Case Of Mixed Infection Research Articles

Epidemiological characteristics of imported malaria in Mianyang, Sichuan, 2009-2019

Objective To analyze the epidemiological characteristics of imported malaria in Mianyang during the 20092019 period, and we provide scientific basis for the control of imported malaria. Methods The epidemic situation was collected from the infectious disease reporting information system and the epidemiological investigation data of imported malaria during 2009–2019 in Mianyang. The data were analyzed by descriptive epidemiological. Results A total of 169 imported malaria cases were reported during 2009–2019 in Mianyang, all were laboratory confirmed cases, with an average annual incidence rate of 0.43/100 000. There were 64 cases (37.876%) of vivax malaria, 91 cases (53.85%) of falciparum malaria, 5 cases (2.96%) of ovale malaria, 1 case (0.59%) of quartan malaria and 8 cases (4.73%) of mixed infections. Imported cases were reported all the year round, June and July had the most cases, with 22 cases each, accounting for 26.04% of the whole year. There were 10 cases (5.92%) imported from other province in China, 38 cases (22.49%) imported from 6 countries in Asia, 121 cases (71.60%) imported from 24 countries in Africa. Imported malaria cases have been reported in 10 counties. The average age of the cases was (38.45±11.74) years. Malaria cases were majorly young men working as peasant and migrant workers. The average time from symptom appearing to being diagnosed was 4.18 d, 39.05% and 56.21% of the patients were diagnosed in municipal and county medical treatment units, respectively. Conclusion The situation of imported malaria from overseas is still serious in Mianyang. It is important to improve the malaria diagnosis and treatment, and strengthen the health education of migrant workers and their families in order to achieve better prevention and control of imported malaria in the area and put an end to secondary cases. 摘要:目的 分析 2009—2019 年四川省绵阳市输人性疟疾的流行病学特征, 为进一步加强输人性疟疾防治工作提 供科学依据。 方法 通过法定传染病报告信息管理系统, 收集绵阳市 2009—2019 年疟疾病例流行病学资料和病例个 案调査资料。采用描述性流行病学方法对这些资料进行统计学分析。 结果 2009—2019 年绵阳市共有 169 例输人性 疟疾病例, 均为实验室确诊病例, 年均发病率 0.43/10 万。其中间日疟64 例 (37.87%)、恶性疟 91 例(53.85%)、三日疟1 例 (0.59%)、卵型疟 5 例 (2.96%)、混合感染 8 例 (4.73%)。输人性病例全年均有分布, 6 月和 7 月最多, 均为 22 例, 占全年 的26.04%。169例输人性疟疾病例中, 10 例 (5.92%)来自国内其他省份, 38 例 (22.49%)来自亚洲 6 个国家, 121 例 (71.60%)来自非洲 24 个国家。全市10 个县市区均有输人性疟疾病例报告。病例平均年龄 (38.45±11.74) 岁, 主要为男 性青壮年, 职业以农民、工人为主。发病至诊断时间平均为 4.18d, 39.05%、56.21% 的病例分别在县级、市级医疗机构确 诊。 结论 绵阳市输人性疟疾疫情仍然严峻, 应引起高度重视, 需进一步加强输人性疟疾防控;提高医务人员疟疾诊 治能力, 完善疟疾监测体系, 加强对重点地区重点人群尤其是出境人员和高疟区回归人员的健康教育, 防止继发病例 发生。

Fatal imported case of Plasmodium mixed infection: cerebral malaria, thrombocytopenia and multi organ dysfunctions (MODs)

Background: Plasmodium falciparum accounts for nearly all severe malaria cases among European travellers, even though, in areas of endemicity, Plasmodium vivax seems to cause severe malaria to a degree which is comparable with P. falciparum. Furthermore, unlike countries at high risk, the incidence of mixed infections among imported cases is very low. We report the case of a man from non-endemic country with a mixed infection diagnosed after a two-year stay in Guinea. Case Presentation: A 43-year-old male Italian patient developed hyperpyrexia and chills the day after his return to Italy. Within 7 days from fever onset, he was found unresponsive with vomiting and seizures. On admission to Emergency Room, the patient was hypotonic with flaccid tetraparesis, with a GCS score of 7. On the basis of personal and working history and clinical features, after exclusion of viral encephalitis, acute pyogenic meningitis, tubercular meningitis and pontine infarct, cerebral malaria infection was suspected. Rapid diagnostic test and peripheral blood smear were positive for plasmodium mixed infection (P. falciparum, P. vivax, Plasmodium ovale). Over the first 30 hours from admission, thrombocyte count dropped, and the patient developed disseminated intravascular coagulation. Renal failure required renal replacement therapy. Death occurred after 48 hours of ICU admission. Conclusion: The fatal course of the severe malaria with related cerebral impairment, lung and kidney failure, disseminated intravascular coagulation, severe acidosis, circulatory collapse with refractory septic shock and subsequent multi organ failure was likely due to delayed medical presentation by the patient and the mixed plasmodium infection. Diagnosis could only be established nine days after onset of symptoms.

Surveillance and analysis of imported malaria from abroad in Baise, Guangxi, 2009–2019

Objective To collect and analyze the epidemic regularity and distribution characteristics of imported malaria in Baise from 2009 to 2019, and we provide scientific basis for Baise to formulate appropriate prevention and control strategies and measures after realizing the goal of eliminating malaria. Methods The results of imported malaria surveillance from abroad in Baise from 2009 to 2019 were collected, analyzed and summarized. Results From 2009 to 2019, a total of 50 malaria cases were reported in Baise, of which 49 cases (98.00%) were blood positive, and 1 case (2.00%) was clinically diagnosed; The distribution of malaria species in blood test positive cases: 14 cases (28.57%) were vivax, 34 cases (69.39%) were falciparum, there was 1 case (2.04%) of ovum type malaria. No mixed infection and malariae malaria cases were found. The largest regional distribution of imported cases was in Longlin Various Nationalities Autonomous County (25 cases, 50.00%); all cases were male; except for a peak in January 2012, there was no significant seasonal distribution of cases overall; The average time from return to onset was 7.2 days, and the average time from onset to diagnosis was 7.8 days; 32 cases (64.00%) were reported by county CDC; Two cases of critical illness occurred in 2016 and 2018 respectively, and no fatal cases occurred. After the last local malaria case was reported in 2008, all malaria cases have been reported as imported malaria cases so far. In 2016, all cases reached the assessment criteria of malaria elimination at the district level in Guangxi, imported malaria cases have not resulted in secondary cases in the urban area of Baise. Conclusion The Malaria Control Strategy and comprehensive anti-malaria measures adopted in Baise are effective under the current situation of malaria control with no local cases. In the future, the measures of aetiological surveillance will be further implemented, health education and training for malaria control will be carried out, and the monitoring of the migrating population will be strengthened. 摘要:目的 分析2009—2019年百色市境外输人性疟疾疫情流行规律和分布特征,为百色市实现消除疟疾的目标 后制定适合的防控策略和措施提供科学依据。 方法 收集及整理2009—2019年百色市境外输人性疟疾疫情监测结果 并对数据进行分析和总结。 结果 2009—2019年百色市累计报告疟疾病例50例,其中49例为血检阳性病例 (98.00%),1例为临床诊断病例（2.00%)。血检阳性病例中虫种分布情况为：间日疟14例（28.57%),恶性疟34例 (69.39%),卵型疟1例(2.04%),无混合感染病例和三日疟病例的发现。输人性病例地区分布以隆林县最多(25例, 50.00%)性别全部为男性；除了 2012年1月份有一个高峰期外,总体上病例无明显的季节分布;从回国至发病平均时 间为7.2 d,从发病至确诊的平均时间为7.8 d;县级疾控中心报告32例（64.00%);危重症病例2例,分别于2016年及 2018年出现,无因重症而死亡的病例出现。2008年报告最后一例本地感染疟疾病例后,至今疟疾病例报告全部为境外 输人性,2016年达到广西壮族自治区消除疟疾考核评估的标准,输人性疟疾病例未在百色市辖区内引起继发性病例。 结论 百色市在没有本地病例的疟疾防治现状下采取的疟疾防控策略和综合抗疟措施有效。今后应进一步落实病原 学监测的措施,开展疟疾防治的健康教育宣传和培训以及加强对流动人口的监测。

Особенности течения и терапии респираторного микоплазмоза у детей в эпидемический сезон 2020–2021 гг.

According to some authors, infection caused by M. pneumoniae is one of the most common in the current epidemic season of 2020–2021 worldwide. This fact is particularly important now because of the need for differential diagnosis between mild COVID-19 and respiratory infection caused by M. pneumoniae, as well as for timely administration of causal therapy. Materials and methods. In this study, we analyzed the frequency of pneumonia caused by M. pneumoniae detected among children admitted to the Pediatric Department for Infectious Diseases of Khimki Hospital over the last 5 years. Results. We observed an increase in the proportion of patients hospitalized with community-acquired pneumonia, primarily between October 2017 and April 2018, as well as in the spring of 2020. In 31% to 67% of children treated in 2020–2021 (depending on the month and season), community-acquired pneumonia was caused by M. pneumoniae. We also analyzed clinical characteristics of community-acquired pneumonia caused by M. pneumoniae and other pathogens. In addition to that, we report a case of mixed infection (M. pneumoniae plus Epstein-Barr virus) and provide a rationale for administration of meglumine acridone acetate (Cycloferon) as a part of comprehensive treatment for this pathology. Key words: community-acquired pneumonia, children, infection caused by Mycoplasma pneumoniae, meglumine acridone acetate

A Mixed Frigoribacterium faeni and Lactococcus garvieae Infection in Cultured Rainbow Trout (O. mykiss)

The aim of this study was to diagnose the bacterial pathogens of moribund rainbow trout (Oncorhynchus mykiss) reared in a dam-lake cage farm located in the Black Sea Region of Turkey and to determine their antibiotic susceptibility and histopathological effects by using routine bacteriological, histopathological and molecular methods. Besides possibility of the use of two probiotics against these pathogens for the prevention of further infections was investigated. In this study, a mixed bacterial infection case caused by Frigoribacterium faeni and Lactococcus garvieae was diagnosed in rainbow trout samples of 100-250 g with general clinical and histopathological symptoms of bacterial hemorrhagic septicemia. Pathogens were found to be resistant against most of the antibiotics tested and the possibility of the use of Bacillus subtilis as a probiotic to prevent diseases caused by these pathogens was proposed.

Distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty

To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty, and to formulate prevention and treatment strategies for drug-resistant bacteria. The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected, including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty. The culture positive rate, pathogenic bacteria composition and drug resistance rate were counted over the years, and the change trend of pathogen distribution and drug resistance was analyzed. One hundredand eight strains of pathogenic bacteria were detected in 146 cases, and the positive rate of culture was 73.97%. Gram positive bacteria accounted for 55.48%, Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34% and 15.07% respectively. Gram negative bacteria accounted for 13.01%, including Enterobacter cloacae, Pseudomonas aeruginosa and Escherichia coli. There were 4 cases of Mycobacterium tuberculosis infection and mixed infection. The results of culture over the years showed that the constituent ratio of Gram positive bacteria had an increasing trend, fluctuating from 39.13% to 76.47%. The results of drug sensitivity showed that the pathogens were highly resistant to β-lactams, quinolones, clindamycin and gentamicin, and the drug resistance rate was increasing, but it was still sensitive to rifampicin, nitrofurantoin, tigecycline, linezolid and vancomycin. Gram positive bacteria are the main pathogens of periprosthetic infection, and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics, and the resistance rate is still increasing. To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.

Molecular and Parasitological Study on Selected Opportunistic Intestinal Parasites in Immunocompromised Patients

The common opportunistic parasites which cause morbidity and/or death in immunocompromisedpopulations are predominantly gastrointestinal ones. This study explained the molecular and parasitologicalaspects on selected opportunistic intestinal parasites in selected groups of immune compromised patientsfrom Al-Anbar hospitals and private laboratories.In the current study, were taken (130) stool samples from immune compromised patients divided into threegroups (50) chemotherapy recipient, (40) chronic renal failures, (40) diabetic Mellitus, and (30) samplesapparently healthy as control. A questionnaire was filled out on each subject including all personal andmedical history. Stool samples were collected from all groups for detection of the parasites.The results were displayed the ratio of opportunistic parasites in (55.3)% of patients, and healthy controlwas (3.3)%. The results showed that the highest group had parasites in those with chemotherapy (64)%,chronic renal failure (57.5)%, and diabetic (42.5)% individually. The highest rate of infection appeared withBlastocystis hominins(26.1%), Cryptosporidium(22.3%), and Cyclospora cayetanensis (8.4%). The age ofthe patient was ranged between 4-66 years, the Mean was 47.5 and deviation was± 9.12, also, the weightof the patient was ranging between 14-85, the mean was 70.3 and deviation ± 8.07. Three cases of mixedinfection were detected.

Severe pneumonia in Chinese patients with systemic lupus erythematosus.

This study aimed to investigate the clinical characteristics and risk factors associated with severe pneumonia in systemic lupus erythematosus (SLE) patients from China. We performed a retrospective study in 112 hospitalized SLE patients who had had pneumonia for 8 years. The primary outcome was severe pneumonia, followed by descriptive analysis, group comparison and bivariate analysis. A total of 28 SLE patients were diagnosed with severe pneumonia, with a ratio of 5:23 between men and women. The mean age at diagnosis was 44.36 ± 12.389 years. The median disease duration was 72 months, and the median SLE Disease Activity Index 2000 (SLEDAI 2K) score was 8. The haematological system was the most affected, with an incidence of anaemia in 85.7% of cases and thrombocytopenia in 75% of cases, followed by lupus nephritis in 50% of cases and central nervous system involvement in 10.71% of cases. Cultured sputum specimens were positive in 17 (68%) SLE patients with severe pneumonia, of whom nine (36%) were cases of fungal infection, five (20%) were cases of bacterial infection and three (12%) were cases of mixed infection. Using multivariate logistic regression analysis, we concluded that a daily dosage of prednisone (>10 mg; odds ratio (OR) = 3.193, p = 0.005), a low percentage of CD4+ T lymphocytes (OR = 0.909, p = 0.000), a high SLEDAI 2K score (OR = 1.182, p = 0.001) and anaemia (OR = 1.182, p = 0.001) were all independent risk factors for pneumonia in SLE patients, while a low percentage of CD4+ T lymphocytes (OR = 0.908, p = 0.033), a daily dose of prednisone of >10 mg (OR = 35.67, p = 0.001) were independent risk factors for severe pneumonia in SLE patients. Severe pneumonia is not rare in lupus, and is associated with high mortality and poor prognosis. Monitoring CD4+ T-cell counts and giving a small dose of glucocorticoids can reduce the occurrence of severe pneumonia and improve the prognosis of patients with lupus.

Analysis of adenovirus infection in acute respiratory tract infection cases in Shanghai from 2015 to 2019

Objective: To study the epidemiological characteristics and mixed infection of adenovirus in acute respiratory tract infections in Shanghai from 2015 to 2019, and to provide scientific basis for the prevention and control of adenovirus. Methods: Acute respiratory tract infections were collected from 3 hospitals in Shanghai from 2015 to 2019. Relevant information was registered and respiratory specimens were sampled for detection of respiratory pathogens by multiplex PCR. Results: A total of 1 543 cases of acute respiratory tract infection were included. The positive rate of adenovirus was 2.92%(45/1 543), the positive rates of influenza like illness (ILI) and severe acute respiratory illness (SARI) were 2.74%(29/1 058) and 3.30%(16/485), respectively. The positive rate of ILI during January-May 2019 was 5.43%(7/129), higher than that in the same period of 2015- 2018 (0.52%-4.48%) (Fisher's exact test value=8.92, P=0.036). The incidence of adenovirus-positive cases was mainly distributed in the first and second quarters, accounting for 62.22% (28/45). The difference of the incidence of adenovirus-positive cases in each quarter was significant (χ(2)= 12.52, P=0.006). The positive rate in the second quarter was highest (6.03%), which was higher than that in other quarters (1.89%-2.93%). There were significant differences among different age groups (χ(2)=16.94, P=0.001), and the positive rate decreased with age (χ(2)=10.16, P=0.001). The positive rate of 13-19 years old group (9.43%) was higher than that of other age groups (1.48%-4.81%). The positive rate of student group (12.07%) was higher than that of other occupations (2.61%). The difference was systematic (χ(2)=11.53, P=0.001). Mixed infection accounted for 31.11% (14/45) of 45 adenovirus positive cases. The mixed infection rates of ILI and SARI were 34.48% (10/29) and 25.00% (4/16), respectively. Among 14 cases of mixed infection, the main mixed infection pathogens of adenovirus were influenza A virus and coronavirus. Conclusion: Adenovirus surveillance should be further strengthened in adolescents with a focus on students and other key groups in the second quarter.

Application of Sysmex XN-Series Automated Haematology Analyser in the Rapid Detection of Malaria.

Malaria, an important parasitic disease worldwide, still has diagnostic challenges in the laboratory. Many studies have been conducted on the detection ability of haematology analysers for malaria. We evaluated the Sysmex XN-series analyser as a tool for detection of malaria by analysing the leukocyte cell population data (LCPD), scattergrams and associated Flow Cytometry Standard (FCS) data from both the WNR (white cell nucleated) and WDF (white cell differential) channels. 1281 clinically suspected cases of malaria were screened for malaria by peripheral blood smear examination and were run in the Sysmex XN-1000 for analysis of haematological parameter data, LCPD, all the scattergrams and FCS data. 1281 clinically suspected cases of malaria were screened for malaria by peripheral blood smear examination and were run in the Sysmex XN-1000 for analysis of haematological parameter data, LCPD, all the scattergrams and FCS data. 48 cases had malarial parasite on microscopy; of which, 41 cases were of Plasmodium vivax, 6 cases of Plasmodium falciparum and 1 case of mixed infection. 46 malaria-positive samples showed certain patterns of clusters in the scattergrams of both WDF and WNR channels. A case with only a few ring forms of P. vivax and another with very low parasite load having only gametocyte of P. falciparum didn't show the distinctive cluster. The most distinctive clusters for all other cases were seen in WNR (SFL-SSC) and WNR (SSC-FSC) scattergrams. FCS data for the same were analysed to gate for those events. The gated events correlated (Spearman ρ = 0.77, p < 0.01) with the parasite load of the patients. By observing the scattergrams and different parameters in the Sysmex XN-series analyser, malaria can be detected from the analyser itself.

Full-genome analysis of hepatitis C virus in HIV-coinfected hemophiliac Japanese patients.

More than 1400 Japanese hemophiliacs acquired HIV infection around 1983 through contaminated blood products imported from the USA, most of whom also acquired hepatitis C virus (HCV) infection. To delineate the HCV genetic relations in HIV-coinfected hemophiliacs, we analyzed stocked plasma samples of the patients seen at the largest referral center for HIV care in Japan. Hepatitis C virus full-genome sequences were amplified and determined using next-generation sequencing, and genotyping and phylogenetic analyses of these sequences were carried out. The results of these hemophiliacs were compared with those of previously studied HIV-coinfected Japanese non-hemophiliacs who had undergone similar analysis of HCV full-genome sequences. From 1997 to the end of 2017, 72 HIV-infected Japanese hemophiliacs regularly visited our outpatient clinic. Of these, 51 patients had detectable plasma HCV-RNA. The HCV full genome was successfully amplified and sequenced in 50 patients. Not only HCV genotypes 1b (28%) and 2a (6%), which are common in Japan, but also HCV genotypes 1a (32%) and 3a (22%) were identified at high frequency. A single case of intergenotypic recombinant form (2b/1a) and a single case of mixed infection (1a and 3a) were also identified. Each sequence derived from hemophiliacs was more than 0.05 genetic distance away from the other sequences in phylogenetic analysis. Various HCV genotypes were identified in Japanese hemophiliacs, a finding that reflects the HCV genotypic distribution in the USA. The genetic distance among them are the results of viral evolution in each patient plus HCV genetic diversity in the USA.

Haematological profile and its outcome in different species of malaria: a two year study

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh, which is also one of the endemic areas for malaria. Several factors have been attributed to increased morbidity and mortality in malaria especially with altered hematological and coagulation parameters playing an important role. The aim of present study was to study the hematological and coagulation abnormalities that correspond to severity and the final outcome.Methods: The present study was carried out on 100 patients admitted during the period of November 2016 to October 2018 at Narayana Medical College and hospital, Nellore. All of these patients were confirmed by Peripheral Smear or MPQBC or Antigen Assay followed by detailed clinical history, physical examination and investigated with hematological and coagulation parameters. Then subsequently required routine and special investigation which was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out of 100 patients 20 patients had severe anemia (Hb% &lt;7 gm%) and most of them patients were falciparum and mixed infection cases. Thrombocytopenia was observed in 63% of the patients and severe thrombocytopenia (&lt;50,000 mm3) was seen in 12% of the patients. PT and APTT were increased in 18% and 13% of the cases respectively. BT was increased in 5% of the cases. None of the patients expired in this study.Conclusions: severe anemia is a poor prognostic factor and has adverse outcome. Thrombocytopenia, increased PT, APTT does not have any correlation to mortality.

The Epidemiological and Clinical Characteristics of Hand, Foot, and Mouth Disease in Hangzhou, China, 2016 to 2018.

Hand, foot, and mouth disease (HFMD) is most frequently caused by several serotypes of human enterovirus (EV) including Enterovirus 71 (EV-A71), coxsackievirus A16 (CV-A16), or other types of EV. The aim of this study was to determine the epidemiological characteristics of HFMD and to describe the epidemiologic characteristics of HFMD among severe and mild cases. We collected 4760 HFMD cases in Hangzhou from 2016 to 2018. Specimens from these cases were collected and tested for EV-A71, CV-A16, CV-A6, CV-A10, CV-A2, and CV-A5 by reverse transcriptase polymerase chain reaction. From 2016 to 2018, the prevalence of HFMD was seasonal each year. Among the 4760 probable HFMD cases, 3559 cases were confirmed (74.8%), including 426 cases of EV-A71 infections (8.9%), 249 cases of CV-A16 infections (5.2%), and 2884 cases of other EV infections (60.6%). The percentage of other EV infections was more than 80%, which increased year by year. Random selection of samples for detection of other EV infections in 2017 and 2018, among the 1297 cases, showed there were 835 (64.4%) cases of CV-A6 infections, 177 (13.6%) cases of CV-A10 infections, 100 (7.7%) cases of CV-A2 infections, 40 (3.1%) cases of CV-A5 infections, 3 (0.02 %) cases of mixed infections, and 11.0% untyped EV infections. Preschool children were still the primary population susceptible to HFMD. In severe cases, EV-A71 infection was the main cause. Characterizing the epidemiology and the relationship between severe and common cases of HFMD would provide relevant evidences for the prevention and treatment of HFMD.

Prevalence of Clinical Artesunate Resistance among Cases of Complicated Malaria in Southern Odisha, India

Introduction: Drug resistant malaria represents the most challenging health problem worldwide. The major threat to malaria control is the increasing incidence of complicated and drug-resistant cases. Aim: To determine the prevalence of clinical artesunate resistance among complicated malaria cases by invivo method. Materials and Methods: The study included 241 patients with complicated malaria, which showed trophozoites of malarial parasite Plasmodium in the blood smear. They were administered with artesunate monotherapy. They were then followed-up for clinical response to therapy and quantification of parasitaemia levels on day 1, day 2, day 3, day 7, day 14 and day 28. Clinical examination included core body temperature recording, assessment of associated complications like vomiting, altered sensorium, anaemia, bleeding tendencies and investigation of renal parameters, liver function test and hypoglycaemia. Results: Out of 241 complicated malaria cases showing malarial parasite in peripheral blood smear, 204 cases were of Plasmodium falciparum, 32 cases were of Plasmodium vivaxand five were cases of mixed Plasmodium falciparum and Plasmodium vivax infection. Among the 241 malaria positive cases, the most commonly associated complication was severe anaemia in 87 (36.1%) cases. All the 32 cases of Plasmodium vivax malaria and the five cases of mixed infection responded and recovered after administration of artesunate monotherapy. But among the 204 cases of Plasmodium falciparum, clinical artesunate resistance was detected in 6 (2.94%) cases and the rest 198 (97.06%) cases were sensitive to artesunate monotherapy. Conclusion: Clinical artesunate resistance was noticed in 2.94% cases of Plasmodium falciparum malaria. Hence, continuous monitoring of antimalarial therapy is required, especially in complicated cases of Plasmodium falciparum malaria, to prevent the emergence of artesunate resistance.

High-Resolution Melting Analysis in Comparison with Microscopic Method: An Experimental Study to Diagnosis of Plasmodium Species Infections in Human.

Background:Among the human parasitic diseases, malaria is the main cause of morbidity and mortality. To prevent the high mortality and tracking malaria elimination efforts, a prompt and sensitive diagnosis is essential. This study aimed to compare High-Resolution Melting (HRM) and microscopic methods to diagnose Plasmodium falciparum and P. vivax.Methods:Eighty-one blood samples were collected from patients with clinical symptoms who were suspect to malaria in Chabahar district, southeastern Iran and also, from those who were referred to Malaria National Laboratory in the Tehran University of Medical Sciences, Tehran, Iran. Microscopic examination and HRM method were used to the diagnosis of Plasmodium parasites simultaneously.Results:Microscopic results revealed 45 positive cases (12 P. falciparum and 33 P. vivax) out of 81 collected samples while according to HRM analysis results 11 and 33 samples were identified as P. falciparum and P. vivax, respectively. HRM analysis also revealed 1 mixed infection of P. falciparum and P. malariae.Conclusion:HRM analysis provides a promising mean for simultaneous detection and discrimination of the Plasmodium spp. especially in mixed infection cases.

Формирование очагов герпесвирусных инфекций в семьях

Objective. To analyze circulation of herpes simplex virus (HSV), Epstein–Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus type six (HHV-6) within families, to evaluate the conditions of formation of family foci, and to identify possible sources of infection. Patients and methods. We examined 124 families, including 11 two-parent families (mother, father, and child) and 108 oneparent families (mother and child). Five families had a mother and two children. Antibodies of various classes against herpesviruses were detected using enzyme-linked immunosorbent assay (ELISA). Herpesvirus antigens were detected using indirect immunofluorescence assay; early antigens and herpesvirus reproduction were evaluated using culture method; viral DNA was identified using polymerase chain reaction. Results. We have revealed a high rate of infection with herpesviruses in both adults and children. Markers of infections caused by HSV and EBV were detected in the majority of mothers (96.0% and 90.3%; 119 and 112), while children had these infections less frequently (66.7% in each group (86)). Detection of active forms of infection and convalescents, both among children and adults, indicates an intensive circulation of herpesviruses within families and leads to the formation of family foci of infection. Active infections were primarily caused by CMV (20.2% of children, 17.8% of mothers, and 15.4% of fathers) and EBV (16.3% of children, 11.3% of mothers, and 9.1% of fathers). Out of 266 participants examined (mothers, fathers, and children), cases of acute mixed infection were observed in children only (4 of 129) and were caused by HHV-6 in combination with HSV (2 cases) or CMV (2 cases). Conclusion. Continuous and intensive circulation of herpesviruses in families leads to the formation of family foci of infection. To stop intra-family transmission of viruses, it is important to identify possible sources of infection and perform antiepidemic measures. This transmission is most likely to occur in families where the mother has markers of active or recent infection, while the child does not have them at all. Such combination was detected in 16 patients with EBV (12.4%), 10 patients with HHV-6 (7.8%), 6 patients with HSV (4.7%), and 5 patients with CMV (3.9%). It is crucial to identify the role of the child as a source of herpesvirus infection. Key words: herpesvirus infections, infection markers, family foci, cytomegalovirus infection.

Рекомбинантные интерфероны в комплексной терапии новой коронавирусной инфекции

The second decade of the 21st century has brought us a new coronavirus infection, SARS-CoV-2, which affects not only animals (livestock, companion animals, birds), but also people, causing severe disease in them (COVID-19) with various clinical variants: from upper respiratory tract lesions to sepsis and thromboembolism. Coronaviruses are known to suppress the production of IFN-I. Therefore, administration of IFN-I is a promising strategy for early treatment and prevention of COVID-19. In the Russian Federation, treatment of COVID-19 in children is performed in accordance with the recommendations of the Ministry of Health of Russia and depends on the clinical form of the disease. Mild and moderate forms of the disease, observed in the majority of children, are treated according to the protocols for managing ARVI, bronchitis, bronchiolitis, and pneumonia in children. However, the fact that non-severe COVID-19 shares clinical manifestations with other infections caused by respiratory viruses and herpesviruses (including cytomegalovirus, HHV6A/B, and Epstein-Barr virus), as well as recently increased proportion of mixed viral infections necessitate (until the etiological diagnosis is confirmed) the administration of drugs recommended for the treatment of seasonal ARVI (including intranasal forms of IFN-α, etc.). Such therapeutic tactics often ensures faster improvement and symptom elimination. We report a case of mixed respiratory infection caused by two viruses (SARS-CoV-2 and Epstein–Barr virus) in a child. Early treatment with recombinant interferon-α2b with taurine resulted in fever alleviation and normalization of child’s condition by the moment of transfer to a specialized department. Key words: SARS-CoV-2, COVID-19, children, treatment, interferon.

Clinico-haematological evaluation and molecular identification of Babesia gibsoni, Babesia canis vogeli, Ehrlichia canis and Trypanosoma evansi in dogs

Clinico-haematological alterations associated with haemoparasites like babesiosis, ehrlichiosis and trypanosomosis in dogs of Kerala, India were studied and the sensitivity of detection methods like light microscopic examination and polymerase chain reaction were compared. Case history and clinical signs of the dogs (n=144), presented to the Teaching Veterinary Clinical Complex (TVCC), Mannuthy during the study period from April 2018 to October 2019, were recorded. Clinical signs like anorexia and lethargy were noticed in all the dogs sampled. Anaemia and thrombocytopenia were the major haematological features noticed and the haematological changes were prominent in babesiosis when compared to other infections. Light microscopic examination of the blood samples revealed vector-borne microorganisms in 33 (22.9%) samples, while a total of 113 cases of babesiosis, 13 cases of ehrlichiosis, 4 cases of trypanosomosis and 31 cases of mixed infections were detected by polymerase chain reaction. The present study showed that PCR was more sensitive when compared to light microscopic examination. A combination of clinico-haematological investigations, direct microscopic examination and polymerase chain reaction could be adopted as standard tool for the routine laboratory investigation of these haemoparasites in dogs.

Clinical case of mixed infection of Viral hepatitis E and Infectious mononucleosis

The article considers a case from clinical practice: mixed infection of viral hepatitis E and infectious mononucleosis caused by Epstein-Barr virus in a boy of 15 years. The patient was long observed by a pediatrician with a diagnosis of lacunar tonsillitis, hospitalized on the 10th day of the disease in an infectious diseases hospital with a preliminary diagnosis of infectious mononucleosis. Objectively, in addition to acute tonsillitis, detected polylithionite, hepatosplenomegaly. The biochemical analysis of blood revealed a pronounced cytolysis syndrome, a study on the markers of viral hepatitis (revealed anti-HEV IgM). Discharged on the 28th day of the disease with residual effects.

Metagenomic next-generation sequencing for mixed pulmonary infection diagnosis

BackgroundMetagenomic next-generation sequencing (mNGS) is emerging as a promising technique for pathogens detection. However, reports on the application of mNGS in mixed pulmonary infection remain scarce.MethodsFrom July 2018 to March 2019, 55 cases were enrolled in this retrospective analysis. Cases were classified into mixed pulmonary infection (36 [65.5%]) and non-mixed pulmonary infection (19 [34.5%]) according to primary diagnoses. The performances of mNGS and conventional test on mixed pulmonary infection diagnosis and pathogen identification were compared.ResultsThe sensitivity of mNGS in mixed pulmonary infection diagnosis was much higher than that of conventional test (97.2% vs 13.9%; P < 0.01), but the specificity was the opposite (63.2% vs 94.7%; P = 0.07). The positive predictive value of mNGS was 83.3% (95% CI, 68.0–92.5%), and the negative predictive value was 92.3% (95% CI, 62.1–99.6%). A total of 5 (9.1%) cases were identified as mixed pulmonary infection by both conventional tests and mNGS, however, the pathogens identification results were consistent between these two methods in only 1 (1.8%) case. In summary, the pathogens detected by mNGS in 3 (5.5%) cases were consistent with those by conventional test, and only 1 (1.8%) case was mixed pulmonary infection. According to our data, mNGS had a broader spectrum for pathogen detection than conventional tests. In particular, application of mNGS improved the diagnosis of pulmonary fungal infections. Within the 55 cases, mNGS detected and identified fungi in 31 (56.4%) cases, of which only 10 (18.2%) cases were positive for the same fungi by conventional test. The most common pathogen detected by mNGS was Human cytomegalovirus in our study, which was identified in 19 (34.5%) cases of mixed pulmonary infection. Human cytomegalovirus and Pneumocystis jirovecii, which were detected in 7 (12.7%) cases, were the most common co-pathogens in the group of mixed pulmonary infection.ConclusionsmNGS is a promising technique to detect co-pathogens in mixed pulmonary infection, with potential benefits in speed and sensitivity.Trial registration(retrospectively registered): ChiCTR1900023727. Registrated 9 JUNE 2019.