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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
Infective Endocarditis Caused by Multi-drug Resistant Corynebacterium Species: A Case Report
Correspondence Address :
Dr. G Vaishnava Devi,
Assistant Professor, Department of Microbiology, Sri Lakshmi Narayana Institute of Medical Sciences, Osudu Agaram Village, Puducherry-605502, India.
E-mail: vaishnavambbs@gmail.com
Corynebacteria species are anaerobic, facultative, non-sporing, gram-positive bacilli that can cause infective endocarditis. In recent years, non-diphtherial Corynebacterium (diphtheroids) has increasingly been recognised as a cause of both localised and systemic infections. Determining the exact species of Corynebacteria is challenging due to their similar characteristics. Infective Endocarditis (IE) caused by Corynebacteria species is uncommon because positive blood cultures might be considered contaminants, leading to missed diagnoses. However, they can indeed cause IE, which is a severe condition. Antibiotic resistance among Corynebacteria species is common and has been increasing, making treatment challenging. In-vitro resistance to vancomycin cannot be detected reliably. Literature on IE caused by Corynebacteria species is limited, and more comprehensive information is needed. In cases of IE caused by Corynebacteria species, prosthetic valves are mainly affected, especially in elderly patients, and surgery is often required. Within the Corynebacterium genus, Corynebacterium striatum is a major causative agent of IE. Although Corynebacteria species in blood cultures are often considered contaminants from skin flora, they can also cause invasive infections such as sepsis and IE. The present case report describes the isolation of Corynebacteria species from the blood specimen of a 50-year-old male who presented with fever, headache, decreased appetite, and fatigue.
Antibiotic resistance, Blood culture, Valve replacement, Vancomycin
A 50-year-old male patient, with an unknown case of IE, presented to the emergency department with symptoms including fever, frontal headache, loss of appetite, and fatigue. The patient had a high-grade, intermittent fever, chills without rigors, and a compressing frontal headache without associated aura, vomiting, etc. He was a known case of systemic hypertension for the past 10 years and was on medications for it. Additionally, he had hypertrophic cardiomyopathy with a bicuspid aortic valve that caused moderate aortic stenosis and regurgitation. He had undergone aortic valve replacement five years ago and was currently on warfarin therapy.
During the examination, the patient was conscious, oriented, and febrile, with a temperature of 40°C. There were no signs of pallor, jaundice, cyanosis, clubbing, or pretibial oedema. His pulse rate was 92 bpm, blood pressure was 90/80 mmHg, and oxygen saturation was 98% on room air. On chest auscultation, a loud P2 was heard in the aortic area, along with a prosthetic click. Respiratory, abdominal, and central nervous system examinations were normal. Blood tests, such as a complete blood count, showed raised leukocytosis (26,500/mm3), while renal and liver function parameters and other tests were Within Normal Limits (WNL). Tests for urine cultures, malaria antigen, dengue NS1/IgM, scrub IgM, and Widal test were negative. Transthoracic echocardiography showed a normal study with no vegetations and normally functioning valve. Blood and urine samples sent for culture showed no growth.
The patient was started on empirical intravenous injection (i.v.) ceftriaxone 2 gm for seven days and oral azithromycin 500 mg for three days. However, he continued to have fever spikes after one week of antibiotics. An ultrasound of the abdomen revealed mild splenomegaly, and the patient was then started on i.v. Amikacin 3 mg/kg per 24 hours in three equally divided doses for two weeks. These findings suggest a possible case of IE. Two blood cultures, drawn more than 12 hours apart, were sent and both cultures grew “Corynebacteria spp” that were sensitive to penicillin and amikacin. After two weeks of treatment, the patient developed fever again, leading to the suspicion of thrombophlebitis, and a bone marrow sample was sent for culture, which also grew “Corynebacteria spp” that were resistant to penicillin but sensitive to vancomycin and amikacin. Therefore, i.v. vancomycin 30 mg/kg/24 h in two equally divided doses and amikacin 3 mg/kg per 24 hours in three equally divided doses were continued for four and two weeks, respectively. Splenomegaly improved, but the patient continued to have fever spikes, leading to suspicion of internal jugular vein thrombophlebitis. Repeat echocardiography showed normal findings.
After six weeks, Candida spp. was reported from blood drawn from the i.v. catheter, indicating catheter-related bloodstream infection. The patient was then started on fluconazole. The catheter line tip was removed and sent for culture, which also grew Candida spp. After 12 weeks using an automated blood culture system, “Corynebacteria spp” grew again, this time showing resistance to vancomycin. The antimicrobial therapy was changed to i.v. linezolid 600 mg twice daily during the hospital stay. The patient showed clinical improvement and was symptomatically better. For further follow-up, the patient was advised to continue taking medications, and there was no recurrence of symptoms or reinfection after a three-month review on an outpatient basis.
According to a study by Grenna B et al., the incidence of Corynebacterium endocarditis was estimated to be one in a million per year (1). Corynebacteria species cause serious infections in immunocompromised patients with prosthetic devices in place. When patients present with recurrent bacteraemia and an unknown source of infection, it is important to consider the diagnosis of IE (2). A systematic review by Belmares J et al., concluded that Corynebacterium endocarditis mainly affects the left side of the heart and is more commonly seen in males. Adults are at a higher risk than children for nosocomial Corynebacterium endocarditis, which can occur due to the presence of prosthetic devices, invasive procedures, and intravascular access (3). In a study by Muttaiyah S et al., 10 cases of C. diphtheriae-IE were found (4).
In this particular case, the patient initially had a febrile illness with a broad differential diagnosis, including enteric fever, scrub typhus, urinary tract infection, meningitis, or a viral disease. The differential diagnosis narrowed down only when the microbiology results showed a positive blood culture. Considering the presence of valve replacement, the source of Corynebacterium bacteraemia, and the possibility of IE were taken into account. This case met three minor criteria (predisposition, fever >38°C, microbiologic evidence with positive blood culture) under possible IE, according to the modified Duke’s criteria for the diagnosis of IE. Early valve-related IE infections can occur through bacteraemia from the site at the time of insertion or by seeding of bacteria either before or after valve insertion (5). In this case, the source of the bacteraemia could be an occult source of sepsis that has remained dormant since the valve replacement surgery five years ago.
When blood cultures isolate Corynebacterium, it is often mistaken as contamination from normal skin flora rather than as a pathogen causing a true infection. Several cohort studies by Kimura SI et al., Ishiwada N et al., and Yanai M et al., showed that between 44% and 71% of patients with Corynebacterium bacteraemia had a true infection (6),(7),(8). Some studies have relied solely on the bacteriological criterion (≥2 positive blood cultures) (6),(7), while a few studies have shown that clinical features and the presence of intravascular devices are risk factors for true infection (9),(10). Rasmussen M et al., modified the definitions for true infection caused by “Corynebacteria spp” based on three criteria. Two or more blood cultures yielding Corynebacterium with signs of infection, such as a temperature ≥38°C, systolic blood pressure <100 mmHg, chills, and leukocytosis, were defined as true infection (criteria 1). Contamination was defined as two or more positive blood cultures with more pathogenic bacteria (criteria 2), and a focal infection where another organism is more likely to be the cause (criteria 3) (11).
The site of infection grew another bacterium or a focal infection such as pneumonia, soft tissue infection, or urinary tract infection, which excluded true infection. If Corynebacterium grew from the site of infection or the focal infection was Infective Endocarditis (IE), spondylitis, or arthritis, it was considered a true infection. However, only one blood culture isolated Corynebacterium, and the episode had to fulfill all three criteria. In addition, an intravascular device should have been placed for more than 48 hours or Corynebacterium had to be isolated from the site of infection to be considered as bacteraemia (11).
Skin commensal bacteria, specifically Corynebacteria spp, can cause IE in the presence of artificial valves and/or intracardiac devices. If all blood culture sets of patients grew Corynebacterium and they were pre-diagnosed to have IE, it should be considered as the aetiology, and the growth should not be considered as contamination (12).
In the present case, Corynebacteria spp grew in all (6/6) of the blood culture samples. There have been some case reports of IE caused by Corynebacteria spp resulting in subacute infections, especially in elderly patients with comorbidities, those on immunosuppressive treatment, or with intracardiac devices. Surgery is often required, and the mortality rate is significant. Patients with IE mainly caused by Corynebacteria spp (70%) were significantly more likely to have Prosthetic Valve Endocarditis (PVE) compared to other pathogens (14%-39%). Surgery was performed in 50% of the patients with PVE caused by Corynebacterium, which was significantly higher than other pathogens. PVE due to Corynebacteria spp prolonged the median duration from the onset of disease to hospital stay (13).
Multidrug-Resistant (MDR) Corynebacterium infections have occurred in immunocompromised patients with intracardiac devices during prolonged hospital stays and exposure to broad-spectrum antibiotics (12). The patient in this case was immunocompromised and had undergone valve replacement surgery. Additionally, they had a history of hospital stays and antibiotic use. Increased antibiotic resistance of Corynebacteria spp to beta-lactams and rifampicin has been observed. Although antibiotic resistance to Corynebacteria spp is common, resistance to vancomycin could not be detected in-vitro (13).
The microorganism in this case was determined to be resistant to vancomycin, which is currently the drug of choice for empirical treatment of Corynebacterium endocarditis. Linezolid, available in both oral and intravenous formulations, is an alternative treatment for MDR Corynebacterium infections. However, a strain resistant to linezolid has never been reported. In the literature review, only one case was treated with oral linezolid after four weeks of vancomycin. The therapy was continued for an additional 28 days (14).
In the present case of endocarditis due to Corynebacteria spp, it was managed with intravenous linezolid after four weeks of vancomycin, resulting in a good outcome and no reinfection after three months of follow-up.
Corynebacteria spp. is an uncommon cause of artificial valve endocarditis, which is a serious disease. It should not be reported as a contaminant when grown in a blood culture, especially in immunocompromised patients and/or those with prosthetic devices. The presented case is a rare instance of valve replacement-related IE caused by Corynebacteria spp. This bacterium is becoming increasingly resistant, and numerous antibiotics have been reported, making treatment more challenging. Using oral antibiotics instead of parenteral therapy could be a key strategy to decrease antimicrobial resistance. The use of oral linezolid, in particular, may lead to a shorter hospital stay, which could help reduce the presence of resistant strains in the hospital environment and minimise transmission to non-infected patients. Once the patient reaches a stable condition, the efficacy and safety of administering oral antibiotics may be similar to vancomycin therapy. However, new trials and prospective studies are required to confirm this therapeutic strategy.
DOI: 10.7860/JCDR/2023/63990.18468
Date of Submission: Mar 09, 2023
Date of Peer Review: Apr 22, 2023
Date of Acceptance: Jul 17, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 21, 2023
• Manual Googling: Apr 29, 2023
• iThenticate Software: Jul 14, 2023 (16%)
ETYMOLOGY: Author Origin
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