Fever Virus Research Articles

The European Mobile Laboratory: key insights from a decade of outbreak response

Abstract EMLab has responded to emergencies including the West Africa Ebola virus outbreak (2014-2016), the COVID-19 pandemic, and outbreaks of yellow fever, Marburg virus, and Lassa fever. It has deployed mobile labs and experts to many countries, including Guinea, Liberia, Sierra Leone, Nigeria, Uganda, the Democratic Republic of the Congo, Germany, and Greece. With accumulated experience from each deployment, EMLab’s diagnostic expertise has evolved beyond RT-PCR and serological testing to include basic point-of-care tests, haematology, and genomic surveillance capacities, also focusing on interoperability with other response capacities such as EMTs. Critical to mission success, the organization works closely with the WHO and GOARN, and was certified in 2023 as an official German response capacity within the European Civil Protection Pool. The two-year continuous deployment from 2014-2016 was pivotal in shaping EMLab’s evolution, also leading to significant capacity-building efforts in West Africa. In Guinea, for example, a surveillance network of three diagnostic laboratories has been established and successfully detected cases of viral haemorrhagic fevers, including the re-emergence of Ebola virus and the first reported case of Marburg virus in Guinea in 2021. Ultimately, EMLab’s extensive experience demonstrates that effective public health emergency response requires constant evolution, strategic partnerships, and a commitment to building local capacities, paving the way for a more resilient and prepared global health community.

Coinfection with Canine Distemper Virus and Yellow Fever Virus in a Neotropical Primate in Brazil

We describe a natural coinfection with canine distemper virus (CDV) and yellow fever virus in a free-ranging neotropical primate of the genus Callithrix, found dead in the northeastern region of Brazil. The laboratory diagnosis included histopathology, immunohistochemistry, rRT-PCR, and phylogenetic analyses. The CDV sequences from this primate in Brazil represent a divergent lineage in Rio Grande do Norte, closely related to genotypes EU1/South America 1 and South America 2. To our knowledge, this is the first report of natural coinfection by CDV and yellow fever virus in a neotropical primate, underscoring the need to further investigate the circulation of this virus in Brazilian nonhuman primates and its potential implications for wildlife conservation.

Sero-epidemiological Study of Japanese Encephalitis in Some Selected Hospitals of Nepal

Japanese encephalitis is a major public health problem in Nepal, about 1000-3000 cases and 200-300 deaths reported annually, mainly in endemic areas and sporadic cases have also been reported from non-endemic areas such as Kathmandu. The diagnosis of JE is based on clinical signs and symptoms. This study was conducted in some hospitals of Nepal to find the epidemiological trend of the disease. Serological surveys have revealed that about 10 % of people living in JE endemic areas are infected with the virus, most of whom are infected before age 15. This type of study is essential to be carried out in our country to know the seroepidemiology of the JE virus. A descriptive cross-sectional study was conducted, and 267 serum samples from suspected Acute Encephalitis Syndrome and viral fever cases were collected from three different hospitals in Nepal. The results were confirmed by an IgM capture enzyme-linked immunosorbent assay. Of 267 serum samples, 242(90.6%) were clinical suspects of Acute Encephalitis Syndrome, and 25(9.4%) were clinical suspects of viral fever. Of 267 cases, 84(34.7%) Acute Encephalitis Syndrome cases and nine (36.0%) viral fever cases were positive for anti-Japanese encephalitis virus IgM antibodies. The seropositivity was higher in males 60(39.9%) than in females 33 (29.2%). Out of the total positive cases, the highest seropositivity (40.2%) was observed in the age group 15-50, and the least (25.0%) was observed in the age group above 50. Tribhuvan University Teaching Hospital accounts for highest seropositivity (36.6%) and the least (32.2%) in Bheri Zonal Hospital. The overall seropositivity rate was found to be 34.8% which was higher than the national data (21.6%). This study reports that the seropositivity was higher than national figure and the seroepidemiology pattern of JE has changed, indicating a need for urgent intervention. Diagnostic facilities should be expanded in every hospital in the endemic region of Japanese Encephalitis for better surveillance.

7527 Subacute Thyroiditis in First Trimester of Pregnancy: Rare Cause of Thyrotoxicosis

Abstract Disclosure: K. Wilcher: None. A. Gupta: None. Background: Subacute thyroiditis (SAT) is extremely rare in pregnancy with only 8 prior cases reported in the literature. SAT can result in maternal and fetal complications. In this case report, we describe a case of subacute thyroiditis presenting in the first trimester of pregnancy. Case Presentation: A 38-year-old female with past medical history of stillbirth presented with thyrotoxicosis in gestational week 10 of her pregnancy. The patient has a history of stillbirth in gestational week 38 of her first pregnancy requiring cesarean section one year prior to presentation. She was in the process of getting in vitro fertilization (IVF) and had an egg retrieval. During the process, she started on thyroxine 50 mcg daily for blood thyroid-stimulating hormone (TSH) 3.77 mcIU/mL. She became pregnant without the help of IVF and stopped thyroxine. One month later, labs showed low TSH 0.022 mcIU/mL (reference range: 0.4-4.5 mcIU/mL) and high blood free thyroxine (FT4) 1.87 ng/dL (reference range: 0.7-1.8 ng/dL). Repeat labs two weeks later showed low blood TSH 0.012 mcIU/mL, high FT4 2.08 ng/dL, and high blood free triiodothyronine (FT3) 5.2 pg/mL (reference range: 2.3-4.2 pg/mL). She was referred to endocrinology for evaluation. She reported mild intermittent right sided neck pain since diagnosis of pregnancy. She denied any history of viral infection, cough, or fever. She reported symptoms of severe nausea, mild constipation, and mild anxiety. She denied diarrhea, tremors, changes in voice, palpitations, or weight loss. Her family history is significant for hypothyroidism in her father. Physical exam demonstrated a non-tender, symmetric thyroid without enlargement or nodules. Ultrasound showed heterogenous thyroid with an ill-defined heterogenous area in the right lobe appearing pseudo-nodule, and increased vascularity. At this time, the patient was diagnosed with mild gestational hyperthyroidism with a plan to monitor thyroid hormone levels. Repeat labs two weeks later showed low blood TSH 0.005 mcIU/mL, high FT4 2.35 ng/dL, and high FT3 6.4 pg/mL. TSH-receptor antibodies, thyroid stimulating immunoglobulin, and thyroid peroxidase antibodies were normal on testing. In gestational week 16, labs showed normal TSH 2.76 mcIU/mL, low FT4 0.56 ng/dL, and low FT3 2.1 pg/mL. At that time, she started on levothyroxine 75 mcg daily and was diagnosed with subacute thyroiditis. Follow up labs in gestational weeks 18, 20, and 24 showed improvement in TSH and FT4 on thyroid hormone supplementation. Conclusion: This case report discusses the findings of SAT in first trimester pregnancy. Currently, she is in gestational week 28 and still requiring thyroid hormone supplementation. SAT in pregnancy is very rare. This case report significantly contributes to the literature and current knowledge of the prevalence, presentation, and disease process of subacute thyroiditis in first trimester pregnancy. Presentation: 6/2/2024

The poster boys of aspirational labor: parables of success and failure in The Viral Fever’s web shows

Abstract Aspirational labor has been understood by scholars based in the Global North to encapsulate a form of labor undertaken by social media content creators that is mostly uncompensated for, but is, nonetheless, integral to the functioning of its economy. While this dominant theorization of aspirational labor is sometimes helpful for explaining the precarity of digital media labor in countries of the Global South, its uncritical application could also be severely limiting. I undertake a close textual analysis of select web shows created by the entertainment brand and YouTube content creators The Viral Fever (TVF) to demonstrate how it would be imprecise to see them as just victims of an exploitative economy. My article shows how TVF web shows consistently imagine elaborate cinematic narratives that valorize and embody the neoliberal values of aspiration and individual growth that in turn is complicit in the machinations of platform economy’s extractive affordances.

Vector Borne Disease Ecology and Environment: Remote Sensing and GIS for Control and Management: A Systematic Review

The prevalence of vector borne disease epidemics are influenced by the thickness of the vectors persistent to climate, landscape, and environment. Historically evidenced of triggering epidemics in both vertical magnitude and horizontal spread (spatial diffusion) of increasing vector borne diseases, such as; malaria, dengue, chikungunya, Japanese encephalitis, filariasis, leishmaniases, scrub typhus, Kyasanur forest disease (KFD), West Nile virus, Lyme disease, Zika virus, and Rift valley fever in the tropical and subtropical regions, particularly, in the third world countries for the past several decades. The geographical analysis of each one VBD epidemics has a unique vector ecology and environment. The prevalence of epidemic distribution patterns and seasonal variations, and associated vector ecology were analyzed throughout the world for the past periods, in order to assess the probability of potential risk and delineate the hotspot regions susceptible to the VBD outbreaks in the country, using Remote Sensing and GIS mapping analysis. It offers a quick and efficient approach to mapping of land uses/land cover patterns and its changes over space and time, and the information on these changes linking with vector profusion and disease ecology. Vector-borne disease epidemics across the country have been evidently associated with climate factors, landscape changes, potential breeding sources; such as, water bodies, rivers, streams, and mega water resource irrigation projects, dams / reservoirs, water pools, lakes, urban agglomerations, Urban sprawl, urban dynamics, industrial developments and growths, floating population, urban migration, land use / land cover changes, wet irrigation agriculture practices, seasonal migrations on occupation, cargo shipping movements, trade and commerce, etc., and have been acted upon changing the aboriginal territories by extent of epidemic scenarios into the non-endemic regions. The integrated Earth Observation Resource Satellite data integrated with GIS has effectiveness upon proved to disease mapping, ecological niche modeling, risk assessment, spatial prediction, and offering answers to both the public health programmers and research scientists concerned on vector fecundity, and vector borne disease ecology, and thus, the geographical, ecological and environmental determinants of its range is considered to be essential for sustainable public health planning. Accordingly, prevention measures and appropriate control strategy may possibly be applied during the sporadic outbreaks situations in the new epidemic regions as well in the hot spot endemic regions regularly, so as to control the erratic transmission and prevent acceleration of epidemics early in advance successfully.

Mosquito dynamics and their drivers in peri-urban Antananarivo, Madagascar: insights from a longitudinal multi-host single-site survey

BackgroundAntananarivo, the capital city of Madagascar, is experiencing a steady increase in population growth. Due to the abundance of mosquito vectors in this locality, the population exposed to mosquito-borne diseases is therefore also increasing, as is the risk of epidemic episodes. The aim of the present study was to assess, in a resource-limited setting, the information on mosquito population dynamics and disease transmission risk that can be provided through a longitudinal entomological study carried out in a multi-host single site.MethodsMosquitoes were collected every 15 days over 16 months (from January 2017 to April 2018) using six CDC-light traps in a peri-urban area of Antananarivo. Multivariable generalised linear models were developed using indoor and outdoor densities of the predominant mosquito species as response variables and moon illumination, environmental data and climatic data as the explanatory variables.ResultsOverall, 46,737 mosquitoes belonging to at least 20 species were collected, of which Culex antennatus (68.9%), Culex quinquefasciatus (19.8%), Culex poicilipes (3.7%) and Anopheles gambiae sensu lato (2.3%) were the most abundant species. Mosquito densities were observed to be driven by moon illumination and climatic factors interacting at different lag periods. The outdoor models demonstrated biweekly and seasonal patterns of mosquito densities, while the indoor models demonstrated only a seasonal pattern.ConclusionsAn important diversity of mosquitoes exists in the peri-urban area of Antananarivo. Some well-known vector species, such as Cx. antennatus, a major vector of West Nile virus (WNV) and Rift-Valley fever virus (RVFV), Cx. quinquefasciatus, a major vector of WNV, Cx. poicilipes, a candidate vector of RVFV and An. gambiae sensu lato, a major vector of Plasmodium spp., are abundant. Importantly, these four mosquito species are present all year round, even though their abundance declines during the cold dry season, with the exception of Cx. quinquefasciatus. The main drivers of their abundance were found to be temperature, relative humidity and precipitation, as well as—for outdoor abundance only—moon illumination. Identifying these drivers is a first step towards the development of pathogen transmission models (R0 models), which are key to inform public health stakeholders on the periods of most risk for vector-borne diseases.Graphical

Real-time quantitative reverse transcription PCR assay for the detection of Nuomin virus – An emerging tick-borne virus

Nuomin virus (NOMV), an emerging tick-borne virus (TBVs) identified in 2020, has been associated with fever, headache, and potential liver dysfunction in infected individuals. This study presents a novel TaqMan real-time quantitative PCR method designed for the rapid, sensitive, and specific detection of NOMV, facilitating early diagnosis. Utilizing Beacon Designer software 8.0, we optimized the PCR assay including the development of primers and probes to precisely target the conserved region of the NOMV genome, followed by optimization of primer and probe concentrations and annealing temperature. The resulting assay demonstrated robust performance, with standard curve represented by the equation y=−3.29x+39.42, a high correlation coefficient (R2 = 0.995) and an efficiency 99.53 %. Importantly, the method exhibited exceptional specificity, which did not yield cross-reacting signals from other TBVs, including Songling virus (SGLV), Beiji virus (BJNV), tick-borne encephalitis virus (TBEV), Yezo virus (YEZV), Alongshan virus (ALSV), and severe fever with thrombocytopenia syndrome bunyavirus (SFTSV). The assay’s detection limit was remarkably low, reaching 10 copies/μL, representing a 100-fold increase compared to semi-nested RT-PCR. Additionally, it demonstrated excellent repeatability, with coefficients of variation for intra- and inter-group tests consistently below 3 %. Clinical evaluations confirmed the assay’s superior performance, highlighting its high specificity, sensitivity, and reproducibility for NOMV detection. In conclusion, the method developed in this study provides a valuable tool to support timely management of NOMV infections, with significant implications for clinical practice.

A recombinant pseudorabies virus surface - displaying the classical swine fever E2 protein induces specific antibodies rapidly

Pseudorabies virus (PRV) and classical swine fever virus (CSFV) are both economically important pathogens threatening the pig industry in many countries. The triple-gene-deleted variant of PRV, herein referred to as rPRVTJ-delgE/gI/TK, has exhibited pronounced efficacy and safety profiles. This underscores its viability as a prospective vaccine vector. However, the generation of specific anti-E2 antibodies necessitates elevated immunization doses and extended durations when the extracellular domain of the E2 protein of CSFV is secreted via the recombinant rPRVTJ-delgE/gI/TK vector. To enhance the presentation of exogenous antigens by antigen-presenting cells (APCs), we engineered the E2 protein expressed on the surface of PRV particles in this study. The recombinant virus expressing the E2 protein with a heterogonous transmembrane domain was generated in the backbone of rPRVTJ-delgE/gI/TK and designated as rPRVTJ-UL44-E2. The E2 gene was fused to the 3′ terminus of the UL44 gene utilizing P2A, a self-cleaving peptide sequence. The electron microscopy showed that the E2 protein was anchored on the surface of the viral particles of rPRVTJ-delgE/gI/TK-E2. The insertion of the E2 gene did not alter the native biological characteristics of the viral vector. Rabbits immunized with 107 median tissue culture infective doses (TCID50) of rPRVTJ-UL44-E2 exhibited a rapid seroconversion to anti-E2 specific antibodies within 7 days post-immunization (dpi). All the rabbits immunized with the rPRVTJ-UL44-E2 had generated antibodies specific to E2 prior to the administration of the booster immunization. However, the immunized rabbits were not protected from the CSFV C-strain challenge. Nevertheless, this strategy has notably achieved rapid induction of E2-specific non-neutralizing antibodies. These findings provide insights that the design of rPRVTJ-UL44-E2 requires optimization, thereby indicating a promising avenue for augmenting vaccine-induced immune responses.

Validation of a direct multiplex real-time reverse transcription PCR assay for rapid detection of African swine fever virus using swine field samples in Vietnam

ObjectiveThis study validates a direct multiplex real-time reverse transcription polymerase chain reaction (rRT-PCR) assay which was previously established for enabling rapid and simultaneous detection of African swine fever (ASF) virus (ASFV) and classical swine fever virus. The assay eliminates the need for viral nucleic acid purification using a buffer system for crude extraction and an impurity-tolerant enzyme. However, the assay had not yet been validated using field samples of ASFV-infected pigs. Therefore, to address this gap, we tested 101 samples collected from pigs in Vietnam during 2018 and 2021 for validation.ResultsThe rRT-PCR assay demonstrated a diagnostic sensitivity of 98.8% and a specificity of 100%. Remarkably, crude samples yielded results comparable to those of purified samples, indicating the feasibility of using crude samples without compromising accuracy in ASFV detection. Our findings emphasize the effectiveness of the rRT-PCR assay for the prompt and accurate diagnosis of both swine fever viruses, which is essential for effective disease prevention and control in swine populations.

Large-Scale Serological Survey of Crimean-Congo Hemorrhagic Fever Virus and Rift Valley Fever Virus in Small Ruminants in Senegal.

Crimean-Congo hemorrhagic fever (CCHF) and Rift Valley fever (RVF) are among the list of emerging zoonotic diseases that require special attention and priority. RVF is one of the six priority diseases selected by the Senegalese government. Repeated epidemic episodes and sporadic cases of CCHF and RVF in Senegal motivated this study, involving a national cross-sectional serological survey to assess the distribution of the two diseases in this country throughout the small ruminant population. A total of 2127 sera from small ruminants (goat and sheep) were collected in all regions of Senegal. The overall seroprevalence of CCHF and RVF was 14.1% (IC 95%: 12.5-15.5) and 4.4% (95% CI: 3.5-5.3), respectively. The regions of Saint-Louis (38.4%; 95% CI: 30.4-46.2), Kolda (28.3%; 95% CI: 20.9-35.7), Tambacounda (22.2%; 95% CI: 15.8-28.6) and Kédougou (20.9%; 95% CI: 14.4-27.4) were the most affected areas. The risk factors identified during this study show that the age, species and sex of the animals are key factors in determining exposure to these two viruses. This study confirms the active circulation of CCHF in Senegal and provides important and consistent data that can be used to improve the surveillance strategy of a two-in-one health approach to zoonoses.

A Study of Neurological Involvement in Dengue and Chikungunya Infection.

Chikungunya virus (CHIKV) and dengue fever have been reported for recent epidemics worldwide, with varied clinical involvement. Chikungunya was first reported to affect the nervous system in the 1960s. The clinical profile of dengue with multi-organ involvement is varied with reported involvement of the central nervous system in some. The aim of this study was to study the frequency and pattern of neurological involvement in patients admitted with dengue and chikungunya in a tertiary care hospital. Patients admitted with confirmed chikungunya and dengue were evaluated clinically and investigations were enrolled in the study. Patients with preexisting neurological issues, obvious metabolic, vascular, or septic causes for neurological involvement were excluded from the study. A total of 309 patients with chikungunya were included in the study. Out of these, 11 (3.56%) patients were found to have neurological involvement. The most common presentations were altered sensorium (100%) followed by headache (81.81%). The relative risk of mortality in patients with neurological involvement due to chikungunya was 7.96. A total of 443 patients with dengue fever were enrolled in the study. Out of these, 5 (1.10%) patients were found to have neurological involvement. The most common presentations were altered sensorium and headache (100%), followed by vomiting (80%). The relative risk of mortality in patients with neurological involvement due to dengue was 5.15. The recent epidemic of chikungunya and dengue virus infections was associated with various neurological complications. Neurological involvement of chikungunya and dengue was identified to be a bad prognostic factor with significantly higher mortality. This is a single center study, involving only the patients admitted to the hospital. Furthermore, being an observational study, follow-up could not be done to look for neurological sequelae.

Clinicohematological Profile of Patients with Bicytopenia

Abstract Background Bicytopenia (BC) is a reduction in counts in any of two cell lineages of blood, which can be a combination of anemia with thrombocytopenia, anemia with leukopenia, or leukopenia with thrombocytopenia. The etiology of BC can be a malignancy, nonmalignant disease, infectious cause, or drug-induced. Aim To assess the clinicohematological profile in patients with BC. Materials and Methods This prospective study was conducted in the hematology laboratory at the Justice K.S. Hegde Charitable Hospital. Patients with BC detected during the analysis of blood for any clinical condition were included in the study. Blood parameters assessed were hemoglobin, red blood cell count, total leukocyte count, and platelet count. Results In this study, 86 patients' samples with BC were collected, out of which 55.8% were male, and 44.2% were female. The most common BC was anemia with thrombocytopenia (69.8%). The most common etiology of BC was found to be nonmalignant (37.2%), followed by malignant (37.2%), infectious (25.6%), and drug-induced (4.7%) cases. Most of the patients with BC presented with fever, pallor, and generalized weakness. Conclusion Anemia with thrombocytopenia emerged as the predominant form of BC in the nonmalignant group, while the malignant etiology group presented with anemia with leukopenia. The infectious etiology group presented with leukopenia with thrombocytopenia. Neonatal sepsis emerged as the most prevalent cause of BC in the age group younger than 10 years, viral fever in the age group of 10 to 39 years, acute lymphoblastic leukemia in the age group of older than 70 years, and chronic liver disease in patients aged between 40 and 69 years.

Characterization and arbovirus susceptibility of cultured CERNI cells derived from sika deer (Cervus nippon).

Cervus nippon (sika deer) are widely distributed throughout eastern Asia. Deer possess a variety of antibodies against several zoonotic pathogens, indicating that they act as reservoir of zoonoses. In this study, we reported the characterization of cultured cells derived from sika deer and evaluated their susceptibility to arthropod-borne viruses to clarify their usefulness in virological studies. Cells derived from testicular tissue in Dulbecco's modified eagle medium with 16% fetal bovine serum started growing as primary cultured cells. The diploid cells consisted of 68 chromosomes, consistent with those of Japanese sika deer previously reported. The phylogenetic analysis showed the cells formed a robust clade with Japanese population of C. nippon, indicating that the cultured cells established in this study were originated from the Japanese sika deer. The cells immortalized by the simian virus 40 T-antigen were predominantly spindle-shaped cells exhibiting adhesive properties, and cultivated at 37°C and 5% CO2, which are common culture conditions for many mammalian cell lines. Western blotting analysis indicated that the cultured cells were multiple types of cells that coexist, including at least epithelial, fibroblast, and also Leydig cells. We confirmed that the cells have susceptibility to several arboviruses distributed in Japan: Getah virus, Japanese encephalitis virus, Oz virus, and severe fever with thrombocytopenia syndrome virus, but not to Tarumiz tick virus. From these results, the cells contribute to clarify the role of sika deer as a reservoir of zoonoses in nature and deer-associated experimental research at the cellular and molecular levels.

A Clinical Study of Rickettsial Fever and Factors Affecting Its Outcome.

Rickettsiae comprise a family of obligate intracellular short gram-negative coco-bacilli and are transmitted by insects, mites, fleas, louse, and tick vectors. Scrub typhus, north-Asian tick typhus, rickettsia pox, and boutonniere fevers are common in India and Asia. In the early phase of illness during the initial five days, all these are indistinguishable among themselves; also, they mimic any other self-limiting viral fever. Patients usually present with fever, headache, myalgia, malaise, nausea, vomiting, and anorexia. Rarely do patients present with rash, or give a history of exposure to animals or tick bite. Thus, rickettsial diseases are missed in the early phase, when they are easily treatable, due to lack of suspicion. To study clinical features, investigations, outcomes, and factors affecting the outcome of rickettsial fever. This was an observational study conducted from December 2012 to November 2014 in a tertiary care hospital. The study population consisted of patients above the age of 13 years with a history of any one or more of the following: fever, headache, jaundice, altered sensorium, renal dysfunction, tick bite, a farmer by occupation, exposure to cattle or sheep or dog, multiorgan failure; with serological evidence of rickettsial infection by Weil-Felix test (ox-19/ox-2/ox-k ≥ 1:320) or rickettsial antibody IgM ≥ 1.1) or PCR positive. A sample size of 40 was considered for the final analysis of this study. Statistical analysis was done using inferential statistical tests such as the chi-square test and odds ratio (OR). The most common presenting symptom was fever (100%) seen in almost every patient followed by body aches (72.5%), joint pain (62.5%), andjaundice (62.5%). General examination showed icterus (37.5%), hypotension (30%), edema (22.5%), lymphadenopathy (22.5%), andpallor (15%).On the day of admission, 17 patients were found to have the Weil-Felix test positive with an OR of 0.538462 (CI = 0.151-1.917), while the Weil-Felix test done in the second week was positive in 37 patients with an OR of 5.4 (CI = 0.439-63.11). Rickettsial antibodies were positive only in three patients on the day of admission with an OR of 0.381 (CI = 0.0317-4.58), while in the second week, rickettsial antibodies were positive in 27 patients with an OR of 16.25. The rickettsial PCR test was positive in 13 patients with an OR of 1.48 (CI = 0.3857-5.722). The mortality rate was significantly high in patients presenting with breathlessnessandrespiratory complications like pneumonia, pulmonary edema, and acute respiratory distress syndrome. Similarly, patients presented with hypotension and required Ionotropic support had a high mortality rate. While the clinical presentation of rickettsia infection is similar, the causative species and epidemiology can vary depending on the region. It is important to recognize both the typical symptoms and the epidemiology of a given region to correctly diagnose and treat these infections promptly, as they can be associated with significant morbidity and mortality. Through this study, we attempt to bring awareness about this disease which would help clinicians to suspect and start treatment at the earliest before complications set in.

Skin Rash with Acute Respiratory Distress Syndrome in Chronic Miliary Tuberculosis: The Role of HRCT Thorax and Bronchoscopy as Diagnostic Tools

Pulmonary tuberculosis (TB) is a leading cause of mortality and morbidity in India, presenting with diverse clinical and radiological manifestations such as consolidation, cavitation, lymphadenopathy, pleural effusion, miliary TB, and endobronchial TB. While acute miliary TB presenting as Acute respiratory distress syndrome (ARDS) is documented, the association with a skin rash mimicking viral exanthematous fever is not. This case report describes the case of a 41-year-old male patient with acute dyspnea, a maculopapular rash, and lung infiltrates on chest radiograph, initially diagnosed with acute hypoxic respiratory failure and later confirmed as ARDS. High-resolution computed tomography (HRCT) thorax revealed consolidation with nodules and a characteristic butterfly pattern sparing the apices and bases. Bronchoscopy confirmed TB etiology through MTB genome in BAL samples. The patient improved significantly with intravenous antibiotics, steroids, and HFNC, leading to a documented cure after 6 months of anti-tuberculosis treatment. This report highlights the importance of considering TB in cases with nodular consolidation and positive limiting signs and recommends ICU bronchoscopy as a reliable diagnostic tool. The Kigali modification for ARDS definition was instrumental in managing this case. Use of Kigali modification for defining ARDS in resource limited setting guided management in our case.

A novel vaccine construct against Zika virus fever: insights from epitope-based vaccine discovery through molecular modeling and immunoinformatics approaches.

The Zika virus (ZIKV) is an emerging virus associated with the Flaviviridae family that mainly causes infection in pregnant women and leads to several abnormalities during pregnancy. This virus has unique properties that may lead to pathological diseases. As the virus has the ability to evade immune response, a crucial effort is required to deal with ZIKV. Vaccines are a safe means to control different pathogenic infectious diseases. In the current research, a multi-epitope-based vaccination against ZIKV is being designed using in silico methods. For the epitope prediction and prioritization phase, ZIKV polyprotein (YP_002790881.1) and flavivirus polyprotein (>YP_009428568.1) were targeted. The predicted B-cell epitopes were used for MHC-I and MHC-II epitope prediction. Afterward, several immunoinformatics filters were applied and nine (REDLWCGSL, MQDLWLLRR, YKKSGITEV, TYTDRRWCF, RDAFPDSNS, KPSLGLINR, ELIGRARVS, AITQGKREE, and EARRSRRAV) epitopes were found to be probably antigenic in nature, non-allergenic, non-toxic, and water soluble without any toxins. Selected epitopes were joined using a particular GPGPG linker to create the base vaccination for epitopes, and an extra EAAAK linker was used to link the adjuvant. A total of 312 amino acids with a molecular weight (MW) of 31.62762 and an instability value of 34.06 were computed in the physicochemical characteristic analysis, indicating that the vaccine design is stable. The molecular docking analysis predicted a binding energy of -329.46 (kcal/mol) for TLR-3 and -358.54 (kcal/mol) for TLR-2. Moreover, the molecular dynamics simulation analysis predicted that the vaccine and receptor molecules have stable binding interactions in a dynamic environment. The C-immune simulation analysis predicted that the vaccine has the ability to generate both humoral and cellular immune responses. Based on the design, the vaccine construct has the best efficacy to evoke immune response in theory, but experimental analysis is required to validate the in silico base approach and ensure its safety.

Serological Evidence of Zika Virus Infections in Sudan.

Little is known about the frequency of Zika virus (ZIKV) infections in Sudan. The aim of this study was to obtain data on the prevalence of ZIKV infections and the immunity of the population in the country. To this end, 198 sera obtained between December 2012 and January 2013 in different regions in Sudan were examined for neutralizing antibodies against ZIKV, dengue virus (DENV), and yellow fever virus (YFV). The sera were non-randomly selected. The neutralization titers were compared with each other and with the WHO 1st International Standard for anti-Asian lineage Zika virus antibody. Twenty-six sera neutralized ZIKV. One-third of these sera had higher neutralization titers against ZIKV than against DENV-2 and -3. Two sera showed higher neutralization titers than the WHO standard for ZIKV antibodies. These data suggest occasional ZIKV infections in Sudan. The low percentage of sera in this cohort that neutralized ZIKV indicates that, in the study period, the population was susceptible to ZIKV infection.

One-pot synthesis, characterization and antiviral properties of new benzenesulfonamide-based spirothiazolidinones

A novel series of benzenesulfonamide substituted spirothiazolidinone derivatives (3a–j) were synthesized, characterized and evaluated for their antiviral activity. The spirocyclic compounds were prepared by the condensation of 4-(aminosulfonyl)-2-methoxybenzohydrazide, appropriate cyclic ketones and 2-mercaptopropionic acid in a one-pot reaction. The structures of the new compounds were established by IR, 1H NMR, 13C NMR (APT), and elemental analysis. The new compounds were evaluated in vitro antiviral activity against influenza A/H1N1, A/H3N2 and B viruses, as well as herpes simplex virus type 1 (HSV-1), respiratory syncytial virus (RSV) and yellow fever virus (YFV). Two derivatives bearing propyl (3d) and tert-butyl (3e) substituents at position 8 of the spiro ring exhibited activity against influenza A/H1N1 virus with EC50 values in the range of 35–45 µM and no cytotoxicity at 100 μM, the highest concentration tested.

Acute Acalculous Cholecystitis in Dengue Fever with Raised Transaminase

Background: Dengue fever is a viral fever classically characterized by high-grade temperature, headache, ocular pain, sternal pain, muscle and joint pain, nausea, vomiting and sometimes rash. Apart from above stated clinical features, there may be hepatitis, ascites, cholecystitis, pleural effusion, etc. which are confirmed by investigations.Objective: To establish the fact that acute acalculous cholecystitis is not uncommon in dengue fever. Raised transaminases are good indicators for further investigation and to find out the prognosis and management of acute acalculous cholecystitis in dengue fever.Materials and Methods: A total of 100 patients with confirmed dengue fever who were admitted to Khwaja Yunus Ali Medical College Hospital, were selected randomly for one month. Among them, 44 patients had undergone for ultrasound of the whole abdomen because of nausea, vomiting, abdominal pain and raised transaminases. Results: Acute acalculous cholecystitis was detected in 20 patients (20%) with confirmed dengue fever. These patients with acute acalculous cholecystitis were treated conservatively and they recovered completely without any surgical intervention.Conclusion: In dengue fever unlike acute pancreatitis or encephalitis, acute acalculous cholecystitis is not uncommon and it is self-limiting and resolved by conservative management. KYAMC Journal Volume: 14, No: 04, January 2024: 190-193.