Endemic Infection Research Articles

Risk factors of severe blastomycosis and comparison of diagnosis and outcomes between immunocompetent and immunocompromised patients.

Blastomycosis is an endemic fungal infection that causes pulmonary and systemic disease. It can occur irrespective of the patient's immune status. The risk factors associated with the severity of the disease are not well studied. This is a retrospective study of patients admitted with blastomycosis at the University of Kentucky Hospital from 2004 to 2019. Logistic regression was used to identify variables associated with severe blastomycosis. A total of 76 patients were identified; 22 (28.9%) had at least one immunosuppressive condition. Pulmonary blastomycosis was reported in 49/76 (65%) of the patients and disseminated infection in 27/76 (35.5%). All diagnostic tests were not significantly different in diagnostic results in immunocompromised vs immunocompetent patients. Cultures and histopathology were positive in 56/61 (91.8%) and 54/63 (85.7%) respectively. Blastomyces or Histoplasma antigen test was positive in 13/17 (76.4%) in immunocompromised patients compared to 26/42 (61.9%) in immunocompetent patients. Immunocompromised patients were more likely to be admitted to the hospital and ICU compared to immunocompetent patients. In the multivariate analysis, pulmonary multilobar disease (RR 5.68; 95% CI 2.13-15.15), obesity (RR 2.39; 95% CI 1.26-4.51), diabetes mellitus (RR 3.50; 95% CI 1.38-8.90) and immunosuppression (RR 2.28; 95% CI 1.14-4.56) were significant independent risk factors for severe blastomycosis. Inpatient mortality proportion was higher in immunocompromised patients but not statistically significant. Pulmonary multilobar disease, obesity, diabetes mellitus and immunosuppression were risk factors associated with severe blastomycosis. Immunocompromised patients required more frequent hospitalisations compared to immunocompetent patients.

Analysis of the epidemiological characteristics and risk factors for epilepsy in the countries of the African continent

Relevance . Epilepsy is a common neurological disease in tropical countries, especially in Africa. Its prevalence in African countries is almost twice as high as in Asia, Europe and North America. Objective: to investigate the characteristics of the spread and risk factors of epilepsy in the countries of the African continent. Materials and Methods : Based on WHO data, an epidemiological analysis of the prevalence and structure of mortality from epilepsy among the inhabitants of continental Africa was carried out. The African continent was clustered into five different regions with conventionally homogeneous sociocultural, climatic and geographic and environmental conditions and, as a consequence, similar dynamics of endemic diseases and infections. Demographic data, etiological factors, risk factors such as infectious diseases (including neglected diseases) with neurological consequences in the form of deaths from epilepsy were compared in five centers in the region. Mathematical and statistical processing of the results was carried out using the SPSS-19 statistical package (SPSS Inc., USA). Results and Discussion . Analysis of socio-demographic characteristics made it possible to establish that mortality from epilepsy is higher: in the countries of the African continent south of the Sahara in comparison with northern Africa; in women compared to men; in the age group younger than 14 compared to older groups and also in countries of subregions with an unsatisfactory state of national health systems and a low level of socio-economic situation in general. Conclusion . State programs aimed at reducing various factors of injury, violence, the prevalence of maternal mortality and hunger, the frequency of suicide among the population can help reduce the prevalence and mortality from epilepsy. In addition, a significant number of risk factors for epilepsy in African countries are virulent and potentially preventable. First of all, these include: neurocysticercosis, schistosomiasis, HIV infection and various forms of meningitis. Health care interventions to prevent these diseases can also significantly reduce the prevalence of epilepsy.

Endemic infections of bovine viral diarrhea virus genotypes 1b and 2a isolated from cattle in Japan between 2014 and 2020.

Bovine viral diarrhea virus (BVDV) is a causative agent of bovine viral diarrhea. In Japan, a previous study reported that subgenotype 1b viruses were predominant until 2014. Because there is little information regarding the recent epidemiological status of BVDV circulating in Japan, we performed genetic characterization of 909 BVDV isolates obtained between 2014 and 2020. We found that 657 and 252 isolates were classified as BVDV-1 and BVDV-2, respectively, and that they were further subdivided into 1a (35 isolates, 3.9%), 1b (588, 64.7%), 1c (34, 3.7%), and 2a (252, 27.7%). Phylogenetic analysis using entire E2 coding sequence revealed that a major domestic cluster in Japan among BVDV-1b and 2a viruses were unchanged from a previous study conducted from 2006 to 2014. These results provide updated information concerning the epidemic strain of BVDV in Japan, which would be helpful for appropriate vaccine selection.

A Rare Case of Salmonella Typhi Presenting with Tonsillitis

Typhoid fever is an endemic infection in developing countries like India. Oral manifestations of enteric fever and typhoid tonsillitis have rarely been reported in the literature. We report a 20 year old male, showing tonsillitis to be an integral part of clinical presentation of typhoid fever.The patient presented with fever, throat pain and oral ulcers. Blood culture and swab from tonsils showed significant growth of Salmonella typhi.This case report adds light to tonsillitis as a rare clinical manifestation of typhoid fever.

942. Pulmonary Infections in Intestinal Transplant Recipients with Preexisting Pulmonary Nodules

BackgroundPulmonary nodules in asymptomatic patients could represent latent pulmonary infections. Intestinal transplant (ITx) recipients with preexisting pulmonary nodules might be at higher risk for pulmonary infections. However, data is lacking. MethodsThis retrospective study included adult patients that underwent intestinal transplantation (ITx) from 5/2016 to 5/2020. Chest computed tomography (CT) scans performed within 12 months prior of ITx were obtained to evaluate for preexisting pulmonary nodules. Screening for endemic mycoses, Aspergillus, Cryptococcus and latent tuberculosis infection (LTBI) performed within 12 months prior ITx was obtained. We assessed for worsening pulmonary nodules, and fungal and mycobacterial infections during the 1st year post-transplant. Survival at one year post-transplant was also assessed. ResultsForty-three patients underwent ITx. Twenty-three (53%) were Female. Median age was 46 years (range: 18-67). Chest CT scans were performed in 36(84%) patients prior to ITx. Preexisting pulmonary nodules were found in 30 (83%) of the patients. All were asymptomatic. Nodules were not calcified in 10 (33%) patients, calcified in 4 (13%), some calcified and some not calcified in 4 (13%) and unclear in 12 (40%). All the patients screened negative for fungi [Coccidioides antibody (Ab) was done in 15 (50%) patients, Blastomyces Ab and Histoplasma Ab in 7 (23%) each, Histoplasma urine antigen (Ag) and Aspergillus serum galactomannan in 3 (10%) each, and Cryptococcus serum Ag in 10 (33%) patients]. QuantiFERON-TB (QFT) was negative in 35 (81%) patients, positive in 2 (5%) and indeterminate in 6 patients (14%). QFT-Gold In-Tube was replaced to QFT-Plus in 3/2019. Post-transplant worsening of pulmonary nodules was noted in 12 (40%) patients and bronchoscopy was performed in six of them. Note that only 1 (3%) of the patients that had pre-existing pulmonary nodules developed a pulmonary infection (invasive pulmonary aspergillosis diagnosed 33 days after ITx). Our cohort survival at one year post-transplant was 79%. ConclusionPreexisting pulmonary nodules was common in our ITx cohort. However, only one case of pulmonary infection was noted among those who had preexisting pulmonary nodules. Clinical monitoring is essential. Disclosures All Authors: No reported disclosures

711. A Unique Breath Secondary Metabolite Volatile Signature for the Diagnosis of Histoplasmosis

BackgroundHistoplasmosis is a common endemic fungal infection in the Americas, causing significant morbidity and mortality, particularly in immunocompromised patients. Existing diagnostic methods are limited in their sensitivity (especially in pulmonary histoplasmosis) and turnaround time. MethodsWe examined prospectively collected breath samples from 84 patients with suspected histoplasmosis 3/2019 - 2/2020 at Hospital Roosevelt (HR; Guatemala City, Guatemala, n = 56) and suspected invasive fungal disease 1/2018 - 10/2019 at Brigham and Women’s Hospital (BWH; Boston, MA, USA, n = 28) using thermal desorption gas chromatography-tandem mass spectrometry (TDU-GC-MS/MS). Patients were evaluated for histoplasmosis and other infections according to the local standard of care – of note, 18/56 patients at HR did not have Histoplasma urine antigen testing.ResultsMedian age was 44 years, 60 (71%) were male, 23 (27%) had HIV, 15 (18%) had hematologic malignancy. 7 patients were diagnosed with histoplasmosis over the study period (4 at HR, 5 at BWH), with a clinical syndrome + positive Histoplasma urine or serum antigen test, with some patients also having yeast forms on tissue biopsy. 3 patients had disseminated and 4 pulmonary histoplasmosis. 4 patients with histoplasmosis had co-infections – 2 tuberculosis (TB), 1 influenza, and 1 Pneumocystis jirovecii (PJP) pneumonia. 4 patients were receiving antifungal therapy active against Histoplasma at the time of their first breath sample. We found 3 sesquiterpenes: (A) cyperene, (B) 1R,4aR,8aR)-2,5,5,8a-Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene, and (C) viridiflorol in patients with histoplasmosis, that distinguished these patients from those with other pneumonia (TB, coccidioidomycosis, invasive aspergillosis, mucormycosis, PJP, bacterial pneumonia) with 100% sensitivity and 70% (95% CI 59, 80) specificity.Figure 1. TDU GC-MS/MS spectral comparison in histoplasmosis vs. the other invasive mycoses aspergillosis or mucormycosis. A: Cyperene; B: (1R,4aR,8aR)-2,5,5,8a Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene; C: viridiflorol; D: 1H-Indene, 2,3,3a,4-tetrahydro-3,3a,6-trimethyl-1-(1-methylethyl)-; E: β-funebrene; F: trans-α-bergamotene; G: eremophilene; H: spathulenol; I: cedrene; J: cedranoxide, 8,14- Conclusion Conclusion: Patients with histoplasmosis have a unique secondary metabolite breath signature that can be used for the noninvasive diagnosis of pulmonary and disseminated histoplasmosis. Many patients in this cohort did not undergo urine antigen testing or other diagnostic workup for histoplasmosis, which may have affected our specificity estimates.Disclosures Francisco M. Marty, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator)

What is the impact of acquired immunity on the transmission of schistosomiasis and the efficacy of current and planned mass drug administration programmes?

Schistosomiasis causes severe morbidity in many countries with endemic infection with the schistosome digenean parasites in Africa and Asia. To control and eliminate the disease resulting from infection, regular mass drug administration (MDA) is used, with a focus on school-aged children (SAC; 5–14 years of age). In some high transmission settings, the World Health Organization (WHO) also recommends the inclusion of at-risk adults in MDA treatment programmes. The question of whether ecology (age-dependant exposure) or immunity (resistance to reinfection), or some combination of both, determines the form of observed convex age-intensity profile is still unresolved, but there is a growing body of evidence that the human hosts acquire some partial level of immunity after a long period of repeated exposure to infection. In the majority of past research modelling schistosome transmission and the impact of MDA programmes, the effect of acquired immunity has not been taken into account. Past work has been based on the assumption that age-related contact rates generate convex horizontal age-intensity profiles. In this paper, we use an individual based stochastic model of transmission and MDA impact to explore the effect of acquired immunity in defined MDA programmes. Compared with scenarios with no immunity, we find that acquired immunity makes the MDA programme less effective with a slower decrease in the prevalence of infection. Therefore, the time to achieve morbidity control and elimination as a public health problem is longer than predicted by models with just age-related exposure and no build-up of immunity. The level of impact depends on the baseline prevalence prior to treatment (the magnitude of the basic reproductive number R0) and the treatment frequency, among other factors. We find that immunity has a larger impact within moderate to high transmission settings such that it is very unlikely to achieve morbidity and transmission control employing current MDA programmes.

Did the severe acute respiratory syndrome-coronavirus 2 pandemic cause an endemic Clostridium difficile infection?

BACKGROUND Clostridium difficile infection (CDI) has increased in prevalence during the last years. The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced patient outcomes. The majority of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-infected patients received antibiotics during hospitalization.AIMTo analyze the factors that influenced CDI development after SARS-CoV-2 infection. METHODSBetween March 2020 to December 2020, we performed a prospective observational study including 447 patients diagnosed with CDI who were admitted to our tertiary referral university hospital. The diagnosis of CDI was based on the presence of diarrhea (≥ 3 watery stools within 24 h) associated with Clostridium difficile toxins A or B. We excluded patients with other etiology of acute diarrhea.RESULTSAmong the total 447 (12.5%) patients with CDI, most were male (54.3%) and mean age was 59.7 ± 10.8 years. Seventy-six (17.0%) had history of COVID-19, most being elderly (COVID-19: 62.6 ± 14.6 years vs non-COVID-19: 56.8 ± 17.6 years, P = 0.007), with history of alcohol consumption (43.4% vs 29.4%, P = 0.017), previous hospitalizations (81.6% vs 54.9%, P < 0.001) and antibiotic treatments (60.5% vs 35.5%, P < 0.001), requiring higher doses of vancomycin and prone to recurrent disease (25.0% vs 13.1%, P = 0.011). Age over 60 years [odds ratio (OR): 2.591, 95% confidence interval (CI): 1.452-4.624, P = 0.001], urban residence (OR: 2.330, 95%CI: 1.286-4.221, P = 0.005), previous antibiotic treatments (OR: 1.909, 95%CI: 1.083-3.365, P = 0.025), previous hospitalizations (OR: 2.509, 95%CI: 1.263-4.986, P = 0.009) and alcohol consumption (OR: 2.550, 95%CI: 1.459-4.459, P = 0.001) were risk factors of CDI in COVID-19.CONCLUSIONCDI risk is unrelated to history of SARS-CoV-2 infection. However, previous COVID-19 may necessitate higher doses of vancomycin for CDI.

Structural screening into the recognition of a potent inhibitor against non-structural protein 16: a molecular simulation to inhibit SARS-CoV-2 infection

COVID-19 infection is caused by endemic crown infection (SARS-CoV-2) and is associated with lung damage and severe immune response. Non-Structural Proteins are the central components of coronaviral transcription and replication machinery in SARS-CoV-2 and also stimulate mRNA cap methylation to avoid the immune response. Non-Structural Protein 16 (NSP16) is one of the primary targets for the drug discovery of coronaviruses. Discovering an effective inhibitor against the NSP16 in comparison with Sinefungin was the main purpose of this investigation. Binding free-energy calculations, computational methods of molecular dynamics, docking, and virtual screening were utilized in this study. The ZINC and PubChem databases were applied to screen some chemical compounds regarding Sinefungin as a control inhibitor. Based on structural similarity to Sinefungin, 355 structures were obtained from the mentioned databases. Subsequently, this set of compounds were monitored by AutoDock Vina software, and ultimately the potent inhibitor (PUBCHEM512713) was chosen. At the next stage, molecular dynamics were carried out by GROMACS software to evaluate the potential elected compounds in a simulated environment and in a timescale of 100 nanoseconds. MM-PBSA investigation exhibited that the value of binding free energy for PUBCHEM512713 (−30.829 kJ.mol−1) is more potent than Sinefungin (−11.941 kJ.mol−1). Furthermore, the results of ADME analysis illustrated that the pharmacokinetics, drug-likeness, and lipophilicity parameters of PUBCHEM512713 are admissible for human utilization. Finally, our data suggested that PUBCHEM512713 is an effective drug candidate for inhibiting the NSP16 and is suitable for in vitro and in vivo studies. Communicated by Ramaswamy H. Sarma

Country differences in transmissibility, age distribution and case-fatality of SARS-CoV-2: a global ecological analysis

Objectives The first COVID-19 pandemic waves in many low-income countries appeared milder than initially forecasted. We conducted a country-level ecological study to describe patterns in key SARS-CoV-2 outcomes by country and region and explore associations with potential explanatory factors, including population age structure and prior exposure to endemic parasitic infections.Methods We collected publicly available data and compared them using standardisation techniques. We then explored the association between exposures and outcomes using random forest and linear regression. We adjusted for potential confounders and plausible effect modifications.Results While mean time-varying reproduction number was highest in the European and Americas regions, median age of death was lower in the Africa region, with a broadly similar case-fatality ratio. Population age was strongly associated with mean (β=0.01, 95% CI, 0.005, 0.011) and median age of cases (β=-0.40, 95% CI, -0.53, -0.26) and deaths (β= 0.40, 95% CI, 0.17, 0.62).Conclusions Population age seems an important country-level factor explaining both transmissibility and age distribution of observed cases and deaths. Endemic infections seem unlikely, from this analysis, to be key drivers of the variation in observed epidemic trends. Our study was limited by the availability of outcome data and its causally uncertain ecological design.

Viral Ecology and Natural Infection Dynamics of Kaeng Khoi Virus in Cave-Dwelling Wrinkle-Lipped Free-Tailed Bats (Chaerephon plicatus) in Thailand.

Kaeng Khoi virus (KKV; Order: Bunyavirales), is an endemic viral infection of the wrinkle-lipped free-tailed bat (Chaerephon plicatus aka Tadarida plicata plicata). Little is known about the ecology and maintenance of KKV within the bat population, nor the infection dynamics and transmission among bats or between bats and other vertebrates. Therefore, KKV was studied in Kaeng Khoi cave, Saraburi province, Thailand, during 1973–1974 with the objectives to (1) characterize the seasonal infection rates of KKV in the context of the bat population ecology, and (2) describe the infection dynamics and viral shedding by naturally- and experimentally-infected bats. To this end, the free-tailed bat population was estimated by a series of timed photographs taken during the evening exodus. The case population of 900,000 adult bats doubled at the time of weaning of the young and returned to its previous level soon thereafter. The newborn bats had neutralizing antibodies to KKV that were likely to be maternal in origin. The KKV antibody prevalence in adult bats was high (69–91%) in March–May and low (29–40%) in August and September. Kaeng Khoi virus was isolated from 75% of dead and 50% of moribund bats, but was not found in nearly 400 apparently healthy bats. Virus was present in saliva, urine and blood of most of the naturally-moribund bats tested. Consistent with observations from naturally-infected bats, experimental infection of bats with KKV revealed significant liver pathology, also suggestive that this is not a benign infection. Kaeng Khoi virus is an endemic, year-round infection maintained by the annual recruitment of a large number of immunologically-naïve juvenile bats. Moreover, it produces an acute infection in the bat, either leading to death by hepatitis, or immunity.

Anti-Leishmanial Effect of Oral Zinc Sulfate in Acute Cutaneous Leishmaniasis: A Mini-review

Cutaneous Leishmaniasis (CL) is an endemic parasitic infection caused by various Leishmania species, with a specific predisposition of each species into a particular geographical area. Cutaneous lesions can either be a single, limited skin lesion or multiple, large, locally destructions skin lesions. Several therapies are proposed for CL, but severe side effects, high costs, and incomplete efficacy make researchers find replaceable therapies. Since the usage of zinc sulfate as a therapeutic agent has a long history in treating of various dermatological diseases, Zinc plays an essential role in the development and function of innate immunity cells (neutrophils and natural killer cells), which play significant roles in killing parasites. It also has a significant inhibitory effect on key enzymes involved in the carbohydrate metabolism and virulence of L. major and L.tropica. Therefore, its use as an oral therapy for CL might represent a significant addition to the armamentarium of anti-leishmanial medications. This review summarizes and discusses previous and recent findings regarding the therapeutic roles of oral zinc sulfate in cutaneous leishmaniasis therapy.

Methods of laboratory diagnosis of histoplasmosis – problems and prospects

Endemic infections, such as histoplasmosis, the causative agent of which is assigned to pathogenicity group II, can cause a number of difficulties in laboratory studies. The culture method is the gold standard of diagnosis, but requires a lot of time and skill of the doctor. Immunological methods used to detect H. capsulatum antigens and/or antibodies to them, although they have received a wide range of applications in endemic regions show variable sensitivity and specificity, which is influenced by: the nature of the course of infection, the immune status of the patient, the type of clinical material and etc. As a result, we are seeing a gradual shift in emphasis towards molecular genetic studies, which demonstrate high analytical performance in the laboratory diagnosis of histoplasmosis.

S1857 Gastrointestinal Histoplasmosis in an Immunocompetent Adult in a Non-Endemic Region

Introduction: Histoplasma capsulatum is an endemic fungus and infection is rarely seen in the United States outside of the Ohio and Mississippi River regions. Disseminated infection is typically seen in immunocompromised patients and primary gastrointestinal involvement is rare. We report the case of an immunocompetent adult who was diagnosed with disseminated histoplasmosis with primarily gastrointestinal symptoms. Case description/methods: A 34-year-old male with history of developmental delay and prior seizures presented with seven months of intermittent bloody diarrhea, abdominal pain, fever and chills. He had a similar presentation previously at another hospital and underwent colonoscopy with evidence of multiple ulcers throughout the colon. He was empirically treated with antibiotics but re-presented due to persistent symptoms. Patient was intermittently febrile on admission. Exam showed diffuse abdominal tenderness to palpation. Labs were notable for Hgb 9.1 g/dL and, WBC 12.3 × 10^9 cells/L Stool calprotectin 1570 mcg/g. CT abdomen showed diffuse colonic thickening. Colonoscopy showed discontinuous scattered non-bleeding deep ulcers throughout the entire colon (Figure 1) which were biopsied. Pathology showed histiocytes with intracellular fungal elements. Even duodenal biopsies showed intracellular fungal elements though the duodenal mucosa appeared normal aside from some lymphoid aggregates on upper endoscopy. Urine histoplasma galactomannan antigen was positive. He had no evidence of pulmonary disease. Further history revealed that the patient had never traveled outside of California but did have some close contact with relatives from Minnesota prior to the onset of symptoms. Other infectious work-up including Aspergillus, HIV, CMV, Coccidiomycosis, Cryptococcus were all normal. He was initially treated with oral itraconazole with no improvement of his symptoms, however symptom resolved after initiating IV amphotericin. Genetic testing is pending for underlying immunodeficiency. Discussion: This unique case illustrates disseminated histoplasmosis with mainly gastrointestinal symptoms in a seemingly immunocompetent adult in a non-endemic area. The patient had diffuse small bowel and colonic involvement led to symptoms mimicking inflammatory bowel disease and he even had a markedly elevated calprotectin. Prior case series of disseminated histoplasmosis have reported 100% mortality when untreated. Endoscopic biopsies were crucial to help make the diagnosis and appropriate therapy.Figure 1.: Deep, non-bleeding ulcerations found in transverse colon on colonoscopy.Table 1.: EGD and colonoscopy biopsy results.

Investigation of an outbreak of sheeppox among native sheep breeds in the Western Himalayas of India.

An outbreak of sheeppox was investigated in a cluster of villages situated in Western Himalayan ranges of a Northern Indian state. Non-migratory sheep (n = 80) of native breeds namely Gaddi and Rampur Bushair were infected and 15 have died. The outbreak started after a few animals contracted the disease during the summer grazing period at the highland pastures from migrating flocks of sheep. This initial outbreak resulted in a further spreading of the disease into the valley. Clinical examination revealed varying degree of cutaneous papular lesions and respiratory distress. Upon necropsy, visceral lesions in the lungs, trachea and kidneys were also found. Clinical and morbid samples were found positive for sheeppox virus using group specific P32 gene and I3L gene based multiplex PCR differentiating sheeppox and goatpox viruses. Histopathological, hematological and blood biochemical analysis also supported the pathology of an acute viral infection. The causative sheeppox virus strain was isolated using lamb testicular cell culture and phylogenetic analysis, based upon P32 and RPO30 genes, showed its clustering with other Indian strains reported from neighboring states. This study demonstrated the spread of sheeppox virus to new niches by migratory sheep flocks leading to establishment of endemic infections in many new pockets of higher Western Himalayas.

Investigations on Vector-Borne and Aerosol Transmission Potential of Kaeng Khoi Virus in Cave-Dwelling Wrinkle-Lipped Free-Tailed Bats (Chaerephon plicatus) in Thailand.

Kaeng Khoi virus (KKV; Order: Bunyavirales, Family: Peribunyaviridae, Genus: Orthobunyavirus), is an endemic viral infection of the wrinkle-lipped free-tailed bat (Chaerephon plicatus; also known as Tadarida plicata plicata). Viral isolates from bat bugs (Family: Cimicidae) suggest vector-borne transmission, but in general little is known about the ecology of KKV and seroprevalence in the local human and animal populations. Transmission studies and a serosurvey were carried out in Kaeng Khoi cave, Saraburi province, Thailand, during 1973–1974. Experimental transmission studies were performed with bat bugs captured within the cave to determine the potential for vector-borne transmission, and sentinel laboratory mice placed inside arthropod-proof cages within the cave to assess the potential for aerosolized transmission. Antibodies to KKV were detected in roof rats (Rattus rattus) inhabiting the cave, in dogs living in the valley, and in humans. Freshly collected cimicids were positive for KKV, but the virus did not replicate in laboratory-inoculated bugs. Sentinel mice placed in Kaeng Khoi cave in open cages consistently became infected with KKV, as determined by the development of neutralizing antibodies. Mice placed in arthropod-proof cages also developed antibodies, indicating the possibility of airborne transmission of KKV.

Antimicrobial Resistance in Endemic Enteric Infections in Kenya and the Region, and Efforts Toward Addressing the Challenges

Resistance to commonly available antimicrobials is a major threat to the fight against endemic bacterial diseases in sub-Saharan Africa, with a majority of the population unable to afford alternative effective antimicrobial options for management of these diseases. Diseases such as typhoid, cholera, and invasive nontyphoidal Salmonella are among the key enteric infections endemic in most parts of sub-Saharan Africa, especially in displaced populations and among the urban populations living in overcrowded informal settlements. Here, we explore the prevalence and the genomic epidemiology of these infections and the growing problem of multidrug resistance, including emerging resistance to the last line of treatment for these infections. Prevalence rates to commonly available antimicrobials, including ampicillin, chloramphenicol, cotrimoxazole, and tetracycline, now range between 65% and 80%, while 15%–20% of recently studied isolates show reduced susceptibility to fluoroquinolones and emerging resistance to extended-spectrum β-lactams mediated by the CTX-M-15 gene carried on a highly mobile genetic element. The high prevalence of multidrug-resistant isolates including resistance to reserve antibiotics, calls for enhanced control and management options. It will be important for governments in the region to enhance the implementation of national action plans, as guided by the global action plan championed by the World Health Organization, to combat the threat of antimicrobial resistance. However, to yield meaningful results, these efforts will require a strong commitment and enhancement at all levels of healthcare in order. In addition, the use of World Health Organization–approved vaccines in the short to medium term and improvement of water and sanitation in the long term will reduce the burden of disease and antimicrobial resistance in the region.

A novel nairovirus associated with acute febrile illness in Hokkaido, Japan

The increasing burden of tick-borne orthonairovirus infections, such as Crimean-Congo hemorrhagic fever, is becoming a global concern for public health. In the present study, we identify a novel orthonairovirus, designated Yezo virus (YEZV), from two patients showing acute febrile illness with thrombocytopenia and leukopenia after tick bite in Hokkaido, Japan, in 2019 and 2020, respectively. YEZV is phylogenetically grouped with Sulina virus detected in Ixodes ricinus ticks in Romania. YEZV infection has been confirmed in seven patients from 2014–2020, four of whom were co-infected with Borrelia spp. Antibodies to YEZV are found in wild deer and raccoons, and YEZV RNAs have been detected in ticks from Hokkaido. In this work, we demonstrate that YEZV is highly likely to be the causative pathogen of febrile illness, representing the first report of an endemic infection associated with an orthonairovirus potentially transmitted by ticks in Japan.

Seroprevalence of bovine viral diarrhea virus (BVDV) infection in cattle population in Iran: a systematic review and meta-analysis.

Bovine viral diarrhea virus (BVDV) is an important pathogen correlated with reproductive, respiratory, and gastrointestinal disorders in cattle. Furthermore, it causes endemic infections and significant economic losses in cattle herds worldwide. This review was performed to determine the pooled seroprevalence of BVDV infection and related risk factors among cattle in Iran. Data were systematically gathered without time limitation until 1 December 2020 in the Islamic Republic of Iran from the following electronic databases: PubMed, Google Scholar, Science Direct, Scopus, Web of Science, Elmnet, Magiran, Irandoc, Scientific Information Database (SID), and Civilica. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 28 eligible studies were obtained from various Iran areas. In total, the pooled seroprevalence of BVDV infection, using random-effect model, was estimated 52% (95% CI, 40.1-63.9) in cattle. According to serological detection methods, pooled seroprevalence was as follows: based on ELISA 53.9% and SVN 25.1%. The highest pooled seroprevalence of BVDV infection was in the southeast provinces of Iran (78.4%) and lowest pooled seroprevalence was in Southwest provinces of the country (28.5%). The pooled seroprevalence of BVDV infection in cattle ≤ 2years was significantly lower than cattle > 2years (OR = 0.606; 95% CI, 0.397-0.925), whereas the pooled seroprevalence had no significant difference according to other factors such as gender, herd size, and herd types. In conclusion, the pooled seroprevalence of BVDV infection among cattle in Iran is relatively high. The seroprevalence was different among geographical regions of the country. These results are desirable for managing the control programs of this infection in Iran.

What Is the Part of Tropical Diseases Among Infectious Complications in Renal Transplant Recipients in the Amazon? A 12-Year Multicenter Retrospective Analysis in French Guiana

Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described. All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory. Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4). This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients.