Fever In Taiwan Research Articles

Improving dengue fever predictions in Taiwan based on feature selection and random forests

BackgroundDengue fever is a well-studied vector-borne disease in tropical and subtropical areas of the world. Several methods for predicting the occurrence of dengue fever in Taiwan have been proposed. However, to the best of our knowledge, no study has investigated the relationship between air quality indices (AQIs) and dengue fever in Taiwan.ResultsThis study aimed to develop a dengue fever prediction model in which meteorological factors, a vector index, and AQIs were incorporated into different machine learning algorithms. A total of 805 meteorological records from 2013 to 2015 were collected from government open-source data after preprocessing. In addition to well-known dengue-related factors, we investigated the effects of novel variables, including particulate matter with an aerodynamic diameter < 10 µm (PM10), PM2.5, and an ultraviolet index, for predicting dengue fever occurrence. The collected dataset was randomly divided into an 80% training set and a 20% test set. The experimental results showed that the random forests achieved an area under the receiver operating characteristic curve of 0.9547 for the test set, which was the best compared with the other machine learning algorithms. In addition, the temperature was the most important factor in our variable importance analysis, and it showed a positive effect on dengue fever at < 30 °C but had less of an effect at > 30 °C. The AQIs were not as important as temperature, but one was selected in the process of filtering the variables and showed a certain influence on the final results.ConclusionsOur study is the first to demonstrate that AQI negatively affects dengue fever occurrence in Taiwan. The proposed prediction model can be used as an early warning system for public health to prevent dengue fever outbreaks.

Strategies for Transboundary Swine Disease Management in Asian Islands: Foot and Mouth Disease, Classical Swine Fever, and African Swine Fever in Taiwan, Japan, and the Philippines.

Swine transboundary diseases pose significant challenges in East and Southeast Asia, affecting Taiwan, Japan, and the Philippines. This review delves into strategies employed by these islands over the past two decades to prevent or manage foot and mouth disease (FMD), classical swine fever (CSF), and African swine fever (ASF) in domestic pigs and wild boars. Despite socio-economic differences, these islands share geographical and climatic commonalities, influencing their thriving swine industries. Focusing on FMD eradication, this study unveils Taiwan's success through mass vaccination, Japan's post-eradication surveillance, and the Philippines' zoning strategy. Insights into CSF in Japan emphasize the importance of wild boar control, whereas the ASF section highlights the multifaceted approach implemented through the Philippine National ASF Prevention and Control Program. This review underscores lessons learned from gained experiences, contributing to a comprehensive understanding of swine disease management in the region.

Clinical manifestations and microbiological features between indigenous and imported enteric fever in Taiwan, 2010–2020

Previous studies had showed that indigenous clones of Salmonella Typhi and S. Paratyphi were originally imported from other countries in Taiwan. We presented the clinical manifestations and laboratory findings of indigenous and imported enteric fever cases in Taiwan in the current decade. We retrospectively reviewed typhoid and paratyphoid fever cases in two medical centers of Chang Gung Memorial Hospitals in 2010-2020. A total of 37 enteric fever cases including 24 typhoid fever and 13 paratyphoid fever were recorded. There were 20 indigenous cases, 16 imported cases, and one indetermined case. Splenomegaly and hepatitis were more frequent in typhoid fever than in paratyphoid fever (P<0.05). Imported cases had more ciprofloxacin non-susceptibility rate (8/16, 50.0%) than indigenous cases (2/20, 10%). Indigenous ciprofloxacin non-susceptible S. Typhi isolates were found in 2018. One indigenous S. Paratyphi B isolate was multi-drug resistant (MDR) to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole.

Genomic surveillance reveals international circulation and local transmission of Salmonella enterica serovars Typhi and Paratyphi A in Taiwan.

Morbidity and mortality from typhoid and paratyphoid fever remain an important problem for public health authorities in developing countries. In countries with lower incidences, most cases occur in travelers who visit regions in which typhoid and paratyphoid fever are highly endemic. The aim was to evaluate the source and transmission dynamics of typhoid and paratyphoid fever in Taiwan by using genomic analysis. During 2012-2019, 15 clinical isolates of Salmonella Typhi and S. Paratyphi A were collected. Demographic and clinical information of the infections were analyzed. We performed whole genome sequencing and evolutionary analysis on these isolates. Clinical and microbiological data from 7S. Typhi and 8S. Paratyphi A isolates in Taiwan showed epidemiological and bacterial genomic link to the infection in South and Southeast Asia. The Taiwanese typhoidal isolates also share highly similar genomes with those collected from UK, indicating global circulation of the typhoidal clones. Local transmission of the imported but indigenized international clones was observed. Mutations occurring at gyrA 83 aa, including S83Y and S83F, were identified in the ciprofloxacin-resistant strains. Due to the advance of global transportation and communication, the transmission mode of infectious disease has been modified. Domestic typhoid and paratyphoid fever caused by international resistant clones can occur in low-incidence countries. Genome analysis showed that the indigenous clone originally imported from other countries has been circulating in Taiwan for over a decade.

Incidence of dementia after dengue fever: Results of a longitudinal population-based study.

To investigate the epidemiological relationship between dengue fever and the subsequent development of dementia. Using nationwide Taiwan registries from the National Health Insurance Research (NHIRD), we identified adults aged over 40years who received a dengue fever diagnosis from 1 January 2000 to 31 December 2012 and who did not have a history of dementia. We used a propensity score match (PSM) to balance the baseline characteristics between groups. All eligible adults were sorted into either the dengue group or non-dengue group at a ratio of 1:4, matching by age, sex, index years, income level, and relevant comorbidities. Using Cox regression with proportional hazards models, we estimated the risk of dementia. The study period started from 1 January 2000 to 31 December 2013. We conducted sensitivity analyses to cross-validate study results. With a median of 8.01years of follow-up, patients in the dengue group were more at risk of developing dementia than the non-dengue group. The estimated cumulative incidence of dementia was 7.21% in the dengue group and 4.03% in the non-dengue group (adjusted hazard ratio (aHR), 1.71; 95% CI, 1.03 to 2.83). Sensitivity analyses yielded consistent findings. We excluded any stroke cases before the end of the study, and subgroup analysis by follow-up time showed that the dengue group has a significantly higher risk of new-onset dementia >6years after the index date (aHR 3.24; 95% CI, 1.42 to 7.37). The P value for interaction was significant (<.0001). This study demonstrated a significantly higher risk of dementia in patients with dengue fever in Taiwan than in those without dengue fever.

Retrospective Seroepidemiology study of dengue virus infection in Taiwan

BackgroundDengue virus infection has been an important and serious public health concern in Taiwan, where local outbreaks of dengue fever occurred almost every year. To our knowledge, no nationwide investigation has been carried out to determine the actual extent of infection in the general population.MethodsA total of 1308 random serum samples were collected from the general population in Taiwan in 2010. The antibody-captured enzyme-linked immunosorbent assays were used to detect DENV-specific IgM and IgG. Demographics data were used for risk analysis.ResultsThe weighted overall seroprevalence was 1.96% for anti-DENV IgM, and 3.4% for anti-DENV IgG, respectively. A significant rise of DENV IgG seropositive rate had been noted since late adulthood stage, from 1.1% at the age group of 50–59 years to 7.6% at the age group of 60–69 years. For people aged over 70 years, the seropositive rate reached 19%. Age, nationality, and regions of residency were associated with the IgG seropositivity. There was no statistically significant difference in seroprevalence of anti-Dengue IgM, indicating recent infection, among univariate predictors we proposed, including gender, age, residency, nationality, and household size.ConclusionsOur results indicated that the majority of population in Taiwan born after 1940 is naive to dengue virus and the prevalence of IgG antibody against dengue virus rises with age. Nationality, and regions of residency are associated with the exposure of population to infection by dengue viruses. Further studies are needed to realize the current situation of seroprevalence of dengue fever in Taiwan.

Helminthostachys zeylanica Water Extract Ameliorates Airway Hyperresponsiveness and Eosinophil Infiltration by Reducing Oxidative Stress and Th2 Cytokine Production in a Mouse Asthma Model.

Helminthostachys zeylanica is a traditional folk herb used to improve inflammation and fever in Taiwan. Previous studies showed that H. zeylanica extract could ameliorate lipopolysaccharide-induced acute lung injury in mice. The aim of this study was to investigate whether H. zeylanica water (HZW) and ethyl acetate (HZE) extracts suppressed eosinophil infiltration and airway hyperresponsiveness (AHR) in asthmatic mice, and decreased the inflammatory response and oxidative stress in tracheal epithelial cells. Human tracheal epithelial cells (BEAS-2B cells) were pretreated with various doses of HZW or HZE (1 μg/ml–10 μg/ml), and cell inflammatory responses were induced with IL-4/TNF-α. In addition, female BALB/c mice sensitized with ovalbumin (OVA), to induce asthma, were orally administered with HZW or HZE. The result demonstrated that HZW significantly inhibited the levels of proinflammatory cytokines, chemokines, and reactive oxygen species in activated BEAS-2B cells. HZW also decreased ICAM-1 expression and blocked monocytic cells from adhering to inflammatory BEAS-2B cells in vitro. Surprisingly, HZW was more effective than HZE in suppressing the inflammatory response in BEAS-2B cells. Our results demonstrated that HZW significantly decreased AHR and eosinophil infiltration, and reduced goblet cell hyperplasia in the lungs of asthmatic mice. HZW also inhibited oxidative stress and reduced the levels of Th2 cytokines in bronchoalveolar lavage fluid. Our findings suggest that HZW attenuated the pathological changes and inflammatory response of asthma by suppressing Th2 cytokine production in OVA-sensitized asthmatic mice.

Epidemiologic Characteristics of Imported and Domestic Chikungunya Cases in Taiwan: A 13-Year Retrospective Study.

Background: Chikungunya fever is caused by the chikungunya virus. Numerous factors affect the risk of chikungunya transmission. This study explored the epidemiological characteristics, differences, and trends in domestic and imported cases of chikungunya fever in Taiwan in terms of patient sex, age, month of confirmation, and area of residence from 2007 to 2019. Methods: Public annual chikungunya data from Taiwan’s Centers for Disease Control (CDC) were analyzed. In total, 21 confirmed domestic and 198 imported cases of chikungunya were reported. Of the domestic cases, one was sporadic and reported in July 2019, and 20 were attributed to a cluster event during August and September 2019. Results: In a comparison between domestic and imported cases reported from July to October 2019, differences in sex were nonsignificant (p = 0.555), whereas significant differences were observed for age (p < 0.001), month of confirmation (p = 0.005), and place of residence (p = 0.001). An age of 69–69 years (odds ratio (OR) = 6.66, 95% confidence interval (95%CI) = 2.15–20.65), month of confirmation of September (OR = 5.25, 95%CI = 1.89–14.61) and place of residence of New Taipei City (OR = 48.70, 95%CI = 6.17–384.44) were identified as potential risk factors. Additionally, domestic cases in August and September 2019 increased in proportion to the increase in imported cases during July and August 2019. Increased domestic patients may have been caused by the domestic mosquitoes that transmitted the virus by biting the imported patients to Taiwan. This is the first report comparing domestic and imported cases of chikungunya from surveillance data from the Taiwan CDC from 2007 to 2019. Conclusion: This study highlights the importance of longitudinal and geographically extended studies to understand the implications of zoonotic disease transmission on Taiwan’s population. Critical data were identified to inform future surveillance and research efforts in Taiwan.

The first imported case of extensively drug-resistant Salmonella enterica serotype Typhi infection in Taiwan and the antimicrobial therapy.

The first imported case of XDR typhoid fever in Taiwan contracted with a bacterial strain, which was most closely related to the blaCTX-M-15-carrying strains linked to Pakistan. Meropenem, in combination with an antimicrobial with intracellular activity against Salmonella, should be used for the treatment of XDR typhoid fever.

Detecting spatio-temporal hotspots of scarlet fever in Taiwan with spatio-temporal Gi* statistic.

A resurgence of scarlet fever has caused many pediatric infections in East Asia and the United Kingdom. Although scarlet fever in Taiwan has not been a notifiable infectious disease since 2007, the comprehensive national health insurance data can still track its trend. Here, we used data from the open data portal of the Taiwan Centers for Disease Control. The scarlet fever trend was measured by outpatient and hospitalization rates from 2009 to 2017. In order to elucidate the spatio-temporal hotspots, we developed a new method named the spatio-temporal Gi* statistic, and applied Joinpoint regression to compute the annual percentage change (APC). The overall APCs in outpatient and hospitalization were 15.1% (95% CI: 10.3%-20.2%) and 7.7% (95%CI: 4.5% -10.9%). The major two infected groups were children aged 5–9 (outpatient: 0.138 scarlet fever diagnoses per 1,000 visits; inpatient: 2.579 per 1,000 visits) and aged 3–4 (outpatient: 0.084 per 1,000 visits; inpatient: 1.469 per 1,000 visits). We found the counties in eastern Taiwan and offshore counties had the most hotspots in the outpatient setting. In terms of hospitalization, the hotspots mostly occurred in offshore counties close to China. With the help of the spatio-temporal statistic, health workers can set up enhanced laboratory surveillance in those hotspots.

Coma Secondary to Rickettsia typhi

SESSION TITLE: Student/Resident Critical Care SESSION TYPE: Student/Resident Case Report Slide PRESENTED ON: Tuesday, October 31, 2017 at 04:30 PM - 05:30 PM INTRODUCTION: Rickettsia typhi is an obligate intracellular gram-negative organism that is transmitted by fleas. It causes murine typhus, which is often misdiagnosed due to its indolent and non-specific disease course and underestimated incidence, making it a diagnostic challenge (1). CASE PRESENTATION: An indigent male was brought in by ambulance for seizures during the summer. Physical examination was unremarkable except for fever and Glasgow Coma Score (GCS) of 3. He was intubated for airway protection. Laboratory values were significant for leukocytosis, thrombocytopenia, hyponatremia and elevated lactate dehydrogenase (LDH) of 400 units. Lumbar puncture and computed tomography brain were normal. Despite two weeks of empiric antibiotic therapy, cultures remained negative and the patient continued to have persistent fevers with GCS 3. At the end of the two weeks, a rash was discovered and a rickettsia panel was sent. It returned positive for murine typhus. After initiating treatment with doxycycline, patient became more responsive within a day, was liberated from the ventilator by day 4, and subsequently made a full recovery. DISCUSSION: Murine typhus, which is transmitted by Rickettsia typhi, is characterized by a classic triad of fever, rash and headache, but the entire triad is only reported in 35.1% of cases. In a large review of 1756 patients, only 26.1% developed complications, with 121 patients developing pulmonary infiltrates, 69 patients developing central nervous system involvement and 3 patients developing seizures. This finding makes the patient's presentation exceedingly rare. The review also observed a characteristic tetrad of laboratory abnormalities consisting of transaminitis, elevated LDH, a high erythrocyte sedimentation rate, and hypoalbuminemia. The tetrad was followed by thrombocytopenia and hyponatremia, which were also observed in this patient in addition to the tetrad. This case study demonstrates the diagnostic challenge presented to clinicians in a patient with altered mental status. Treatment of choice is empiric coverage with doxycycline, chloramphenicol, or quinolones, which should not be delayed while awaiting diagnostic confirmation (1,2,3). CONCLUSIONS: We present a case of a rare but possibly life threatening murine typhus, which should be kept in the differential for patients with fever and altered mental status. Reference #1: Tsioutis, C et al. (2017). Clinical and laboratory characteristics, epidemiology, and outcomes of murine typhus: A systematic review. Acta Tropica, 166, 16-24. Reference #2: Phongmany, S. et al. (2006). Rickettsial infections and fever, Vientiane, Laos. Emerging infectious diseases, 12(2), 256. Reference #3: Chang, K. et al. (2014). Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. Journal of Microbiology, Immunology and Infection. DISCLOSURE: The following authors have nothing to disclose: Ki-Yoon Kim, John Kern, Ahmet Baydur, Zea Borok, Terese Hammond No Product/Research Disclosure Information

Effects of local and regional climatic fluctuations on dengue outbreaks in southern Taiwan.

BackgroundSouthern Taiwan has been a hotspot for dengue fever transmission since 1998. During 2014 and 2015, Taiwan experienced unprecedented dengue outbreaks and the causes are poorly understood. This study aims to investigate the influence of regional and local climate conditions on the incidence of dengue fever in Taiwan, as well as to develop a climate-based model for future forecasting.Methodology/Principle findingsHistorical time-series data on dengue outbreaks in southern Taiwan from 1998 to 2015 were investigated. Local climate variables were analyzed using a distributed lag non-linear model (DLNM), and the model of best fit was used to predict dengue incidence between 2013 and 2015. The cross-wavelet coherence approach was used to evaluate the regional El Niño Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD) effects on dengue incidence and local climate variables. The DLNM results highlighted the important non-linear and lag effects of minimum temperature and precipitation. Minimum temperature above 23°C or below 17°C can increase dengue incidence rate with lag effects of 10 to 15 weeks. Moderate to high precipitation can increase dengue incidence rates with a lag of 10 or 20 weeks. The model of best fit successfully predicted dengue transmission between 2013 and 2015. The prediction accuracy ranged from 0.7 to 0.9, depending on the number of weeks ahead of the prediction. ENSO and IOD were associated with nonstationary inter-annual patterns of dengue transmission. IOD had a greater impact on the seasonality of local climate conditions.Conclusions/SignificanceOur findings suggest that dengue transmission can be affected by regional and local climatic fluctuations in southern Taiwan. The climate-based model developed in this study can provide important information for dengue early warning systems in Taiwan. Local climate conditions might be influenced by ENSO and IOD, to result in unusual dengue outbreaks.

Forecasting the transmission of dengue fever in Taiwan based on spatiotemporal trend analysis

There are round 1,500 cases of Dengue Fever (DF) which are reported annually and the DF incidence has seen an exponential growth over the last decade in Taiwan. This study aims to investigate the dynamic spatiotemporal trend of DF incidence (locally-acquired DF and imported DF) and forecast the transmission possibilities of DF in next few years in Taiwan. Methods: Data was retrieved from the Centers for Disease Control, R.O.C.(Taiwan) and spatial cluster analysis was used to display the spatial distribution and high risk areas of DF in the city level throughout the three periods of 2003–2006, 2007-2010 and 2011–2014. Time series regression model and Bayesian spatial Kriging technique were used to forecast the distribution of locally-acquired DF and imported DF incidences in Taiwan for 2015–2018 and 2019–2022. Results: The results indicate that the spatial distribution of DF was clustered during each of the three periods of 2003–2006, 2007-2010 and 2011–2014. The high-incidence clusters of local DF were pr...

Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan.

Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors. We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals. Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase>aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9mg/L, absence of bone pain, and absence of a bleeding syndrome. Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment.

Parental Knowledge, Concerns, and Management of Childhood Fever in Taiwan

Childhood fever is a commonly treated condition in medical settings. Many studies around the world have reported on the phenomenon of parental fever phobia. Studies of parental knowledge regarding childhood fever are lacking in Taiwan. This study explores parental knowledge, concerns, and management of childhood fever and their correlates in Taiwan. This study used a cross-sectional survey and self-administered questionnaire. Six hundred forty-nine parents were recruited as participants from pediatric clinics and kindergartens in southern Taiwan. Nearly half (47.2%) of participants incompletely understood the healthcare information about childhood fever provided by physicians and nurses. Furthermore, 41.6% of parents were dissatisfied with the information provided. The median score of parental knowledge was 10 (interquartile range [IQR] = [8, 12] out of a maximum of 23). Parent gender, religion, education level, and occupation were independent predictors of knowledge scores. Parents who were never or sometimes concerned about childhood fever had significantly higher knowledge scores than those who were always concerned about childhood fever (median knowledge score: 11, IQR = [9, 13] vs. 10, IQR = [8, 11]). Most parents followed Western medical advice to manage childhood fever; however, 31.1% of parents combined this with traditional folk treatments. Levels of concern among parents included 86.6% of parents who frequently or always worried about their children's fever. Fever-induced anxiety was reported by 68.8% of the parents. Participants' lack of fever-related knowledge was because, in part, of either their not understanding or their dissatisfaction with provided information. The higher level of concern compared with other countries and studies indicates that parents in Taiwan need appropriate information about fever management to alleviate their concerns and guide them in caring for their febrile children.

An Integrated Syndromic Surveillance System for Monitoring Scarlet Fever in Taiwan

In 2011, Hong Kong, being so close geographically to Taiwan, had encountered an outbreak of scarlet fever. In response, Taiwan Centers for Disease Control developed a timely integrated syndromic surveillance system using daily updated data from National Health Insurance (scarlet fever ICD-9-CM code 034.1) and death certifications (cause of death text mining with keywords "scarlet fever", "group A streptococcus" or "toxic shock syndrome") since July 2011. Interagency collaborations add values to existing health data in the government and have strengthened the capacity of disease surveillance in Taiwan.

Chemical Characterization and In Vivo Anti-Inflammatory Activities of Actinidia callosa var. ephippioides via Suppression of Proinflammatory Cytokines

Actinidia callosa var. ephippioides (ACE) has been widely used to treat anti-pyretic, antinociceptive, anti-inflammation, abdominal pain and fever in Taiwan. This study aims to determine the mechanism of anti-inflammatory activities of ethyl acetate fraction of ACE (EA-ACE) using a model of λ-carrageenan (Carr)-induced paw edema in mouse model. In HPLC analysis, chemical characterization of EA-ACE was established. In order to investigate the anti-inflammatory mechanism of EA-ACE, we have detected the activities of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) and the levels of malondialdehyde (MDA) in the paw edema. Serum NO, tumor necrosis factor α (TNF-α), and interleukin-1β (IL-1β) were evaluated. Chemical characterization from HPLC indicated that EA-ACE contains betulinic acid, ursolic acid and oleanolic acid. In the anti-inflammatory test, EA-ACE decreased the paw edema after Carr administration, increased the activities of CAT, SOD, and GPx and decreased the MDA level in the edema paw at the 5th hr after Carr injection. EA-ACE affects the serum NO, TNF-α, and IL-1β levels at the 5th hr after Carr injection. EA-ACE decreased Carr-induced inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expressions by Western blotting. Actinidia callosa var. ephippioides have the potential to provide a therapeutic approach to inflammation-associated disorders.

Antioxidant, Antinociceptive, and Anti-Inflammatory Activities from Actinidia callosa var. callosa In Vitro and In Vivo.

Actinidia callosa var. callosa has been widely used to treat antipyretic, analgesic, anti-inflammation, abdominal pain, and fever in Taiwan. The aim of this study was to evaluate the antioxidant, antinociceptive, and anti-inflammatory lipopolysaccharide-(LPS-)induced nitric oxide (NO) production in RAW264.7 macrophages and pawedema induced by λ-carrageenan activities of the methanol extract from A. callosa. In HPLC analysis, the fingerprint chromatogram of ethyl-acetate fraction of A. callosa (EAAC) was established. EAAC showed the highest TEAC and DPPH radical scavenging activities, respectively. We evaluated that EAAC and the reference compound of catechin and caffeic acid decreased the LPS-induced NO production in RAW264.7 cells. Treatment of male ICR mice with EAAC significantly inhibited the numbers of acetic acid-induced writhing response and the formalin-induced pain in the late phase. Administration of EAAC showed a concentration-dependent inhibition on paw edema development after Carr treatment in mice. Anti-inflammatory mechanisms of EAAC might be correlated to the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and heme oxygenase-1 (HO-1) in vitro and in vivo. Overall, the results showed that EAAC demonstrated antioxidant, antinociceptive, and anti-inflammatory activity, which supports previous claims of the traditional use for inflammation and pain.

Identification of Risk Factors of Coxiella burnetii (Q fever) Infection in Veterinary‐Associated Populations in Southern Taiwan

The first case of Q fever in Taiwan was reported in 1993. The disease is considered to be emerging in Taiwan, but the route of transmission has remained unclear. The annual number of confirmed Q fever cases has been increasing up to more than 100 cases since 2005, comparing with less than 30 before 2003. The purpose of this study was to determine the seroprevalence and risk factors of Coxiella burnetii infection in veterinary-associated populations in southern Taiwan. A total of 228 serum samples of high risk individuals engaging in veterinary-related work or animal-farm work, were collected between March and June in 2007. The study individuals were interviewed by a structured questionnaire designed for Q fever investigation. Serum samples from different animal species were also obtained for Q fever analysis in the same study areas. Serological test was conducted by indirect immunofluorescence antibody assay (IFA). The result demonstrated the overall seroprevalence of Q fever was 26.3% in individuals engaging in veterinary and animal-related work in southern Taiwan. After multiple logistic regression analysis, goat exposure was significantly associated with seropositivity of Q fever in the study population in southern Taiwan (adjusted odds ratio: 2.62; 95% CI: 1.06-6.46). In addition, the highest seroprevalence (43.8%) of Q fever was identified in goats (P < 0.05). Finally, this study documented that people with prior knowledge of Q fever were less likely to be seropositive for C. burnetii. It was concluded that goat exposure was the most important risk factor associated with C. burnetii infection and appropriate health education could be useful to prevent high risk individuals from the infection in southern Taiwan.

Comparison of the effects of oral hydration and intravenous fluid replacement in adult patients with non-shock dengue hemorrhagic fever in Taiwan

The level of plasma leakage is mild to moderate in patients with non-shock dengue hemorrhagic fever (DHF grade I and grade II), and the necessity of intravenous fluid replacement for these patients remains controversial. We conducted an observational study in adult patients (>18 years) with non-shock DHF admitted to a medical centre in southern Taiwan comparing the effects of oral hydration [group 1 ( n = 19); age (mean ± SD) 54.6 ± 15.5 years] and intravenous fluid replacement, with a volume of >40 ml/kg/day in the first 72 h of hospitalization [group 2 ( n = 30); age 55.9 ± 11.6 years]. No significant difference was found in demographics, clinical manifestations, and mean peak level of hematocrit between the two groups. Patients in group 2 had a significantly longer hospital stay compared to those in group 1 ( P = 0.007), and there was a trend suggesting patients in group 2 were prone to develop pleural effusion and/or pulmonary edema. No difference was found in daily mean pulse pressure, mean hematocrit level, and mean platelet count between the groups for the duration of the 7 days in hospital. All 49 patients survived. Our data suggest that oral hydration may be as effective as intravenous fluid replacement for adults with non-shock DHF and this warrants investigation in a larger series of patients.