Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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




Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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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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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.
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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.
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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

Case report
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : DD01 - DD02 Full Version

Strongyloides stercoralis Hyperinfection in an Immunocompetent Patient: An Unusual Case


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51720.16078
Sibabrata Bhattacharya, Rima Das, Debapriya Baidya, Tapan Majumdar

1. Associate Professor, Department of Microbiology, Agartala Government Medical College, Agartala, Tripura, India. 2. 2nd Year Postgraduate Trainee, Department of Microbiology, Agartala Government Medical College, Agartala, Tripura, India. 3. 1st Year Postgraduate Trainee, Department of Microbiology, Agartala Government Medical College, Agartala, Tripura, India. 4. Professor and Head, Department of Microbiology, Agartala Government Medical College, Agartala, Tripura, India.

Correspondence Address :
Dr. Debapriya Baidya,
1st Year Postgraduate Trainee, Department of Microbiology AGMC and GBPH,
Agartala, Tripura, India.
E-mail: debbaidya1987@gmail.com

Abstract

Strongyloides stercoralis is a soil-dwelling nematode causing endemic infection, mostly in immunocompromised individuals, in tropical and subtropical regions. However, strongyloidiasis has been reported in immunocompetent individuals in several case reports. Here, a case of an immunocompetent individual is reported. A 25-year-old male patient presented with chief complaints of abdominal discomfort with vomiting and weight loss since last three months. The pain was dull aching in nature and had no relation with food intake but vomiting worsened after taking food. Clinical diagnosis of inflammatory bowel disease was made and patient was started on steroid therapy. Later stool was sent for microbiological examination and Strongyloides stercoralis larvae was demonstrated. Patient responded to albendazole therapy which was given for seven days. Hence, strongyloidiasis should be suspected not only in immunocompromised individual but also in immunocompetent individuals as well.

Keywords

Immunosuppressed, Nematode, Parasitic infection

Case Report

A 25-year-old male farmer was referred from a sub-divisional hospital to a tertiary care hospital of Tripura with the chief complaints of upper abdominal pain and discomfort accompanied with vomiting since last three months. The pain was dull aching in nature and had no relation with food intake but vomiting worsened after intake of food. Frequency of vomiting also increased gradually from 2-3 episodes per day to 7-8 episodes during the course of illness hampering his daily life. His bowel habit was irregular with history of passage of mucoid stool on and off. He also complained of loss of appetite, severe weakness and weight loss for last one month. There was history of repeated admission in sub-divisional hospital with the same complaints. Despite receiving symptomatic treatment with injectable pantoprazole, ceftriaxone and intravenous (i.v.) fluids, there was no clinical improvement. On general examination, he was conscious, well oriented to time, place and person, built was cachectic and afebrile. There was mild pallor along with bilateral pedal oedema, but no clubbing, icterus, lymphadenopathy was found. His pulse rate was 92 beats/minute, regular and blood pressure was 90/60 mmHg. Systemic examinations were within normal limits.

Initial investigations revealed that haemoglobin was 8.5 gm%, platelet count was 3.42×105/cu.mm. There was leukocytosis with total count of 19800/cu.mm with differential count of neutrophil 88%, lymphocyte 9%, monocyte 1% and eosinophil 2%. Kidney Function Test (KFT) and Liver Function Test (LFT) were within normal limits. Viral markers {Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HBsAg), Anti-Hepatitis C Virus (HCV)} were negative and Cluster of Differentiation 4 (CD4) count was 947/μL. Ultrasound of whole abdomen showed grade-I fatty liver. Upper gastrointestinal endoscopy revealed inflamed and eroded mucosa more extensively in antrum, suggestive of antral gastritis and chronic duodenitis. Tissue from both antrum and duodenum were taken and sent for biopsy. Stool was sent for microbiological examination. On both saline and iodine mount, larvae of Strongyloides stercoralis were demonstrated. Later duodenal biopsy report showed presence of eggs and larval form of Strongyloides stercoralis within the duodenal crypts. The (Table/Fig 1) shows saline mount of stool and (Table/Fig 2) shows iodine mount revealing Strongyloides stercoralis larva, respectively.

Patient was started with tablet ivermectin 12 mg twice daily for five days and tablet albendazole 400 mg twice daily for seven days along with i.v. albumin. Follow-up was done after seven days. His condition improved on receiving treatment, second stool sample was collected after 10 days of treatment. Saline and iodine mount did not reveal any significant findings. Formol-ether concentration technique was done for confirmation on consecutive three samples which also did not reveal any significant findings.

Discussion

Strongyloidiasis is considered to be one of the neglected tropical diseases which are often underdiagnosed due to its uncertain clinical symptoms (1). Strongyloides stercoralis, the causative agent of strongyloidiasis, is a soil transmitted helminth which is usually found in tropical and subtropical areas (2). Here, authors report a case of Strongyloides stercoralis hyperinfection in an immunocompetent individual which is an unusual case. Indeed this was the first reported case of Strongyloides stercoralis infection from Tripura, India. Similar finding was also reported by Sridhara S et al., where strongyloidiasis was found to be reported from a case of pancolitis in an immunocompetent individual (3). Tiwari S et al., and Qu TT et al., have reported cases where strongyloidiasis was found to be associated with chronic diarrhoea (4),(5). Humans acquire strongyloidiasis when filariform larvae in faecally contaminated soil penetrate the skin or mucus membranes (3). The patient in index case probably had acquired the infection while working bare footed in the paddy field as he was farmer by occupation.

In index case, patient was immunocompetent and had normal eosinophil count which was contrary to a case reported by Marathe A and Date V where strongyloidiasis was found to be associated with extreme eosinophilia (6). Individuals with peripheral eosinophilia during hyperinfection seem to have a better prognosis. High eosinophil count plays an important role in restricting the hyperinfection from wide dissemination (7). But here in index case, although patient had normal eosinophil count, responded well with anti-helminthic treatment.

Initially, it was thought to be a case of inflammatory bowel disease and treatment with steroid was started. Later when stool was sent for examination, Strongyloides larva was seen and further the endoscopic biopsy also revealed the same. In patients with hyperinfection syndrome, ulcerative lesions are seen in gastrointestinal tract and hence is misdiagnosed as inflammatory bowel disease. Initiation of treatment with steroids in turn worsens the outcome of patient.

Conclusion

Clinician must have high index of suspicion in patient presenting with abdominal pain and vomiting, as diagnosis is often challenging, particularly in immunocompetent individual who usually lacks risk factors that would otherwise prompt targeted investigations.

Acknowledgement

The authors acknowledge the patient and the staffs of Department of Microbiology, AGMC for their co-operation.

References

1.
Gupta N, Choudhary A, Mirdha BR, Kale P, Kant K, Ghosh A, et al. Strongyloides stercoralis infection: A case series from a tertiary care center in India. J Glob Infect Dis. 2017;9(2):86-87. [crossref] [PubMed]
2.
Ashrafi K, Tahbaz A, Rahmati B. Strongyloides stercoralis: The most prevalent parasitic cause of eosinophilia in Gilan province, northern Iran. Iranian Journal of Parasitology. 2010;5(3):40.
3.
Sridhara S, Simon N, Raghuraman U, Crowson N, Aggarwal V. Strongyloides stercoralis pancolitis in an immunocompetent patient. Gastrointestinal Endoscopy. 2008;68(1):196-99. [crossref] [PubMed]
4.
Tiwari S, Rautaraya B, Tripathy KP. Hyperinfection of Strongyloides stercoralis in an immunocompetent patient. Tropical Parasitology. 2012;2(2):135. [crossref] [PubMed]
5.
Qu TT, Yang Q, Yu MH, Wang J. A fatal Strongyloides stercoralis hyperinfection syndrome in a patient with chronic kidney disease: A case report and literature review. Medicine. 2016;95(19):e3638. [crossref] [PubMed]
6.
Marathe A, Date V. Strongyloides stercoralis hyperinfection in an immunocompetent patient with extreme eosinophilia. Journal of Parasitology. 2008;94(3):759-60. [crossref] [PubMed]
7.
Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev. 2004;17(1):208-17. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/51720.16078

Date of Submission: Aug 03, 2021
Date of Peer Review: Nov 24, 2021
Date of Acceptance: Jan 05, 2022
Date of Publishing: Mar 01, 2022

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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 04, 2021
• Manual Googling: Jan 04, 2022
• iThenticate Software: Feb 28, 2022 (4%)

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