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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
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
Case report
Full Version
Delftia acidovorans: A Rare Pathogen Isolated from Pleural Fluid in an Immunocompromised Host
Correspondence Address :
P Ganesh Perumal,
Assistant Professor, Department of Microbiology, PSGIMSR, Coimbatore-641004,
Tamil Nadu, India.
E-mail: drganeshp2014@gmail.com
Delftia acidovorans is an aerobic, non fermentative gram negative rod that belongs to the Pseudomonas ribosomal Ribonucleic Acid (rRNA) homology Group III. The sources of isolation are sludge, biological waste water treatment plants. Patients in hospitals or with compromised immune systems are more likely to be affected. Delftia acidovorans can result in infectious endocarditis, ocular infections, otitis media, peritonitis, urinary tract infections, empyema, cavitary and interstitial pneumoniae, and nosocomial bacteraemia, including bacteraemia linked to central venous catheters in people with compromised immune systems. This case report is about a 57-year-old male with complaints of loss of appetite for six days and vomiting, as well as loss of weight. He was diagnosed with HIV two years ago and was on HAART (Highly Active Antiretroviral Therapy). This atypical bacterium was isolated from pleural fluid of the patient; and he was managed with albumin infusion, anticoagulants, beta blockers, fluid and salt restriction and intravenous antibiotics. It is an emerging source of Gram negative bacilli which is normally a non pathogen causing serious infections among immunocompromised patients.
Human immunodeficiency virus, Highly active antiretroviral therapy
A 57-year-old male presented to the Department of Gastroenterology with the complaints of loss of apetite for six days associated with vomiting, weight loss of about 12 kgs in the past one month. He was a known case of retroviral disease, diagnosed with HIV two years ago, and was on HAART. He was admitted a year ago for shortness of breath, orthopnea, abdominal pain, and was diagnosed to have Decompensated Chronic Liver Disease (DCLD), grade III esophageal varices, and portal hypertensive gastropathy.
On physical examination, he had pallor, and mild pedal edema. His abdomen was distended, there was splenomegaly, and free fluid was present. On auscultation, there was decreased air entry on the right lung and a chest drain in-situ was present on the right side. Complete Blood Count (CBC) done on the day of admission revealed increased total leucocyte count (14.7×103/μL), and differential count revealed increased neutrophils (77%), decreased lymphocytes (7%), increased monocytes (14%) with increase in alkaline phosphatase (175 U/L), Gamma-glutamyl transferase (GGT) (77 U/L), S.creatinine (1.15 mg/ dL), ammonia (149 μg/dL), and reduced serum sodium (115 meq/L). After 24 hours, urine chemical analysis revealed increased leucocytes (2+) and urine culture done on Hicrome UTI (HiMedia) agar reported significant bacteriuria with Escherichia coli. The chest drain was kept in place and the pleural fluid was sent for analysis. Macroscopically (with naked eye) colourless, cloudy, slightly clotted pleural fluid were seen, whereas, microscopically Giemsa staining revealed lymphocytes, macrophages, few neutrophils, and scattered mesothelial cells with red blood cells, suggestive of chronic inflammation. Meanwhile, the Gramstaining of pleural fluid showed pus cells and Gram negative bacilli in direct smear with heavy growth of non lactose fermenting colonies in MacConkey agar and oxidase-positive reaction identified as Delftia acidovorans in culture (Table/Fig 1),(Table/Fig 2). Identification and antimicrobial susceptibility testing were done in VITEK 2 compact calorimetric card (version 9.02) with excellent identification of rate 98%. The isolate was sensitive to BL+BLI combinations like Piperacillin-tazobactam (MIC=16), Cefaperazone-sulbactam (MIC ≤8) and Carbapenems (MIC ≤0.25) like Imipenem, Meropenem and Doripenem. This isolate demonstrated not only resistance to aminoglycosides but also an index case of fluoroquinolone resistance, which is a concerning trend for this bacteria.
On the second day of admission USG abdomen and CT chest were done. USG abdomen showed chronic parenchymal liver disease with splenomegaly, portal vein thrombosis with right sided pleural effusion. CT abdomen revealed similar findings along with an additional finding of right-sided inguinal hernia containing ascitic fluid. CT chest revealed that moderate pleural fluid collection involving parenchymal strands in lower lobe of the left lung along with CORADS-1 score, in-situ chest drain observed.
The final diagnosis was DCLD with pleural effusion and subsequent secondary bacterial superinfecion with pure culture of Delftia acidovorans. He was treated with intravenous Magnex Forte (Cefoperazone-sulbactam) for 10 days (according to culture and sensitivity report of pleural fluid), i.v. albumin, anticoagulants, antihypertensives with beta blockers, electrolytes and insulin were given.
The patient’s general condition improved following antibiotic therapy and he was discharged in a stable condition. He was advised to get readmitted one week later for Trans-jugular intrahepatic portosystemic shunt (TIPS) procedure or report immediately to emergency if there was fever, abdominal pain or gastrointestinal bleed.
Delftia acidovorans (formerly Comamonas acidovorans) is an aerobic, non fermentative gram negative rod which grows on MacConkey agar that belongs to the Pseudomonas rRNA homology Group III (1). Generally considered non pathogenic bacteria, it has been isolated from sludge, biological waste water treatment plants (2). It occurs most commonly in hospitalised or immune-compromised patients (3). Delftia acidovorans can cause infective endocarditis, ocular infections, otitis media, peritonitis, urinary tract infections, empyema, cavitary and interstitial pneumonia, and nosocomial bacteraemia, including bacteraemia induced by central venous catheters in people with compromised immune systems (4). These are inherently resistant to all aminoglycosides especially gentamicin (5). An increase in the number of people infected with this pathogen who are immune-competent without a doubt is a disturbing trend (1).
The genus Delftia consists of 4 species: D. acidovorans, D. lacustris, D. litopenaei and D. tsuruhatensis. D. acidovorans is the most common of this group to be isolated from clinical specimens like sputum, urine, ureters of transplanted kidney, corneal scrapings and blood (6). There were reports on Delftia acidovorans associated with catheter related bacteraemia, suppurative otitis, urinary tract infection, ocular infections and peritonitis in a patient who underwent Continuous Ambulatory Peritoneal Dialysis (CAPD) (5),(7). D. acidovorans endocarditis has also been described in a 42-year-old intravenous drug abuser (5). Other conditions associated with bacteria are Acquired Immunodeficiency Syndrome (AIDS) associated pneumonia, an immune-competent patient with chronic empyema in the pleural cavity, and a case of umbilical sepsis in neonates (7).
The ability of the organisms to make anthranilic acid from tryptophan is boosted when Kovac’s reagent is added to the medium, giving the media its unique "Pumpkin Orange" colour (1). Subsequent biochemicals were acetamide positive and nitrate reduction positive without gas formation (8). When the indole test is performed with xylene and Ehrlich’s reagent, these same strains produce a vivid yellow reaction (8).
D. acidovorans is usually susceptible only to broad-spectrum cephalosporins, ureidopenicillins, co-trimoxazole, fluoroquinolones and tetracyclines (8). D. acidovorans is often resistant to aminoglycosides, a class of drugs commonly used empirically to treat systemic Gram negative infections. Timely identification of this organism to its species level is necessary to determine the most appropriate antibiotic therapy (3). The organism can survive in the biofilm formed in water-pipes or sewage pipes (9). In present case, AST (VITEK 2 and manual) showed Polymyxin B (300 μg) and colistin (MIC ≥16) resistant with intrinsic resistance to aminoglycosides like Amikacin, Gentamycin, Netilmycin and Tobramycin. Other drugs which were resistant include Piperacillin, Ciprofloxacin and Levofloxacin. The isolate showed intermediate sensitivity to Ceftazidime (MIC=16) and Cefepime (MIC=4).
Cases of Delftia acidovorans empyema, endophthalmitis, and newborn umbilical sepsis have been reported in India (7),(10),(11). Delftia acidovorans was isolated from B cell lymphoma, peritonitis and pneumonia in HIV patients (3),(12),(13). Others were isolated from endocarditis in i.v. drug users, UTI and bacteraemia (5),(14),(15), and skin infection in a diabetic individual.
This is probably the first case of Delftia acidovorans isolated from a pleural fluid of a HIV positive patient. In terms of therapy, it is similar to Pseudomonas, however this isolate showed resistance to aminoglycosides and fluoroquinolones, which is an alarming trend for this bacteria. With rising rates of medication resistance among immunocompromised patients with major co-morbidities, a disturbing situation has arisen in which saprophytic bacteria have turned pathogenic and are causing serious infections.
DOI: 10.7860/JCDR/2022/58627.16914
Date of Submission: Jun 22, 2022
Date of Peer Review: Jul 14, 2022
Date of Acceptance: Aug 22, 2022
Date of Publishing: Oct 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 25, 2022
• Manual Googling: Aug 09, 2022
• iThenticate Software: Sep 08, 2022 (11%)
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