Non-endemic Regions Research Articles

Disseminated Melioidosis Presenting as Sepsis, Neurological Melioidosis, Liver and Prostate Abscess in United Arab Emirates.

Melioidosis is an infection caused by Burkholderia pseudomallei, a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection. This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses. In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future. Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.

The Incidence of malignancy in nodular goiter in endemic and non-endemic regions.

Aim: The purpose of this study is to look into the prevalence of thyroid cancer in Azerbaijan's endemic and non-endemic regions, as well as the effect of unmanaged iodine prophylaxis on the development of thyroid cancer. Material and methods: The study includes 352 patients who were treated operatively for nodular goiter between 2015 and 2022. Patients were separated into two groups based on endemic (n=126) and non-endemic (n=226) regions, as well as two subgroups based on the number of nodules in the thyroid: single nodule (169) and multinodule (183). Thyroid cancer was discovered in 20 patients (15.9%) in the endemic zone (p=0259). Malignancy was found in 11 (8.7%) of single-nodular goiter (SNG) patients and 9 (7.1%) of multi-nodular goiter (MNG) patients (p=0,259): 19 (15.1%) had the classic variation of papillary cancer and 1 (0.8%) had the follicular variant of papillary cancer. Cancer was discovered in 47 cases (20.8%) (p=0.259) in non-endemic regions: malignancy was detected in 23 (10.2%) cases of MNG patients and in -24 (10.6%) of SNG patients. In non-endemic areas, 2 patients (0.7%) had follicular cancer, 36 (15.9%) had the classic type of papillary cancer, 7 (3.1%) had microcarcinoma, and 2 (0.9%) had medullary cancer (p=0,220). Results: Although there was a decrease in the frequency of incidence of goiter disease in general in endemic regions due to the prohibition of iodized table salt, an increase in the frequency of occurrence of MNG (56.4%) was noted. Thyroid malignancy have been identified in 15.9% of endemic nodular goiter patients and 20.8% of non-endemic nodular goiter patients. The significant percentage increase in papillary carcinoma in our region study was consistent with the literature. Conclusions: According to data collected in endemic areas, the use of unregulated iodine prophylaxis resulted in a decrease in the prevalence of follicular carcinoma while increasing the frequency of papillary carcinoma. The prevention of iodized table salt under the conditions of sanitary-epidemiological follow-up under the control according to the endemic characteristics of the regions can lead to a decrease in the risk of follicular cancer

Outbreak Over Monkey Pox Virus in Human: Immediate Countermeasures from the Endemic to Non-Endemic Regions

A zoonotic orthopoxvirus called human monkeypox has symptoms that resemble smallpox. When people come into contact with diseased animals, they may unintentionally contract monkeypox. According to reports, the virus can also spread through close physical contact, such as skin-to-skin contact or sexual contact, respiratory droplets, and by household items like towels and blankets. There are numerous medical countermeasures on hand for orthopoxviruses like monkeypox. Monkeypox, which originated in western and central Africa, has lately been found in a integer of nations, counting Spain, Canada, Australia, and the United Arab Emirates. Despite its extremely low incidence rate, it nonetheless poses a serious concern that needs to be addressed as soon as possible because of the strong likelihood that it will spread to many other nations. Outside of endemic areas, the danger of monkeypox transmission in medical settings is not well known. One recorded instance of transmission was found after a quick assessment of the literature from 2000 to 2022, which also included cases outside of areas where monkeypox is endemic. It is unusual for monkeypox to recur in non-endemic nations. It is a zoonosis that can extend from animal to human and from human to human, and it has clinical characteristics comparable to smallpox. The latest outbreaks may be attributed to lowered resistance to the orthopoxviruses, movement of people from widespread to non-endemic areas, hereditary alterations in the viral genome, and diminished observation. Transmission and pathogenicity could be avoided with the use of a multifaceted strategy that includes health education, monitoring human mobility, the development of diagnostic tools, and an efficient vaccination.
 Keywords: Monkeypox, Outbreak, Orthopoxvirus, Epidemiology, Vaccination, Virology, Public health, Preventive measures

Improved Antibody Detection for Canine Leptospirosis: ELISAs Modified Using Local Leptospiral Serovar Isolates from Asymptomatic Dogs.

Leptospirosis is a zoonotic disease of significant concern for human and animal health, with domestic animals, including dogs, acting as reservoirs for human infection. Serology is widely used for leptospirosis diagnosis, even though the standard microscopic agglutination test (MAT) using a panel of serovars lacks specificity and can lead to detection limitations in certain regions. In this study, we aimed to develop an antibody detection tool for dogs using an indirect enzyme-linked immunosorbent assay (ELISA) with a set of local serovar isolates, including Paidjan, Dadas, and Mini, to enhance the accuracy of leptospirosis surveillance in our region. The specificity and sensitivity of various antigen preparations, namely leptospiral whole-cell protein (WCP), total membrane protein (TMP), and outer membrane protein (OMP), were assessed using sera from infected and non-infected dogs, as well as negative puppy sera. Leptospirosis diagnosis was supported using a genus-specific nested polymerase chain reaction test on all collected sera. Protein preparations were validated using SDS-PAGE and Western blotting analysis. In the results, the standard MAT failed to detect antibodies in any of the dogs confirmed as being infected using PCR and isolation, highlighting its limitations. In contrast, the OMP-based ELISAs using local isolates of Leptospira serovars gave positive results with sera from all infected dogs, and negative results with sera from all dogs from non-endemic areas. IgG titres of infected and unvaccinated dogs from endemically affected areas were significantly higher than those in non-endemic regions. Using the OMP-based IgG/ELISAs with the local serovar Dadas resulted in higher specificity and lower sensitivity than when using the WCP- and TMP-based IgG/ELISAs. Agreement analysis revealed fair and moderate concordance between OMP-based IgG/ELISAs and PCR results, whereas slight and fair agreement was observed between OMP-based ELISAs and the MAT. Overall, the modified OMP-based IgG/ELISAs, utilising relevant local serovar isolates from dogs, demonstrated improved accuracy in detecting leptospirosis in the study area, overcoming the limitations of the MAT. This study highlights the importance of identifying and incorporating these local circulating serovar isolates into serological techniques for leptospirosis diagnosis and surveillance.

Clinical and laboratory characterization of cutaneous leishmaniasis in Chinese migrant workers returned from Iraq.

Imported cutaneous leishmaniasis (CL) is a growing problem with increasing global travel to endemic areas. Returned travelers with CL are easy to be misdiagnosed and mistreated due to the lack of awareness for the disease to the physicians in non-endemic region that may lead to unfavorable outcome. Our study intends to summarize the characteristics of Leishmania infection imported from Iraq, so as to help Chinese physicians diagnose and treat the disease. All CL patients were treated with intralesional injection of antimony. The definitive diagnosis of CL is based on the parasite identification by microscopic examination directly on lesion smear or parasite culture, PCR amplification of Leishmania-specific internal transcribed spacer 1 (ITS-1). The phylogenetic analysis, the immunopathological examination and the cytokine detection were proceeded after the diagnosis. We have identified 25 CL cases in migrant Chinese workers returned from Iraq for the first time with L. major as the major species of infected Leishmania parasite. Clinical features of the Iraq-imported CL include the history of skin exposure to sandflies bite and the lesions mostly on the exposed limbs. More ulcerative wet lesion was observed than nodular dry lesion. PCR is not only used to detect Leishmania parasite with high sensitivity, but also to identify the species of infected parasite through sequencing the amplified Leishmania-specific ITS-1 gene. The phylogenetic analysis based on the amplified ITS-1 sequences revealed that the infected Leishmania was closed related to the species and strains endemic in Iraq. The immunopathological examination revealed the T-cell filtrated cellular immune response with less B cells and NK cells involved. The cytokine profile measured in the skin lesion also confirmed the Th1 cellular response with higher expression levels of IFN-γ, IL-6 and IL-8. The skin lesions in CL patients were healed after being treated locally with antimony. The clinical and parasitological features of these Chinese CL cases imported from Iraq provide useful information for the diagnosis and treatment of CL that is not commonly seen in Chinese local population.

211 Plasma EBV estimation in Nasopharyngeal carcinoma from a nonendemic region: Impact of probe assay type, EBV copy numbers as a predictive and prognostic marker.

211 Plasma EBV estimation in Nasopharyngeal carcinoma from a nonendemic region: Impact of probe assay type, EBV copy numbers as a predictive and prognostic marker.

Japanese encephlu emergence in Australia: the potential population at risk.

Japanese encephalitis virus (JEV), an RNA virus transmitted by Culex mosquitoes, primarily cycles between aquatic birds and mosquitoes with pigs as amplifying hosts, posing a significant global encephalitis threat. The emergence and spread of the JEV in new epidemiological regions, such as recent cases in Australia and nonendemic areas like Pune, India, raise significant concerns. With an estimated 68000 clinical cases and 13600 to 20400 deaths annually, JEV poses a substantial global health threat. The virus primarily affects children, with a case-fatality ratio of 20-30% and long-term neurological sequelae in survivors. The changing epidemiology, influenced by factors like bird migration, climate change, and increased urbanization, contributes to the geographic expansion of JEV. The recent outbreaks underscore the potential for the virus to establish itself in nonendemic regions, posing a threat to populations previously considered at low-risk. With limited treatment options and high rates of neurological complications, continued surveillance, traveler vaccination, and research into treatments are crucial to mitigate the impact of JEV on human health. The evolving scenario necessitates proactive measures to prevent and control the spread of the virus in both endemic and newly affected areas.

The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study

BackgroundThe 2022–2023 mpox (monkeypox) outbreak has spread rapidly across multiple countries in the non-endemic region, mainly among men who have sex with men (MSM). In this study, we aimed to evaluate mpox’s importation risk, border screening effectiveness and the risk of local outbreak in Chinese mainland.MethodsWe estimated the risk of mpox importation in Chinese mainland from April 14 to September 11, 2022 using the number of reported mpox cases during this multi-country outbreak from Global.health and the international air-travel data from Official Aviation Guide. We constructed a probabilistic model to simulate the effectiveness of a border screening scenario during the mpox outbreak and a hypothetical scenario with less stringent quarantine requirement. And we further evaluated the mpox outbreak potential given that undetected mpox infections were introduced into men who have sex with men, considering different transmissibility, population immunity and population activity.ResultsWe found that the reduced international air-travel volume and stringent border entry policy decreased about 94% and 69% mpox importations respectively. Under the quarantine policy, 15–19% of imported infections would remain undetected. Once a case of mpox is introduced into active MSM population with almost no population immunity, the risk of triggering local transmission is estimated at 42%, and would rise to > 95% with over six cases.ConclusionsOur study demonstrates that the reduced international air-travel volume and stringent border entry policy during the COVID-19 pandemic reduced mpox importations prominently. However, the risk could be substantially higher with the recovery of air-travel volume to pre-pandemic level. Mpox could emerge as a public health threat for Chinese mainland given its large MSM community.Graphical

Safety and Efficacy of Gemcitabine Plus Cisplatin Against Recurrent/Metastatic Nasopharyngeal Carcinoma: A Retrospective Study.

Although gemcitabine plus cisplatin (GC) prolongs survival in patients with recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) compared with fluorouracil plus cisplatin, no study has evaluated the efficacy and safety of GC in nonendemic regions, including Japan, yet. Therefore, we assessed the safety and efficacy of GC in Japanese patients with R/M NPC. We retrospectively reviewed patients with R/M NPC who received GC treatment at the Aichi Cancer Center Hospital from January 2017 to March 2020. The main eligibility criteria were histologically confirmed NPC, Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-2, and locally recurrent disease unsuitable for local treatment or metastatic disease. The regimen was administered every 3 weeks (gemcitabine, 1,000 mg/m2 on days 1 and 8; cisplatin, 80 mg/m2 on day 1). Fourteen patients (median age, 58 years) were included in the study. Two patients had an ECOG PS of 2 and 11 exhibited nonkeratinizing histology. Of the eight patients with measurable lesions, one exhibited complete response and seven exhibited partial response, with an objective response rate of 75%. Median progression-free survival and overall survival were 7.7 and 24.2 months, respectively. Common grade 3 or 4 adverse events included neutropenia (64%), thrombocytopenia (14%), and febrile neutropenia (14%). The median relative dose intensity of gemcitabine and cisplatin was 62% and 60%, respectively. No treatment-related deaths occurred. The GC regimen demonstrates promising activity and is tolerable in Japanese patients with R/M NPC.

Drug rash with eosinophilia and systemic symptoms to anti-tuberculosis therapy: A retrospective review of inpatients at an academic medical centre in the United States.

This retrospective cohort study analyzes the presentation, diagnosis, and treatment outcomes of patients who developed drug rash with eosinophilia and systemic symptoms (DRESS) to tuberculosis (TB) therapy in a TB non-endemic region. Anti-TB agents represented 7.5% of all antimicrobial-induced DRESS cases, and rifampin was the most commonly implicated agent among drugs used to treat TB.

An unexpected case of a dog from Poland co-infected with Dirofilaria repens and Dirofilaria Immitis.

Dirofilariasis is a vector-borne disease caused by parasitic nematodes of the genus Dirofilaria spp., considered an emerging concern in both veterinary and human medicine. Climate changes and human activities, such as pet travel, contribute to the spread of diseases to new non-endemic regions. Poland is dominated by subcutaneous dirofilariasis caused by D. repens infections. Cardiopulmonary dirofilariasis, also known as a heartworm disease is much more rare with only single autochthonous cases reported so far. Also, imported infections are observed sporadically in dogs traveling to endemic countries. In this study, we report the first case of a dog in Poland, never having traveled abroad, co-infected with Dirofilaria repens and Dirofilaria immitis. A 14-year-old mixed breed, an intact male dog with fever, lightly pale mucosal membranes, moderate abdominal pain, and a mild cough was presented in a veterinary clinic in Warsaw, Poland. The examination of the blood sample collected for complete morphology and biochemistry revealed the presence of live microfilariae. Presence of the DNA of both microfilariae species was detected using Real-Time PCR with species-specific primers. Since the remaining diagnostic methods like Knott's test, antigen test or echocardiography did not reveal the presence of D. immitis, we discussed the impact of microfilariae periodicity and low worm burden infections on the limited efficiency of these techniques. We strongly recommend using a mixed diagnostic approach for the most sensitive and specific diagnosis since the ideal diagnostic method does not exist, and several factors may contribute to misdiagnosis. Furthermore, we considered factors that contribute to the uncontrolled spread of dirofilariasis such as climate changes, introduction of new species of mosquitoes competent for the transmission of the disease, and wildlife animals as an important reservoir of this parasitosis. Given that Poland shares borders with countries classified as endemic and pre-endemic for D. immitis, such as Slovakia and Ukraine, it is reasonable to anticipate a rise in autochthonous heartworm infections and shifts in the epidemiological pattern of dirofilariasis in the coming years.

Genetic variation of FcγRIIa induces higher uptake of Leishmania infantum and modulates cytokine production by adherent mononuclear cells in vitro.

Single nucleotide variations (SNVs) are specific genetic variations that commonly occur in a population and often do not manifest phenotypically. However, depending on their location and the type of nucleotide exchanged, an SNV can alter or inhibit the function of the gene in which it occurs. Immunoglobulin G (IgG) receptor genes have exhibited several polymorphisms, including rs1801274, which is found in the FcgRIIa gene. The replacement of A with T results in a Histidine (H) to Arginine (R) substitution, altering the affinity of the IgG receptor for IgG subtypes and C-reactive protein (CRP). In this study, we analyzed rs1801274 and its functional implications concerning L. Infantum uptake and cytokine production. We genotyped 201 individuals from an endemic area for visceral leishmaniasis to assess the presence of rs1801274 using Taqman probes for a candidate gene study. Additionally, we included seventy individuals from a non-endemic area for a functional study. Subsequently, we isolated and cultivated one-week adherent mononuclear cells (AMCs) derived from the peripheral blood of participants residing in the non-endemic region in the presence of L. infantum promastigotes, with and without antigen-specific IgG and/or CRP. We analyzed the rate of phagocytosis and the production of nitric oxide (NO), tumor necrosis factor (TNF)-a, interleukin (IL)-10, IL-12 p70, IL-1b, IL- 6, and IL-8 in the culture supernatants. In participants from the endemic region, the A/G (H/R isoform) heterozygous genotype was significantly associated with susceptibility to the disease. Furthermore, SNVs induced a change in the phagocytosis rate in an opsonin-dependent manner. Opsonization with IgG increased the production of IL-10, TNF-a, and IL-6 in AMCs with the H/R isoform, followed by a decrease in NO production. The results presented here suggest that the rs1801274 polymorphism is linked to a higher susceptibility to visceral leishmaniasis.

Imported malaria: A 20-year retrospective study from a tertiary public hospital in Brussels, Belgium

BackgroundMalaria continues to cause a significant number of infections in non-endemic regions. In this paper, we describe the epidemiological trend and morbidity of imported malaria diagnosed in a tertiary hospital in Brussels. MethodsWe conducted a retrospective study describing a cohort of malaria episodes (in- and outpatients) at Centre Hospitalier Universitaire Saint-Pierre from 1998 to 2017. Epidemiological and clinical data were collected by reviewing medical files. ResultsA total of 1011 malaria episodes were analyzed. Median age at diagnosis was 35 years, and 66 % of patients were men (672/1011). Malaria cases significantly increased over the two decades (from 17 in 1998 to 79 in 2017). Plasmodium falciparum malaria was most often diagnosed (846/935, 89 %), primarily from Central (530/935, 57 %) and West Africa (324/935, 35 %). Many cases (383/764, 50 %) were diagnosed in patients “visiting friends and relatives”. HIV-infected and other immunocompromised patients were significantly more likely to present with severe malaria (at least one severity criteria as defined by the WHO) compared to other patients (24/57, 42 % vs 138/732, 19 %, p < 0.01 and 15/21, 71 % vs 147/767, 19 %, p < 0.001). Severe malaria was diagnosed in 16.9 % and the mortality rate was low (5/1011, 0.5 %). ConclusionImported malaria increased over the years with a large, albeit stable number of cases diagnosed in patients visiting friends and relatives. These findings, along with the high rate of severe malaria in HIV and immunocompromised patients, underscore an urgent need for strengthened malaria surveillance and targeted preventive interventions.

Nasopharyngeal carcinoma: nationwide trends in subtype-specific incidence and survival over 3 decades in a non-endemic area

PurposeTo identify trends in incidence and survival of NPC, subdivided by EBV status and histopathological subtype, over a 30-year period in the Netherlands.MethodsAnonymized data from the Netherlands Cancer Registry and the Dutch Nationwide Pathology Databank (PALGA) for the period 1989–2018 were linked to identify and classify NPC cases.ResultsIncidence of NPC remained stable, with an annual percentage change (APC) of − 0.2. (95% CI − 0.9; 0.5). EBV testing became routine only in the last decade, the incidence of EBV-positive tumors remained stable over this period (APC 1.2, 95% CI − 1.3; 3.8). An increase in EBV-negative tumors (APC: 7.1, 95% CI 2.5; 11.9) and a decrease in untested tumors were found (APC: − 10.7, 95% CI − 15.7; − 5.7). The incidence of non-keratinizing, differentiated tumors increased (APC: 3.8, (95% CI 2.2; 5.5) while the incidence of other histological subtypes remained stable. Overall survival was better in patients diagnosed after 1998 (hazard ratio 0.8, 95% CI 0.6; 0.9). EBV status, histology, stage, and age were independently associated with relative excess risk of dying, but period of diagnosis was not.ConclusionTesting for EBV increased over time, and a stable incidence of EBV-positive NPC over the last 10 years. The rising incidence of non-keratinizing, differentiated NPC mirrors data from the US and suggests a shift in non-endemic regions.

Emerging Burkholderia Musculoskeletal Infections With Delayed Diagnosis in Non-endemic Regions Affect Patient Morbidity: A Case Series of 10 Patients With a Review of the Literature.

Burkholderia infection commonly presents as bacteraemic pulmonary disease; however, it is notorious for its wide variety of presentations in chronic cases, including musculoskeletal manifestations. It is common in patients living in endemic areas with comorbidities such as diabetes and who have chronic alcoholism.It was previously under-reported due to a low index of suspicion. Now, there is an increasing trend of diagnosis of these infections in non-endemic areas because of various factors, such as MALDI-TOF, molecular tests, and PCR. This is a single tertiary centre study of 10 patients, diagnosed with Burkholderia infection and treated at our institution between 2021 and 2023 and followed up for a minimum of six months. Information was collected from outpatient and inpatient records. In this study, the mean age of the patients was 45 years, with eight males and two females. Out of 10, seven patients had comorbidities. However, only one patient has a history of travelling to an endemic area. All our patients were treated operatively, and the course of intervention and the planning of the surgical procedure were decided according to clinico-radiological findings. Six out of 10 patients suffering from Burkholderia species infections have a history of prolonged ICU stay, four of them tested positive for Burkholderia pseudomallei and the remaining two tested positive for Burkholderia cepacia,with a mean average time of 24.6 days. Diabetes was the most common comorbidity in 70% of the patients. The knee was the most commonly affected joint, showing involvement in 60% of patients. We have done surgical intervention in all patients. In our study, we have given IV antibiotics for a minimum of six weeks to all patients, followed by oral antibiotic therapy for three to six months on the basis of regular follow-up of clinico-haematologic parameters. Infections caused by Burkholderia species should be considered a potential causative agent of musculoskeletal infections in non-endemic areas without prior history of travelling to endemic areas. It may present with a chronic, mild course; a high index of suspicion is required, and it is important that due suspicion translates to prompt diagnosis and appropriate treatment to mitigate the course of the disease and associated morbidities in patients.

Detection of Plasmodium spp. in asymptomatic blood donors by the new Brazilian NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos kit.

Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.

Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening.

Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. Mean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.

Preliminary survey on the distribution of Ixodid ticks in domestic ruminants and vegetation of Pathanamthitta district, Kerala, South India.

Tick borne diseases (TBD) are becoming a major public and animal health problem in the Kerala. Recently, during 2021 - 2022, a new focus of tick nuisance and associated fever has been reported in some villages of Pathanamthitta district. The study on the diversity of tick fauna in Southern Kerala is limited. Therefore, a preliminary survey was carried out for the first time in this focus for implementation of future tick borne pathogen detection and control measures. This research may provide a proper understanding of tick density and acarological risk by tick ecology through surveillance and identification. A cross sectional study was conducted during the summer season of 2021 and 2022 in the tick bite infected area - Naduvathumoozhy, Vayakkara, Malayalappuzha and Pallikuzhi. Ticks were manually collected from ruminants and by dragging method from vegetation. A total of 727 ticks of 8 different species were collected from the genus Amblyomma, Haemaphysalis, Hyalomma, and Rhipicephalus. The most prevalent species were H. bispinosa and H.turturis, at 38.7% and 29.1%, respectively. Ticks were sampled from 197 animals with the proportion of infestation being 73.60%. It was highest in goats (85.9%), followed by buffalo (73.6%) and cow (65.4%). The study concludes that, despite the absence of any TBD outbreaks, the Pathanamthitta district has a high diversity of tick fauna and a high rate of tick infestation in domestic ruminants, especially in goats. Hence active tick surveillance is necessary in order to prevent TBD outbreaks in future; the study also emphasizes the importance of performing tick surveillance in both KFD endemic and non-endemic regions.

MPOX: Research priorities for threat reduction

MPOX: Research priorities for threat reduction Concerted efforts are needed to close knowledge gaps around mpox to improve preparedness and response efforts for this neglected disease. Mpox, formerly known as monkeypox, is a previously neglected re-emerging zoonotic disease caused by monkeypox virus (MPV), genus Orthopoxvirus, family Poxviridae. This virus can cause severe illness in infected patients and is endemic in numerous countries across Central and West Africa, including the Democratic Republic of Congo (DRC), Nigeria, Cameroon, Sierra Leone, Ghana, Liberia, and others. However, in 2022, a global mpox outbreak led to the declaration of a public health emergency of international concern by the World Health Organization, with more than 90,000 confirmed cases reported from non-endemic global regions. While swift responses to this outbreak helped reduce case trends across highly impacted regions by Fall 2022, including the distribution of vaccine and therapeutics to at-risk communities, as well as increased public awareness, ongoing outbreaks in endemic regions continue to have deleterious effects on public health.

Pediatric urogenital schistosomiasis diagnosed in France.

Schistosomiasis affects approximately 230 million people worldwide. There is an increased incidence of schistosomiasis cases in France acquired from outside the country. This increases the risk of schistosomiasis outbreaks as observed in Corsica. Clinicians from non-endemic regions are not accustomed to diagnosing and managing this pathology. The objective of this study is to provide a better description of the clinical and paraclinical characteristics and disease evolution of affected children. Through the French Pediatric Nephrology Society and the Pediatric Infectious Pathology Group, we contacted all French pediatric centers that may have treated children with urinary schistosomiasis between 2013 and 2019. Age, sex, comorbidities, and clinical, biological, and radiological data (at discovery and follow-up) were collected retrospectively. A total of 122 patients from 10 different centers were included. The median age was 14 years and the sex ratio M/F was 4:1. Hematuria was present in 82% of the patients while urinary tract abnormality was found in 36% of them. Fourteen patients (11%) displayed complicated forms of urinary schistosomiasis including 10 patients with chronic kidney disease. A total of 110 patients received treatment with praziquantel, which was well-tolerated and led to clinical resolution of symptoms in 98% of cases. Patients with schistosomiasis present frequent kidney, urinary, or genital involvement. Systematic screening of patients returning from endemic areas is therefore recommended, especially since treatment with antiparasitic drugs is effective and well-tolerated. Enhancing medical knowledge of this pathology among all practitioners is essential to improve care and outcomes.