{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T17:56:05Z","timestamp":1751478965601,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,6,20]],"date-time":"2020-06-20T00:00:00Z","timestamp":1592611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A cluster of 15 acute skin and soft tissue infections (SSTIs), including two cases of necrotizing fasciitis, reported in July 2018 from Kalwala village, led us to investigate and describe their epidemiology and to provide recommendations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cases, defined as localized painful swelling and redness in Kalwala residents from 1 December 2017 to 20 August 2018, were identified from hospital records and house-to-house surveys. We conducted an unmatched case-control study to identify risk factors for severity. We cultured wound samples and environmental samples from wound-dressing stations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 36 cases (median age: 55 [range 17\u201380] y; 78% male), village attack rate 1% (36\/4337) and no deaths. In 34 cases (94%), lower limbs were involved. Lymphatic filariasis (LF) was a common predisposing condition (67%). Comorbidities (diabetes or hypertension) (OR=9; 95% CI 2.0 to 41.1), poor limb hygiene (OR=16; 95% CI 2.8 to 95.3) and poor health-seeking behavior (OR=5; 95% CI 1.6 to 30.8) were associated with severity. All seven wound samples and 8\/11 samples from wound-dressing stations showed atypical polymicrobial growth (Pseudomonas, Proteus, Klebsiella, Escherichia coli and Clostridium).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The outbreak of SSTIs among older males with LF was due to secondary bacterial infections and severity was associated with comorbidities, poor hygiene and health-seeking behavior, and likely contamination during wound-dressing. The LF elimination program managers was alerted, programmatic interventions were scaled up, home\/facility-based morbidity and comorbidity management was facilitated and the outbreak was rapidly contained.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/traa046","type":"journal-article","created":{"date-parts":[[2020,5,28]],"date-time":"2020-05-28T19:12:50Z","timestamp":1590693170000},"page":"742-750","source":"Crossref","is-referenced-by-count":1,"title":["An outbreak of acute skin and soft tissue infections including necrotizing fasciitis in Kalwala village, India, 2018: Public health implications for the lymphatic filariasis elimination program"],"prefix":"10.1093","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4343-3220","authenticated-orcid":false,"given":"Kiran Kumar","family":"Maramraj","sequence":"first","affiliation":[{"name":"National Centre for Disease Control, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha Latha","family":"ML","sequence":"additional","affiliation":[{"name":"Ronald Ross Institute of Tropical and Communicable Diseases, Hyderabad, Telangana State, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanzin","family":"Dikid","sequence":"additional","affiliation":[{"name":"National Centre for Disease Control, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushma","family":"Choudhary","sequence":"additional","affiliation":[{"name":"South Asia Field Epidemiology and Technology Network, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukrutha","family":"Reddy","sequence":"additional","affiliation":[{"name":"State Health Department, Government of Telangana, Hyderabad, Telangana State, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir Kumar","family":"Jain","sequence":"additional","affiliation":[{"name":"National Centre for Disease Control, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujeet Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"National Centre for Disease Control, Ministry of Health and Family Welfare, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,6,20]]},"reference":[{"issue":"2","key":"2020100421241274000_bib1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1155\/2008\/846453","article-title":"Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care","volume":"19","author":"Ki","year":"2008","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2020100421241274000_bib2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"6","key":"2020100421241274000_bib3","first-page":"474","article-title":"Skin and soft tissue infections","volume":"92","author":"Ramakrishnan","year":"2015","journal-title":"Am Fam Physician"},{"key":"2020100421241274000_bib4","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1086\/511638","article-title":"Necrotizing soft-tissue infection: diagnosis and management","volume":"44","author":"Anaya","year":"2007","journal-title":"Clin Infect Dis"},{"issue":"5","key":"2020100421241274000_bib5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00256-013-1813-2","article-title":"Necrotizing fasciitis: an urgent diagnosis","volume":"43","author":"Paz Maya","year":"2014","journal-title":"Skeletal Radiol"},{"issue":"2","key":"2020100421241274000_bib6","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1017\/S095026880500484X","article-title":"Cellulitis incidence in a defined population","volume":"134","author":"Ellis Simonsen","year":"2006","journal-title":"Epidemiol Infect"},{"volume-title":"Morbidity statistics from general practice: fourth national study, 1991-92. Series MB5 no 3","year":"1995","author":"McCormick","key":"2020100421241274000_bib7"},{"key":"2020100421241274000_bib8","article-title":"Necrotizing fasciitis","volume-title":"StatPearls","author":"Wallace","year":"2019"},{"issue":"8","key":"2020100421241274000_bib9","doi-asserted-by":"crossref","first-page":"e0005424","DOI":"10.1371\/journal.pntd.0005424","article-title":"The global burden of disease study 2013: What does it mean for the NTDs?","volume":"11","author":"Herricks","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"2020100421241274000_bib10","doi-asserted-by":"crossref","first-page":"e0006038","DOI":"10.1371\/journal.pntd.0006038","article-title":"India's neglected tropical diseases","volume":"12","author":"Hotez","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"volume-title":"Census of India (2011). Demographic data of Kalwala village","year":"2018.","key":"2020100421241274000_bib11"},{"volume-title":"World Health Organization. Lymphatic filariasis: managing morbidity and preventing disability","year":"2013","key":"2020100421241274000_bib12"},{"volume-title":"World Health Organization. Neglected tropical diseases: lymphatic filariasis","year":"2010","key":"2020100421241274000_bib13"},{"volume-title":"Government of India. Accelerated plan for elimination of lymphatic filariasis","year":"2018","key":"2020100421241274000_bib14"},{"volume-title":"World Health Organization. Guideline: Alternative mass drug administration regimens to eliminate lymphatic filariasis","year":"2017","key":"2020100421241274000_bib15"},{"issue":"5","key":"2020100421241274000_bib16","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s11908-007-1003-2","article-title":"Recent considerations in recurrent cellulitis","volume":"3","author":"Baddour","year":"2007","journal-title":"Curr Infect Dis Rep"},{"key":"2020100421241274000_bib17","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ijsu.2013.11.014","article-title":"Study to evaluate the role of severity stratification of skin and soft tissue infections (SSTIs) in formulating treatment strategies and predicting poor prognostic factors","volume":"12","author":"Tiwari","year":"2014","journal-title":"Int J Surg"},{"issue":"1","key":"2020100421241274000_bib18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S0001-706X(99)00090-X","article-title":"Acute adenolymphangitis due to bancroftian filariasis in Rufiji district, south east Tanzania","volume":"75","author":"Gasarasi","year":"2000","journal-title":"Acta Trop"},{"issue":"6","key":"2020100421241274000_bib19","doi-asserted-by":"crossref","first-page":"591","DOI":"10.4269\/ajtmh.1996.54.591","article-title":"The epidemiology of acute adenolymphangitis due to lymphatic filariasis in northern Ghana","volume":"54","author":"Gyapong","year":"1996","journal-title":"Am J Trop Med Hyg"},{"key":"2020100421241274000_bib20","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S0035-9203(96)90415-0","article-title":"Epidemiology of acute filarial episodes caused by Wucheria bancrofti infection in two rural villages in Tamil Nadu, south India","volume":"90","author":"Ramaiah","year":"1996","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"2","key":"2020100421241274000_bib21","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.actatropica.2003.11.015","article-title":"Entry lesions in bancroftian filarial lymphoedema patients - a clinical observation","volume":"90","author":"Ananthakrishnan","year":"2004","journal-title":"Acta Trop"},{"key":"2020100421241274000_bib22","first-page":"320","article-title":"Epidemiology of \u201cacute attacks\u201d among patients in a treatment program for filariasis-associated lymphedema of the leg, Leogane, Haiti","volume":"61","author":"Addiss","year":"1999","journal-title":"Am J Trop Med Hyg"},{"volume-title":"Managing Morbidity and Preventing Disability: an Aide-M\u00e9moire for National Programme Managers","year":"2013","author":"World Health Organization. Global programme to eliminate lymphatic filariasis","key":"2020100421241274000_bib23"},{"journal-title":"Basic Lymphedema Management","year":"2002","author":"Dreyer","key":"2020100421241274000_bib24"},{"key":"2020100421241274000_bib25","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1475-2883-6-2","article-title":"Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature","volume":"6","author":"Addiss","year":"2007","journal-title":"Filaria J"},{"volume-title":"Centers for Disease Control and Prevention. Gram-negative bacteria infections in healthcare settings","year":"2011","key":"2020100421241274000_bib26"},{"key":"2020100421241274000_bib27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/0255-0857.58721","article-title":"Infection control with limited resources: Why and how to make it possible?","volume":"28","author":"Sarma","year":"2010","journal-title":"Indian J Med Microbiol"},{"key":"2020100421241274000_bib28","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1476-0711-10-36","article-title":"Infection control practice in countries with limited resources","volume":"10","author":"Alp","year":"2011","journal-title":"Ann Clin Microbiol Antimicrob"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/114\/10\/742\/33834967\/traa046.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/114\/10\/742\/33834967\/traa046.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T01:24:31Z","timestamp":1601861071000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/114\/10\/742\/5860264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,20]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,6,20]]},"published-print":{"date-parts":[[2020,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/traa046","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"type":"print","value":"0035-9203"},{"type":"electronic","value":"1878-3503"}],"subject":[],"published-other":{"date-parts":[[2020,10]]},"published":{"date-parts":[[2020,6,20]]}}}