Use of a Direct, Rapid Immunohistochemical Test for Diagnosis of Rabies Virus in Bats

Rabies, a zoonotic encephalitis due to transmission of a lyssavirus, such as rabies virus (RABV), has the highest case fatality of any infectious disease. A global program for the elimination of human rabies caused by dogs is proposed for realization by 2030. Sensitive, specific, and inexpensive diagnostic tests are necessary for enhanced surveillance to detect infection, inform public health and veterinary professionals during risk assessments of exposure, and support overall programmatic goals. Multiple laboratory techniques are used to confirm a suspect case of rabies. One method for the detection of lyssavirus antigens within the brain is the direct rapid immunohistochemical test (dRIT), using light microscopy, and suitable for use under field conditions. Besides dogs, other major RABV reservoirs reside among mammalian mesocarnivores and bats. To date, use of the dRIT has been applied primarily for the diagnosis of RABV in suspect mesocarnivores. The purpose of this study was to assess the usefulness of the dRIT to the diagnosis of rabies in bats, compared to the gold-standard, the direct fluorescent antibody test (DFAT). Brains of 264 suspect bats, consisting of 21 species from Arizona and Texas, were used in the evaluation of the dRIT. The overall sensitivity of the dRIT was 100% (0.969–1.0, 95% CI) and the specificity was 94.6% (0.896–0.976, 95% CI), comparable to the DFAT. This preliminary study demonstrated the utility of the dRIT in the confirmation of RABV infection in bats. Future studies should include additional geographic, lyssavirus, and mammalian species representations for broader application during enhanced rabies surveillance, with incorporation of any potential adjustments to standard protocols, as needed.

COVID-19 case definitions, diagnostic testing criteria, and surveillance across the pandemic's 25 highest burden countries

Objective: We compared suspect, probable, and confirmed case definitions, as well as diagnostic testing criteria, used in the COVID-19 pandemic's 25 highest burden countries to aid interpretation of global and national surveillance data. Methods: We identified the COVID-19 pandemic's 25 countries with the highest disease burden based on the number of cumulative reported cases to the World Health Organization (WHO) as of 1 October 2020. We searched official websites of these countries for suspect, probable, and confirmed case definitions. Given that confirmation of COVID-19 usually requires diagnostic testing, we also searched for diagnostic testing eligibility criteria in these countries. Extracted case definitions and testing criteria were managed in a database and analyzed in Microsoft Excel. Findings: We identified suspect, probable, and confirmed case definitions in 96%, 64%, and 100% of countries, respectively. Testing criteria were identified in 100% of countries. 56% of identified countries followed WHO recommendations for using a combination of clinical and epidemiological criteria as part of the suspect case definition. 75% of identified countries followed WHO recommendations on using clinical, epidemiological, and diagnostic criteria for probable cases. 72% of countries followed WHO recommendations on using PCR testing for confirming a case of COVID-19. Finally, 64% of countries used testing eligibility criteria at least as permissive as WHO. Conclusion: There is marked heterogeneity in who is eligible for testing in countries and how countries define a case of COVID-19. This affects the ability to compare burden, transmission, and response impact estimates derived from case surveillance data across countries.

Severe Acute Thromboinflammation: Case Report of Individualized Homeopathic Treatment

Thromboinflammation is a still not well-understood phenomenon, which has recently come to the foreground as a function of its relevance in the pathophysiology of coronavirus disease 2019 (COVID-19). The patient described in the present case report exhibited acute fever, giant urticaria, elevated acute phase reactants, and very high d-dimer levels, thus characterizing thromboinflammation. She was diagnosed as a COVID-19 suspect case, which was not confirmed; urticarial vasculitis was ruled out. Homeopathic treatment was started with the earliest clinical manifestations, resulting in rapid and drastic reduction of inflammation and hypercoagulability within the first 12 hours, and full recovery on 10-day follow-up assessment. This case demonstrates the effectiveness of homeopathy in a severe acute disorder, and points to the need to include laboratory testing in homeopathic clinical assessment to achieve an accurate picture of disease, and to avoid the risk of passing over life-threatening disorders.

Period prevalence and identification challenges of viral haemorrhagic fever suspect cases in a tertiary referral hospital in Guinea: a cross-sectional, retrospective study of triage and emergency room patient profiles

Background A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs. Methods This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review. Results The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice. Conclusions Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.

Identification of Covid-19 suspect cases through a digital triage: a multicenter Italian-Iranian study on

Objective: To explore, through a digital triage monitoring, the frequency of demographic and clinical characteristics suggestive for COVID-19 among two large samples of people with Multiple Sclerosis (pwMS) and to evaluate the association between demographic and clinical characteristics of pwMS and the likelihood of being identified as COVID-19 suspect. Methods: A Google Forms triage was e-mailed to 3500 pwMS. pwMS suspects for having COVID-19 were: A) patients who reported recent contact with a patient with suspicion or diagnosis of COVID-19 and the presence of at least one symptom suggestive of COVID-19; B) pwMS with at least two symptoms suggestive of COVID-19. Demographics, clinical characteristics, and DMT categories of COVID-19-suspect vs non-suspect pwMS were compared.Results: 1035/1500 questionnaires were fulfilled by Italian pwMS and 1346/2000 by Iranian patients. 4.9% of Iranian and 1,5% of Italian pwMS met our criteria for the COVID-19-suspect case. Only diabetes and heart disease (OR: 5,374, 95%CI: 2,470 – 11,985, p-value<0.001) were independently associated with the likelihood of being suspect for COVID-19.Conclusion: The results of a digital triage system applied to a large Italian-Iranian population of pwMS to identify suspect cases of COVID-19 were discussed. Demographic and clinical characteristics of pwMS suspect for COVID-19 and the factors influencing the likelihood of being COVID-19 suspect are comparable to those of previous studies. Therefore, we encourage the use of the digital triage in patients with this chronic and severely disabling disease to pinpoint suspect case of COVID-19 in order to promptly activate the second phase of the intervention.

COVID-19 Cases Detection: Suspect Case Strategy

<p><strong>Background and objective:</strong> as COVID-19 has triggered enormous human casualties and disastrous economic loss, the strategies to contain its spread are urgently needed. We aim to assess the value of our suspect case strategy on COVID-19 cases detection and ensure it to be a complement to the RT-PCR test. <strong>Materials and methods:</strong> from January 23 to April 30, 2020, patients admitted to our emergence isolation ward (EIW) were analyzed in this study. With RT-PCR as a reference standard, all participants were assigned to COVID-19 positive and negative groups. We compared the performance of the suspect case strategy, WBC, LYM, and chest radiography on COVID-19 detection. <strong>Results:</strong> one hundred twenty-five cases were analyzed in the study period. The receiver operating characteristic (ROC) curve revealed the sensitivity of WBC and LYM on COVID-19 detection was 92.11% and 76.31%, respectively. The sensitivity of the suspect case was 94.73%, and the sensitivity of chest CT was 53.33%. Statistically significant differences were observed for the suspect case, WBCs, LYM, and chest CT on COVID-19 detection. <strong>Discussion:</strong> suspect case strategy can help identify false negative RT-PCR tests and be a useful complement to RT-PCR in some countries with a tremendous shortage of RT-PCR agents and specialized laboratory during the COVID-19 outbreak.</p>

Previous two lower segment caesarean section with placenta previa and placenta accreta woman with COVID-19 suspect: case report

A pregnant woman with gravida 3, para 2, living 2 and gestational age of 37 weeks and 3 days was referred to a zonal hospital as previous two lower segment caesarean section (LSCS) term pregnancy with placenta previa for safe confinement with complaints of dry cough. She was admitted with a diagnosis of COVID-19 suspect. During her hospitalization, oxygen (O2) saturation was normal. On investigations her counts were normal. Patient was planned for elective LSCS. COVID-19 test i.e. real time-polymerase chain reaction (RTPCR) report was suspect and asked for repeat sampling. During elective LSCS, delivered single live female baby with intra operative findings of placenta previa with adherent placenta and permpartum hysterectomy was done for same. Uterus with placenta was sent for histopathological examination (HPE). During the surgery her oxygen concentration was normal. Her postoperative recovery was uneventful.

Encapsulating Peritoneal Sclerosis (EPS): Analysis of Current Knowledge in the Literature and Observation of a Suspect Case

Among the medical complications of long-lasting Peritoneal Dialysis (PD) a particular pathology has been observed, the so-called Encapsulating Peritoneal Sclerosis (EPS). The main properties of the pathological process of EPS is represented by proliferative fibrosis and sclerosis of the peritoneum, which lead to the formation of the typical "cocoon" and obstruction. Since glucose, Advanced Glycation End products (AGEs), and Glucose Degradation Products (GDPs), are responsible for peritoneum fibrosis and sclerosis, biocompatible peritoneal dialysis solutions are recommended, with reduced quantities of AGEs and GDPs. Furthermore, careful monitoring of the patients is very important, especially after 5-8 years of PD. We performed an overview of the current literature available and discuss a “suspect” case of a 59-year-old male patient who underwent a single kidney transplant after a period of 8 year of peritoneal dialysis with numerous sub occlusive episodes, some of them required hospitalizations in a period between 2011 and 2019. Patient underwent to several radiologic exams for a suspect of a cocoon syndrome.

Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré prefecture, Guinea: a cross-sectional study

Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.

Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré Prefecture, Guinea: a cross-sectional study

Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.