Cases Of Local Transmission Research Articles

Plasmodium Ovale Malaria-A Case Report from Tertiary Care Centre Central Kerala

Abstract Background: According to World Malaria Report 2019, 3% of the global malaria cases are reported from India. Most cases of malaria in India are due to infestation by Plasmodium falciparum (65%) and Plasmodium vivax (35%). Only a few thousand cases of Plasmodium malariae has been reported from foothill areas in Orissa. Malaria due to Plasmodium ovale is not very common in India and till date only 9 cases have been reported. We are reporting a case of P. ovale malaria which was diagnosed and treated at Government Medical College, Thrissur, Kerala, in a patient who had returned from Uganda. Diagnosis was made with the specific morphological features of these parasites like oval shape of parasitised RBCs, fimbriation of RBCs and very prominent shuffners dots. Interpretation & Conclusion: This is the first case of Pl. ovale reported from central Kerala. This case of plasmodium ovale malaria could be an isolated imported case and there are no reported cases of local transmission so far following detection of this case. Keywords: Malaria, Plasmodium ovale, fimbriation.

Study on the spatial decomposition of the infection probability of COVID-19

In the course of our observations of the transmission of COVID-19 around the world, we perceived substantial concern about imported cases versus cases of local transmission. This study, therefore, tries to isolate cases due to local transmission (also called community spread) from those due to externally introduced COVID-19 infection, which can be key to understanding the spread pattern of the pandemic. In particular, we offer a probabilistic perspective to estimate the scale of the outbreak at the epicenter of the COVID-19 epidemic with an environmental focus. First, this study proposes a novel explanation of the probability of COVID-19 cases in the local population of the target city, in which the chain of probability is based on the assumption of independent distribution. Then it conducts a spatial statistical analysis on the spread of COVID-19, using two model specifications to identify the spatial dependence, more commonly known as the spillover effect. The results are found to have strong spatial dependence. Finally, it confirms the significance of residential waste in the transmission of COVID-19, which indicates that the fight against COVID-19 requires us to pay close attention to environmental factors. The method shown in this study is critical and has high practical value, because it can be easily applied elsewhere and to other future pandemics.

Sequencing of SARS-CoV-2 in local transmission cases through Oxford Nanopore MinION platform from Karachi Pakistan.

The first case of severe acute respiratory syndrome 2 (SARS-CoV-2) was imported to Pakistan in February 2020, since then 8,260 deaths have been witnessed. The virus has been constantly mutating and local transmission cases from different countries vary due to host dependent viral adaptation. Many distinct clusters of variant SARS-CoV-2 have been defined globally. In this study, the epidemiology of SARS-CoV-2 was studied and locally transmitted SARS-CoV-2 isolates from Karachi were sequenced to compared and identify any possible variants. The real time PCR was performed on nasopharyngeal specimen to confirm SARS-CoV-2 with Orf 1ab and E gene as targets. The virus isolates were sequenced through oxford nanopore technology MinION platform. Isolates from the first and second wave of COVID-19 outbreak in Karachi were compared. The overall positivity rate for PCR was 26.24% with the highest number of positive cases in June. Approximately, 37.45% PCR positive subjects aged between 19-40 years. All the isolates belonged to GH clade and shared missense mutation D614G in spike protein linked to increased transmission rate worldwide. Another spike protein mutation A222V coexisted with D614G in the virus from the second wave of COVID-19. Based on the present findings it is suggested that the locally transmitted virus from Karachi varies from those reported from other parts of Pakistan. Slight variability was also observed between viruses from the first and second wave. Variability in any potential vaccine target may result in failed trials, therefore information on any local viral variants is always useful for effective vaccine design and/or selection.

Temporal Analysis of SARS-CoV-2 Variants during the COVID-19 Pandemic in Nepal

Nepal has suffered two waves of SARS-CoV-2 infections, one in the year 2020 and another in the year 2021. Although the government of Nepal keeps a detailed record of daily coronavirus infections and deaths throughout the country, and publishes the result every day, genomic surveillance of mutants in the country has lagged behind. Sequencing of COVID-19 samples has been conducted sporadically during the pandemic. From the GISAID database, 127 high-quality sequences deposited by different health authorities in Nepal were collected and analyzed. From the analysis, it can be concluded that at least two variants of concern, alpha and delta, and one variant of interest, kappa, were detected in Nepal in 2021. As in other countries, the delta variant outcompeted the kappa and alpha variants and by July 2021 had established itself as the dominant variant. It can be hypothesized that the second wave in Nepal was primarily caused by the delta variant. Further, phylogenetic tree analysis suggests cases of local transmission and global transmission of coronavirus. This analysis reveals the global nature of the disease, where variants arising in one part of the world can quickly spread to other parts of the world and can also spread through individual communities. This paper highlights a need to structure public policy of Nepal to target the delta variant since it has become the predominant variant in Nepal. A further policy suggestion is to appropriately sample and sequence genomes of SARS-CoV-2 at regular intervals to understand the dynamics of variants in the population.

COVID-19: Epidemiology and Preventive Measures in Jiangsu Province, China

Objective: To analyze the epidemiological features of coronavirus disease 2019 (COVID-19) in Jiangsu Province after starting level 1 response to major public health emergencies and assess the effectiveness of epidemic prevention and control measures took by the government. Methods: Individual information on all novel coronavirus pneumonia confirmed cases from January 10, 2020 to March 18th in Jiangsu was collected from the official website of Health Commission of Jiangsu province and its cities, Hubei Health Commission and the Chinese Health Commission. The trends in demographic and epidemiological characteristics of confirmed cases were estimated and the real time reproduction number (Rt) were calculated. Results: 631 COVID-19 cases were diagnosed in Jiangsu Province, covering 13 districts in Jiangsu. The confirmed cases consisted of imported cases (30.27%) and local transmitted cases (69.73%). 64.15% (238/371) local transmitted cases had reported a history of exposure to COVID-19 cases or patients with acute respiratory infection. Close contact with COVID-19 infectors in families, parties or some public places is the main transmission route for local transmission cases. The epidemic peak occurred from January 30 to February 4, then began to decline. The ratio of male to female cases was 1.22 to 1, and most patients were in the group of 30-70 years old, 49 patients (7.8%) with mild symptom and 572 patients (90.6%) with common type accounted for the majority. As of March 18, the cities with higher cumulative confirmed cases were Nanjing (93 cases, 15%), Suzhou (87 cases, 14%) and Xuzhou (79 cases, 12%). The Rt reached a peak of 4.05 (95%CI 2.27-6.34) on January 20, then began to decline. Rt was below the epidemic threshold (Rt<1) after January 31 and maintained a continuing downward trend. Conclusion: The epidemic preventive and control measures have contributed to interrupt local transmission of COVID-19 in Jiangsu Province, and the epidemic in Jiangsu Province was well under control in less than a month.

The Association Between the Syrian Crisis and Cutaneous Leishmaniasis in Lebanon.

IntroductionDisplacement of refugees from highly endemic areas of leishmaniasis to adjacent countries is associated with the spread of Leishmania. Syria is a country with a known high endemicity for cutaneous leishmaniasis and the presence of Syrian refugees in Lebanon has contributed to the re-emergence of the disease. The aim of this article is to evaluate the burden of cutaneous leishmaniasis in Lebanon in view of the presence of a large number of Syrian refugees.MethodsData regarding all cases of leishmaniasis were collected from reports by the Lebanese Ministry of Public Health-Epidemiology Surveillance (LMPH-ESU), and the World Health Organization (WHO) between 2005 and 2018. All cases were reviewed in terms of area of residence, age and gender, clinical presentation, treatment, and outcome. An extensive literature review was conducted using “PubMed”, “Medline”, and “Google Scholar”.ResultsThe annual number of leishmaniasis cases recorded in Lebanon between 2005 and 2011 ranged between 0 and 6 cases. In 2012, this number increased to 1275 cases and dropped to 263 in 2018, where all those infected were Syrian refugees from Aleppo, with zero cases of local transmission. Seventy-two percent of cases were seen in patients aged < 20 years. The predominant species of Leishmania was L. tropica followed by L. major.ConclusionLebanon was affected by leishmaniasis following the Syrian crisis, and the influx of refugees to the country. Accurate disease monitoring and strategic training of healthcare personnel based within refugee camps are essential for proper containment. Preventative measures remain the best way to avoid both local and adjacent spread of leishmaniasis.

Effectiveness of Epidemic Preventive Policies and Hospital Strategies in Combating COVID-19 Outbreak in Taiwan.

(1) Background: The implementation of effective control measures in a timely fashion is crucial to control the epidemic outbreak of COVID-19. In this study, we aimed to analyze the control measures implemented during the COVID-19 outbreak, as well as evaluating the responses and outcomes at different phases for epidemic control in Taiwan. (2) Methods: This case study reviewed responses to COVID-19 and the effectiveness of a range of control measures implemented for epidemic control in Taiwan and assessed all laboratory-confirmed cases between 11 January until 20 December 2020, inclusive of these dates. The confirmation of COVID-19 infection was defined as the positive result of a reverse-transcriptase–polymerase-chain-reaction test taken from a nasopharyngeal swab. Test results were reported by the Taiwan Centers for Disease Control. The incidence rate, mortality rate, and testing rate were compiled, and the risk ratio was provided to gain insights into the effectiveness of prevention measures. (3) Results and Discussion: This study presents retrospective data on the COVID-19 incidence rate in Taiwan, combined with the vital preventive control measures, in a timeline of the early stage of the epidemic that occurred in Taiwan. The implementation of multiple strategy control measures and the assistance of technologies to control the COVID-19 epidemic in Taiwan led to a relatively slower trend in the outbreak compared to the neighboring countries. In Taiwan, 766 confirmed patients were included, comprised of 88.1% imported cases and 7.2% local transmission cases, within the studied period. The incidence rate of COVID-19 in Taiwan during the studied period was 32 per million people, with a mortality rate of 0.3 per million people. Our analysis showed a significantly raised incidence risk ratio in the countries of interest in comparison to Taiwan during the study period; in the range of 1.9 to 947.5. The outbreak was brought under control through epidemic policies and hospital strategies implemented by the Taiwan Government. (4) Conclusion: Taiwan’s preventive strategies resulted in a drastically lower risk for Taiwan nationals of contracting COVID-19 when new pharmaceutical drug or vaccines were not yet available. The preventive strategies employed by Taiwan could serve as a guide and reference for future epidemic control strategies.

An Overview of Epidemiology of COVID-19 in Macau S.A.R.

The Greater Bay Area of southern China has a population of over 71 million people. The area is well-connected with Hubei province, the epicenter of the COVID-19 outbreak. Macau, as the most densely populated city in the world, is very vulnerable to infectious disease outbreaks. Since its return to the sovereignty of China 20 years ago, the city has experienced outbreaks such as severe acute respiratory syndrome (SARS), Swine flu, and COVID-19. At the time of writing, 10 confirmed imported/local transmission cases were recorded. The government undertook measures to attain and then maintain 40 days without new cases. In this article, we report on the 10 confirmed cases and discuss the measures that the Macau Special Administrative Region (S.A.R.) government undertook during the COVID-19 pandemic.

Incubation period and serial interval of Covid-19 in a chain of infections in Bahia Blanca (Argentina).

The objective of this work was to estimate the incubation period and the serial interval of Covid-19 from a sample of symptomatic patients in Bahia Blanca city during the period March-May 2020. We collected dates of illness onset for primary cases and secondary cases for the first 18 secondary patients infected with SARS-Cov-2. Estimations of incubation period are based on a log-normal distribution while we assume a Gamma distribution for the serial interval. In both cases maximum likelihood estimator was applied to estimate main parameters. Of the total of 18 cases of local transmission analyzed, 17% occurred in the presymptomatic and asymptomatic phase. The mean incubation period for symptomatic patients is 7.9 days (95%CI: 4.6, 11.1) considering the full sample and 7.5 days (95%CI: 4.1, 10.9) if the sample is restricted to the most certain cases. The median is 6.1 and 5.8 days respectively. The point estimation for the mean serial interval is 6.8 days (95%CI: 4.0-9.6). or 5.5 days (95%CI: 2.8, 8.1) for most certain pairs. The estimated median serial intervals were 5.2 and 4.1 days respectively. Comparisons with foreign estimates show that incubation period and serial interval could be longer in Bahia Blanca city than in other regions. Transmission from pre-symptomatic and asymptomatic is not negligible.

Risk estimation of the SARS-CoV-2 acute respiratory disease outbreak outside China

BackgroundOn December 31, 2019, the World Health Organization was alerted to the occurrence of cases of pneumonia in Wuhan, Hubei Province, China, that were caused by an unknown virus, which was later identified as a coronavirus and named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to estimate the reproductive number of SARS-CoV-2 in the Hubei Province and evaluate the risk of an acute respiratory coronavirus disease (COVID-19) outbreak outside China by using a mathematical model and stochastic simulations.ResultsWe constructed a mathematical model of SARS-CoV-2 transmission dynamics, estimated the rate of transmission, and calculated the reproductive number in Hubei Province by using case-report data from January 11 to February 6, 2020. The possible number of secondary cases outside China was estimated by stochastic simulations in various scenarios of reductions in the duration to quarantine and rate of transmission. The rate of transmission was estimated as 0.8238 (95% confidence interval [CI] 0.8095–0.8382), and the basic reproductive number as 4.1192 (95% CI 4.0473–4.1912). Assuming the same rate of transmission as in Hubei Province, the possibility of no local transmission is 54.9% with a 24-h quarantine strategy, and the possibility of more than 20 local transmission cases is 7% outside of China.ConclusionThe reproductive number for SARS-CoV-2 transmission dynamics is significantly higher compared to that of the previous SARS epidemic in China. This implies that human-to-human transmission is a significant factor for contagion in Hubei Province. Results of the stochastic simulation emphasize the role of quarantine implementation, which is critical to prevent and control the SARS-CoV-2 outbreak outside China.

Ion torrent-based nasopharyngeal swab metatranscriptomics in COVID-19

Herein, we describe the detection of a SARS-CoV-2 genome through metatranscriptome next-generation sequencing directly from the nasopharyngeal swab of a suspected case of local transmission of Covid-19, in Brazil. Depletion of human ribosomal RNA and use of an optimized in-house developed bioinformatics strategy contributed to successful detection of the virus.

COVID-19: Preparedness and response by union territory of Jammu and Kashmir for containment of pandemic

Like the rest of the world, the onslaught of COVID-19 has hit India and poses as a major challenge to its country people. On January 31, India faced the jolt of COVID-19 for the first time when the maiden case was reported in Kerala. The numbers grew steadily in the following days. In the initial stages, the virus was contracted through patients with foreign travel history. However, as the numbers surged, the cases of local transmission also came to the fore. Various directives were issued by the administration to limit the spread of the virus. This included the closure of schools, colleges, and universities and the cancelation of visas. While the cases showed no signs of subsiding, the restrictions were intensified with the closure of interstate transport and cancelation of all flights. On March 24, the countrywide lockdown was announced for 21 days as a major precautionary measure against the growing virus. While the country continues to contain the coronavirus pandemic and the possible economic slowdown due to it, the newly formed union territory (UT) of Jammu and Kashmir has been put under another lockdown – this time due to the disease. However, this time, there is one silver lining in the dark cloud. The administration had been active beforehand. It had stepped up its preparedness measures before the outbreak of the pandemic in the UT.

Shortfalls in home quarantine for COVID-19 prevention: a case report

Quarantine of COVID-19 high risk groups is one strategy of interrupting chains of transmissions of the disease. We describe a COVID-19 imported case placed under home quarantine that resulted in 8 local transmission cases at the beginning of the COVID-19 epidemic in Botswana. This case report highlights that home quarantine if not well managed can lead to a surge in local cases and drawing from the literature we propose recommendations of strengthening home quarantine.

Outbreak of COVID-19 in Thailand: Time Serial Analysis on Imported and Local Transmission Cases.

Outbreak of COVID-19 in Thailand: Time Serial Analysis on Imported and Local Transmission Cases.

SARS-CoV-2 genomic surveillance in Taiwan revealed novel ORF8-deletion mutant and clade possibly associated with infections in Middle East

ABSTRACT Taiwan experienced two waves of imported infections with Coronavirus Disease 2019 (COVID-19). This study aimed at investigating the genomic variation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Taiwan and compared their evolutionary trajectories with the global strains. We performed culture and full-genome sequencing of SARS-CoV-2 strains followed by phylogenetic analysis. A 382-nucleotides deletion in open reading frame 8 (ORF8) was found in a Taiwanese strain isolated from a patient on February 4, 2020 who had a travel history to Wuhan. Patients in the first wave also included several sporadic, local transmission cases. Genomes of 5 strains sequenced from clustered infections were classified into a new clade with ORF1ab-V378I mutation, in addition to 3 dominant clades ORF8-L84S, ORF3a-G251V and S-D614G. This highlighted clade also included some strains isolated from patients who had a travel history to Turkey and Iran. The second wave mostly resulted from patients who had a travel history to Europe and Americas. All Taiwanese viruses were classified into various clades. Genomic surveillance of SARS-CoV-2 in Taiwan revealed a new ORF8-deletion mutant and a virus clade that may be associated with infections in the Middle East, which contributed to a better understanding of the global SARS-CoV-2 transmission dynamics.

Molecular characterization of multidrug-resistant Mycobacterium tuberculosis (MDR-TB) isolates identifies local transmission of infection in Kuwait, a country with a low incidence of TB and MDR-TB

BackgroundIncreasing incidence of multidrug-resistant Mycobacterium tuberculosis infections is hampering global tuberculosis control efforts. Kuwait is a low-tuberculosis-incidence country, and ~ 1% of M. tuberculosis strains are resistant to rifampicin and isoniazid (MDR-TB). This study detected mutations in seven genes predicting resistance to rifampicin, isoniazid, pyrazinamide, ethambutol and streptomycin in MDR-TB strains. Sequence data were combined with spoligotypes for detecting local transmission of MDR-TB in Kuwait.MethodsNinety-three MDR-TB strains isolated from 12 Kuwaiti and 81 expatriate patients and 50 pansusceptible strains were used. Phenotypic drug susceptibility was determined by MGIT 460 TB/960 system. Mutations conferring resistance to rifampicin, isoniazid, pyrazinamide, ethambutol and streptomycin were detected by genotype MTBDRplus assay and/or PCR sequencing of three rpoB regions, katG codon 315 (katG315) + inhA regulatory region, pncA, three embB regions and rpsL + rrs-500–900 regions. Spoligotyping kit was used, spoligotypes were identified by SITVIT2, and phylogenetic tree was constructed by using MIRU-VNTRplus software. Phylogenetic tree was also constructed from concatenated sequences by MEGA7 software. Additional PCR sequencing of gidB and rpsA was performed for cluster isolates.ResultsPansusceptible isolates contained wild-type sequences. Mutations in rpoB and katG and/or inhA were detected in 93/93 and 92/93 MDR-TB strains, respectively. Mutations were also detected for pyrazinamide resistance, ethambutol resistance and streptomycin resistance in MDR-TB isolates in pncA, embB and rpsL + rrs, respectively. Spoligotyping identified 35 patterns with 18 isolates exhibiting unique patterns while 75 isolates grouped in 17 patterns. Beijing genotype was most common (32/93), and 11 isolates showed nine orphan patterns. Phylogenetic analysis of concatenated sequences showed unique patterns for 51 isolates while 42 isolates grouped in 16 clusters. Interestingly, 22 isolates in eight clusters by both methods were isolated from TB patients typically within a span of 2 years. Five of eight clusters were confirmed by additional gidB and rpsA sequence data.ConclusionsOur study provides the first insight into molecular epidemiology of MDR-TB in Kuwait and identified several potential clusters of local transmission of MDR-TB involving 2–6 subjects which had escaped detection by routine surveillance studies. Prospective detection of resistance-conferring mutations can identify possible cases of local transmission of MDR-TB in low MDR-TB settings.

Cross-Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika Transmission.

Perceptions of infectious diseases are important predictors of whether people engage in disease-specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and self-efficacy (i.e., control). The 2015-2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved cross-sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (March-May 2016) and one just after the first cases of local transmission (July-August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and self-efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.

SITUASI PRA ELIMINASI MALARIA DI KABUPATEN OKUS

Malaria merupakan penyakit menular yang masih menjadi masalah kesehatan global termasuk di Indonesia. Untuk memberantas malaria, pemerintah telah mencanangkan gerakan eliminasi malaria di seluruh wilayah Indonesia dengan target tahun 2030 indonesia bebas malaria. Eliminasi malaria di Kabupaten Ogan Komering Ulu Selatan (OKUS) ditargetkan di tahun 2020. Data dalam penulisan ini berasal dari data sekunder Dinas Kesehatan Kabupaten OKUS tahun 2017 dan 2018. Berdasarkan data tersebut diperoleh hasil bahwa API Kabupaten OKUS di tahun 2017 dan 2018 adalah 0,470/00 dan 0,630/00. Plasmodium falciparum merupakan penyebab terbesar dari kasus malaria yang terjadi di Kabupaten OKUS yaitu 135 kasus di tahun 2017 dan 200 kasus di tahun 2018. Masih ditemukan kasus penularan setempat di Kabupaten OKUS dalam dua tahun terakhir yaitu 93 kasus di tahun 2017 dan 112 kasus di tahun 2018. Penderita malaria laki-laki lebih banyak dibandingkan dengan penderita malaria wanita di tahun 2017, sebaliknya di tahun 2018 penderita malaria wanita lebih banyak dari laki-laki. Berdasarkan kelompok umur, penderita malaria paling banyak terjadi pada kelompok umur produktif 15-64 tahun yaitu 77 kasus di tahun 2017 dan 112 kasus di tahun 2018. Berdasarkan tiga kriteria eliminasi malaria, Kabupaten OKUS telah memenuhi indikator API &lt;1 per 1000 penduduk, namun dalam kurung waktu dua tahun terakhir masih ditemukan kasus penularan setempat yang seharusnya selama tiga tahun berturut-turut tidak boleh ada kasus penularan setempat sehingga di tahun 2020 dapat diusulkan untuk eliminasi malaria. Diperlukan peran aktif masyarakat dalam kegiatan pemberantasan malaria supaya tidak terjadi lagi penularan malaria di wilayah mereka seperti pemberantasan sarang nyamuk melalui kegiatan gotong royong dan peningkatan pemahaman tentang bagaimana mencegah gigitan nyamuk melalui sosialisasi bagi masyarakat

759. Molecular Characterization and Epidemiology of Multidrug-Resistant Mycobacterium tuberculosis (MDR-TB) and Identification of Possible Cases of Local Transmission of MDR-TB in Kuwait

BackgroundIncreasing incidence of multidrug-resistant tuberculosis (MDR-TB) is hampering efforts to control TB. Kuwait is a low (25/100,000) TB incidence country and ~1% of Mycobacterium tuberculosis strains are resistant to rifampin, RIF and isoniazid, INH (MDR-TB). Analysis of resistance conferring mutations in seven genes was combined with spoligotyping for detecting local transmission of MDR-TB in Kuwait.MethodsMDR-TB strains (n = 131) from 88 TB patients and 50 susceptible strains were used. Susceptibility testing was done by MGIT 960 system, gMTBDRplus assay and PCR-sequencing of three regions of rpoB, katG codon 315 (katG315) + inhA regulatory region, embB (embB306/embB406/embB497 regions), rpsL + rrs-500–900 regions and pncA for RIF, INH, ethambutol (EMB), streptomycin (SM) and pyrazinamide (PZA), respectively. Sequencing data were used to construct phylogenetic tree by MEGA7 software. Spoligotypes were identified by SITVIT2 and phylogenetic tree was made by MIRU-VNTRplus software.ResultsMutations were detected in most isolates in rpoB, katG+inhA, embB, rpsL+rrs and pncA which confer resistance to RIF, INH, EMB, SM and PZA, respectively. Phylogenetic analysis of multi-locus concatenated sequences showed unique patterns for 51 patient’s isolates while 37 patient’s isolates grouped in 14 clusters. Spoligotyping identified 35 patterns (19 unique patterns and 69 patients’s isolates in 16 patterns) including 11 orphan patterns. Sixteen isolates yielded six clusters (each containing two to five isolates) by both fingerprinting methods.ConclusionOur study provides the first insight into molecular epidemiology of MDR-TB in Kuwait and identified six potential cases of local transmission of MDR-TB involving two to five subjects (including five Kuwaiti patients) which had escaped detection by routine surveillance studies. Prospective detection of resistance conferring mutations thus identifies possible cases of local transmission of MDR-TB in low TB incidence countries.Disclosures All authors: No reported disclosures.

434. Neurocysticercosis in Houston

BackgroundNeurocysticercosis (NCC) is a central nervous system infection that occurs by ingesting the larval form of the parasite, Taenia solium. It is the most common parasitic disease of the central nervous system in developing countries, and the most common cause of acquired epilepsy. Even though seizures are the most common presenting symptom, NCC can present with many manifestations.MethodsThis is a retrospective chart-review cohort study. Patients referred to the Neurology Clinic at Smith Clinic in Houston from January 2013 to December 2015 for a diagnosis of headache and/or seizure were evaluated. The prevalence of NCC was determined, as well as epidemiological characteristics for those referred to the clinic and those with NCC. For patients with a diagnosis of NCC, further clinical data and zip codes were abstracted.ResultsA total of 16,050 visits were documented at the neurology clinic from January 2013 to December 2015. Of those, 9,317 of those visits were attributed to headache and/or seizure and included a total of 3,158 patients. A total of 33 patients had a diagnosis of NCC by ICD code alone, and of those, 29 also had a diagnosis of headache and/or seizure. All NCC patients were Hispanic/Latino, and the overall prevalence of NCC among those with a headache and/or seizure diagnosis was 0.92%. The prevalence among those with headaches was 0.25% and those with seizures was 1.37%. Based on ArcMap software and the zip codes of those diagnosed with NCC, most cases appear in the south-central area of the city.ConclusionNCC has now spread to the developed world mainly due to increased migration, although sporadic cases of local transmission have also been documented. Our data could help develop a preliminary but current epidemiological profile of NCC in Houston and determine if there are areas of high prevalence within certain communities.Disclosures All authors: No reported disclosures.