History Of Recent Contact Research Articles

PA34 A case of disseminated herpes zoster in an immunocompetent child

Abstract Herpes zoster (HZ) caused by the reactivation of varicella-zoster virus (VZV) affects mainly the adult population. The incidence is low in children (0.45 cases per 1000 individuals annually), especially in the immunocompetent. It is said to be disseminated when there are > 20 lesions outside the primary and adjacent affected dermatome. We present this case to highlight a rare complication of cutaneous dissemination in a previously healthy child with HZ, following in utero exposure to varicella at 28 weeks’ gestation. A 15-year-old boy presented with painful blisters in the T2 dermatome of 1 week’s duration, which later spread to trunk, extremities and face. This was associated with fever and neuralgia. There was no previous history of varicella and no recent contact history. He had no significant past medical history and was not on any medications. Antenatal history revealed that his mother had varicella at 28 weeks’ gestation and was treated with aciclovir. He was febrile on admission (39°C). There were coalesced vesiculopustules and crusted lesions with marked perilesional erythema in the T2 dermatome. In addition, disseminated vesicular lesions were seen on the trunk, extremities and face. Remaining systemic examination was unremarkable. C-reactive protein was elevated. Complete blood count and renal function tests were normal. Liver function tests, namely alanine transaminase and γ-­glutamyl transferase were elevated. Blood culture showed no growth. Varicella-zoster IgG was positive. Viral swab (polymerase chain reaction) from the skin lesions was positive for varicella-zoster DNA. Infectious serology for HIV, hepatitis B and hepatitis C was negative. Antinuclear antibody and antineutrophil cytoplasmic antibodies were negative. A clinical diagnosis of HZ with cutaneous dissemination was made, and he was treated with intravenous aciclovir. Intravenous antibiotics were added for suspected secondary bacterial infection. Disseminated zoster is less common in children and mainly occurs in patients with underlying immunodeficiency like HIV, immunosuppressive drug use or malignancy. In immunocompetent children, this can happen when primary infection (varicella) has occurred in utero or the first year of life due to the low response in specific varicella-zoster virus immunity. Complications like cutaneous dissemination due to viraemia are rare in healthy children, but can affect 2–10% of immunocompromised patients. It occurs 3–4 days after the onset of dermatomal lesions. It is important to look for other complications, especially in the immunocompromised, as viraemia can affect the brain, kidneys, lung and liver. Sequelae like postherpetic neuralgia is rare, but it is important to follow-up these children to look for its development.

Unilateral eyelid itching with eyelash loss after travelling.

Tinea blepharitis is a rare dermatophyte infection. The characteristic broken eyelash is an important diagnostic clue by trichoscopy or slit lamp examination. Other clinical clues suggesting dermatophytosis include pruritic scaly annular erythema and a history of recent contact with pets.

Global concerns about camel flu: outbreak, etiology, genomic structure, transmission, symptoms, diagnostic tests, prevention, and treatment - correspondence.

Global concerns about camel flu: outbreak, etiology, genomic structure, transmission, symptoms, diagnostic tests, prevention, and treatment - correspondence.

Effectiveness of mRNA COVID-19 Vaccines in Japan during the Nationwide Pandemic of the Delta Variant.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remained a major global health concern in 2021. To suppress the spread of infection, mass vaccinations have been performed across countries worldwide. In Japan, vaccinations of the first and second doses for most of the nation were performed during the nationwide outbreak of the B.1.617.2 (Delta) variant with the L452R spike protein mutation, and the effectiveness of the vaccinations to suppress the spread of COVID-19 among the people in Japan remains uncertain. In this study, adults aged ≥18 years, who were in contact with patients with COVID-19 and underwent nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) tests during August and September 2021 at a mass screening test center in Japan, were enrolled. In this period, more than 95% of the COVID-19 infections were reportedly caused by the Delta variant. As a result, a total of 784 adults with recent contact history, including 231 (29.5%) RT-PCR test-positive cases, were enrolled. The test positivity rate was lower in individuals who had been vaccinated twice than in unvaccinated individuals (12.5% vs. 39.0%, p < 0.0001), with the risk ratio of 0.32 (95% confidence interval 0.23-0.46). The vaccine effectiveness was the highest between 7-90 days after the second vaccine dose. In conclusion, two doses of mRNA COVID-19 vaccines effectively suppressed transmission in Japan during the nationwide pandemic of the Delta variant, estimated to have prevented 50-80% of the infection.

COVID-19 transmission in group living environments and households

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the world’s largest public health concern. This study evaluated COVID-19 transmission risks in people in group living environments. A total of 4550 individuals with a history of recent contact with patients at different places (dormitory/home/outside the residences) and levels (close/lower-risk) were tested for SARS-CoV-2 viral RNA using a nasopharyngeal swab test between July 2020 and May 2021. The test-positive rate was highest in individuals who had contact in dormitories (27.5%), but the rates were largely different between dormitories with different infrastructural or lifestyle features and infection control measures among residents. With appropriate infection control measures, the secondary transmission risk in dormitories was adequately suppressed. The household transmission rate (12.6%) was as high as that of close contact outside the residences (11.3%) and accounted for > 60% of the current rate of COVID-19 transmission among non-adults. Household transmission rates synchronized to local epidemics with changed local capacity of quarantining infectious patients. In conclusion, a group living environment is a significant risk factor of secondary transmission. Appropriate infection control measures and quarantine of infectious residents will decrease the risk of secondary transmission in group living environments.

Atypical presentation of bartonellosis with hepatolienal lesions

Cat scratch disease is caused by the gram-negative intracellular bacterium Bartonella henselae (B. henselae). Human infection occurs mainly through cat scratches and bites. In typical cases, the clinical course is presented by a primary affect on the skin and regional lymphadenitis. The atypical presentation of infection can occur with fever, abdominal, ocular and neurological manifestations. A special feature of the abdominal form is the presence of solitary or multiple hypo/anechoic foci of different size and shape in the liver and spleen. B. henselae infection is one of the most common mimics of malignant lymphoma, when the spleen is involved in combination with B symptoms (weight loss, night sweats and prolonged fever). A history of recent contact with cats and diagnostic IgG titers to B. henselae indicate infection. There is no consensus on the choice of antimicrobial drug and the duration of therapy for systemic forms. The article presents its own experience in the diagnosis and treatment of such patients. The patient's parents agreed to use the information, including the child's photo, in scientific research and publications.

Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study.

To determine whether contemporary sex-specific cardiovascular disease (CVD) risk prediction equations underestimate CVD risk in people with severe mental illness from the cohort in which the equations were derived. We identified people with severe mental illness using information on prior specialist mental health treatment. This group were identified from the PREDICT study, a prospective cohort study of 495,388 primary care patients aged 30 to 74 years without prior CVD that was recently used to derive new CVD risk prediction equations. CVD risk was calculated in participants with and without severe mental illness using the new equations and the predicted CVD risk was compared with observed risk in the two participant groups using survival methods. 28,734 people with a history of recent contact with specialist mental health services, including those without a diagnosis of a psychotic disorder, were identified in the PREDICT cohort. They had a higher observed rate of CVD events compared to those without such a history. The PREDICT equations underestimated the risk for this group, with a mean observed:predicted risk ratio of 1.29 in men and 1.64 in women. In contrast the PREDICT algorithm performed well for those without mental illness. Clinicians using CVD risk assessment tools that do not include severe mental illness as a predictor could by underestimating CVD risk by about one-third in men and two-thirds in women in this patient group. All CVD risk prediction equations should be updated to include mental illness indicators.

Learning from Anangu Histories: Population Centralisation and Decentralisation Influences and the Provision of Schooling in Tri-state Remote Communities

Remote Australian Aboriginal and Torres Strait Islander schools and communities are diverse and complex sites shaped by contrasting geographies, languages, histories and cultures, including historical and ongoing relationships with colonialism, and connected yet contextually unique epistemologies, ontologies and cosmologies.This paper explores the history of Anangu (Pitjantjatjara, Yankunytjatjara, Ngaanyatjarra and Ngaatjatjarra) populations, including the establishment of incorporated communities and schools across the tri-state remote region of central Australia. This study will show that Anangu have a relatively recent contact history with Europeans and Anangu experiences of engagement with colonisation and schooling are diverse and complex.By describing historical patterns of population centralisation and decentralisation, I argue that schooling and broader education policies need to be contextually responsive to Anangu histories, values, ontologies and epistemologies in order to produce an education approach that resists colonialist social models and assumptions and instead, works more effectively towards a broader aim of social justice. Through assisting educators and policy makers to acquire a clearer understanding of Anangu histories, capacities and struggle, I hope to inform a more nuanced, contextually responsive and socially-just consideration of the provision of Western education in the tri-state region.

A time-considered multicast routing scheme based on social differences in delay-tolerant networks

In delay-tolerant networks (DTNs), multicast is widely used in many group communication scenarios as it can make full use of network resources and provide high data delivery ratio. As node behaviours demonstrate social characteristics in DTNs, in this paper, a multicast routing scheme based on social difference (SDMR) is proposed. SDMR considers the social differences between nodes, including both the similarity and the centrality differences. SDMR chooses the nodes with greater social differences to forward data, which can expand the data transmission range and increase the data delivery ratio to multicast destinations efficiently. Considering the critical role of the recent contact history, we further propose a time-considered multicast routing scheme based on social difference (SDMRT), which can improve the transmission efficiency further. Through extensive trace-driven simulation with the Infocom06 trace data, it shows that SDMR cannot only ensure high data delivery ratio and low delay, but also reduce the transmission cost greatly compared to other existing protocols. Moreover, SDMRT can further reduce the transmission cost of SDMR without comprising data delivery ratio and delay.

Incidence of tuberculosis among anti-tumor necrosis factor users in patients with a previous history of tuberculosis

We aimed to investigate the results of anti-tumor necrosis factor (TNF) therapy in patients with a previous history of tuberculosis (TB). A total of 101 patients with a previous history of TB receiving TNF antagonists between December 2004 and September 2012 at the Asan Medical Center in South Korea were retrospectively analyzed. The mean age of the 101 subjects was 40.4±16.0 years and 51 patients (50.5%) were male. The underlying immune-mediated inflammatory diseases (IMIDs) were Crohn's disease in 55 (54.5%), rheumatoid arthritis in 27 (26.7%), and ankylosing spondylitis in 13 (12.9%) patients. Chest radiography findings were suggestive of previous TB lesions in 33 (32.7%) patients. The rates of positivity in the tuberculin skin test and interferon-gamma release assay were 21.8% (22/101) and 44.6% (45/101), respectively. Latent TB infection (LTBI) treatment was initiated in 11 subjects (10.9%) based on previous inappropriate anti-TB treatments (n=10) or recent TB contact history (n=1), irrespective of the LTBI test results. The median follow-up duration after the initiation of TNF antagonist therapy was 31.5 months. Active TB developed, six years after the initiation of TNF antagonist, in one patient (1.0%) who had not received LTBI treatment. The incidence rate of TB was calculated at 336 per 100,000person-year (PY). Patients with IMIDs who have a previous history of TB can be treated with TNF antagonists with an acceptable incidence of TB, if LTBI treatment is performed based on clinical judgments including the adequacy of previous anti-TB treatment and recent contact history.

Association between traditional systemic antipsoriatic drugs and tuberculosis risk in patients with psoriasis with or without psoriatic arthritis: Results of a nationwide cohort study from Taiwan

Although the link between tuberculosis (TB) and biologics use is well established, the risk of TB among patients with psoriasis exposed to traditional systemic therapies remains elusive. The aim is to investigate the association between traditional systemic therapies and TB among patients with psoriasis. We conducted a retrospective cohort study on the risk of active TB among patients with psoriasis and psoriatic arthritis, using the National Health Insurance Research Database of Taiwan, 1996 through 2008. Standardized incidence ratios of TB were analyzed in comparison with age- and gender-matched general population. Logistic regression was used in a nested case-control analysis to estimate the odds ratios of TB related to exposure to traditional systemic agents during the year before TB development. Among the 81,266 patients in the psoriasis cohort, 497 new active TB cases were identified. The incidence rate of TB was 102 cases per 100,000 person-years among patients with psoriasis (standardized incidence ratio 1.22, 95% confidence interval 1.18-1.33). The risk of TB was higher in patients with severe disease (standardized incidence ratio 1.52, 95% confidence interval 1.46-1.74). To facilitate comparisons with the 497 active TB cases, a total of 1988 matched control subjects were selected for a nested case-control study. Patients taking systemic corticosteroids and nonsteroidal anti-inflammatory drugs were associated with higher incidence of TB, especially frequent users, after adjustment for multiple TB risk factors, drug exposures, hospital visits, and level of urbanization. Stratified analyses of current users and new users of these drugs revealed similar results. Finally, traditional systemic antipsoriatic treatment was not associated with TB on any of the analyses. The National Health Insurance Research Database did not contain information regarding severity of psoriasis, smoking status, alcohol use, diet, laboratory parameters, chest radiograph, or history of recent contact with an individual with TB. Misclassification of disease cannot be ruled out in a registry-based database. The accessibility of health care may be associated with the level of urbanization, which could confound the effect of drugs in multivariate analyses. Severe psoriasis may be associated with an elevated TB risk. Traditional systemic therapies do not seem to be strongly associated with TB occurrence.

Clinical features of the 2009 swine-origin influenza A (H1N1) outbreak in Japan.

To clarify the clinical symptoms of the influenza A virus during the 2009 pandemic influenza outbreak, we describe the clinical features of outpatients diagnosed with type A influenza by use of the rapid influenza diagnostic test (RIDT) from September to December 2009. Questionnaires were used to collect prospective data on 1,122 cases with influenza-like illness at our medical institutions. The independent predictors of influenza A virus were identified on the basis of demographic features and the clinical symptoms of the patients who tested positive for influenza A virus in the RIDT test. Of the 1,122 cases tested, 389 (34.7%) were positive for the influenza A virus. The median age of the influenza-positive patients was 14, and 58.9% of the patients were male. The symptoms fever, cough, rhinorrhea, and headache were statistically dominant. A history of recent contact with persons suffering from influenza or influenza-like illness at home, school, or in the workplace was significantly more common in the positive group than in the negative group. Pneumonia was observed in 2 (0.5%) of the positive patients, but the symptoms were only severe enough to require hospitalization in 1 of the 2. No deaths were observed among the 389 RIDT-positive patients. Although the spread of influenza A virus was both rapid and extensive, mainly among children under the age of 18, it seemed to be mild. Appropriate interpretation of the RIDT on the basis of recent clinical information, and early treatment with antiviral drugs might help to prevent severe illness from influenza pandemics in the future.

Mycotic Abdominal Aortic Aneurysm Due toStreptococcus Suis: A Case Report

Streptococcus suis is a common infection of pigs. Human infection is often related to accidental inoculation through skin injuries during occupational exposure to pigs and pork. The disease may present as meningitis, bacteremia, and less commonly endocarditis, arthritis, or bronchopneumonia. Case report and review of the literature. We report a case of bacteremia and severe sepsis caused by S. suis serotype 2 complicated by septic arthritis in a 56-year-old male with history of a prior contact with unprocessed pork. The causative agent was isolated from blood cultures and aspirated synovial fluid. The patient's condition improved after treatment with penicillin, but he was found subsequently to have an abdominal aortic aneurysm, confirmed by computed tomography (CT) scan. The mycotic aneurysm was successfully repaired using an in situ graft reconstruction. Tissue samples analyzed using polymerase chain reaction identified S. suis serotype 2 as the causative organism. After completion of two weeks of parenteral antibiotics, an oral form of ciprofloxacin (0.25 g twice a day) was continued for one month. The patient was discharged from our institution after uncomplicated recovery. Clinical review, a CT scan, and inflammatory markers nine months after surgery revealed no evidence of infection. This is the first report of mycotic aneurysm caused by S. suis, which may be an etiologic agent of mycotic aneurysms, especially when complicated by bacteremia in adults with a recent history of contact with pigs or unprocessed pork.

Murine typhus in children: clinical and laboratory features from 41 cases in Crete, Greece

Murine typhus, also known as endemic typhus, is a flea-borne infectious disease with a worldwide distribution, caused by an obligate intracellular, gram-negative microorganism, Rickettsia typhi [1]. The transmitting agent of R. typhi is the rat flea, Xenopsylla cheopis, although the cat flea, Ctenocephalides felis, has also been implicated [1–4]. Main reservoirs are rats, house mice, opossums, skunks and cats [1–3]. The actual incidence of murine typhus is unclear, as the common clinical manifestations of the disease are non-specific [1,2]. In children, only a small number of studies have focused on the occurrence and on clinical profiles of the disease [3–5]. The aim of this study was to confirm the presence and to assess the clinical and laboratory characteristics of R. typhi infection among children in the area of Chania, Crete, Greece. Forty-one children were hospitalised with acute R. typhi infection in the Pediatric Department of the General Hospital of Chania, from 2001 through to 2006. All other causes included in the differential diagnosis were ruled out. Diagnosis of acute R. typhi infection was considered positive by the combination of compatible clinical features and an indirect immunofluorescence test (Biomerieux, Lyon, France), when specific IgM and ⁄ or IgG titres on admission were >1 ⁄ 400 and >1 ⁄ 960, respectively. All cases were reviewed retrospectively for demographic, clinical and laboratory findings, treatment and outcome. Most admissions (87.8%) occurred between May and October. The mean age was 9.8 years old (range, 1–15 years old). Twenty children (48.8%) were males. History of recent contact with animals was positive in 13 children (31.7%); all 13 children reported contact with cats and 10 ⁄ 13 reported contact with dogs. On admission all patients had fever. Common clinical characteristics were fever, rash, hepatomegaly, splenomegaly and anorexia. Main laboratory features included elevated aspartate aminotransferase and alanine aminotransferase, abnormal chest radiography, thrombocytopenia and leucopenia. CSF analysis in one patient with confusion did not reveal any abnormalities. Clinical and laboratory manifestations found on admission are presented in Table 1. Serologic testing through IFA performed on admission was diagnosed for all 41 children, with a median IgM titre of 1 ⁄ 3200 (range, 1 ⁄ 400 to 1 ⁄ 31200) and a median IgG titre of 1 ⁄ 2880 (range, 1 ⁄ 480 to 1 ⁄ 30720). All children were treated upon admission. Combination therapy was administered to two of them. Antibiotics administered were doxycycline in 19 children (46.3%), chloramphenicol in 12 (29.3%), quinolones in five (12.2%), cephalosporins in three children (7.3%), and a combination of trimethoprim ⁄ sulfamethoxazole and b-lactams in two children (4.9%). The outcome was favourable for all 41 patients; apyrexia was recorded on a mean of 4.9 days after admission (range, 2–12 days). The mean total duration of fever was 9.1 days (range, 3–17 days). No complication or relapse was observed within 1 month of follow-up.

Single dose mifepristone, single dose levonorgestrel, or 2 dose levonorgestrel were effective emergency contraceptives

<h3>Aims</h3> Human scabies is a common contagious infestation in the developing world that is predominantly related to poverty and overcrowding. This study aimed to assess the clinical–demographic profile and quality...

Identification by spoligotyping of a caprine genotype in Mycobacterium bovis strains causing human tuberculosis

We have used spoligotyping to characterize 18 Mycobacterium bovis strains isolated from cattle and 23 M. bovis strains isolated from goats. The spoligotypes revealed that caprine strains form a separate and well-differentiated group that we refer to hereafter in this abstract as the caprine genotype. To evaluate the importance of this genotype as a cause of tuberculosis in other animal species, including humans, we applied the spoligotyping method to 112 strains, including to all isolates identified as M. bovis by a Mycobacterial National Reference Laboratory (Majadahonda, Madrid) from 1994 to 1996. Eighty-three of these strains were identified in human isolates. In addition to being identified in three goat isolates and two sheep isolates, the caprine genotype was also found in three isolates causing human tuberculosis. Evidence to support the argument that there is a zoonotic risk of caprine tuberculosis was presented by the identification of the caprine genotype in an isolate from a veterinary worker with a recent history of contact with tuberculous goats.

Improving mortality data in South Africa: review of next of kin statements to determine cause of death in police certification.

The study aimed to improve mortality data by finding ways of reducing the large number of deaths certified as being from "ill-defined" causes (ICD 780-798) in South Africa. This problem is attributable to the absence of cause of death information in many cases where the police issue the death certificate. A total of 600 consecutive death certification records at the Salt River State Mortuary, Cape Town were reviewed. Altogether 347 (58%) deaths were from unnatural causes, 111 (18%) were certified by a doctor, 83 (14%) were certified as being the result of natural causes after a necropsy, and 59 (10%) were certified by the police as being from natural causes. Analysis of sworn statements obtained from the next of kin of all those certified dead by the police rather than a doctor provided a clear cause of death in 72.9%, and a history of recent contact with health services (less than one week previously) in 47.5%. All infants certified dead by the police had a history consistent with diarrhoeal disease. The method of death certification may be an indicator of access to health care and reviewing sworn statements to determine the cause of death should improve the quality of mortality data in the developing world.

Legal Adaptation in a Papua New Guinea Village Court

As the title of Starr and Collier's (1989) recent volume, History and Power in the Study of Law: New Directions in Legal Anthropology suggests, anthropologists are becoming increasingly concerned with asymmetrical power relations and historical time in the comparative study of law. As anthropology concerns itself more with the politics of domination and resistance, law is more frequently seen as a vehicle for encoding and perpetuating power relationships. No longer is local-level conflict management examined without reference to the broader social milieu of which it is part. In situations of pluralism, the relationship between the local community and the state is of more central importance, and must be examined in the colonial and postcolonial context in which it developed. Papua New Guinea is a particularly interesting location for the investigation of pluralism not only because of the diversity of its traditional cultures, but also because of its relatively recent history of contact and political independence. Historical process can be more easily examined if only because there are fewer historical documents to be found and, in many locations, colonial history does not extend beyond the memory of living individuals. Thus, time depth is shallow. Furthermore, Papua New Guinea has made a conscious effort to integrate its many customary systems with its national law through the development of a system of Village Courts, designed to operate by employing local customs. In examining the articulation among national and local systems in Papua New Guinea, scholars have been informed by the new directions in the comparative study of law described above, and recent research has focused on the nature of development. Two basic approaches have emerged. One, heavily influenced by dependency theory, takes what Galanter (1981:1) has called a legal centralism perspective, also called the command model of law (cf. Kidder 1979). Law is regarded as an instrument of domination of an essentially powerless peasantry by a ruling class (see, e.g., Fitzpatrick 1980). Thus Paliwala (1982:191), in an analysis of Papua New Guinea's Village Courts, sees these local-level courts as bringing about, ...greater involvement and control by the state and a degree of authoritarianism on the part of court officials. result is relatively alienated dispute settlement with little scope for community involvement and party concensus. In another study, lamo (1987) argues that among the hierarchically-organized, Austronesian-speaking Keakalo people, Village Court Magistrates choose to impose judgments rather than use mediation techniques, and the Court serves the interests of the elite. He (lamo 1987:115) concludes that, The Village Court system, originally planned to integrate a rich body of customary mediation and negotiation techniques, has in fact enhanced a

Chlamydia trachomatis infection in sexually active women with no known sexual contacts with urethritis.

During the period from March 1985 to March 1986, 216 consecutive patients with vaginal symptoms were screened for cervical infection with Chlamydia trachomatis and other sexually transmitted organisms. Eleven (5%) yielded C. trachomatis without a history of recent contact with males with urethritis.

Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8.

In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining seven patients (25%) had radiological changes consistent with pulmonary tuberculosis, but no miliary shadows. Of those who completed chemotherapy, only five (42%) received 18 months' treatment. Nine patients (32%) died from their miliary tuberculosis. Failure to consider the diagnosis, leading to a delay in starting chemotherapy, appeared to be a major problem.