akanksha Dubey, Romya Singh, Chinmoy Sahu, Sangram Singh Patel

1. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 2. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 3. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 4. Additional Professor, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 5. Associate Professor, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Chinmoy Sahu,
Additional Professor, Department of Microbiology, C-Block, 2nd Floor, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
E-mail: csahu78@rediffmail.com

Abstract

Aerococcus viridans is a rare Gram positive microorganism identified largely as environmental or skin contaminants. With the advent of an increase in the immunosuppressed population due to diabetes, the use of steroids and the Coronavirus Disease 2019 (COVID-19) pandemic, this bacteria caused a variety of infections like bacteraemia, urinary tract infections, and endocarditis. The use of Matrix-Assisted Laser Desorption Ionisation Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), a unique technique of microorganism identification, has placed Aerococci among human pathogens, capable of causing infection among immunocompromised patients. The present case was of a 48-year-old female presented with dry cough, high-grade fever associated with chills and rigors, and generalised body ache and weakness for the past one week. She was a known case of bronchial asthma. She tested positive for COVID-19 and over the course of hospital stay, her BACTEC blood culture performed due to high fever which flagged positive indicated her as a case of Aerococcus viridans bacteraemia. Despite of all the efforts she developed respiratory distress followed by an episode of asystole following which she could not be revived.

Keywords

Antibiotic sensitivity testing, Bronchial asthma, Coronavirus disease 2019, Dry cough, Fever

Case Report

A 48-year-old female presented to the Internal Medicine Outpatient Department with dry cough, high-grade fever associated with chills and rigors, and generalised body ache and weakness for the past one week. The patient was a known case of bronchial asthma. She also had shortness of breath on exertion from five days, which got worsened by respiratory distress at rest for the past two days. She came to the COVID-19 testing facility where she tested positive for COVID-19. As oxygen saturation was more than 94%, she was managed at home as a case of COVID-19 pneumonia with oral doxycycline 100 mg twice daily, oral azithromycin 500 mg once daily, intravenous paracetamol 10 mg/mL and within 5 to 10 minutes of starting administration, continuous monitoring of oxygen saturation was being performed at home. She also had a family history of type 2 diabetes mellitus but was not diagnosed as diabetic. After two days of home isolation, when her oxygen saturation dipped to 82%, she was admitted to a COVID-19 treatment facility at a 1600 bedded teaching hospital in Northern India. On admission, pulse rate was raised to 114/min and blood pressure was 108/68 mmHg and her respiratory rate and oxygen saturation on ambient air was 24 per min and 80% respectively.

She was started on high flow oxygen up to 10 L/min, administered through nasal prongs, with i.v. ceftriaxzone and remdesivir therapy as per standard treatment protocol for COVID-19 disease at the centre. Due to a further decrease in her oxygen saturation to 78% on the second day after admission, she was started on methylprednisolone pulse therapy and enoxaparin 60 mg/0.6 mL administered subcutaneously once daily. Her routine investigations were sent for biochemical investigations as a standard protocol which showed elevated levels of dimer and fibrinogen along with raised total leukocyte count and procalcitonin levels which pointed towards the development of secondary bacterial infection (Table/Fig 1). Further, her stay in the ward was prolonged due to a high fever ranging from 102º to 104º occurring every 8 hrs for three days. Her oxygen saturation further dropped to 74% on fifth day after admission, when high flow oxygen up to 16 L/min was administered and further fall in the blood pressure to 100/65 mmHg was noted over the course of hospital stay due to which she was put on Non Invasive Ventilation (NIV). To confirm the diagnosis of secondary bacterial infection, a pair of BACTEC bacterial cultures was sent to the Department of Microbiology which flagged positive within 36 hrs of incubation. A direct smear from the blood culture bottles revealed Gram positive cocci (Table/Fig 2), and was subcultured on blood agar to obtain α haemolytic colonies (Table/Fig 3) that were further identified as Aerococcus viridians by Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass-Spectrometry (MALDI-TOF MS) assay. Antibiotic sensitivity testing was put up for the microorganism by Kirby-Bauer disc diffusion method on Muller-Hinton agar with 5% sheep blood culture media using a selected set of antibiotics, according to the Clinical and Laboratory Standards Institute (CLSI) 2019 guidelines (1). The isolate was sensitive to daptomycin, minocycline, and linezolid. Eleven days after her admission to the facility, her condition deteriorated and she developed respiratory distress with an oxygen saturation of 72%. She was intubated and shifted on mechanical ventilation in the intensive care unit. She had an episode of hypotension and was started on inotropes but her ionotropic support requirement increased and she went into respiratory distress. Two days later she developed an episode of asystole and she could not be revived.

Discussion

These microorganisms with colonies and characteristics similar to Aerococcus viridans, streptococci are rare Grams positive microorganism called Aerococci. These microorganisms are identified largely as environmental or skin contaminants. The use of Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), a unique technique of microorganism identification, has identified Aerococci as a significant human pathogen capable of causing a diverse range of infections (2). Commonly known species of Aerococci are, Aerococcus viridans, Aerococcus sanguinicola, and Aerococcus urine (3). Aerococci can be pathogenic to immunosuppressed patients. Although the risk factors for their role as a pathogenic microorganism are not fully known, an increase in length of hospital stay, previous exposure to broad-spectrum antibiotics, surgical procedures, and foreign bodies like implants and artificial heart valves have been implicated in the risk factors for developing systemic infections caused by Aerococcus viridans (4). In light of the COVID-19 pandemic, prolonged hospitalisation, rigorous use of steroids, and immunosuppressed state of the patient have led to an increase in the incidence of secondary bacterial infections caused by rare and opportunistic pathogens.

In the present case report, a 48-year old female, known case of bronchial asthma suffering from COVID-19 developed respiratory distress needing mechanical ventilation. She was immunosuppressed due to the viral infection that caused damage to the respiratory epithelial cells and steroid therapy which made her susceptible to rare and opportunistic infections. The hospital environment harbors opportunistic microorganisms known to be multidrug-resistant and causing infections like bacteraemia, endocarditis, and urinary tract infection (5). In a study by Sierra-Hoffmann M et al., a correlation between urinary tract infections and bacteraemia was seldom noted in cases of elderly women in contrast to the present case report whose urine culture was sterile (6).

Recommendations on antibiotic sensitivity testing and sensitivity interpretations have been released by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing have released (EUCAST) for Aerococcus species (7),(8),(9),(10). The isolate was subjected to antibiotic sensitivity testing by Kirby-Bauer disc diffusion method. The measurement of zones of inhibition for each antibiotic against each isolate was measured and classified as sensitive, intermediate, and resistant according to the tables and guidelines by CLSI 2019 (1). The isolate was sensitive to daptomycin, minocycline, and linezolid and resistant to amoxicillin, ampicillin, doxycycline, gentamicin, levofloxacin, vancomycin and teicoplanin. Most pathogenic infections by Aerococcus species isolates respond to treatment by carbapenems and penicillin, higher MICs are observed for cephalosporins, in contrast with our case report where the isolate was penicillin-resistant. Resistance to clindamycin, ciprofloxacin, cotrimoxazole, gentamicin, and tetracycline has been observed among Aerococcus isolates (8),(10),(12),(13). Reports of resistance to vancomycin and penicillin have been reported earlier in studies by Shelton-Dodge K et al., Skov R et al., Christensen JJ et al., Lupo A et al., and Varshini K et al., which correlates with the antibiotic resistance pattern in the present study (9),(10),(11),(12),(14). There is a lack of literature on antibiotic susceptibility pattern among cases of Aerococcus viridans bacteraemia in COVID-19 patients. As it is an opportunistic and more commonly a nosocomial infection, the antibiotics should be administered according to antibiotic susceptibility testing to prevent delay in appropriate antibiotic therapy owing to multidrug resistance (2). Isolation of such hospital pathogens emphasises use of automated methods of bacterial identification that help us identify these rare pathogens and formulate appropriate guidelines for antibiotic therapy (14). This case study emphasises the importance of MALDI-TOF-MS assay which has helped in giving direction to treatment in cases not responding to empirical antimicrobials. Although studies conducted by Castaldi S et al., (15) and Moudgil N et al., (16) both reported Aerococcus viridans as one of the causative pathogens of hospital acquired infections in COVID-19 patients, still no other data about the clinical outcome of the patient was discussed. To authors best knowledge this is the first case report that describes Aerococcus viridans bacteraemia in a COVID-19 patient.

Conclusion

The use of MALDI-TOF MS has helped us recognise Aerococcus as a human pathogen capable of causing a variety of infections. The antibiotic sensitivity testing and knowledge of newer antibacterial agents will facilitate in swiftly combating overt bacteraemia and sepsis in immunocompromised patients.

References

1.
Wayne PA. Clinical and Laboratory Standards Institute 2019. Performance standards for antimicrobial disk susceptibility tests, 14th ed CLSI standard M02 Clinical and Laboratory Standards Institute.
2.
Mohan B, Zaman K, Anand N, Taneja N. Aerococcus viridans: A rare pathogen causing urinary tract infection. J Clin Diagn Res. 2017;11(1):DR01. [crossref] [PubMed]
3.
Rasmussen M. Aerococcus: An increasingly acknowledged human pathogen. Clinical Microbiology and Infection. 2016;22(1):22-27. [crossref] [PubMed]
4.
Uh Y, Son JS, Jang IH, Yoon KJ, Hong SK. Penicillin-resistant Aerococcus viridans bacteremia associated with granulocytopenia. Journal of Korean Medical Science. 2002;17(1):113-15. [crossref] [PubMed]
5.
Kerbaugh MA, Evans JB. Aerococcus viridans in the hospital environment. Applied Microbiology. 1968;16(3):519-23. [crossref] [PubMed]
6.
Sierra-Hoffman M, Watkins K, Jinadatha C, Fader R, Carpenter JL. Clinical significance of Aerococcus urinae: A retrospective review. Diagn Microbiol Infect Dis. 2005;53(4):289-92. [crossref] [PubMed]
7.
Carkaci D, Nielsen XC, Fuursted K, Skov R, Skovgaard O, Trallero EP, et al. Aerococcus urinae and Aerococcus sanguinicola: Susceptibility testing of 120 isolates to six antimicrobial agents using disk diffusion (EUCAST), Etest, and broth microdilution techniques. The Open Microbiology Journal. 2017;11:160. [crossref] [PubMed]
8.
Humphries RM, Hindler JA. In-vitro antimicrobial susceptibility of Aerococcus urinae. Journal of Clinical microbiology. 2014;52(6):2177-80. [crossref] [PubMed]
9.
Shelton-Dodge K, Vetter EA, Kohner PC, Nyre LM, Patel R. Clinical significance and antimicrobial susceptibilities of Aerococcus sanguinicola and Aerococcus urinae. Diagnostic microbiology and infectious disease. 2011;70(4):448-51. [crossref] [PubMed]
10.
Skov R, Christensen JJ, Korner B, Frimodt-Møller N, Espersen F. In-vitro antimicrobial susceptibility of Aerococcus urinae to 14 antibiotics, and time-kill curves for penicillin, gentamicin and vancomycin. Journal of Antimicrobial Chemotherapy. 2001;48(5):653-58. [crossref] [PubMed]
11.
Christensen JJ, Korner B, Casals JB, Pringler N. Aerococcus-like organisms: Use of antibiograms for diagnostic and taxonomic purposes. Journal of Antimicrobial Chemotherapy. 1996;38(2):253-58. [crossref] [PubMed]
12.
Lupo A, Guilarte YN, Droz S, Hirzel C, Furrer H, Endimiani A, et al. In-vitro activity of clinically implemented β-lactams against Aerococcus urinae: Presence of non-susceptible isolates in Switzerland. New Microbiol. 2014;37(4):563-66.
13.
Swanson H, Cutts E, Lepow M. Penicillin-resistant Aerococcus viridans bacteremia in a child receiving prophylaxis for sickle-cell disease. Clinical infectious diseases. 1996;22(2):387-88. [crossref] [PubMed]
14.
Varshini K, Ganesan V, Charles J. Aerococcus viridans Bacteremia: A rare case report from India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2022;26(1):127. [crossref] [PubMed]
15.
Castaldi S, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, et al. Hospital acquired infections in COVID-19 patients in sub intensive care unit. Acta Bio Medica: Atenei Parmensis. 2020;91(3):e2020017.
16.
Moudgil N, Riaz A, Makan A, Crawford EJ, Srinivasan K, Ahmad N, et al. Blood cultures in patients with acute covid-19 pneumonitis: Contamination or bacterial co-infection?. Chest. 2021;160(4):A546. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58755.17148

Date of Submission: Jul 05, 2022
Date of Peer Review: Jul 27, 2022
Date of Acceptance: Aug 25, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 06, 2022
• Manual Googling: Aug 15, 2022
• iThenticate Software: Aug 18, 2022 (5%)

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  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com