Rapid Test Research Articles

SARS-CoV-2 antigen rapid detection tests: test performance during the COVID-19 pandemic and the impact of COVID-19 vaccination

SARS-CoV-2 antigen rapid detection tests (RDTs) emerged as point-of-care diagnostics alongside reverse transcription polymerase chain reaction (RT-qPCR) as reference. In a prospective performance assessment from 12 November 2020 to 30 June 2023at a single centre tertiary care hospital, the sensitivity and specificity (primary endpoints) of RDTs from three manufacturers (NADAL®, Panbio™, MEDsan®) were compared to RT-qPCR as reference standard among patients, accompanying persons and staff aged≥six month in large-scale, clinical screening use. Regression models were used to assess influencing factors on RDT performance (secondary endpoints). Among 78,798 paired RDT/RT-qPCR results analysed, overall RDT sensitivity was 34.5% (695/2016; 95% CI 32.4-36.6%), specificity 99.6% (76,503/76,782; 95% CI 99.6-99.7%). Over the pandemic course, sensitivity decreased in line with a lower rate of individuals showing typical COVID-19 symptoms. The lasso regression model showed that a higher viral load and typical COVID-19 symptoms were directly significantly correlated with the likelihood of a positive RDT result in SARS-CoV-2 infection, whereas age, sex, vaccination status, and the Omicron VOC were not. The decline in RDT sensitivity throughout the pandemic can primarily be attributed to the reduced prevalence of symptomatic infections among vaccinated individuals and individuals infected with Omicron VOC. RDTs remain valuable for detecting SARS-CoV-2 in symptomatic individuals and offer potential for detecting other respiratory pathogens in the post-pandemic era, underscoring their importance in infection control efforts. German Federal Ministry of Education and Research (BMBF), Free State of Bavaria, Bavarian State Ministry of Health and Care.

Rabies post-exposure prophylaxis: a retrospective analysis of timing of initiation and antibody responses in a Belgian cohort.

BackgroundWe aimed to determine the timeliness of rabies post-exposure prophylaxis (PEP) and the proportion of individuals with an adequate antibody response post-PEP among those attending the Belgian national reference center. MethodsRetrospective analysis of patient records who attended our center from 2018-2023. Delay was defined as rabies immunoglobulin (RIG) and vaccine initiation beyond 2 calendar days after exposure. Antibodies were measured by rapid fluorescent focus inhibition test (RFFIT) after PEP in high-risk exposures. A titer ≥0.5 IU/ml was considered adequate. ResultsWe reviewed 317 patient records. Among individuals with inland exposure (n=103), 85% timely received PEP. Among travelers exposed abroad (n=214), administration of RIG and vaccine initiation were timely in 30% and 50% of cases, respectively. An adequate antibody response was detected in 99.5% (195/196) individuals. ConclusionSubstantial PEP delays among travelers were observed. The robust antibody responses suggest that routine serological follow-up is not necessary for all patients.

Role of admission rapid antigen testing (RATs) for COVID-19 on patients transferred from acute hospitals to a post-acute rehabilitation setting.

BackgroundRapid antigen tests (RATs) are suitable for point-of -care testing, require no laboratory time and give immediate results. However, are RATs useful for detecting asymptomatic COVID-19 infection when compared with polymerase chain reaction (PCR) testing in healthcare settings? AimThe aim of this study was to implement a reliable testing system utilising RATs to promptly detect COVID-19 infection in predominantly asymptomatic patients transferred from acute hospitals to a post-acute rehabilitation unit (PARU). MethodsRAT testing was carried out on all new admissions without a history of confirmed Covid-19 infection within three months of admission. PCR testing was carried out on all patients with a positive RAT for confirmation purposes. The cycle threshold (Ct) values of COVID-19 detected results on PCR testing were examined to determine the utility of the RATs. ResultsA total of 1,403 patients were transferred to the PARU from January to December 2023. The results of the study revealed an 85% accuracy of RATs with a 15% rate of false negative results at the time of admission. All patients that had a positive RAT at the time of admission also had a positive PCR test. ConclusionThis testing algorithm resulted in early detection and prompt isolation of positive cases reducing the likely spread of COVID-19 infection, hospital outbreaks and bed/ward closures.

Highly Sensitive and Specific Diagnosis of Enterovirus A71 by Reverse Transcription Multiple Cross-Displacement Amplification-Labeled Nanoparticles Biosensor.

Enterovirus A71 (EVA71) is a leading causative agent of hand, foot, and mouth disease, posing a significant threat to the health of young children, particularly in the Asia-Pacific region. Currently, there is no specific antiviral drug for EVA71 infection; therefore, early and rapid diagnosis is critical for disease prevention and control. Here, we report the development of a simple, rapid, and sensitive detection method for EVA71 infection using reverse transcription-multiple cross displacement amplification (RT-MCDA) combined with nanoparticle-based lateral flow biosensors (LFB). In the RT-MCDA system, a set of 10 primers was designed to target the highly conserved region of the VP1 gene of EVA71 and amplify the genes in an isothermal amplification device. The RT-MCDA amplification reaction products could then be identified by visual detection reagent (VDR) and LFB without the need for specialized equipment. The results demonstrated that the optimal reaction condition for the EVA71-RT-MCDA assay was 65℃ for 40 min. The EVA71-RT-MCDA assay could detect as low as 40 copies of plasmid and 50 copies of pseudotyped virus in a reaction. No cross-reaction was found between EVA71 strains and non-EVA71 strains. For 125 clinical anal swab samples, with EVA71-RT-MCDA assay, 30 samples were positive, which was in consistent with the the conventional real-time quantitative reverse transcription polymerase chain reaction assays. The entire procedure, including a 15-min specimen processing step, a 40-min MCDA reaction, and result reporting within 2 min, was completed in less than 60 min. In conclusion, the EVA71-RT-MCDA-LFB assay targeting the VP1 gene is a rapid, highly sensitive, simple, and specific test that could be widely applied in point-of-care settings and basic medical facilities in rural areas.

A Standardized MRI Phantom for Dissolved Phase 129Xe MRI.

Pulmonary MRI of hyperpolarized xenon-129 (hp129Xe) dissolved in the lung parenchyma and vascular phase is gaining increasing attention for clinical assessment of gas exchange in multiple diseases. These conditions can involve thickening of barrier tissues due to fibrotic scarring or reduced capillary blood flow leading to diminished gas-blood exchange hence, the ratios between hp129Xe signals arising from the lung membrane (M), the red blood cells (RBC), and the gas phase hold significant diagnostic value. However, comparing hp129Xe signal ratios quantitatively across different studies may pose challenges due to varied experimental conditions and slightly modified pulse sequence protocols.A solution to this problem arises from materials science applications of hp129Xe where xenon dissolved in porous materials or polymers can display chemical shifts similar to the M and RBC shift in lungs. This work explored the generation of MR spectral profiles with respect to chemical shift and signal intensity ratios that closely resemble spectral profiles observed in human lungs in health and disease. At ambient temperatures, reticulated open cell polyurethane foam treated with olive oil as a fatty phase produced dissolved phase 129Xe chemical shifts of 215 ppm and 196 ppm, respectively, that emulate typical RBC and M signals. The uptake kinetics into the non-toxic materials was sufficiently similar to pulmonary signal uptake to enable hp129Xe MRI with dissolved phase ratios that closely resemble clinical data.A phantom assembly was devised to allow for gas handling protocols that match clinical protocols. The current iteration of the developed phantom enabled rapid testing of basic experimental protocols and can be used for training purposes without regulatory approval and governance. Furthermore, the introduced concept shows a pathway for the development of a quantitative universal phantom standard for dissolved phase pulmonary hp129Xe MRI. A robust phantom standard will require materials with longer shelf lifetime than the oil-foam system and would benefit from a more defined microstructure.

Fourth-Generation HIV Rapid Tests: Enhanced Sensitivity and Reduced Diagnostic Window for HIV-1 Primary Infection Screening.

As most HIV rapid tests (HRT) detect only HIV-1/2 antibodies, their performance during primary HIV infection is poor. Determine HIV Early detect (Abbott) (Determine) is the only HRT with an HIV-1 p24-antigen detection, but the impact of this addition in shortening the diagnostic window remains unclear. A total of 183 HIV-1 primary infection samples were tested using the HRTs Determine and ONE STEP anti-HIV (1&2) Test (InTec Products) (One-Step). The pre-seroconversion subgroup was defined as p24-antigen positivity without Western blot nor Liaison XL (fouth generation enzyme immunoassay with distinct signal for p24-antigen and HIV-1 antibody) HIV-1 antibodies. Global sensitivity (95% CI) was 95% (91-97) for Determine versus 80% (74%-85%) for One-Step (difference p = 1.38e-06). Pre-seroconversion subgroup sensitivity was lower, at 71.9 (54.6%-84.4%) for Determine and 9.7% (3.3%-24.9%) for One-Step. Among the 45 samples with an HIV-1 infection date, no HRT was reactive up to 2 weeks. Between 2 and 3 weeks, Determine sensitivity was 78% (45%-95%) versus 56% (27%-81%) for One-Step. From 3 weeks to 1 month Determine sensitivity was 90% (62%-98%) and One-Step 45% (21%-72%). The last negative sample occurred at 3 weeks for Determine versus 70-90 days for One-Step. HRT with p24-antigen detection significantly shortens the diagnostic window from approximatively 3 months to 1 month. HRTs should be used with caution in the first month after HIV infection.

PREVALENCE OF MALARIA PARASITES AMONG PREGNANT WOMEN ATTENDING GENERAL HOSPITAL GARAKU, KOKONA LOCAL GOVERNMENT, NASARAWA STATE

Malaria remains a significant health concern, particularly among pregnant women in various regions of Nigeria, including the Kokona metropolis. This study aimed to determine the prevalence of malaria among pregnant women in Garaku, Kokona LGA, Nasarawa State, and to assess the diagnostic accuracy of Microscopy versus Rapid Diagnostic Test (RDT). Blood samples were collected from 150 pregnant women in the Kokona Local Government Area and analyzed using both Microscopy and RDT. Data were analyzed using SPSS software version 23.0, with statistical significance set at P < 0.05. The overall prevalence of malaria was found to be 31.33%, with the highest prevalence observed among women in their first trimester (36.71%). Microscopy demonstrated a higher positivity rate compared to RDT. Additionally, women aged 31-40 years exhibited the highest susceptibility, with a prevalence of 42.11%. However, no significant difference was noted in malaria prevalence based on the usage of mosquito nets or parity status. The study underscores the high prevalence of malaria among pregnant women in the region, emphasizing the need for enhanced intervention strategies. Microscopy remains a more reliable diagnostic tool than RDT. Early antenatal booking and regular preventive measures are crucial to mitigating the adverse effects of malaria during pregnancy. Furthermore, environmental sanitation efforts should be intensified to reduce mosquito breeding and subsequent malaria transmission.

Performance of rapid antigen tests to detect SARS-CoV-2 variant diversity and correlation with viral culture positivity: implication for diagnostic development and future public health strategies.

Despite the availability of vaccines, COVID-19 continues to be a major health concern, and antigen-based rapid diagnostic tests (Ag-RDTs) are commonly used as point-of-care or at-home diagnostic tests. In this study, we evaluated the performance of two commercially available Ag-RDTs and a research Ag-RDT to detect multiple SARS-CoV-2 variants using upper respiratory tract swab samples from clinical COVID-19 cases. Furthermore, we determined whether Ag-RDT results correlated with culture positivity, a potential proxy of viral transmissibility. Our results have important implications to inform future testing and response strategies during periods of high COVID-19 transmission with new variants.

Identifikasi Zat Pewarna Rhodamin B pada Sampel Makanan Menggunakan Metode Rapid Test di Loka POM di Kota Surakarta

There are many problems regarding cases of misuse of hazardous substances in food carried out by business actors by adding Rhodamine B dye. Therefore, the Government, in this case, BPOM and its staff, namely BBPOM/BPOM/Loka POM, routinely supervise and secure, including sampling samples suspected of containing hazardous materials. In carrying out its duties of supervising processed food, the POM Workshop in Surakarta City in its supervision area, the POM Workshop in Surakarta City conducts cross-sectoral guidance to business actors not to resell products that positively contain Rhodamin B. The purpose of carrying out practical work is to find out the Rhodamin B dye test on samples obtained from traditional markets in Surakarta City, Central Java. The sample testing method was carried out using the Rhodamin B Rapid Test. Nine samples were tested: rengginang crackers, cleret crackers, gado-gado crackers, chili powder, cenil, kueku, sentiling, chili sauce, and tomato sauce. The results of the Rhodamin B test on nine samples showed that two of the samples tested were suspected of containing Rhodamin B dye. So it can be concluded that there are still foods on the market using Rhodamin B dye.

Dual-Fluorescent Quantum Dot Nanobead-Based Lateral Flow Immunoassay for Simultaneous Detection of C-Reactive Protein and Procalcitonin.

Simultaneous detection of C-reactive protein (CRP) and procalcitonin (PCT) at the point of care is crucial for the management of infections in patients with inflammation and in critical care settings. The challenge of detecting high concentrations of CRP alongside low concentrations of PCT in plasma from inflammatory patients has limited the clinical application of multiplexed immunoassays. Herein, we developed a lateral flow immunoassay (LFIA) that employs quantum dot nanobeads (QDNBs) of varying sizes and colors to enable the simultaneous quantification of PCT and CRP in human plasma. To extend the dynamic range of CRP detection, we combined QDNBs with smaller particle sizes with the CRP detection antibodies, thereby increasing the assay's dynamic range and reducing the hook effect. At the same time, the stronger fluorescence emitted by these larger QDNBs, in conjugation with the PCT detection antibodies, allows for the detection of PCT at the nanogram level, meeting the demand for high sensitivity. The results show that this method can detect CRP concentrations from 0.1 to 3 mg/L and PCT with a detection limit of 0.09 ng/mL, which is on par with clinically used methods. By employing this dual-color and dual-size QDNB labeling strategy, we successfully achieved simultaneous detection of CRP with a broad dynamic range and PCT with high sensitivity in a one-step point-of-care rapid test.

Molecular detection of Staphylococcus aureus in urine in patients with S. aureus bacteremia: an exploratory study.

Staphylococcus aureus bacteremia (SAB) is associated with a 90-day mortality of 28-34%. Many SAB-patients (7.8-39%) have a secondary S. aureus bacteriuria (SABU) mainly without symptoms of a urinary tract infection. Due to high morbidity and mortality, there is an interest in rapid detection of S. aureus bacteremia. Here, we compared a rapid nucleic acid amplification test (NAAT) with conventional culture to detect S. aureus in urine and to identify cases with increased risk for SAB. In a cross-sectional study, we assessed urine samples (mid-stream, clean catch and catheter urine) of patients with SAB and bacteremia other than SAB (non-SAB). Urine samples were collected ± 3 days to the collection of the positive blood culture and were cultured on a set of selective and non-selective agar plates. NAAT was performed using a commercial test (Xpert® SA Nasal Complete G3, Cepheid) from a sterile swab soaked in urine. We included samples from 100 patients (68% male, median age: 67.4 years) with SAB and 20 patients (75% male, median age: 65.84 years) with non-SAB. The sensitivity of detecting SAB from urine samples was 47% (specificity: 90%) for NAAT, when applying a Ct-value of ≤ 37.4 for positive results. Urine culture had a sensitivity of 25% and a specificity of 95%. Molecular and culture methods showed a moderate agreement (80%, Cohens kappa: 0.55). NAAT from urine has a higher sensitivity than culture in patients with SAB and could potentially identify cases with increased risk for SAB. Future studies should investigate whether this characteristic could translate into a clinical benefit through rapid detection of SAB.

Prevalence of Salmonella Typhi, its associated factors and antimicrobial susceptibility profile among patients attending Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia

IntroductionSalmonella Typhi infections cause significant morbidity and mortality worldwide, especially in developing countries including Ethiopia. This study aimed to determine the prevalence of Salmonella Typhi, its associated factors and antibiotic susceptibility profile among suspected typhoid patients.MethodsA cross-sectional study was conducted on 270 typhoid fever suspected patients at Hawassa University Comprehensive Specialized Hospital from June 2022 to September 2022. Data were collected using questionnaires by face-to-face interview. Stool samples for microbiological culture, blood samples for S. Typhi IgM/Entero-check WB rapid test and isolates for antimicrobial susceptibility tests were used through standard procedures and according to the reagents manufactures’ instructions. Hygiene implementation of patients was also assessed using interview. Sociodemographic and clinical characteristics of the patient’s were considered. Descriptive statistics were used to summarize the data, and logistic regression model analysis was performed to assess associations between S. Typhi infection and the associated sociodemographic and clinical factors.ResultsThe prevalence of S. Typhi IgM/Entero-check WB rapid test and stool culture results were 3.3%; (95% CI: 1.5–5.6) and 3.7%; (95% CI: 1.9–6.3) respectively. Not washing hands after latrine [AOR = 0.85, 95% CI (0.15–4.79), p = 0.05] is not significant but, not washing hands before meal [AOR = 0.053, 95% CI (0.08–0.36), p = 0.03], eating raw vegetables [AOR = 0.024, 95% CI (0.001–0.48), p = 0.015] and drinking water from a stream [AOR = 0.12, 95% CI (0.19–0.70), p = 0.001] were significantly associated with S. Typhi infection, but in terms of AOR, all are preventive. Susceptibility of isolates was 9/10 (90%), 8/10 (80%), and 8/10 (80%) to ciprofloxacin, ceftriaxone, and chloramphenicol, respectively. The majorities 100% and 80% of the isolates were resistant to ampicillin and cotrimoxazole, respectively. About 40% of the isolates were MDR.ConclusionThe prevalence of Salmonella Typhi with MDR has been observed. Therefore, health programmers and stakeholders should make efforts to improve the habit of sanitation, strengthen the capacity of laboratory diagnostic methods and increase awareness of the misprescription and misuse of antibiotics to reduce the impact of MDR bacteria.

When and What to Test for Diarrhea: Focus on Stool Testing.

To review stool diagnostic tests in acute and chronic diarrhea. Narrative review of published literature. (A). In acute diarrhea, stool tests are indicated when there is strong pre-test probability of infectious etiology or C. difficile infection (CDI) suggested by >3 unformed bowel movements per 24h, symptoms lasting >7 days, and circumstances that are suggestive of infection. Several commercially available rapid tests for bacterial, viral or protozoal infections may be offered in addition to traditional methods (e.g. culture, microscopy), and provide a result within 6 hours. For CDI infection, a highly sensitive test such as glutamate dehydrogenase test is required; however, this does not distinguish infection from carrier state. That differentiation requires specialized nucleic acid amplification test (for toxin B) or enzyme immunoassays for toxin A or B, which are unfortunately not generally offered by microbiology labs. (B). Chronic diarrhea may result from inflammatory, fatty, osmotic or secretory causes; the commonest causes are IBS-D/functional diarrhea. Current recommendations in societal guidelines or clinical practice updates regarding stool tests in IBS-D/functional diarrhea in the absence of alarm symptoms include testing for giardia, calprotectin, fecal immunochemical test (FIT), and bile acid diarrhea (BAD). Comprehensive stool biochemical analyses (osmolality, pH, electrolytes) differentiate osmotic from secretory diarrhea and identify laxative abuse. Specific stool diagnostic tests for BAD and exocrine pancreatic insufficiency can lead to specific diagnosis and treatments. Surrogate markers associated with high fecal output and rapid transit in chronic diarrhea are stool form and colonic transit. Fecal testing is still very relevant in the practice of gastroenterology and deserves introduction of advanced microbiological and biochemical tests.

The effectiveness of information, education, and communication (IEC) methods on food safety and hygiene among food vendors during Ramadan

Background: During Ramadan 2023, only 4.7% of the 104 snack and food outlets in Jakarta, Indonesia, at the Cilandak District Primary Health Center met hygiene and sanitation standards. The inspections involved supervising cleanliness, implementing HACCP (Hazard Analysis & Critical Control Point), and counseling on the implementation of health and food safety practices. Purpose: To evaluate the impact of information, education, and communication (IEC) methods on food safety and hygiene practices among street food vendors during Ramadan. Method: A quantitative design with a quasi-experimental approach, an information, education, and communication (IEC) methods on food safety and hygiene for food vendors during the month of Ramadan consisting of one group. The study had two steps: first, it inspected food outlets before and after an educational intervention using a health environment inspection (eIKL PaJan) form; secondly, it tested food samples using a rapid test. Three outlets were randomly selected from each of the five sub-districts, and the data was analyzed using a paired T-test. The level of statistical significance was set at an alpha level of 0.05. Results: Fifteen "takjil" snack vendors were evaluated, and most had non-conformity scores. The highest non-conformity scores were due to hand hygiene issues and lack of knowledge about food safety. After the intervention, the mean score of knowledge about safe food handling increased from 57.5 to 75.9, with p<0.001 indicating an increase in awareness of food safety perceptions. Of the fifteen food samples tested, six showed the presence of formalin in the rapid test. However, subsequent testing at the laboratory revealed that the samples were free of formalin. Conclusion: Our study highlights a significant public health concern: enhancing awareness can bolster the safety, cleanliness, and knowledge of snack food outlet proprietors. This could positively affect the economy, human resource quality, and health through the implementation of food security practices.

Serological Status of Vaccine and Hepatitis B Virus Exposure Among Children Under 5 and Aged 15–17 Years in Kampala, Uganda

Background: Pediatric hepatitis B virus (HBV) serostatus remains variably characterized, hardly determined at times, or documented as part of national monitoring of the Extended Programs for Immunization (EPI). Methods: We cross-sectionally characterized the seroprevalence of HBV vaccine and/or infection status among 501 and 288 children <5 and 15–17 years old, respectively, in Kawempe Division, Kampala, Uganda, between May and August 2023. These children received HBV vaccination under the Uganda National Extended Program on Immunizations (UNEPI). Samples were qualitatively screened for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb or anti-HBs), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb or anti-HBe), and for hepatitis B core antibody (HBcAb or anti-HBc) using three different HBV Combo test rapid immunochromatographic diagnostic tests: Nova, Fastep, and Beright. Results: The seroprevalence of HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc was 1.52%, 27.75%, 0.88%, 0.63%, and 0.76%, respectively, for the combined study age groups. The HBsAg seroprevalence of 2.78% was almost 3.5-fold higher among adolescents when compared to the 0.8% observed in the under-5-year-olds. The qualitative seroprevalence of anti-HBs was 33.1% and 18.4% in the under-5 and among the 15–17-year-old study groups, respectively. Conclusions: The proportion of qualitatively detectable anti-HBs in both groups of vaccinated children is low and probably indicates reduced seroprotection. Consequently, a large proportion of children who received the hepatitis B vaccine under UNEPI may be at risk of HBV infection, especially adolescents. A booster dose of the Hepatitis B Vaccine may be required for adolescents.

Development of Worksheets for Immunomodulator Shared Decision-Making to Facilitate Patient-Clinician Communication: A Quality Improvement Project Employing Design Thinking Principles.

Shared decision-making (SDM) is a principle of humanistic, patient-centered health care within the field of rheumatology. However, clear communication between patients and their clinicians regarding the benefits and risks of immunomodulators may be challenging in a clinical setting. The design-thinking process is a human-centered approach to quality improvement that can help to identify insights to uphold high-quality communication. The development process adhered to the Stanford design thinking process framework, encompassing 5 stages: (1) empathize, (2) define, (3) ideate, (4) prototype, and (5) test. During the empathy stage, quality improvement members spent 4 hours immersed in the clinical setting observing how patients and clinicians engage in SDM conversations. These observations were augmented by unstructured debriefing sessions to better understand the needs and drivers of high-quality SDM. Following this, a rapid ideation workshop was convened to generate creative solutions. These led to rapid prototyping and testing, yielding a final product. The iterative design process identified 4 critical needs: (1) ensuring comprehensibility of materials, (2) upholding accuracy of information, (3) balancing standardization with individualization, and (4) promoting retention of knowledge. During the rapid ideation workshop, the concept of a Worksheet for Immunomodulator Shared Decision-Making (WISDM) was introduced and selected for further elaboration. This led to the creation of 5 prototypes for methotrexate, which were subsequently tested. These were reconciled and modified to make a final product. The WISDM template contains 7 elements that support SDM. Forty-five WISDMs were created for 23 immunomodulators. Further investigation will focus on how WISDMs exactly impact SDM.

Concomitant primary and secondary syphilis: a case series from a reference center in Mexico

Primary syphilis is characterized by the presence of a chancre and secondary syphilis by the presence of syphilis. The presence of chancres within secondary syphilis have been reported, however, this form of presentation is rare. Patients with synchronous diagnosis of primary and secondary syphilis were included. They underwent a reverse sequence algorithm for syphilis diagnosis with a rapid syphilis test, if positive, a rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) tests were performed. A total of 15 patients were included. All were men. In primary syphilis, penile chancre predominated in 13 patients (86.6%), and one (6.7%) was in the tongue. In secondary syphilis syphilitic roseola was the most common type of presentation in 10 patients (66.6%), followed by the palmoplantar plaques in 6 patients (40%) and condyloma lata in 2 patients (13.3%). One patient presented alopecia in a “moth-eaten” pattern and this presentation coexisted with a condyloma lata and the palmoplantar plaques. Other patient presented with syphilitic roseola, palmoplantar plaques and condyloma lata. Clinical presentation as coexistent primary-secondary syphilis will become more frequent. First contact physicians and dermatologists would have to take more in consideration infrequent and atypical clinical forms of this disease.

A case study of the 2023 highly pathogenic avian influenza (HPAI) outbreak in tern (Sternidae) colonies on the east coast of the Republic of Ireland

ABSTRACT Capsule:HPAI H5N1 had a significant impact on breeding Common Terns Sterna hirundo, Arctic Terns Sterna paradisaea and Roseate Terns Sterna dougallii on the east coast of the Republic of Ireland (ROI) in 2023, with a lesser impact on Sandwich Terns Thalasseus sandvicensis and only two cases among Little Terns Sternula albifrons. Aims: To document the outbreak of HPAI H5N1 in the tern colonies on the east coast of ROI during the 2023 breeding season. Methods:Precautions were taken from the start of the breeding season, including personal protective equipment (PPE) and safe operating procedures. Regular meetings were held between BirdWatch Ireland and the National Parks and Wildlife Service (NPWS) to respond to the emerging situation. Once HPAI was confirmed in a colony, all ringing and nest visits were stopped. Carcass removal was carried out at all affected colonies and most carcasses were incinerated. Results: Common Terns suffered the highest mortality across all colonies in 2023, with smaller but notable numbers of dead Roseate Terns and Arctic Terns, but very few Sandwich Terns and only two Little Tern deaths were attributed to HPAI. Conclusion: Regular meetings between relevant organizations were invaluable in preparing for outbreaks and ensuring an adaptive approach as the situation changed over time and between colonies. There was no way of knowing if the actions taken were effective, as the pattern of virus spread between species and sites remains poorly understood. Future clarity over the role of various state agencies and other relevant bodies in responding to HPAI in wild birds, greater sharing of real-time information, and pre-arranged agreements to ensure rapid testing and disposal of carcasses, would be useful to ensure an effective response to future outbreaks.

Dengue virus transmission during non-outbreak period in Dar Es Salaam, Tanzania: a cross-sectional survey

BackgroundTanzania has experienced multiple dengue outbreaks between 2010 and 2019, caused by various dengue virus (DENV) strains. In 2019, there were 6917 confirmed dengue cases and 13 deaths in Tanzania. Routine diagnosis of dengue fever is unfortunately excluded, particularly during non-outbreak periods, resulting in delayed outbreak detection and control. The aim of this study was to improve early detection and control measures for DENV by investigating its circulation in human and Aedes aegypti (A.aegypti) mosquitoes during the non-outbreak periods in Dar es Salaam, Tanzania, which is an area frequently affected by dengue outbreaks.MethodsFour hundred and fifteen (415) blood samples were collected from patients attending randomly selected health facilities in five wards; Azimio, Keko, Mtoni, Mbagala and Chamazi within Temeke district. The samples were tested for DENV NS1 antigen and anti-dengue IgM and IgG antibodies by rapid test. Then, 150 out of 415 blood samples were tested for the DENV by conventional Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Two thousand two hundred and fifty (2,250) adult female A.aegypti mosquitoes were collected using a Prokopack aspirator and BG sentinel trap or obtained after rearing immature stages and tested, in pools of 15 for DENV by RT-PCR. Statistical Software, SPSS version 23, was used for data analysis.ResultsOf the tested blood samples, 17% (71/415) were positive by NS1 antigen, 0.5% (2/415) by IgM, 0.5% (2/415) by IgG antibodies, and 0.5% (2/415) by IgM and IgG. None of the samples tested positive by DENV RT-PCR. Moreover, 3.3% (5/150) of tested mosquito pools had DENV by RT-PCR. Individuals aged between 21 and 40 years of age had increased risk of testing positive for DENV NS1 antigen, followed by those aged 5–20 years old, particularly those residing from Azimio ward, Keko ward, Mtoni ward and Mbagala ward, p-value ≤ 0.05.ConclusionFindings from this study revealed evidence of DENV circulation during non-outbreak periods in Dar es Salaam, Tanzania. These findings underscore the importance of including testing for dengue infection in routine differential diagnoses of febrile cases, and also frequent dengue surveillance in mosquitos. This proactive approach will help early DENV outbreak detection and control in the country.

Clinical Practice: Estimating the Breakpoints for EUCAST Fast Antimicrobial Susceptibility Testing Using Flagged BacT/Alert Blood Culture Bottles

<i>Introduction</i>: The escalating prevalence of multidrug resistance is a global threat to human health particularly in critically ill patients with bloodstream infections (BSIs). Delay in the administration of the appropriate antimicrobial treatment is associated with higher mortality rates and adverse consequences. This study attempted to estimate the rapid antimicrobial susceptibility testing (RAST) breakpoints directly from flagged BacT/Alert blood culture bottles in clinical practice. <i>Material & Methods</i>: A descriptive, cross-sectional study conducted at a tertiary care hospital in Delhi over a period of two months. The RAST was performed directly from the clinical samples for blood cultures received in our laboratory in parallel with the routine antimicrobial testing as per standard CLSI guidelines. Blood cultures were routinely incubated in BacT/Alert 3D. The inhibition zones were read at 4, 6, 8 and 16-20 hour of incubation as per European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The identification of the isolates was confirmed by Vitek-2 compact system. <i>Results</i>: In our study, the area of technical uncertainty (ATU) percentage was initially high at 4 hours but decreased significantly in later incubation periods. At 4 hours, none of the <i>S. aureus</i> isolates showed >90% categorical agreement (CA) for any antimicrobial tested. However, clindamycin achieved the highest CA (100%) at 6 hours and 90% thereafter, with no very major errors (VME) or major error (ME). Cefoxitin required 8 hours to reach >90% CA, with no VME observed at any time point, but up to 75% ME at 8 hours. At 4 hours, most antimicrobials had high (>1.5%) rates of VME among <i>Enterobacteriales</i>. By 6 hours, only Meropenem and Gentamicin had >90% CA, with no VME observed for other antibiotics. <i>Conclusion</i>: The RAST method is relatively easy to implement in clinical microbiology labs, offering cost-effectiveness, simplicity, and rapid results, especially in resource-limited settings. However, reporting RAST results can be complex due to potential challenges with CA, VME, and ME, particularly in the initial hours of incubation and within the ATU.