Malaria and dengue in Hodeidah city, Yemen: High proportion of febrile outpatients with dengue or malaria, but low proportion co-infected

Background The emergence of dengue in malaria-endemic countries with limited diagnostic resources, such as Yemen, can be problematic because presumptive treatment of febrile cases as being malaria is a common practice. Co-infections with dengue and malaria are often overlooked and misdiagnosed as being a mono-infection because of clinical similarities. In Hodeidah city, Yemen, the capacity to conduct the diagnosis can be aggravated by the war context. To assess the magnitude of the problem, we determined the proportions of malaria, dengue and co-infection in relation to clinical characteristics among febrile outpatients. Methods This cross-sectional study included 355 febrile outpatients from Hodeidah city during the malaria transmission season (September 2018 –February 2019). Sociodemographic and clinical characteristics were collected using a pre-designed, structured questionnaire. Malaria was confirmed using microscopy and rapid diagnostic tests (RDTs), while dengue was confirmed using RDTs. Results Mono-infection proportions of 32.4% for falciparum malaria and 35.2% for dengue were found, where about two-thirds of dengue patients had a recent probable infection. However, co-infection with falciparum malaria and dengue was detected among 4.8% of cases. There was no statistically significant difference between having co-infection and mono-infection with malaria or dengue in relation to the sociodemographic characteristics. On the other hand, the odds of co-infection were significantly lower than the odds of malaria among patients presenting with sweating (OR = 0.1, 95% CI: 0.05–0.45; p <0.001), while the odds of co-infection were 3.5 times significantly higher than the odds of dengue among patients presenting with vomiting (OR = 3.5, 95% CI: 1.20–10.04; p <0.021). However, there were no statistically significant differences between having co-infection and mono-infection (malaria or dengue) in relation to other clinical characteristics. Conclusions Mono-infection with malaria or dengue can be detected among about one-third of febrile outpatients in Hodeidah, while almost 5.0% of cases can be co-infected. Sociodemographic and clinical characteristics cannot easily distinguish malaria patients from dengue-infected or co-infected ones, reinforcing the necessity of laboratory confirmation and avoidance of treating febrile patients as being presumed malaria cases.

Missing data matters in participatory syndromic surveillance systems: comparative evaluation of missing data methods when estimating disease burden

Introduction Traditional surveillance methods have been enhanced by the emergence of online participatory syndromic surveillance systems that collect health-related digital data. These systems have many applications including tracking weekly prevalence of Influenza-Like Illness (ILI), predicting probable infection of Coronavirus 2019 (COVID-19), and determining risk factors of ILI and COVID-19. However, not every volunteer consistently completes surveys. In this study, we assess how different missing data methods affect estimates of ILI burden using data from FluTracking, a participatory surveillance system in Australia. Methods We estimate the incidence rate, the incidence proportion, and weekly prevalence using five missing data methods: available case, complete case, assume missing is non-ILI, multiple imputation (MI), and delta (δ) MI, which is a flexible and transparent method to impute missing data under Missing Not at Random (MNAR) assumptions. We evaluate these methods using simulated and FluTracking data. Results Our simulations show that the optimal missing data method depends on the measure of ILI burden and the underlying missingness model. Of note, the δ-MI method provides estimates of ILI burden that are similar to the true parameter under MNAR models. When we apply these methods to FluTracking, we find that the δ-MI method accurately predicted complete, end of season weekly prevalence estimates from real-time data. Conclusion Missing data is an important problem in participatory surveillance systems. Here, we show that accounting for missingness using statistical approaches leads to different inferences from the data.

Understanding the role of HDL during COVID-19 infection

Background: Recently emerged COVID-19 pandemic has caused a large number of deaths with lacs of confirmed cases worldwide posturing a grim situation and severe threat to public health. There is an imperative necessity of analyzing emerging clinical and laboratory data of COVID-19 patients, which may contribute to elucidate the pathogenic mechanism and development of effective prevention and treatment countermeasures. Method: Under this manuscript, the emerging role of High-Density Lipoprotein (HDL) was analyzed by collecting recently published articles on this field in which clinical data of COVID-19 patients was given. Result: Based on recently published reports of laboratory-confirmed COVID-19 infected hospitalized patients it was consistently observed that levels of HDL were low at the time of admission to hospital and remained relatively low during the disease course i.e., treatment, recovery, and discharge stage. It was also reported critically that levels of HDL in the patients, those did not survive, decreased continuously until death. Conclusion: These clinical reports of patients have risen the concern about probable infection and worsen the clinical outcome of a healthy person having a compromised level of HDL for COVID-19 infection. Eventually, these findings stated that there is a strong association of low HDL levels with a higher risk of COVID-19 infection and further severity of the illness. Proper attention is needed to understand the significance of altered quantity and quality of HDL in COVID-19 patients compared to healthy controls, so that appropriate therapies could be given at the right time to combat severity and mortality due to this infection.

Characteristic Temporary Loss of Taste and Olfactory Senses in SARS-CoV-2-positive-Individuals with Mild Symptoms

SARS-CoV-2 infection has been characterized as an upper and lower respiratory tract infection with symptoms ranging from sore throat, cough, headache, and fatigue to a severe respiratory syndrome that requires intensive care [1-7]. Although a lower death rate has been recorded for SARS-CoV-2 in comparison to other recent coronavirus outbreaks, such as MERS or SARS, a compromised respiratory status on admission has been associated with fatal outcomes. Among the >1200 SARS-CoV-2-infected individuals in Germany to date, many of the diagnosed persons show mild symptoms to no clinical signs of infection. Here we describe the onset and characteristics of symptoms in a cluster outbreak after a carnival celebration in a small town in the state of North Rhine-Westphalia currently contributing 43% of the total number of infected individuals in Germany to date [8]. Among the nearly 500 individuals in domestic quarantine as ordered by the Local Health Authority at that time, we interviewed 41 randomly selected individuals with qPCR confirmed SARS-CoV-2 infection. Inclusion criteria for the survey participation were: residents, positive for SARS-CoV-2 in pharyngeal swabs, ≥18 years of age, and confirmed informed consent. Median age was 40 years (IQR: 31-53, range: 18-82) and 51% were female. All persons examined had attended a carnival festivity also attended by the SARS-CoV-2positive index patient. All persons who attended this carnival festivity were tested for SARS-CoV-2 by the local health authorities 10 days later. Among survey participants, onset of symptoms began 12 days (IQR: 11-13) after probable infection and a median of 6 distinct symptoms (IQR: 4-8) were described.

Successful Modified Therapy in a Patient with Probable Infection-Associated Hemophagocytic Lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare, hyperinflammatory syndrome characterized by clinical signs and symptoms of extreme inflammation. In adults, HLH is typically a complication of infections, autoimmune diseases, and malignancies. While the disease is often fatal, classic management of HLH revolves around early diagnosis and initiation of protocolized therapy. We present a case of a previously healthy 56-year-old female who developed distributive shock requiring intubation, vasopressors, and continuous venovenous hemofiltration. In the setting of multiple infectious syndromes, severe cytopenias, and rising direct hyperbilirubinemia, her diagnosis of HLH was confirmed. Therapy was initiated with dexamethasone and two doses of reduced-intensity etoposide based on the patient’s clinical course. Over the next few weeks, she continued to improve on dexamethasone monotherapy and has maintained remission up to the present with complete resolution of her cytopenias and return of baseline renal function. Our case highlights the variability in the management of probable infection-associated HLH (IHLH) with a good patient outcome. We demonstrate the potential to treat IHLH with partial protocols and minimal chemotherapeutics.

The influence of early antibiotic therapy on the clinical manifestations in patients with early Lyme disease

Introduction/Objective. Lyme borreliosis is a multisystem infectious disease caused by Borrelia burgdorferi spirochetes transmitted by the bite of an infected tick. The disease manifestations are very different, with the skin, joints, heart, and nervous systems being most often affected. The aim of this study was to find out whether there are significant differences in the appearance of symptoms and signs of the disease between the subjects who did / did not receive prophylactic, early antibiotic therapy, after the tick bite in patients diagnosed with the early phase of Lyme borreliosis. Methods. The study was carried out on 2,070 patients, who were treated or examined at the Clinic for Infectious and Tropical Diseases in the 1989?2004 period. The patients were divided into group ? (n = 591), in which they were given early antibiotic therapy, and group B (n = 1,479), in which they were not. The antibiotic therapy was used within five days of a tick bite in patients with a probable infection, who, at the time, did not have any symptoms or signs. The applied antibiotics included cephalosporins, macrolides, tetracyclines, semisynthetic penicillins, repeatedly for seven or 14 days, or benzathine benzylpenicillin once only. Results. The disease developed in a statistically significantly larger number of patients who were not given early antibiotic therapy (537/1,479) than in those who received the therapy (10/951), i.e. the ratio was 36.3% vs. 1.7%. We concluded that only two antibiotics were sufficient for optimal prevention: doxycycline and ampicillin, administered for seven days. The applied antibiotics showed a high statistically significant efficacy, ranging from 93.7% (cephalosporins) to 99.4% (macrolides). Conclusion. The application of early antibiotic therapy after a tick bite was effective in preventing the early phase of Lyme borreliosis, while in the case of infection it prevented the development of extracutaneous manifestations.

Factors associated with knowledge about tuberculosis and attitudes of relatives of patients with the disease in Ribeirão Preto, São Paulo, Brazil

OBJECTIVE: To investigate the knowledge regarding tuberculosis among relatives of patients with tuberculosis and the possible factors associated with this event and also to conduct comparative analyses between groups of relatives with or with few knowledge regarding tuberculosis, considering their attitudes in both groups. METHODS: Cross-sectional study in which the sample was obtained through simple and randomized method. The data were collected by trained interviewers and validated tool. Logistic regression analyses were done using statistical software SPSS, version 22.0. RESULTS: Among the 110 subjects recruited for the study, 85 (87.5%) were women, and the mean age was 49 years. Regarding common symptoms of tuberculosis, 102 relatives (90.9%) pointed the chronic cough; regarding the knowledge about tuberculosis transmission modes, 100 (90.9%) of them pointed symptomatic respiratory as the probable infection source. The relatives also reported other tuberculosis transmission models: sharing of clothes (n = 87; 79.1%) and household utensils (n = 66; 60%); sexual relations (n = 50; 50%). Illiterate relatives (adjusted OR = 4.39; 95%CI 1.11 - 17.36), those who do not watch or watch little television (adjusted OR = 3.99; 95%CI 1.2 - 13.26), and also those who do not have the Internet access (adjusted OR = 5.01; 95%CI 1.29 - 19.38) were more likely to have low knowledge regarding tuberculosis. Regardless the group, with or without tuberculosis knowledge, the attitudes of both were satisfactory. CONCLUSION: There are evidences that social inequity is associated to the tuberculosis knowledge of patient relatives.

Graft versus host disease-related Hafnia alvei colonization and probable infection

We describe the case of a graft versus host disease (GvHD) patient, in whom Hafnia alvei was cultured as a single organism, and at high bacterial counts from stool samples, from the onset of the disease until its resolution. This case is a further example of the contentious role of this species in causing human intestinal disease. Furthermore, it focuses on enteric damage by GvHD as a risk factor for acquiring H. alvei colonization, and probably infection.

Infection Rates in Standard vs. Hydrogel Coated Ventricular Catheters

Background:Infection related to external ventricular drain (EVD) use is a common neurosurgical complication. Modified catheters with a hydrophilic surface may impede bacterial adherence and thereby reduce catheter related cerebrospinal fluid (CSF) infection.Methods:A prospective randomized clinical trial compared the occurrence of CSF infection related to use of either standard silastic or hydrogel coated EVD catheters (Bioglide®, Medtronic). Enrolment was available to all adult neurosurgery patients undergoing placement of a first EVD, at three university centers. The catheters were presoaked in a low concentration of bacitracin solution for 5-10 minutes prior to insertion. Bacterial infection was defined by heavy growth in a single CSF sample or light / medium growth in two consecutive samples. A secondary analysis was also conducted for “probable” CSF infection, including patients started on antibiotics after light / medium growth in a single CSF sample. Statistical analyses included Kaplan-Meier survival curve estimates accompanied by Log Rank and Breslow tests.Results:There were 158 randomized patients available to assess for EVD related infection of CSF. The two study groups had similar clinical characteristics including average duration of EVD use (8±4 days). Definite CSF infection occurred in seven and probable infection in another six (8% total). Infection incidence rose steadily from day 2 (1%) to day 11 (11%). There was no difference of daily occurrence of EVD infection between the two catheter types.Conclusion:Infection remains a common hazard in the use of EVD, and we found no reduction of infection using the hydrogel-coated catheters when presoaked in low concentration bacitracin solution.