scholarly journals Canine leishmaniosis in Tunisia: Growing prevalence, larger zones of infection

2021 ◽  
Vol 15 (12) ◽  
pp. e0009990
Author(s):  
Ali Bouattour ◽  
Amine Amri ◽  
Jaber Amine Belkhiria ◽  
Adel Rhim ◽  
Ons Fezaa ◽  
...  
Keyword(s):  
Leishmania Infantum ◽  
Environmental Changes ◽  
Climatic Factors ◽  
Arid Zone ◽  
Present Report ◽  
Clinical Signs ◽  
Sand Fly ◽  
Canine Leishmaniosis ◽  
Age Group ◽  
Bioclimatic Zone

Background Discovered by Nicolle and Comte in 1908 in Tunisia, Leishmania infantum is an intracellular protozoan responsible for zoonotic canine leishmaniosis (CanL) and zoonotic human visceral leishmaniasis (HVL). It is endemic in several regions of the world, including Tunisia, with dogs considered as the main domestic reservoir. The geographic expansion of canine leishmaniosis (CanL) has been linked to global environmental changes that have affected the density and the distribution of its sand fly vectors. Methodology/Principal findings In this study, a cross-sectional epidemiological survey on CanL was carried out in 8 localities in 8 bioclimatic areas of Tunisia. Blood samples were taken from 317 dogs after clinical examination. Collected sera were tested by indirect fluorescent antibody test (IFAT; 1:80) for the presence of anti-Leishmania infantum antibodies. The overall seroprevalence was 58.3% (185/317). Among positive dogs, only 16.7% showed clinical signs suggestive of leishmaniosis. Seroprevalence rates varied from 6.8% to 84.6% and from 28% to 66% by bioclimatic zone and age group, respectively. Serological positivity was not statistically associated with gender. The presence of Leishmania DNA in blood, using PCR, revealed 21.2% (64/302) prevalence in dogs, which varied by bioclimatic zone (7.3% to 31%) and age group (7% to 25%). The entomological survey carried out in the studied localities showed 16 species of the two genera (Phlebotomus and Sergentomyia). P. perniciosus, P. papatasi, and P. perfiliewi were the most dominant species with relative abundances of 34.7%, 25% and 20.4%, respectively. Conclusions/Significance The present report suggests a significant increase of CanL in all bioclimatic areas in Tunisia and confirms the ongoing spread of the infection of dogs to the country’s arid zone. Such an expansion of infection in dog population could be attributed to ecological, agronomic, social and climatic factors that affect the presence and density of the phlebotomine vectors.

scholarly journals Frequency of co-seropositivities for certain pathogens and their relationship with clinical and histopathological changes and parasite load in dogs infected with Leishmania infantum

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247560
Author(s):  
Valéria da Costa Oliveira ◽  
Artur Augusto Velho Mendes Junior ◽  
Luiz Claudio Ferreira ◽  
Tatiana Machado Quinates Calvet ◽  
Shanna Araujo dos Santos ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Leishmania Infantum ◽  
Dirofilaria Immitis ◽  
Clinical Signs ◽  
Parasite Load ◽  
Inflammatory Cells ◽  
Canine Leishmaniosis ◽  
Conventional Pcr ◽  
Serum Samples ◽  
Histological Changes

In canine leishmaniosis caused by the protozoan Leishmania infantum, little is known about how co-infections with or co-seropositivities for other pathogens can influence aggravation of this disease. Therefore, the objectives of this study were to evaluate the frequency of co-infections with or co-seropositivities for certain pathogens in dogs seropositive for L. infantum and their relationship with clinical signs, histological changes and L. infantum load. Sixty-six L. infantum-seropositive dogs were submitted to clinical examination, collection of blood and bone marrow, culling, and necropsy. Antibodies against Anaplasma spp., Borrelia burgdorferi sensu lato, Ehrlichia spp. and Toxoplasma gondii and Dirofilaria immitis antigens were investigated in serum. Samples from different tissues were submitted to histopathology and immunohistochemistry for the detection of Leishmania spp. and T. gondii. Quantitative real-time PCR was used to assess the L. infantum load in spleen samples. For detection of Coxiella burnetii, conventional PCR and nested PCR were performed using bone marrow samples. All 66 dogs tested positive for L. infantum by qPCR and/or culture. Fifty dogs (76%) were co-seropositive for at least one pathogen: T. gondii (59%), Ehrlichia spp., (41%), and Anaplasma spp. (18%). Clinical signs were observed in 15 (94%) dogs monoinfected with L. infantum and in 45 (90%) dogs co-seropositive for certain pathogens. The L. infantum load in spleen and skin did not differ significantly between monoinfected and co-seropositive dogs. The number of inflammatory cells was higher in the spleen, lung and mammary gland of co-seropositive dogs and in the mitral valve of monoinfected dogs. These results suggest that dogs infected with L. infantum and co-seropositive for certain pathogens are common in the region studied. However, co-seropositivities for certain pathogens did not aggravate clinical signs or L. infantum load, although they were associated with a more intense inflammatory reaction in some organs.

Antibodies to Leishmania infantum in peritoneal effusion from a dog with atypical signs of leishmaniosis: treatment and follow-up

2020 ◽  
Vol 8 (2) ◽  
pp. e001144
Author(s):  
Sergio Villanueva-Saz ◽  
Cristina Peréz Sala ◽  
Andrés Yzuel Estévez ◽  
Antonio Fernández ◽  
María Teresa Verde
Keyword(s):  
Leishmania Infantum ◽  
Peritoneal Fluid ◽  
Clinical Signs ◽  
Abdominal Distension ◽  
Canine Leishmaniosis ◽  
Abdominal Ultrasonography ◽  
Abdominal Radiology ◽  
Peritoneal Effusion ◽  
French Bulldog

A three-year-old entire male French bulldog was brought in with the following clinical signs: apathy, vomiting and abdominal distension. Physical examination showed dehydration, tachypnoea and presence of jaundice. Abdominal radiology revealed the presence of an important loss of details in the abdominal structures compatible with peritoneal effusion, confirmed by abdominal ultrasonography. Findings detected by ultrasonography consisted of splenomegaly with alteration of the echotexture, hepatomegaly with presence of nodules and irregular areas in the liver capsule. An ultrasound-guided sample of the peritoneal fluid was taken for laboratory analysis. Abnormal clinicopathological results included pancytopenia, hyperglobulinaemia, hypoalbuminaemia, and elevation of the hepatic parameters and total bilirubin. High antibodies to Leishmania infantum were detected by ELISA in serum and peritoneal fluid samples. However, PCR for L infantum showed a negative result from the peritoneal fluid sample. This is the first reported case of canine leishmaniosis with the specific detection of L infantum antibodies in peritoneal effusion.

scholarly journals Early onset of clinical leishmaniosis in a litter of pups with evidence of in utero transmission

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Harold Salant ◽  
Yaarit Nachum‑Biala ◽  
Barbara Feinmesser ◽  
Maya Perelmutter ◽  
Gad Baneth
Keyword(s):  
Lymph Node ◽  
Vertical Transmission ◽  
Early Onset ◽  
Clinical Signs ◽  
Sand Fly ◽  
Enzyme Linked Immunosorbent Assay ◽  
Canine Leishmaniosis ◽  
Sand Flies ◽  
Cutaneous Lesions ◽  
Pcr Targeting

Abstract Background Canine leishmaniosis (CanL) is a zoonotic disease caused by Leishmania infantum. Although usually transmitted by phlebotomine sand flies, infection by vertical transmission and by blood transfusion have also been reported. Methods We describe the very early onset of clinical leishmaniosis, starting from 2 months of age, in a litter of pups born to an infected dam and sire. Seven pups from the litter of nine living in different households showed alopecic, exfoliative dermatitis and ulcerative cutaneous lesions. All pups and both parents were tested on at least one occasion both serologically, by enzyme-linked immunosorbent assay (ELISA), and by polymerase chain reaction (PCR) targeting the Leishmania ribosomal operon internal transcribed spacer 1 region and a short fragment of the kinetoplast minicircle; positive amplicons were sequenced. Results All nine pups were PCR positive for L. infantum verified by DNA sequencing, seven were positive by conjunctival, five by blood, four by lymph node, and one by skin PCR from an ulcerative lesion. Both pups with no clinical signs were seronegative, while five of the seven pups with dermatologic abnormalities were seropositive by ELISA. The sire had typical clinical dermatologic and visceral findings of CanL, was seropositive and PCR positive for L. infantum in the lymph node and fluid from the vas deferens tested after the testes were removed by castration. The dam was sub-clinically infected and seronegative, but positive by blood, lymph node and conjunctival PCR for L. infantum. Allopurinol administered to all clinically affected dogs resulted in clinical recovery. Conclusions Infection with L. infantum in both parents, the very early age of clinical onset among most of the pups, and the fact that the puppies were born and detected with signs of leishmaniosis in the winter, which is a season without sand fly activity in Israel, strongly suggest vertical transmission. Awareness of the possibility of vertical transmission of L. infantum and infection in littermates should be increased. It is recommended that littermates of young dogs with clinical leishmaniosis should be tested for sub-clinical infection as they may also be infectious to sand flies and thus to other dogs and to humans. Restricting the mating of infected bitches should also be considered to prevent the vertical transmission of the infection. Graphic abstract

scholarly journals Leishmaniosis in Rodents Caused by Leishmania infantum: A Review of Studies in the Mediterranean Area

2021 ◽  
Vol 8 ◽  
Author(s):  
M. Magdalena Alcover ◽  
M. Cristina Riera ◽  
Roser Fisa
Keyword(s):  
Leishmania Infantum ◽  
Mediterranean Area ◽  
Molecular Techniques ◽  
Domestic Dog ◽  
Sand Fly ◽  
Mammalian Host ◽  
Canine Leishmaniosis ◽  
Transmission Cycle ◽  
Domestic Cycle ◽  
The Mediterranean

Leishmaniosis infection begins when a phlebotomine sand fly vector inoculates pathogenic protozoan parasites of the genus Leishmania into a mammalian host. In the case of Leishmania infantum, the domestic dog is considered to be the main parasite reservoir, and canine leishmaniosis (CanL) has a high mortality rate in untreated dogs. Hundreds of cases of human leishmaniosis (HL) are reported in the world each year, the incidence in Europe being relatively low. Leishmaniosis control is primarily focused on the dog, combining methods that prevent sand fly bites and boost host resistance to infection. However, these measures are only partially effective and new solutions need to be found. One of the main factors limiting CanL and HL control is the existence of a sylvatic Leishmania transmission cycle that interacts with the domestic cycle maintained by dogs. It is suspected that the main reservoir of infection in wildlife are rodents, whose expansion and rapid population growth worldwide is increasing the risk of human and zoonotic pathogen transfer. The aim of this review is therefore to analyze reports in the literature that may shed light on the potential role of rodents in the leishmaniosis transmission cycle in the Mediterranean area. Following the general methodology recommended for reviews, six databases (Google Scholar, Ovid, PubMed, Science Direct, Scopus and Web of Science) were explored for the period January 1995 to December 2020. The results extracted from 39 publications that met the established inclusion criteria were analyzed. It was found that 23 species of rodents have been studied in nine countries of the Mediterranean basin. Of the 3,643 specimens studied, 302 tested positive for L. infantum infection by serology, microscopy and/or molecular techniques.

scholarly journals Clinical, Hematological and Biochemical Profiles of Dogs with Leishmania infantum

2018 ◽  
Vol 46 (1) ◽  
pp. 7
Author(s):  
Stela Maria Argôlo Montargil ◽  
Fábio Santos Carvalho ◽  
Gabriela Mota Sena De Oliveira ◽  
Alexandre Dias Munhoz ◽  
Renata Santiago Alberto Carlos ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Leishmania Infantum ◽  
False Negative ◽  
Clinical Signs ◽  
The Other ◽  
Sand Fly ◽  
Molecular Diagnostic ◽  
Canine Visceral Leishmaniasis ◽  
Biochemical Profiles ◽  
The City

Background: Canine Visceral Leishmaniasis is a zoonosis affecting dogs worldwide. Its epidemiological importance is observed in Brazil, wherein the largest number of cases originates in the Northeast Region of the country. The disease is caused by the etiologic agent Leishmania chagasi (= infantum) and transmitted by an invertebrate form of sand fly of the genus Lutzomia. Domestic dogs are one of the main reservoirs. The aim of this study was to use molecular analysis to diagnose dogs naturally infected with Leishmania spp. in the city of Jequié, State of Bahia, Brazil, and to describe the clinical signs, as well as the hematological and biochemical profiles associated with these cases.Materials, Methods & Results: In the present study, 198 dogs underwent physical examination and had blood samples collected for hematological, biochemical and PCR tests for Leishmania infantum. Two primers have been used for the molecular diagnostic technique (PCR): first, the ITS-1 specific to Leishmania species followed by the PCR-RFVL to identify the genus; and second, the primer pair RV1/RV2 specific to the Leishmania infantum species in all the samplesAmong the 198 samples collected, four animals tested positive for the Leishmania infantum via PCR, two of which were symptomatic and two asymptomatic. Among the symptomatic animals, animal one presented with diffuse alopecia, ulcerated lesions on the tip of the ears, ophthalmopathy, onychogryphosis, cachexia, anemia and neutrophilic leukocytosis, and animal two presented with alopecia, pustules, crusting, diffusely-spread erythema, anemia, hyperproteinemia, thrombocytopenia and azotemia. Among the two asymptomatic dogs, one animal had anemia, hyperproteinemia, thrombocytopenia, leukocytosis with neutrophilia, and azotemia; the other animal’s laboratory findings revealed hyperproteinemia and leukocytosis with neutrophilia.Discussion: Although 48 animals presented clinical signs, as well as hematological and biochemical alterations commonly reported in the available literature on Leishmaniasis, only two tested positive by PCR. This implies that a positive diagnosis for this pathology should not be given only based on nonspecific clinical and laboratory data. On the other hand, two animals positive via PCR were asymptomatic, and could act as silent disseminators of the parasite in the region. Since the region is considered endemic for the disease, many dogs may be in the chronic phase, with low parasitemia. The fact that blood with low parasitemia was examined may have influenced the estimate of the ocurrence, as it is common knowledge that in such cases the PCR can deliver a false-negative result due the low amount of DNA for amplification. The ideal tissue should be obtained from the spleen, liver, lymph nodes or via bone marrow puncture. However, it was not possible to collect this kind of tissue due to the need for general anesthesia, which is a limiting factor when the study is conducted with domiciliated animals. Clinical signs found in positive animals involve different systems, due to the multisystemic nature of the disease, and evaluation for differential diagnosis is essential to rule out other pathologies that lead to similar changes, such as systemic lupus erythematosus, ehrlichiosis, and babesiosis, among others. Some of the hematologic changes found in positive animals included: anemia, hyperproteinemia, leukocytosis; all of which are respectively correlated with spinal cord dysfunction, splenic sequestration and hyperglobulinemia due to the intense immune response. We concluded that the PCR enabled the identification of canine visceral leishmaniasis cases in the city of Jequié. However, our study did not identify a relationship between the molecular positivity of dogs to Leishmania infantum and the clinical signs and the hematologic and biochemical analysis of samples from suspected cases.

scholarly journals Canine Leishmaniosis Control through the Promotion of Preventive Measures Appropriately Adopted by Citizens

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Giulia Simonato ◽  
Erica Marchiori ◽  
Federica Marcer ◽  
Silvia Ravagnan ◽  
Patrizia Danesi ◽  
...  
Keyword(s):  
Leishmania Infantum ◽  
Preventive Measures ◽  
Sand Fly ◽  
Local Administration ◽  
Canine Leishmaniosis ◽  
Collaborative Approach ◽  
Serological Tests ◽  
Health Authorities ◽  
Northeastern Italy ◽  
Dog Owners

Canine leishmaniosis (CanL) is a disease caused by the protist Leishmania infantum and transmitted to dogs by sand fly (Diptera: Phlebotominae) bites. In 2005, a new autochthonous focus of CanL was recognised in the southern part of Euganei hills (northeastern Italy). In subsequent years, this outbreak was monitored, testing dogs and evaluating sand fly population. Moreover, dog owners were sensitized on the adoption of preventive measures, thanks to the collaboration of local administration, health authorities, and private veterinarians. This study includes serological tests on dogs, questionnaires submitted to dog owners regarding the use of preventive measures on their animals, and the evaluation of sand fly abundance. Data collected were statistically compared with those of previous years. The canine seroprevalence was significantly lower than that recorded at the beginning of the outbreak, despite the fact that sand fly abundance did not significantly decrease. In addition, most of the dog owners declared using regularly the topical insecticides on their dogs during the sand fly season. This experience demonstrated that a collaborative approach among scientific researchers, local authorities, and private veterinarians can achieve excellent results in the management of a leishmaniosis outbreak.

Clinical, Hematological and Biochemical Profiles of Dogs with Leishmania infantum

2018 ◽  
Vol 46 (1) ◽  
Author(s):  
Stela Maria Argôlo Montargil ◽  
Fábio Santos Carvalho ◽  
Gabriela Mota Sena De Oliveira ◽  
Alexandre Dias Munhoz ◽  
Renata Santiago Alberto Carlos ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Leishmania Infantum ◽  
False Negative ◽  
Clinical Signs ◽  
The Other ◽  
Sand Fly ◽  
Molecular Diagnostic ◽  
Canine Visceral Leishmaniasis ◽  
Biochemical Profiles ◽  
The City

Background: Canine Visceral Leishmaniasis is a zoonosis affecting dogs worldwide. Its epidemiological importance is observed in Brazil, wherein the largest number of cases originates in the Northeast Region of the country. The disease is caused by the etiologic agent Leishmania chagasi (= infantum) and transmitted by an invertebrate form of sand fly of the genus Lutzomia. Domestic dogs are one of the main reservoirs. The aim of this study was to use molecular analysis to diagnose dogs naturally infected with Leishmania spp. in the city of Jequié, State of Bahia, Brazil, and to describe the clinical signs, as well as the hematological and biochemical profiles associated with these cases.Materials, Methods & Results: In the present study, 198 dogs underwent physical examination and had blood samples collected for hematological, biochemical and PCR tests for Leishmania infantum. Two primers have been used for the molecular diagnostic technique (PCR): first, the ITS-1 specific to Leishmania species followed by the PCR-RFVL to identify the genus; and second, the primer pair RV1/RV2 specific to the Leishmania infantum species in all the samplesAmong the 198 samples collected, four animals tested positive for the Leishmania infantum via PCR, two of which were symptomatic and two asymptomatic. Among the symptomatic animals, animal one presented with diffuse alopecia, ulcerated lesions on the tip of the ears, ophthalmopathy, onychogryphosis, cachexia, anemia and neutrophilic leukocytosis, and animal two presented with alopecia, pustules, crusting, diffusely-spread erythema, anemia, hyperproteinemia, thrombocytopenia and azotemia. Among the two asymptomatic dogs, one animal had anemia, hyperproteinemia, thrombocytopenia, leukocytosis with neutrophilia, and azotemia; the other animal’s laboratory findings revealed hyperproteinemia and leukocytosis with neutrophilia.Discussion: Although 48 animals presented clinical signs, as well as hematological and biochemical alterations commonly reported in the available literature on Leishmaniasis, only two tested positive by PCR. This implies that a positive diagnosis for this pathology should not be given only based on nonspecific clinical and laboratory data. On the other hand, two animals positive via PCR were asymptomatic, and could act as silent disseminators of the parasite in the region. Since the region is considered endemic for the disease, many dogs may be in the chronic phase, with low parasitemia. The fact that blood with low parasitemia was examined may have influenced the estimate of the ocurrence, as it is common knowledge that in such cases the PCR can deliver a false-negative result due the low amount of DNA for amplification. The ideal tissue should be obtained from the spleen, liver, lymph nodes or via bone marrow puncture. However, it was not possible to collect this kind of tissue due to the need for general anesthesia, which is a limiting factor when the study is conducted with domiciliated animals. Clinical signs found in positive animals involve different systems, due to the multisystemic nature of the disease, and evaluation for differential diagnosis is essential to rule out other pathologies that lead to similar changes, such as systemic lupus erythematosus, ehrlichiosis, and babesiosis, among others. Some of the hematologic changes found in positive animals included: anemia, hyperproteinemia, leukocytosis; all of which are respectively correlated with spinal cord dysfunction, splenic sequestration and hyperglobulinemia due to the intense immune response. We concluded that the PCR enabled the identification of canine visceral leishmaniasis cases in the city of Jequié. However, our study did not identify a relationship between the molecular positivity of dogs to Leishmania infantum and the clinical signs and the hematologic and biochemical analysis of samples from suspected cases.Keywords: zoonosis, molecular diagnosis, symptomatology, DNA sequence.

scholarly journals Cherubism: Report of a Case

2020 ◽  
Author(s):  
Sachin G. Ram ◽  
Vidya Ajila ◽  
Subhas G. Babu ◽  
Pushparaja Shetty ◽  
Shruthi Hegde ◽  
...  
Keyword(s):  
Fibrous Dysplasia ◽  
Developmental Disorder ◽  
Present Report ◽  
Maximum Growth ◽  
Posterior Region ◽  
Therapeutic Management ◽  
Age Group ◽  
Cystic Disease ◽  
Radiographic Features

AbstractCherubism, also known as familial fibrous dysplasia of the jaws or familial multilocular cystic disease is a rare hereditary, developmental disorder. This condition affects the posterior region of the jaws bilaterally in children belonging to the age group of 2 to 5 years. Maximum growth is recorded till puberty after which the lesion regresses over a period of time. Cherubism classically manifests radiographically as bilateral, multilocular radiolucencies affecting the posterior mandible and maxilla. Therapeutic management varies from patient to patient and is directed mainly by esthetic and functional concerns. The present report highlights the clinical and radiographic features of nonfamilial cherubism in a 6-year-old girl.

Correlations between tissue parasite load and common clinical signs in dogs naturally infected by Leishmania infantum

2021 ◽  
Vol 291 ◽  
pp. 109368
Author(s):  
Úrsula Maira Russo Chagas ◽  
Daniel Moreira de Avelar ◽  
Andreza Pain Marcelino ◽  
Gustavo Fontes Paz ◽  
Célia Maria Ferreira Gontijo
Keyword(s):  
Leishmania Infantum ◽  
Clinical Signs ◽  
Parasite Load

scholarly journals Performance of case definitions and clinical predictors for influenza surveillance among patients followed in a rural cohort in Senegal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mamadou Aliou Barry ◽  
Florent Arinal ◽  
Cheikh Talla ◽  
Boris Gildas Hedible ◽  
Fatoumata Diene Sarr ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Sore Throat ◽  
Predictive Value ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Influenza Virus Infection ◽  
Nasal Discharge ◽  
Age Group ◽  
Case Definitions

Abstract Background Influenza is a major cause of morbidity and mortality in Africa. However, a lack of epidemiological data remains for this pathology, and the performances of the influenza-like illness (ILI) case definitions used for sentinel surveillance have never been evaluated in Senegal. This study aimed to i) assess the performance of three different ILI case definitions, adopted by the WHO, USA-CDC (CDC) and European-CDC (ECDC) and ii) identify clinical factors associated with a positive diagnosis for Influenza in order to develop an algorithm fitted for the Senegalese context. Methods All 657 patients with a febrile pathological episode (FPE) between January 2013 and December 2016 were followed in a cohort study in two rural villages in Senegal, accounting for 1653 FPE observations with nasopharyngeal sampling and influenza virus screening by rRT-PCR. For each FPE, general characteristics and clinical signs presented by patients were collected. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for the three ILI case definitions were assessed using PCR result as the reference test. Associations between clinical signs and influenza infection were analyzed using logistic regression with generalized estimating equations. Sore throat, arthralgia or myalgia were missing for children under 5 years. Results WHO, CDC and ECDC case definitions had similar sensitivity (81.0%; 95%CI: 77.0–85.0) and NPV (91.0%; 95%CI: 89.0–93.1) while the WHO and CDC ILI case definitions had the highest specificity (52.0%; 95%CI: 49.1–54.5) and PPV (32.0%; 95%CI: 30.0–35.0). These performances varied by age groups. In children < 5 years, the significant predictors of influenza virus infection were cough and nasal discharge. In patients from 5 years, cough, nasal discharge, sore throat and asthenia grade 3 best predicted influenza infection. The addition of “nasal discharge” as a symptom to the WHO case definition decreased sensitivity but increased specificity, particularly in the pediatric population. Conclusion In summary, all three definitions studies (WHO, ECDC & CDC) have similar performance, even by age group. The revised WHO ILI definition could be chosen for surveillance purposes for its simplicity. Symptomatic predictors of influenza virus infection vary according the age group.

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