Positive Serological Tests Research Articles

Dengue & COVID-19: A Comparison and the Challenges at Hand.

The COVID-19 pandemic caused by SARS-CoV-2spread across many countries between 2020 and 2022. The similarities in clinical presentation with other endemic diseases pose a challenge to physicians in effectively diagnosing and treating the infection. Approximately129 nations have a risk of dengue infection, and more than 100 of those are endemic to dengue. During the COVID-19 pandemic, the number of dengue cases decreased in many countries owing to the isolation measures followed. However, the common clinical presentation between them has led to misdiagnosis. Both COVID-19 and dengue fever cause a surge in pro-inflammatory cytokines and chemokines, thus sharing a common pathophysiology. False positive serological test results also posed difficulty differentiating between COVID-19 and dengue fever. This review aims to compare the clinical features, pathophysiology, and immune response between dengue and COVID-19, to benefit public health management during the pandemic.

Anti-Aspergillus fumigatus IgG in patients with bronchiectasis and its relationship with clinical outcome

Aspergillosis is a mycosis, most commonly affecting the airways. This mycosis can worsen the clinical condition of patients with concurrent lung diseases. We assayed for the presence of serum anti-A. fumigatus IgG in bronchiectasis patients from a tertiary hospital in south Brazil and evaluated the relationship with clinical outcome. Thirty-one patients with bronchiectasis, without cystic fibrosis, were included. Clinical and epidemiological data were collected from all participants. Positive serological tests were detected in 13% (4/31) of the patients. The mortality rate for the year following the assay was, in the seropositive group, 75% (3/4), whereas in the seronegative group, 15% (4/27). An illustrative case is also shown and discussed. Our study highlights the diagnostic challenge and the possible impact of Aspergillus infection on these patients, indicating the necessity of more and larger investigations in the field.

Prevalence of Syphilis in Pregnancy using a Rapid Treponemal Specific Test in a Low Resource Setting

Background: The rapid treponemal specific test such as immunochromatographic (ICS) test is being recommended as a point of care (POC) test as alternative to the non-specific Treponemal test such as Venereal Disease Research Laboratory (VDRL) commonly used in most developing countries. Objectives: To determine the yields of the ICS test for syphilis among pregnant women. Method: This was a crosssectional study. One hundred and sixty consecutive pregnant women who satisfied the inclusion criteria were recruited into the study. Blood samples obtained from respondents were tested for the presence of Treponema pallidum antibodies using both, Diaspot®syphilis ultra-rapid test kit and MAST-TPHATM TPHA (Treponema pallidum Haemaglutination Assay) test. Results: Out of the 160 pregnant women studied, 4 (2.5%) were sero-reactive for syphilis using the Treponema pallidum haemmaglutination assay (TPHA) while only 2 (1.25%) were sero-reactive to syphilis using the (immunochromatographic screening) ICS method of screening. The sensitivity of the ICS method in detecting syphilis infection was 50% (95% CI: 6.76% – 93.24%) whereas it was 100% specific for syphilis (95% CI: 97.66% -100%). The Positive Predictive Value of the ICS for syphilis screening was 100% while its Negative Predictive value was 98.73% (95% CI: 96.70% – 99.52%). There was no statistically significant difference in the yield of a positive syphilis serology test result comparing the rapid immunochromatographic screening test with the TPHA (P= 0.479). Conclusion: The rapid immunochromatographic screening test (ICS) for syphilis is highly specific and compares favorably with TPHA test in excluding syphilis infection but has a lower sensitivity.

CRITICAL FAILURE OF A CELL THERAPY PRODUCTS STORAGE TANK: DESCRIPTION, INVESTIGATION AND IMPLEMENTED IMPROVEMENTS

Cryopreserved cell therapy products are usually stored in vapor or liquid storage tanks to maintain long-term viability. Storage tank (ST) failure can lead to the loss of cryopreserved cell therapy (CT) products, which means the only possibility of treating serious illnesses. We aimed to describe a serious vapor ST failure, as well as the improvements implemented in the storage procedure to increase the safety and quality of cryopreserved CT products. This is a case report of a vapor ST failure (CBS, isothermal V5000-AB series). The records were reviewed to obtain information regarding the frozen units. On 07-dec-2021, the technical staff observed the accumulation of liquid nitrogen (LN2) at the bottom of the ST. The engineering team was contacted and adjusted the ST's maximum LN2 level. The problem recurred on 23-dec-2021. The engineering and maintenance company carried out a series of tests on the ST. On 06-Jan-2022, it was requested emptying and defrosting of the ST for 48 hours for corrective maintenance of the LN2 level sensor. Planning to transfer the inventory to another ST was started, including bags with serology/NAT reagent overwrapping. However, on 23-Jan-2022 (Sunday), the LN2 level sensor stuck at level zero leading the automated LN2 filling of the ST to start and not stop. There was an overflow of LN2 inside the vapor ST, and 3 of 4 rack positions were submerged in LN2. The engineering team performed the filling interruption manually, after being called by the concierge. There were 553 frozen bags from 307 patients/donors stored in the ST at the time of failure. Out of the 553 bags, 87 (15.7%) had positive serology or NAT tests. Of these, 11 (1.9%) were anti-HIV positive (NAT HIV negative) and two (0.3%) were HBsAg and NAT HBV reagents. Out of the 553 bags, 10 (1.8%) had a positive microbiological test, including four (0.7%) for multi-sensitive Salmonella sp . Excess of LN2 was manually removed from the ST and the actions to transfer the inventory to the backup ST were intensified, including changing the bags with positive tests (PT) to positions A or B of the racks, as well as finishing these bags overwrapping. The inventory was transferred and stored in the backup ST for approximately 72 hours. Surveillance actions were performed, including virtual meeting and discussion with the Brazilian National Health Surveillance Agency, visual examination to disclose leaking or breakage of seals, thawing of the unit with positive HBV NAT (authorized disposal) to confirm the absence of leaking or breakage of seals, monitoring external signs of vacuum loss, and discussion of the possibility of cross-contamination with the bag supplier. The data provided by this study are unique and should be considered when evaluating the cryopreserved cell therapy products storage procedure, including ST monitoring, detection of a failing ST, and contingency plan. After this ST failure, improvement actions in the storage procedure were implemented in our institution, including the modification of the storage location of the bags in quarantine and those with PT (positions A and B of the rack) and implementation of the routine use of overwrap in bags with PT. All activities conducted to resolve the issue and the improve actions were documented in non-compliance. Vapor ST may fail, leading to an unexpected accumulation of LN2. Improvements in the storage procedure can avoid the serious consequences of this failure, including cross-contamination.

Clinical features and outcomes of patients with myasthenia gravis affected by COVID-19: A single-center study

IntroductionMyasthenia Gravis (MG) is an autoimmune disorder that can exacerbate for various reasons including infections. In this study, we describe clinical symptoms, outcomes, and management of MG patients affected by COVID-19 infection. MethodsThis observational retrospective study was performed on patients previously diagnosed as MG, presenting with COVID-19 in the clinic or emergency department between April 2020 and August 2021. The clinical data, outcome, and therapeutic interventions were assessed in 83 patients with MG and COVID-19 infection. ResultsSeventy-seven patients performed PCR testing for COVID-19, of which 73 (94.8 %) were positive. Seven patients had the positive serologic test for COVID-19 (IgG and IgM). Fifty-seven (68.7 %) patients had lung involvement. Thirty-five (42.1 %) of patients were admitted to the hospital. Twelve (14.5 %) patients needed hospitalization in an intensive care unit (ICU), with a mean stay of 7.36 ± 5.6 days (rang: 2–20 days). Four (4.8 %) patients were intubated and required mechanical ventilation. Sixteen (19.3 %) patients experienced an exacerbation of myasthenia gravis and were treated with PLEX (n = 2), IVIG (n = 7), and intravenous (IV) methylprednisolone (n = 7). The outcome was favorable in 79 patients and fatal in four patients, three of whom had other comorbidities. One patient died due to severe COVID-19 involvement. ConclusionThe findings from our study demonstrated that patients with previous MG concurrence with COVID-19 have favorable clinical outcomes. Most patients did not need to be hospitalized and more than 80 % of patients did not display MG exacerbation.

Characteristics and outcomes of COVID-19 in heart transplantation recipients in the Netherlands.

BackgroundImmunocompromised patients are at high risk of complicated severe acute respiratory coronavirus 2 infection. The aim of this retrospective study was to describe the characteristics and outcomes of heart transplantation (HTx) recipients with coronavirus disease 2019 (COVID-19) in the Netherlands.MethodsHTx patients from one of the three HTx centres in the Netherlands with COVID-19 (proven by positive reverse-transcription polymerase chain reaction or serology test result) between February 2020 and June 2021 were included. The primary endpoint was all-cause mortality and the secondary endpoint was disease severity.ResultsCOVID-19 was diagnosed in 54/665 HTx patients (8%), with a mean (± standard deviation (SD)) time after HTx of 11 ± 8 years. Mean (± SD) age was 53 ± 14 years and 39% were female. Immunosuppressive therapy dosage was reduced in 37% patients (20/54). Hospitalisation was required in 39% patients (21/54), and 13% patients (7/54) had severe COVID-19 (leading to intensive care unit (ICU) admission or death). In-hospital mortality was 14% (3/21), and all-cause mortality was 6%. Compared with patients with moderate COVID-19 (hospitalised without ICU indication), severe COVID-19 patients tended to be transplanted earlier and had a significantly higher mean (± SD) body mass index (26 ± 3 vs 30 ± 3 kg/m2, p = 0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients.ConclusionHTx patients were at increased risk of complicated COVID-19 with frequent hospitalisation, but the all-cause mortality was substantially lower than previously described (7–33%).Supplementary InformationThe online version of this article (10.1007/s12471-022-01720-9) contains supplementary material, which is available to authorized users.

Multisystem inflammatory syndrome in children related to COVID-19: Data from a Mexican national referral children's hospital.

ObjectivesTo describe characteristics of patients with the pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS)/multisystem inflammatory syndrome in children (MIS-C) and to identify factors associated with admission to the pediatric intensive care unit (PICU) in the Mexican children without coronavirus disease 2019 (COVID-19) vaccination.MethodsThis was a cross-sectional study performed at Hospital Infantil de Mexico Federico Gomez, a referral children's hospital in Mexico. The study included all cases that met the criteria for PIMS-TS/MIS-C, unvaccinated, between March 2020 and January 2022. The primary outcome was the admission to PICU. Associations of PICU admission with demographic and clinical variables were estimated using logistic regression analyses.ResultsWe identified a total of 90 cases, with a median age of 7.5 years old, 47 (52.2%) girls. A previously healthy status was recorded in 76 (85%) children. All patients had positive PCR, serology test, or COVID-19 exposure. PICU admission was reported in 41 (45.6%) children. No deaths were reported. Patients received as treatment only corticosteroids in 53.3% of the cases. In univariable analyses, baseline factors associated with PICU admission were older age, hypotension or shock, positive PCR test, hypoalbuminemia, elevated procalcitonin, ferritin, and lymphopenia. Age, shock at admission, and hypoalbuminemia remained independently associated in the multivariable analysis adjusted by gender and previously healthy status.ConclusionWe found a high proportion of previously healthy children in patients with PIMS-TS/MIS-C in our center. Critical care attention was received by nearly half of the children. The main treatment used was steroids. Age, shock at admission, and hypoalbuminemia were factors associated with PICU admission.

US LI-RADS: Ultrasound liver imaging reporting and data system application for screening and surveillance of hepatocellular carcinoma during national mass screening campaign for patients with positive HCV serological test

Purpose: We aimed to apply Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) to the patients with positive serological HCV test surveyed during the national mass screening campaign. Methods: We conducted a cross-sectional study that recruited patients with positive serological test for HCV, who underwent the national mass screening campaign during the period from April 2019 to June 2020. Each operator was required to classify the patients into one of the following three categories according to the US visualization into: A, no or minimal limitations; (2) B, moderate limitations; and (3) C, severe limitations. Results: A total of 763 HCV patients were recruited in the present study. Conclusion: US is the modality of choice during mass screening for HCC, yet the presence of the human factor (being operator dependent) and the lack of unified reporting scheme were drawbacks; thus US- LI-RADS, overcome the latter drawback with ready to go plan according to the given score of each individual patient.

A study on the role of lepidopterism in seasonal fever outbreaks

1. To screen subjects with clinical features resembling viral fevers for specific IgE antibodies against tiger moth toxin. 2. To assess the role of tiger moths in producing features resembling viral fevers in humans. This hospital-based, cross-sectional analytical study was conducted from March 2015 to March 2016 in a tertiary hospital in North Kerala. The sample population included patients who had clinical manifestations suggestive of viral fevers and presented to the outpatient departments of Family Medicine, Internal Medicine, or Emergency Medicine and satisfied the inclusion criteria. After collecting the informed consent, the blood sample needed for the study was collected simultaneously with the blood collected for other tests ordered by the consulting doctor. No extra needle insertion was needed for the study. A total of 234 samples were examined for the presence of moth-toxin-specific IgE antibodies. Data were analysed using SPSS 17.0. Graphs were produced using Microsoft Excel. Categorical variables were expressed as frequencies with percentages and analysed using Chi-square test/Fisher's exact test. Incidence/prevalence was also expressed in percentages with confidence interval. The continuous variable was expressed as mean with standard deviation or median with inter-quartile range. For all tests, a probability value (p value) < 0.05 was considered as statistically significant. Among the 234 subjects who were screened in the 13-month period, 44 subjects (18.8%) tested positive for moth-toxin IgE, of which 28 were males and 16 were females. The maximum percentage of samples with positive moth-toxin IgE antibodies was detected during the months of March, June, July, November, December, and January. Out of the 44 subjects who had positive moth-toxin IgE antibodies, 24 tested positive for Dengue fever (of which eight were positive for the Dengue NS1 antigen, 11 were positive for the Dengue IgM antibody, and five were positive for both Dengue NS1 antigen and Dengue IgM antibody), two tested positive for Leptospira IgM antibody, two tested positive for Rickettsial antibody, and three had a positive Widal test. It was found that association of moth-toxin IgE with all the presenting symptoms of subjects analysed in this study was not statistically significant, except for lymphadenopathy. Skin rashes of different morphologies were seen in the study group. 20.5% (n = 9) of the subjects who tested positive for moth-toxin IgE had skin rashes. A majority of these weffigurere erythematous and maculopapular rashes, with incidence of 44% (n = 4) and 33% (n = 3), respectively. 1. A seasonal variation is evident in the incidence of cases with positive moth-toxin IgE. 2. There is no significant age/sex preference for moth-toxin IgE positivity. 3. Subjects who tested positive for moth-toxin IgE also had positive serological tests for other infectious causes of fever, including Dengue fever, Leptospirosis, Enteric fever, and Rickettsial fever. The role of tiger moth exposure in producing fever and related symptoms hence needs to be studied further. 4. It was observed that moth-toxin IgE had significant association with lymphadenopathy. This should be investigated in further studies. 5. Even though the role of lepidopterism in seasonal fever epidemics is not clear, primary care physicians should be more aware of such entities which can present with a wide range of manifestations.

The Serological Examination of Immunoglobulin A Anti-Early Antigen of Epstein–Barr Virus (Anti-EA EBV IgA) in the Nias Tribe Nasopharyngeal Cancer Patients

BACKGROUND: Nasopharyngeal cancer (NPC) is a health problem associated with malignancies of the ear, nose, and throat. The main pathogenesis of NPC is Epstein–Barr virus (EBV) infection. The signs and symptoms of NPC are non-specific, causing the occurrence of delay in diagnosis leading to treatment failure. The early detection based on the NPC profile using immunoglobulin A (IgA) antibodies against the early antigen (EA) can be done, but many factors affect anti-EA EBV IgA levels, one of which is ethnicity. AIM: This study aimed to compare levels of anti-EA EBV IgA in NPC patients and non-NPC in the Nias tribe. MATERIALS AND METHODS: This study was cross-sectional involving 29 NPC patients and 29 non-NPC in the Nias tribe. The subjects of the study were blood tests to measure the levels of anti-EA EBV IgA by a serological test. Data were analyzed by Chi-square test. RESULTS: The results showed that the mean value of anti-EA EBV IgA levels is 246.22 ± 320.05 U/mL and the proportion of positive serology tests is 55.2% in NPC patients. The mean value of anti-EA EBV IgA levels is 51.79 ± 1.55 U/mL and the proportion of positive serology tests is 10.3% in non-NPC. The comparison of mean anti-EA EBV IgA between NPC patients and non-NPC was significant (p &lt; 0.001). The comparison of positive and negative serology tests of anti-EA EBV IgA between NPC patients and non-NPC was significant (p &lt; 0.05). CONCLUSION: The serology tests of anti-EA EBV IgA play a role in differentiating NPC patients from non-NPC, so it can be useful as a screening tool for NPC in the Nias tribe.

Knowledge, attitudes and practices towards patients with HIV/AIDS in staff nurses in one university hospital in Sicily

&#x0D; Background: nurses’ knowledge, attitudes and practices towards patients with HIV/AIDS are of ongoing interest, especially in developing countries. Nothing or very little is known about Italian nurses.&#x0D; Methods: HIV/AIDS knowledge, attitudes and behaviours of the nurses (n=107) from one university hospital inCatania,Sicily, were documented. Comparisons among nurses belonging to different Operative Units (O.U.) were conducted by the chi-square test (P&lt;0.05).&#x0D; Results: although HIV was nurses’ main concern in regard to contracting infections in the workplace (54%), the vast majority of them (98%) had never refused an HIV/AIDS patient care assignment. Moreover, despite their concern of being more at risk of contracting HIV than the general population (41%), a not negligible percentage of nurses did not use gloves routinely (21%) and only a few treated all patients as potentially HIV-positive (9%). The vast majority of the respondents knew the meaning of AIDS (87%) and of a positive serological test (78%). On the contrary, a relatively low percentage of them knew what is the ‘window period’ (62%) and were acquainted with HIV pathophysiology (65%). No statistically significant differences in terms of risk perception were found between nurses who had previously attended an HIV/AIDS workshop, lecture or specific course (43%) and nurses who did not (57%). Level of knowledge was positively associated to age (P=0.000) and to education (P=0.016), and it was found higher in nurses working in a O.U. of Infectious Diseases.&#x0D; Conclusions: data from our study show that also in developed countries, such as Italy, nurses could have some misconceptions and concerns about HIV/AIDS. The importance of examining the impact of continuing education on nurses’ preparedness to care for patients with HIV/AIDS and to prevent the risks of occupational HIV transmission is discussed. &#x0D;

COVID-19 testing in Delaware’s underserved communities: demographic and social determinants of testing inequality

BackgroundHealth experts believe that frequent COVID-19 testing is one of the most important practices for stopping the spread of the COVID-19 virus. Demographic and social factors might play a role in whether a person gets tested for COVID. This present study aimed to investigate (1) the demographic and social factors affecting a person’s likelihood of getting tested for COVID-19, and (2) the demographic and social factors related to a positive serology test (i.e., indicating likely past infection).MethodsData were extracted from a survey conducted in Delaware’s underserved communities. Participants were asked to complete a questionnaire about their COVID-19 testing history, and nurses at the study site collected a serology sample from each participant.ResultsOur results indicated that Black or Hispanic individuals living in underserved communities had greater odds of having been tested previously for COVID compared to being non-Hispanic White. In addition, our study found that being female, educated, feeling safe in one’s neighborhood, being vaccinated against COVID, and being an essential worker increased one’s odds of having been previously tested for COVID-19. Regarding the results of the COVID-19 antibody serology tests, our findings revealed that Hispanic respondents were more likely to have a positive serology test compared to non-Hispanic White respondents, indicating that the Hispanic individuals were more likely to contract the virus. Educated individuals were less likely to have a positive serology test compared to the less-educated. Those who expressed hesitancy about getting vaccinated for COVID-19 and identified themselves as essential workers were more likely to have a positive serology test and to have previously contracted the virus.ConclusionsIdentifying key factors associated with COVID-19 testing may help establish novel strategies to increase testing rates among vulnerable population. Public health and policy implications are discussed in the article.

Challenge of hepatitis B testing following intravenous immunoglobulin therapy in patients with autoimmune skindiseases.

Intravenous immunoglobulin (IVIg) contains pooled immunoglobulins from the plasma of healthy blood donors. All plasma samples are tested for HIV, hepatitis viruses (A, B, and C), and parvovirus B19. As part of this screening step, nucleic acid amplification technology (NAT) is used and allows the presence of specific antibodies targeting viral structures that are commonly used to test for infection status, such as anti-hepatitis B surface antigen (HBs) or anti-hepatitis B virus core (HBc) antibodies. For this reason, manufacturers point to the possibility of false-positive viral serological test results following IVIg treatment due to the passive transfer of antibodies. IVIg therapy is commonly used to manage patients with severe, treatment-refractory autoimmune skin diseases. The aim of this cohort study was to retrospectively quantify newly-discovered positive serological HBV test results after IVIg treatment in patients with autoimmune skin diseases. Between March 2018 and June 2021, 28 patients with autoimmune skin diseases received IVIg therapy, of whom 17 were longitudinally followed-up. None of the patients had evidence of active HBV infection prior to IVIg therapy. All patients (n=17) had detectable anti-HBs antibodies and 12 patients had anti-HBc antibodies 4 weeks after commencing IVIg treatment. Passive antibody transfer seems the most likely interpretation. Nevertheless, complete serological hepatitis assessment should be performed to exclude a new infection. We recommend hepatitis screening before IVIg therapy to prevent diagnostic confusion which may arise due to passive antibody transfer.

Алгоритм инфекционного скрининга доноров роговиц в Глазном тканевом банке ФГАУ «НМИЦ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

Purpose. To analyze an algorithm for infectious screening of cadaver corneal donors during corneal processing at the Eye Tissue Bank (ETB) of The Fyodorov Eye Microsurgery Federal State Institution and compare it with the European Eye Bank Association (EEBA) data from 2011 through 2015. Material and methods. Data analysis were done using the ETB in-house donor data registry and EEBA annual directory forms. The extracted data included the number of received eye globes, rates of inconclusive and serological tests for human immunodeficiency virus (type 1 and 2), Hepatitis B and C viruses, and Syphilis. Results. During the analyzed period 3479 eye globes were delivered in the ETB for the processing. Hemolysis caused exclusion for 13.9% (n=486) of corneas in the ETB. In opposite, the EEBA data demonstrated far lower rates of inconclusive tests. The positive serology tests lead to canceling 19.4% (n=676) of the incoming corneas in the ETB. Overall, the rates of positive tests were far higher in comparison with EEBA data. At the ETB, positive serological tests for HIV (type 1 and 2) and Syphilis had low variability annually, while the rates of Hepatitis B increased in 2015. Predomination of Hepatitis C was also noted. Often enough, the blood samples were multiply-infected. Conclusion. Overall, the positive serology and hemolysis were the major contraindications and led to exclusion 33.4% (n=1162) of incoming corneas in the ETB. Serological tests rates for indicated infections were higher in the ETB with predomination of Hepatitis C. An algorithm for infectious screening at the Eye Tissue Bank (ETB) of The S. Fyodorov Eye Microsurgery Federal State Institution was effective in selection of postmortem donors for cornea processing in clinical use. Key words: cornea transplantation, eye bank, serological tests, human immunodeficiency virus, hepatitis B viruses, hepatitis C virus, syphilis

Absolute Risk of Oropharyngeal Cancer After an HPV16-E6 Serology Test and Potential Implications for Screening: Results From the Human Papillomavirus Cancer Cohort Consortium.

Seropositivity for the HPV16-E6 oncoprotein is a promising marker for early detection of oropharyngeal cancer (OPC), but the absolute risk of OPC after a positive or negative test is unknown. We constructed an OPC risk prediction model that integrates (1) relative odds of OPC for HPV16-E6 serostatus and cigarette smoking from the human papillomavirus (HPV) Cancer Cohort Consortium (HPVC3), (2) US population risk factor data from the National Health Interview Survey, and (3) US sex-specific population rates of OPC and mortality. The nine HPVC3 cohorts included 365 participants with OPC with up to 10 years between blood draw and diagnosis and 5,794 controls. The estimated 10-year OPC risk for HPV16-E6 seropositive males at age 50 years was 17.4% (95% CI, 12.4 to 28.6) and at age 60 years was 27.1% (95% CI, 19.2 to 45.4). Corresponding 5-year risk estimates were 7.3% and 14.4%, respectively. For HPV16-E6 seropositive females, 10-year risk estimates were 3.6% (95% CI, 2.5 to 5.9) at age 50 years and 5.5% (95% CI, 3.8 to 9.2) at age 60 years and 5-year risk estimates were 1.5% and 2.7%, respectively. Over 30 years, after a seropositive result at age 50 years, an estimated 49.9% of males and 13.3% of females would develop OPC. By contrast, 10-year risks among HPV16-E6 seronegative people were very low, ranging from 0.01% to 0.25% depending on age, sex, and smoking status. We estimate that a substantial proportion of HPV16-E6 seropositive individuals will develop OPC, with 10-year risks of 17%-27% for males and 4%-6% for females age 50-60 years in the United States. This high level of risk may warrant periodic, minimally invasive surveillance after a positive HPV16-E6 serology test, particularly for males in high-incidence regions. However, an appropriate clinical protocol for surveillance remains to be established.

Diagnostic Challenges of Helicobacter pylori Infection in Ethiopia: A Community-Based Cross-Sectional Study.

Background In resource-constrained countries, accurate diagnosis of Helicobacter pylori infection remains a challenge. This study aimed to assess the clinical utility of locally available serological and stool antigen test kits in the management of people with suspected H. pylori infection in Ethiopia. Methods A community-based cross-sectional study was conducted with apparently healthy adults and children living in southwest Ethiopia. Participants were interviewed for dyspepsia symptoms and related clinical conditions. H. pylori infection was examined using commercially available serological and stool antigen tests. The association between H. pylori tests and dyspepsia symptoms was analyzed using logistic regression models. Results Out of 1392 participants included in the final analysis, 49.1% and 6.5% tested positive for H. pylori infection with serology and stool antigen test kits, respectively. Participants reporting epigastric symptoms in the past three months (AOR = 1.93, 95% CI = 1.28–2.91) and those with recent dyspepsia treatment (AOR = 1.51, 95% CI = 1.05–2.18) were likely to have positive serology test. However, no association between dyspepsia symptoms and H. pylori stool antigen positivity was observed in our study. Conclusion ccurate detection of H. pylori infections using commercially accessible diagnostics remains difficult in Ethiopia. With these methods, it will be hard to ensure adequate diagnosis and early treatment of H. pylori infection, as well as rational antibiotic use.

Investigation of Visceral LeishmaniasisTransmission in Selected Districts of Nepal.

Visceral leishmaniasis is transmitted to humans by Leishmania donovani infected Phlebotomus argentipes sandflies. Nepal has successfully met the elimination target of less than 1 case per 10,000, although recently this threshold has been surpassed demonstrating ongoing transmission. The main objective of the present study was to investigate transmission of visceral leishmaniasis in 4 visceral leishmaniasis endemic districts of Nepal including Palpa, Morang, Saptari and Sarlahi. Human blood samples (331), domestic animals blood samples [goats (n=67), dogs (n=1), cows (n=6), buffaloes (n=16), and ox (n=10)] and sandflies samples (3976 from 142 households) were collected from the villages of these 4 districts. Human blood samples were tested for VL antibodies using the rK39 rapid diagnostic test (InBios International, Seattle, WA). kDNA of L.donovani was amplified by PCR from DNA extracted from human blood, animal blood and sandfly samples. Out of 331 screened across 4 districts,32 were positive on rK39 serology and 16 were positive by PCR amplification of kDNA from L. donovani. The majority of the positive serology and PCR tests were from the Ishworpur village in the Sarlahi district where there was an outbreak of 18 cases of VL. This study also revealed the presence of L. donovani DNA in female P. argentipes sandflies collected from the Ishworpur village of Sarlahi, 6 villages in the Saptari,10 villages in the Palpa, and from 9 villages in the Morang. Blood samples from domestic animals in the same villages were negative for kDNA detection by PCR. The results of human and sandfly findings strongly point towards local transmission of visceral leishmaniasis in these 4 districts of Nepal. Notably, there is a significant level of transmission in the Ishworpur village in the Sarlahi district. The observations from this study suggest that domestic animals are not a reservoir host forL. donovaniin these districts in Nepal. Ongoing surveillance is needed to identify new outbreaks such as in the Sarlahi district.

Serological follow up of positive SARS-CoV-2 cases.

To describe the humoral response in a cohort with mild and asymptomatic SARS-CoV-2 infection previ-ously identified in a community-based serological survey. This study was an observational follow up of 193 subjects previously identified with positive anti-SARS-CoV-2 antibodies invited for a second test 112 days after the first sampling. All completed a standardized electronic questionnaire. IgM/IgG antibodies were determined using a qualitative IgM/IgG chemiluminescent immunoassay. Among the 193 eligible subjects, a total of 174 (90%) attended the follow-up visit, and their serum samples were tested. Of the samples, 171 (98.3%) were still positive, and 3 (1.7%) were negative. Also, the cut-off index (COI) value of the immunoassay significantly increased from the first to the second test (P <0.001). Our findings support a sustained humoral response in individuals with mild and asymptomatic SARS-CoV-2 infection up to 112 days after a positive serologic baseline test, accompanied by increasing antibody titers.

Multiple Myeloma with Skin and Renal Involvement and Anaplasma Phagocytophilum Co-Infection in a Dog

Abstract An 11-year-old male Cocker Spaniel was presented with acute onset of apathy, polyuria and polydipsia. Blood examination showed hypoalbuminemia and hyperglobulinemia, while electrophoresis revealed monoclonal gammopathy. Subsequent tests showed glycosuria, proteinuria, a positive serology test for Anaplasma spp. and ultrasonographical changes of the liver and spleen. Urine electrophoresis confirmed the presence of Bence-Jones protein. The dog’s condition deteriorated, and the dog had developed skin lesions on the neck and body. The owner decided to euthanize the dog and agreed to bone marrow and skin biopsy. Bone marrow cytology revealed an increased number of plasma cells and several cellular atypia. Histopathology of the skin lesions showed a round cell tumor of lymphoid or plasmacytoid origin. Subsequent immunohistology supported the diagnosis of multiple myeloma cutaneous involvement. This case report describes unusual features observed in a dog with multiple myeloma.

A Retrospective Analysis of Tick-borne Encephalitis in Children Treated in Kaunas Hospital During 2012 to 2019.

Lithuania has the highest tick-borne encephalitis (TBE) rates in Europe. Although TBE incidence in children is lower, it may still cause long-term consequences. So far pediatric epidemiological and clinical characteristics of TBE in Lithuania were not described. We performed a retrospective analysis of 87 cases of children who were hospitalized for TBE in Kaunas Hospital of the Lithuanian University of Health Sciences from 2012 to 2019. Each case was identified with neurological symptoms and positive serological tests. Around half of the children (50.6%) reported having a tick bite, whereas 6.9% stated having exposure to unpasteurized milk. Biphasic course of the disease occurred in 70.1% of the cases. The most common clinical symptoms were headache (100%), fever (100%), nausea (85.1%), vomiting (78.2%), drowsiness (67.8%) and general weakness (66.7%). Meningeal symptoms were present in 93.1% of the cases, and 93.1% of the children had at least one focal neurological sign (tremor 82.3%, impaired balance 73.6%). Isolated meningitis was diagnosed in 57.5%, meningoencephalitis in 41.4% and meningoencephalomyelitis in 1.1% of the cases. Majority of younger children (1-8 years old) had meningitis (77.3%), whereas 49.2% of older children (9-17 years old) had more severe forms of TBE. Cerebrospinal fluid pleocytosis was found in 94.3% of cases (average white blood cell count: 111.7 per μL, protein: 0.5 g/L). Higher levels of cerebrospinal fluid protein were associated with more severe forms of TBE and older age. Duration of the symptomatic disease lasted ≈11 days. Early residual signs were observed in 75.9% of all cases. The epidemiological and clinical characteristics of TBE in children in Lithuania are similar to those described in other countries. Only half of the subjects reported having a tick bite. Younger children tend to suffer from meningoencephalitis and meningoencephalomyelitis less frequently than elder ones. Focal neurological signs were commonly observed. Majority of children had lasting symptoms of TBE upon discharge from the hospital.