Case Of Mixed Infection Research Articles

Клинико-лабораторные особенности ко-инфекции COVID-19 и менингококковой инфекции

Objective. To analyze clinical and laboratory characteristics of patients with COVID-19 and meningococcal co-infection. Patients and methods. We analyzed cases of mixed infection caused by SARS-CoV-2 and meningococci in 8 patients treated in Moscow Multidisciplinary Clinical Center ‘Kommunarka.’ We used mass spectrometry for microbiological examination followed by culturing in accordance with the results of examination. All patients were tested positive for COVID-19 by PCR and meningococcal infection by bacteriological method. Results. Patients were admitted to hospital on average 5.88 ± 4.2 days after COVID-19 onset. Two patients had moderate disease, whereas 6 patients had severe disease and were admitted to the intensive care unit. Study participants presented with different forms of meningococcal infection, including nasopharyngitis (n = 1), meningitis (n = 1), pneumonia (n = 2), meningococcemia (n = 3), and mixed form meningitis and meningococcemia (n = 1). Fatal outcome was observed in 37.5% of cases. Conclusion. The problem of meningococcal infection remains highly relevant during the COVID–19 pandemic. Сo-infection is characterized by an increase in the proportion of rare forms (pneumonia), which requires special attention of clinicians. The implementation of mass spectrometry will allow early detection of meningococcal infection in patients with rare forms and timely initiation of adequate and optimal therapy. Key words: meningococcal infection, COVID–19, co-infection.

A mixed Bacillus gibsonii and Sphingomonas echinoides infection in cultured rainbow trout (Oncorhynchus mykiss)

Rainbow trout (Oncorhynchus mykiss) is a fish species with a long history of cultivation and bacterial pathogens are limiting the success rate. The aim of this study is the biochemical and molecular identification of two opportunistic pathogens detected in the rainbow trout cultured in net cages in a dam lake located on the Kızılırmak river; revealing the pathological symptoms of them in the moribund fish samples; determination of their antimicrobial susceptibility profile and determination of the antagonistic effect of two probiotic-candidate strains against them. Depending on the results of the conventional bacteriologic and molecular identification studies, bacterial isolates recovered from the internal organs of the moribund fish samples, a mixed bacterial infection case of Bacillus gibsonii and Sphingomonas echinoides was identified in the moribund fish samples showing general bacterial hemorrhagic septicemia symptoms for the first time in rainbow trout. Despite it was not possible to identify these isolates at the species level using conventional bacteriological methods, our isolates separately showed similarities more than 99% with the above mentioned species in the 16s RNA sequence analysis. The results of this study showed that, long term water quality parameter determination and bacterial distribution monitoring studies which include molecular tools should be carried out in the aquaculture sites to increase the success in trout culture.

Mixed tuberculosis infections in Northwest of Iran.

Primary Mycobacterium tuberculosis (MTB) infection doesn't provide protection against secondary infection and patients can suffer from multiple strains of M. tuberculosis simultaneously. The aim of this study was to use molecular genotyping to identify cases of mixed infection in Northwest of Iran. One hundred and twenty-one positive culture isolates of M. tuberculosis were prepared from patients consecutively in Northwest of Iran from March 2017 to March 2018 and then microevolution and mix infection were assessed using the mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) method. MIRU-VNTR analysis revealed that nine samples (7.3%) had double alleles in at least one locus, as observed by five cases of microevolution, and four cases (3.3%) of mixed infection. According to this study, mixed infection in Northwest of Iran has significantly decreased compared to 13 years ago (7.1% decreased to 3.3%), and in order to eradicate tuberculosis it is necessary to identify all cases of mixed infection, at least in recurrent cases, in the future.

Випадок гострого нейробореліозу у хлопчика шкільного віку

Наведено клінічний випадок гострої мікст-інфекції, асоційованої з анаплазмою і Borrelia burgdorferi (ПЛР ДНК+), первинно-дисемінованим ураженням центральної нервової системи, нейробореліозом, у хлопчика 11 років, який був госпіталізований у неврологічне відділення Тернопільської обласної дитячої клінічної лікарні зі скаргами на біль голови розпираючого характеру після сну. В анамнезі був укус кліща за 4 тижні до початку хвороби. Недуга перебігала з вираженою цефалгією за відсутності підвищення температури в дебюті, наявністю у неврологічному статусі загальномозкової симптоматики за відсутності клінічно вогнищевого неврологічного дефекту на фоні спричиненої мікст-інфекції (бореліозу та анаплазмозу).

Mixed infection of Plasmodium vivax and Plasmodium falciparum diagnosed by polymerase chain reaction

We have reported two cases of mixed infection of Plasmodium species, namely Plasmodium vivax and Plasmodium falciparum, whose DNA was tested by nested polymerase chain reaction (PCR). One case was a 29-year-old male, who presented fever and diurnal variation. He belonged to Jharkhand but was admitted in the emergency ward of PGIMER, Chandigarh, while the other was a 21-year-old female from Aligarh, Uttar Pradesh, who was admitted to PGIMER, Chandigarh, with complaints of fever and vomiting. Smear test of peripheral blood of both the patients found the presence of P. falciparum while nested PCR diagnosis detected the DNAs of both P. vivax and P. falciparum.

Violet colonies of Talaromyces marneffei produce on CHROMagar candida medium

In the present report, we describe an unusual case of mixed infection of Candida albicans and Talaromyces marneffei in the oral cavity and oropharynx with cutaneous involvement. On the CHROMagar Candida plate, green colonies (identified as C. albicans) and tiny violet colonies (identified as T. marneffei) grew from the throat swab after incubation for 96 hours. 10 clinical isolates of T. marneffei were used to verify their color production on CHROMagar Candida. All colonies were violet on the fourth, seventh and ninth day incubated at 37 °C. T. marneffei appears violet on the CHROMagar Candida plate, but it may be easily ignored because of its slow growth and small colony size, especially after incubation for 48 hours. Therefore, when using CHROMagar Candida plate to detect specimens in AIDS patients, special attention must be paid to detect non–yeasts such as T. marneffei for up to 96 hours.

Selective isolation of foot-and-mouth disease virus from coinfected samples containing more than one serotype.

The foot-and-mouth disease virus (FMDV) causes a highly infectious disease of all cloven-footed animals. The RNA genome of the virus continuously evolves, leading to the generation of new strains; this necessitates the selection of new vaccine strains to ensure complete protection. Infection with one FMDV serotype does not provide cross-protection against the other FMDV serotypes. Many of the recovered animals may become carriers of the FMDV, but they still remain susceptible to the other serotypes. Coinfection with multiple FMDV serotypes has been reported and studied to understand the virus evolution. Isolation and characterization of all the involved serotypes in the mixed infection case is essential to understand the molecular evolution of the virus. In this study, two cases of coinfection were studied by selective isolation of each of the FMDV serotypes under the cross-serotype-specific immune pressure. It was estimated that the virus present in a minimum of 10-0.92 TCID50 could be isolated from the mixed population containing other serotypes in infective doses of 100.25 TCID50 or less. All involved serotypes present in the mixed infection cases were isolated, without any cross-contamination. Virus characterization revealed that genotype 2 was of serotype A virus from a sample collected in 1995, which was last reported in 1986, indicating a possible subdued prevalence of the genetic group even after vanishing from the field.

High incidence of Plasmodium knowlesi malaria compared to other human malaria species in several hospitals in Malaysia.

Through the regional control programme, Malaysia has been successfully reducing the incidence of Plasmodium falciparum and Plasmodium vivax infections. However, the incidence of zoonotic malaria Plasmodium knowlesi infection is increasing and now has been the major cause of malaria in Malaysia especially Malaysian Borneo. The emergence of knowlesi infection has threatened the malaria elimination programme which the government aims to reduce the overall malaria infections by 2020. Unlike other benign human Plasmodium spp., P. knowlesi can cause fatal infections. The aim of this study was to determine the incidence and distribution of five human malaria parasites including P. knowlesi in Peninsular Malaysia and Malaysian Borneo. A total of 112 blood samples were collected from seven states and district hospitals in Peninsular Malaysia and Malaysian Borneo from year 2015 to 2016. The samples were examined by microscopy and further confirmed by nested PCR assay targeting 18S rRNA gene of Plasmodium spp. Following the nested PCR assays, a total of 54 (48.2%) samples were positive for P. knowlesi infections, 12 (10.7%) cases were positive for P. vivax infections, followed by 7 (6.3%) cases of P. falciparum and 4 (3.5%) cases of P. malariae. There were 3 cases (2.7%) of mixed infections (P. knowlesi/P. vivax). However, no cases were identified as P. ovale. A total of 32 (28.6%) cases were found as negative infections. LoopMediated Isothermal Amplification Assay (LAMP) was performed to confirm inconclusive results produced by microscopy and nested PCR. P. knowlesi showed the highest prevalence in Sarawak (n= 30), Sabah (n=13), Pulau Pinang (n=5) and Pahang (n=6). PCR and LAMP was not able to detect a large number of microscopy positive samples due to DNA degradation during storage and shipping. Among all the states involved in this study, the highest prevalence of P. knowlesi infection was found in Sabah and Sarawak.

Epizootiology and Molecular Identification of Trypanosome Species in Livestock Ruminants in the Gambia.

African Animal Trypanosomiasis (AAT) or nagana in animals, is caused by the blood-borne parasitic protozoa called trypanosomes, and is potentially fatal. It is estimated that Africa loses $4‒5 billion annually due to the death of livestock to nagana in the tsetse belt. Although The Gambia lies within this belt, there is scanty data regarding the epizootiology of nagana in The Gambia. Here, records of reported cases of nagana for the period 2010-2019 at the International Trypanotolerance Centre (ITC) in The Gambia were analyzed retrospectively. For insights into the current prevalence of AAT, blood samples of 384 cattle, 42 goats, and 59 sheep from the Central River Region (CRR) and Lower River Region (LRR) were analyzed microscopically for parasite identification. Furthermore, trypanosomes were characterized by polymerase chain reaction (PCR) using a panel of primers that identify trypanosomes to the level of the species and subspecies by targeting a portion of the internally transcribed spacer-one (ITS-1) of the ribosomal RNA. The retrospective study indicates that Trypanosoma vivax (66%) and T. congolense (33.4%) were the predominant species. Based on the archive records of ITC, the villages Touba, Misera, and Sambel Kunda all in the CRR of the Gambia are the most burdened with AAT. Microscopic examination of blood samples from cattle showed a prevalence of 1.56%, whereas the PCR-based analysis gave a higher prevalence of 12.5%. The molecular analysis revealed the presence of T. vivax (3.65%), T. congolense kilifi (2.6%), T. b. brucei (1.3%), T. congolense savannah/forest (0.52%), T. b. gambiense (0.52%). Interestingly, 4.43% of mixed infections i.e. multiple trypanosome species in individual animals were recorded. In 18% of the mixed infection cases, T. godfreyi, T. simiae were coinfecting cattle alongside T. congolense. The molecular identification including the phylogenetic analysis implicated T. congolense as the most predominant trypanosome species infecting animals in The Gambia. The incidence of nagana in The Gambia is documented and the prevalent trypanosomes identified to be T. vivax, different types of T. congolense, and T. brucei including the gambiense subspecie. Finally, nagana is less profound in sheep and goats compared to cattle, with seasonal and regional variations playing a significant role in the disease dynamics.

Modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes

To investigate the effectiveness of modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes. A clinical data of 22 diabetic patients with chronic tibial osteomyelitis between January 2017 and March 2019 was retrospectively analyzed. There were 15 males and 7 females with an average age of 52 years (range, 44-65 years). The course of diabetes was 3-12 years (mean, 6.1 years). The course of chronic osteomyelitis was 4 months to 7 years (mean, 3.3 years). The chronic osteomyelitis was rated as type Ⅲ in 9 cases and as type Ⅳ in 13 cases according to the Cierny-Mader classification criteria. Bacterial culture showed 21 cases of single bacterial infection and 1 case of mixed bacterial infection. Preoperative color Doppler ultrasound and CT angiography confirmed that the anterior and posterior tibial arteries were unobstructed. In the first stage of treatment, the bone and soft tissue defects were filled with antibiotic bone cement after the lesion was thoroughly debrided; the length of bone defect was 4-9 cm (mean, 5.6 cm), and the size of soft tissue defect was 5 cm×2 cm to 10 cm×7 cm. After 7-10 days, the bone cement was removed and a new antibiotic bone cement was filled into the bone defect. Meanwhile, the pedicled skin (myocutaneous) flap was performed to repair the wound. After 7-12 weeks, the inflammatory indexes returned to normal, autogenous iliac bone or combined with artificial bone was used to repair the bone defect in the second stage of treatment. The wound healing, bone defect healing, complications, and the number of successful treatments were recorded. The satisfaction of the skin flap efficacy and the function of the affected limb were evaluated. Local necrosis of the skin flap occurred in 3 cases after operation, leading to delayed healing of the wound; the other 19 flaps survived successfully, leading to primary healing of the wound. The skin grafts survived completely and the incisions healed by first intention. All cases were followed up 13-28 months with an average of 20 months. The infection recurred in 2 cases within 12 months after operation, and the bone defects healed after treated by modified induced membrane technique. The bone defect healing rate was 100%; the bone healing time was 6-10 months, with an average of 8.9 months; the infection control rate and successful treatment rate were 90.9% (20/22) and 90.9% (20/22), respectively. At 12 months after operation, according to the satisfaction evaluation standard of skin flap efficacy formulated by ZHANG Hao et al., all were satisfied. According to Johner-Wruhs adjacent joint function method, the limb function recovery was excellent in 13 cases, good in 7 cases, and fair in 2 cases, with an excellent and good rate of 90.9%. For the treatment of chronic tibial osteomyelitis in patients with diabetes without vascular occlusion, the modified induced membrane technique and pedicled skin (myocutaneous) flap can repair bone and soft tissue defects, and control the infection at the same time, the short- and medium-term effectiveness are good.

Exploring the Clinical Utility of Metagenomic Next-Generation Sequencing in the Diagnosis of Pulmonary Infection.

IntroductionWe aimed to explore the real-world clinical application value and challenges of metagenomic next-generation sequencing (mNGS) for pulmonary infection diagnosis.MethodsWe retrospectively reviewed the results of mNGS and conventional tests from 140 hospitalized patients with suspected pulmonary infections from January 2019 to December 2020. The sample types included bronchoalveolar lavage fluid, lung tissue by transbronchial lung biopsy, pleural effusion, blood, and bronchial sputum. Apart from the mNGS reports that our patients received, an extra comprehensive and thorough literature search was conducted.ResultsSignificant differences were noticed in the positive detection rates of pathogens between mNGS and conventional diagnostic testing (115/140, 82.14% vs 50/140, 35.71%, P < 0.05). The percentage of mNGS-positive patients was significantly higher than that of conventional testing-positive patients with regard to bacterial detection (P < 0.01), but no significant differences were found with regard to fungal detection (P = 0.67). Significant statistical differences were found between mixed infection cases (15, 22.70%) and single infection cases (4, 7.84%) in terms of diabetes (P = 0.03). The most frequent pattern of mixed infection was bacteria and fungi mixed infection (40, 40/89 = 44.94%), followed by bacteria mixed infection (29, 29/89 = 32.58%). The sensitivity of mNGS in pulmonary infection diagnosis was much higher than that of conventional test (89.17% vs 50.00%; P < 0.01), but the specificity was the opposite (75.00% vs 81.82%; P > 0.05).ConclusionmNGS is a valuable tool for the detection of pulmonary infections, especially mixed pulmonary infections. The most common combinations we found were bacterial–fungal coinfection and bacterial–bacterial coinfection. Still, there are many challenges in the clinical application of mNGS in the diagnosis of pulmonary infections. There is still a lot of work to be done in interpreting the mNGS reports, because both clinical judgment and literature analysis strategy need to be refined.

Pre-and post-treatment evaluation of intestinal inflammation in Giardia and Blastocystis infected children: a community-based study.

Giardia intestinalis and Blastocystis hominis cause frequent infections in children in developing countries. However, the role of intestinal inflammation in their pathogenesis is still poorly understood. Faecal calprotectin (FC) level is used as an indicator of intestinal inflammation and neutrophil migration in the intestinal tract. The present study aimed to evaluate intestinal inflammation by measuring FC level among children infected with either G. intestinalis or B. hominis before and after treatment. Stool samples were collected from 282 children inhabiting a rural area in Egypt and examined microscopically for intestinal parasites. FC level was estimated in a group of children infected with G. intestinalis (n = 12) or B. hominis (n = 12) before and 3weeks after receiving nitazoxanide (200mg twice daily for 3days) and compared to a control group (n = 18) of parasite-free children. Cases of mixed infection were excluded. Nitazoxanide cure rate was 83% in both infections with a remarkable reduction of infection intensity in uncured children. The difference in FC levels between infected children and controls was not statistically significant. Also, the difference between the pre- and post-treatment estimations was not statistically significant. Elevated levels were observed before treatment in three children (two infected with G. intestinalis and one with B. hominis) who displayed normal post-treatment levels. Although G. intestinalis and B. hominis infections appear to cause no remarkable intestinal inflammation, they may induce abnormally elevated FC levels in a subset of children.

Study on specific species of malaria in relation to haematological changes

Background: As malaria is a potential medical emergency, prompt and accurate diagnosis is criticalfor its effective management. Conventional microscopic examination of peripheral thick and thinblood smear examination remains the “gold standard” for malaria diagnosis. Material: A 2 yearprospective study from 2011 to 2013 was conducted at Navodaya Medical College Hospital andResearch Centre, Raichur. The study comprised of a total number of 150 cases positive for Malaria,collected from above mentioned centre and those referred from peripheral referral centres. Clinicalhistory regarding age, sex, nature and duration of illness were elicited. Blood sample forhaematological study was taken before starting anti-malarial drugs in all these cases. Result: Out oftotal cases, P. vivax infected cases (62%) were common than P. falciparum (34%) and mixedinfection cases [PV &amp; PF] (4%). Most common presenting symptom of cases affected by PV, PF andmixed infection were fever and chills &amp; rigors and least common symptom was cough. Mostimportant haematological changes observed were anaemia and thrombocytopenia (77.3% each) andleucopenia (31.3%). All the above mentioned changes in haematological parameters were speciesspecific and statistically significant, except for red cell indices, DLC and ESR. Conclusions: Inconclusion, changes in haematological profile can help in early diagnosis of specific species ofmalaria for timely and appropriate treatment that can reduce the severity and prevention ofadditional consequences.

High frequency of the Duffy-negative genotype and absence of Plasmodium vivax infections in Ghana

BackgroundRecent studies from different malaria-endemic regions including western Africa have now shown that Plasmodium vivax can infect red blood cells (RBCs) and cause clinical disease in Duffy-negative people, though the Duffy-negative phenotype was thought to confer complete refractoriness against blood invasion with P. vivax. The actual prevalence of P. vivax in local populations in Ghana is unknown and little information is available about the distribution of Duffy genotypes. The aim of this study was to assess the prevalence of P. vivax in both asymptomatic and symptomatic outpatients and the distribution of Duffy genotypes in Ghana.MethodsDNA was extracted from dried blood spots (DBS) collected from 952 subjects (845 malaria patients and 107 asymptomatic persons) from nine locations in Ghana. Plasmodium species identification was carried out by nested polymerase chain reaction (PCR) amplification of the small-subunit (SSU) rRNA genes. For P. vivax detection, a second PCR of the central region of the Pvcsp gene was carried out. Duffy blood group genotyping was performed by allele-specific PCR to detect the presence of the FYES allele.ResultsNo cases of P. vivax were detected in any of the samples by both PCR methods used. Majority of infections (542, 94.8%) in the malaria patient samples were due to P. falciparum with only 1 infection (0.0017%) due to Plasmodium malariae, and 2 infections (0.0034%) due to Plasmodium ovale. No case of mixed infection was identified. Of the samples tested for the FYES allele from all the sites, 90.5% (862/952) had the FYES allele. All positive samples were genotyped as FY*B-33/FY*B-33 (Duffy-negative homozygous) and therefore classified as Fy(a−b−).ConclusionsNo cases of P. vivax were detected by both PCRs and majority of the subjects tested carried the FYES allele. The lack of P. vivax infections observed can be attributed to the high frequency of the FYES allele that silences erythroid expression of the Duffy. These results provide insights on the host susceptibility for P. vivax infections that had not been investigated in Ghana before.

Epidemiological characteristics of four common respiratory viral infections in children

BackgroundViruses are the main infectious agents of acute respiratory infections in children. We aim to describe the epidemiological characteristics of viral pathogens of acute respiratory tract infections in outpatient children.MethodsFrom April 2018 to March 2019, the results of viral detection using oral pharyngeal swabs from 103,210 children with acute respiratory tract infection in the outpatient department of the Children’s Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV), were detected by the colloidal gold method.ResultsAt least one virus was detected in 38,355 cases; the positivity rate was 37.2%. A total of 1910 cases of mixed infection with two or more viruses were detected, and the positivity rate of multiple infection was 1.9%. The ADV positivity rate was highest in the 3–6-year-old group (18.7%), the FLUA positivity rate was highest in the > 6-year-old group (21.6%), the FLUB positivity rate was highest in the > 6-year-old group (6.6%), and the RSV positivity rate was highest in the < 1-year-old group (10.6%). There was a significant difference in the positivity rate of viral infection among different age groups (χ2 = 1280.7, P < 0.001). The rate of positive viral infection was highest in winter (47.1%). The ADV infection rate was highest in spring (18.2%). The rates of FLUA and FLUB positivity were highest in winter (28.8% and 3.6%, respectively). The rate of RSV positivity was highest in autumn (17.4%). The rate of positive viral infection in different seasons was significantly different (χ2 = 6459.1, P < 0.001).ConclusionsViral infection rates in children differ for different ages and seasons. The positivity rate of ADV is highest in the preschool period and that of RSV is highest in infants; that of FLU increases with age. The total positive rate of viral infection in different seasons is highest in winter, as is the rate of FLU positivity.

Epidemiological and clinical characteristics of imported malaria cases in Wuhan, 2016–2019

Objective To understand the epidemiology and clinical characteristics of imported malaria in Wuhan, and we provide reference for epidemic prevention and control. Methods The epidemiological and clinical characteristics of 85 imported malaria patients in Wuhan from 2016 to 2019 were retrospectively analyzed. Results From 2016 to 2019, all the 85 malaria cases reported were imported from abroad, including 3 foreign patients, 82 Chinese nationals, 68 cases of falciparum malaria (80.00%), 12 cases of vivax malaria (14.12%), 4 cases of ovale malaria (4.71%) and 1 case of malariae malaria (1.18%), and 0 cases of mixed infection. Imported malaria cases were reported from January to December. There was an obvious concentration trend in May, and a small peak in January and August. Imported malaria cases were mainly male young and middle-aged people, 79 cases (92.94%) from Africa and 6 cases (7.06%) from Asia. The patients were generally treated within 4 days after the onset of the disease. And 63.53% of the patients had a history of malaria, and had fever symptoms. Some of them were combined with chills, headache and disturbance of consciousness. And 83.53% were mild cases, 92.86% of severe cases were falciparum. Many patients were with anemia, and platelet, albumin decreased, combined with liver function, kidney function and other organ damage. Artemisinin and its derivatives were used to standardize the antimalarial treatment, and no deaths occurred. Conclusion The pressure of imported malaria in Wuhan is persistent. We should strengthen the monitoring and management of the working population and maintain an efficient malaria monitoring system. Standardized anti malaria and comprehensive treatment should be adopted for imported cases, and the prognosis is good. 摘要:目的 了解武汉市输人性疟疾的流行病学和临床特征,为疫情防控提供参考。 方法 对2016—2019年武 汉市85例输人性疟疾患者的流行病学和临床特征进行回顾性分析。 结果 2016—2019年报告的85例疟疾病例全为 境外输人病例,外籍患者3例,中国籍82例,恶性疟68例(80.00%),间日疟12例（14.12%),卵形疟4例(4.71%),三日疟 1例（1.18%),混合感染0例。1—12月都有输人性疟疾病例报告,5月份出现明显集中趋势,1、8月份存在小高峰。输人 性疟疾病例以青壮年男性为主,来源于非洲国家79例(92.94%),亚洲国家6例(7.06%)。患者一般在发病后4 d内就 诊,63.53%患者既往有疟疾病史,均有发热症状,部分合并寒战、头痛及意识障碍。83.53%为轻症病例,重症病例中恶 性疟占92.86%。不少患者出现贫血,血小板、白蛋白降低,合并肝功能、肾功能等多器官损害。采用青蒿素及衍生物规 范抗疟治疗,无死亡病例。 结论 武汉市面临的境外输人性疟疾压力持续存在,应加强对出国务工人员的监测和管 理,保持高效的疟疾监测体系;对于输人性病例采用规范的抗疟原虫及综合治疗手段,预后良好。

Epidemiological characteristics of imported malaria cases in Huai’an, Jiangsu, 2012-2019

Objective To analyze the epidemiological characteristics of 258 imported malaria cases of Huai’an city, and we provide scientific basis for improving malaria diagnosis and monitoring capacity, preventing secondary transmission of imported malaria, and consolidating the achievements of malaria elimination work. Methods Descriptive analysis was conducted by collecting the epidemiological survey data, basic situation table of epidemic spot, report of epidemic investigation and medical record data related to malaria diagnosis and treatment in hospital in Huai’an city from 2012 to 2019. Results All the types of malaria were detected in Huai’an city, including 203 cases of falciparum malaria, 4 cases of vivax malaria, 39 cases of ovale malaria, 8 cases of quartan malaria and 4 cases of mixed infection. These cases had a wide range of importing countries (22 countries). There were 255 cases from Africa, 2 cases from Oceania, and 1 case from Southeast Asia, corresponding to the proportion of 98.83%,0.78% and 0.39% respectively. The number of living days abroad ranged from 15 to 2 990 days, and the number of onset times from 0 to 30. Before the Spring Festival, before the wheat harvest and before the autumn harvest were the three peaks of cases returning to China, accounting for 72.48% (187/258). Most of the reported cases are from District Qingjiangpu, which were 109 cases accounting for 42.25%. The young adults aging from 20 to 49 years old account for 83.33% (215 cases). There are 131 cases detected in the group of the migrant workers, accounting for 50.78%. The average time interval from returning home to onset was 9.5 days, and the longest was 634 days. Among them, 93.10% (189/203) of patients with falciparum malaria became ill within 30 days. The average interval between onset and diagnosis of patients was 2 days, and 254 cases were diagnosed within 30 days (98.45%). Conclusion Since 2012, all the reported malaria cases were imported. The health education for personnel shuttling between high malaria areas and screening for malaria among returnees should be strengthened. We should improve the ability of malaria diagnosis and treatment of medical institutions above the county level to review blood tablets. These methods can avoid the death cases and the secondary spread of the imported malaria, and consolidate the achievements in the elimination of the malaria. 摘要: 目的分析淮安市 258 例输人性疟疾病例流行病学特征,为提升疟疾诊治能力和监测响应水平,防止输人性 疟疾的继发传播,巩固消除疟疾工作成果提供科学依据。 方法 收集淮安市 2012—2019 年疟疾病例流行病学个案调 査表、疫点基本情况表、疫点调査与处置报告、医院有关疟疾诊治的病历资料等,对其进行描述性分析。 结果 淮安市 2012—2019 年输人性疟疾 258 例,其中恶性疟 203 例,间日疟 4 例,卵形疟 39 例,三日疟8例,混合感染 4 例。输人地广 泛,涉及 22 个国家,其中非洲 255 例、大洋洲2例和东南亚 1 例,分别占总病例数 98.83%、0.78%和0.39%。国外居住15~2 990 d,期间发病次数0~30次；回国多集中在春节前、麦收前和秋收前三个高峰,占总回国人数72.48%(187/258)。清 江浦区报告病例数最多,为109例,占42.25%;20~<49岁青壮年215例,占总病例数的83.33%;民工131例,占总病例数 的50.78%;回国至发病时间间隔平均为9.5 d,最长为634 d,其中93.10%(189/203)的恶性疟患者在回国后30 d内发病。患者自发病至确诊时间平均为2 d,30 d内确诊254例,占总数的98.45%。 结论 淮安市自2012年以来全市报告的均 是境外输人性疟疾病例,应加强对往返于高疟区人员的健康教育和归国人员的疟疾筛査,提高县级以上医疗机构的疟 疾诊治和疾控部门复核血片的能力,避免死亡病例发生和防止输人性疟疾继发传播,巩固消除疟疾工作成果。

Mathematical model for transmission dynamics of HIV and tuberculosis co-infection in Kogi State, Nigeria

In this work, we formulated a deterministic co-infection mathematical model made up of a system of nonlinear differential equations and rigorously analyzed it so as to gain insight into the transmission dynamics of each of the diseases as they were co-circulating in the population. We investigated the existence and stability of equilibria of the co-infection model and we subjected the model to rigorous analysis. The analysis of the sub-models (HIV only and TB-only models) and that of the co-infection model revealed that their disease-free equilibrium are locally and globally asymptotically stable when their reproduction numbers were each less than unity, showing that the diseases can be put under control under these conditions. We carried out sensitivity analysis of the co-infection model, using data relevant to Kogi state of Nigeria, which revealed that the top ranked parameters that drive the tuberculosis infection (with respect to the associated response function RT) is (u1), the control measure, educational awareness for the susceptible to always cover their mouth when coughing, sneezing and the need for the infants to be inoculated against the disease, while the top ranked parameter that drive the HIV infection (with respect to the associated response function RH) is (u2), the educational awareness campaign measure for the susceptible individuals to practice safe sexual activities, the need to avoid contacts with bodily fluids of infected patients and the prevention of vertical transmission of the disease. From the simulation of the co-infection model, the phenomenon of competitive exclusion occur where the disease with higher reproduction number drives out that with lesser one; furthermore, it was revealed that increasing the treatment rates of the individuals co-infected with TB and HIV could bring down the burden of the two diseases significantly, while increasing the control measures (u1) and (u2) leads to significant reduction in the cumulative co-infection new cases of mixed infection in the population.

Study of Epidemiological Behaviour of Malaria and Its Control in the Purulia District of West Bengal, India (2016-2020)

Background: Purulia is a malaria-prone district in West Bengal, India, with approximately half of the jurisdictional blocks defined as malaria endemic. Methods: We examined the malaria incidence in each block of the district of Purulia for the period between January 1, 2016 and December 31, 2020. Per the Annual Parasite Incidence (API), 20 blocks of Purulia district were assigned to four different categories (0-3) and mapped using ArcGIS software version 10.8. An exponential decay model was fitted to forecast the trend of malaria cases for each block of the district for the 2021-2025 timeline. Findings: There was a sharp decrease in total malaria cases and API from 2016 to 2020. Plasmodium vivax (Pv) cases were decreased by 96.43%, Plasmodium falciparum (Pf) by 90.34%, and mixed infection cases by 92.78%. The majority of cases (72.63%) were found in the 15 year and older age group. Males were more prone to malaria (60.09%) than females. Malaria was highly prevalent among Scheduled Tribes (ST) (48.44%). Six blocks were reported in Category 3 (high risk) and none in Category 0 (no risk) in 2016 while no blocks were determined to be in Category 3 and three blocks were in Category 0 in 2020. The exponential decay model prediction is oriented towards gaining malaria-free status in thirteen blocks of the Purulia district by 2025. Interpretation: By efficiently diagnosing malaria, implementing a GIS system to track malaria incidences, fair usage of Long-lasting insecticidal nets (LLINs), and conducting effective awareness campaigns, malaria control could be possible. Nevertheless, consistent funding is needed to avoid reappearance and sustain eradication goals. Funding Information: None. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was permitted by Zilla Swasthya Bhawan, Purulia, Govt. of West Bengal (Memo No. 2041; Dated: 03.11.2020).

Epidemiological analysis of imported malaria in Fujian, 2015-2019

Objective To analyze the monitoring data, and explore the epidemic characteristics of imported malaria in Fujian Province from 2015 to 2019, so as to provide a scientific basis for the monitoring work after elimination of malaria. Methods The epidemiological data on malaria cases in Fujian Province, 2015-2019 were collected. The epidemic situation, the distribution of cases in different regions, age, gender and season, malaria diagnosis and treatment were analyzed by Microsoft Excel 2007 software. Results A total of 562 cases of malaria were reported in Fujian Province, 2015-2019. All cases were imported from overseas, mainly from African (516 case, 91.81%). All cases were confirmed in reference laboratories, comprising 428 (76.16%) falciparum malaria cases, 72 (12.81%) vivax malaria cases, 39 (6.94%) ovale malaria cases, 19 (3.38%) quartan malaria cases and 4 (0.71%) mixed infection cases. The median time, which was from onset to see a doctor and from seeing the doctor to diagnosis, was 1 day and 0 day, respectively. The cases of definitive diagnosis were 426 at initial diagnosis (75.80%), the prefecture level hospital was the preferred selection for patients to visit after onset of the disease (350 cases, 62.28%). By report area, most cases were mainly distribution in Gulou district (421 cases, 74.91%), Fuzhou city, and by the present address, 174 cases (30.96%) were distributed in Fuqing country, Fuzhou city. Most malaria cases (527, 93.77%) were young men, whose age from 20 to 49. The malaria cases were reported in each month across the year, the most cases were 66 and 63 in January and February, accounting for 11.74% (66/562) and 11.21% (63/562) of the total cases, respectively. 5 deaths were reported in Fujian Province, 2015-2019. Conclusions Imported malaria cases were still existed after elimination of malaria, the diagnosis and treatment capacity of medical institutions should be further strengthened in the future, so as to consolidate achievements in malaria eradication. 摘要:目的 分析2015—2019年福建省输人性疟疾监测数据,探讨福建省消除疟疾阶段疟疾流行特点,为福建省 消除疟疾后监测工作提供科学依据。 方法 收集2015—2019年福建省疟疾疫情数据资料,应用Microsoft Excel 2007软 件对疫情概况、三间分布及诊治情况进行描述性统计分析。 结果 福建省2015—2019年共报告输人性疟疾病例562 例,均为境外输人,其中516例（91.81%)来自非洲；562例均为确诊病例,其中恶性疟428例（76.16%)、间日疟72例 (12.81%)、卵形疟39例(6.94%)、三日疟19例（3.38%)、混合感染4例(0.71%)。报告病例中发病到就诊的中位时间为 1 d,从就诊到确诊的中位时间为0d;首诊确诊的426例（75.80%),首诊单位以地市级医疗机构为主,为350例（占 62.28%)。按报告地分,病例主要分布在福州市鼓楼区,为421例,占74.91 % ;按现住址分,病例主要分布于福州市福清 市,174例,占30.96%。病例以青壮年男性(20~49岁）为主,527例,占93.77% ;各月份均有病例分布,累计报告病例数 较多的是1、2月份,分别为66例和63例,占总病例数的11.74%(66/562)和11.21%(63/562)。2015—2019年全省共报告 死亡病例5例。 结论 消除疟疾后输人性疟疾病例依然存在,今后应进一步提髙医疗机构的诊治能力,巩固消除疟疾 成果。