Re-emerging Disease Research Articles

Pathological Responses in Asian House Shrews (Suncus murinus) to the Naturally Acquired Orientia tsutsugamushi Infection.

Scrub typhus is a re-emerging disease caused by Orientia tsutsugamushi, transmitted by mites belonging to the family Trombiculidae. Humans and rodents acquire the infection by the bite of larval mites/chiggers. Suncus murinus, the Asian house shrew, has been reported to harbor the vector mites and has been naturally infected with O. tsutsugamushi. The present study aimed to localize and record O. tsutsugamushi in the tissues and the host response in shrews naturally infected with O. tsutsugamushi. Sheehan's modified May-Grunwald Giemsa staining was carried out in 365 tissues from 87 animals, and rickettsiae were documented in 87 tissues from 20 animals. Immunohistochemical (IHC) staining, using polyclonal antibodies raised against selected epitopes of the 56-kDa antigen, was carried out, and 81/87 tissue sections were tested positive for O. tsutsugamushi. By IHC, in addition to the endothelium, the pathogen was also demonstrated by IHC in cardiomyocytes, the bronchiolar epithelium, stroma of the lungs, hepatocytes, the bile duct epithelium, the epithelium and goblet cells of intestine, the tubular epithelium of the kidney, and splenic macrophages. Furthermore, the pathogen was confirmed by real-time PCR using blood (n = 20) and tissues (n = 81) of the IHC-positive animals. None of the blood samples and only 22 out of 81 IHC-positive tissues were tested positive by PCR. By nucleotide sequencing of the 56-kDa gene, Gilliam and Karp strains were found circulating among these animals. Although these bacterial strains are highly virulent and cause a wide range of pathological alterations, hence exploring their adaptive mechanisms of survival in shrews will be of significance. Given that the pathogen localizes in various organs following a transient bacteremia, we recommend the inclusion of tissues from the heart, lung, intestine, and kidney of reservoir animals, in addition to blood samples, for future molecular surveillance of scrub typhus.

Emerging and re-emerging infectious diseases in pregnant women in an amazonian region: a large retrospective study from French Guiana.

Over the past decade, the Amazon basin has faced numerous infectious epidemics. Our comprehension of the actual extent of these infections during pregnancy remains limited. This study aimed to clarify the clinical and epidemiological features of emerging and re-emerging infectious diseases during pregnancy in western French Guiana and along the Maroni River over the previous nine years. This retrospective cohort study enrolled pregnant women living in west French Guiana territory and giving birth in the only local referral center after 22 weeks of gestation between 2013 and 2021. Data on symptomatic or asymptomatic biologically confirmed emerging or re-emerging diseases during pregnancy was collected. Six epidemic waves were experienced during the study period, including 498 confirmed Zika virus infections (2016), 363 SARS-CoV-2 infections (2020-2021), 87 chikungunya virus infections (2014), 76 syphilis infections (2013-2021), and 60 dengue virus infections (2013-2021) at different gestational ages. Furthermore, 1.1% (n = 287) and 1.4% (n = 350) of pregnant women in west French Guiana were living with HIV and HTLV, respectively. During the study period, at least 5.5% (n = 1,371) faced an emerging or re-emerging infection during pregnancy. These results highlight the diversity, abundance, and dynamism of emerging and re-emerging infectious agents faced by pregnant women in the Amazon basin. Considering the maternal and neonatal adverse outcomes associated with these infections, increased efforts are required to enhance diagnosis, reporting, and treatment of these conditions.

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

Leptospirosis is a re-emerging zoonotic disease that has had an unprecedented impact on most health systems in the world. The spectrum of symptoms is variable and usually ranges from asymptomatic cases to severe manifestations involving multiple organ dysfunction accompanied by jaundice, hemorrhage, meningitis, and acute kidney injury that requires the need for intensive care assistance. Although early antibiotic treatment is usually effective, in severe cases, it may require renal replacement therapy, invasive mechanical ventilation, vasoactive support, and invasive hemodynamic monitoring, increasing the risk of death. In Latin America, the real burden of acute kidney injury in this condition is unknown and may be underestimated due to the rapid progression of the disease, similar to other vector zoonoses, and the low coverage of diagnostic tests in primary care, especially in rural regions. Therefore, below, we review the clinical aspects and describe the scientific, clinical, and therapeutic evidence of acute kidney injury attributed to Leptospira spp. and its relevance in patients with severe leptospirosis in Latin America.

Epidemiological and Clinical Characteristics of Patients with Diphtheria Attending the Infectious Disease Hospital in Delhi.

Diphtheria is a re-emerging disease with a changing epidemiology. It is thus essential to recognize diphtheria's clinical profile, patterns of morbidity and mortality, and the level of immunization. This study aimed to analyze the clinical-epidemiological profile of patients with diphtheria at the Infectious Disease Hospital, New Delhi, India. The present study was a cross-sectional investigation conducted on 94 patients diagnosed with diphtheria. The data collection tool was a questionnaire that had questions eliciting details such as socio-demographic characteristics, clinical history, examination findings, and vaccination history. The case fatality rate was calculated. Means and proportions were also measured, and the significance level was set at P <0.05. The meanSD age of the participants was 94.4 years. Laryngeal involvement was found in 10 (11%) participants. Complete diphtheria vaccination doses were taken by 6 (6.4%) participants. The case fatality rate was 13%, and complications such as neuropathy were found in 21 (22%) cases, cardiac problems in 12 (13%), and respiratory problems in 13 (14%). Longer duration of the illness, delayed presentation, and complications were associated with poor clinical outcomes (P<0.05). The majority of diphtheria cases were 6-10 years old and had a low socio-economic status. Most of them had a partial vaccination against diphtheria. Around one-third of the patients had complications related to diphtheria, and the case fatality rate was also high. Key preventive measures for controlling the deadly diphtheria disease include specialized immunization programs for areas with poor immunization coverage, as well as the early detection and treatment of suspected cases.

"Monkeypox: Re-Emerging Infectious Disease and One Health Strategy"

"Monkeypox: Re-Emerging Infectious Disease and One Health Strategy"

Design, Implementation and Evaluation of a Training Workshop on Mindfulness in Clinical Encounters for Nursing Students of the Shahid Beheshti University of Medical Sciences

Abstract&#x0D; Introduction: With the emergence of new and re-emerging diseases and their medical staff and students facing infectious diseases, it was felt necessary to support them regarding the stress and anxiety caused by the disease. Therefore, this study was conducted to design, implement, and evaluate a workshop on mindfulness in clinical encounters for nursing students.&#x0D; Method: This educational research was conducted on 66 nursing students based on the Glasik criteria. First, the needs and goals were determined based on the literature review and expert panel; the workshop was designed with a focused group of student representatives, and then the implementation of the program began. For evaluation, the satisfaction form was used to measure learning, anxiety, and performance.&#x0D; Results: The average satisfaction of the learners with the efficiency of the course was 32.3 and the satisfaction with the organization of the course was 25.6. The average work participation before the workshop was 19.33 ± 6.19, which after the workshop was 28.13 ± 4.69 and was significant (P &lt; 0.001). The average anxiety before the workshop was 20.40 ± 10.73, but after the workshop decreased to 10.90 ± 13.64 and was significant (P &lt; 0.001). The mean of mindfulness before the workshop was 89.46 ± 17.16, which reached 99.26 ± 18.70 after the workshop (P = 0.007).&#x0D; Conclusion: The mindfulness workshop provides a suitable opportunity to practice techniques for dealing with stress and critical situations for undergraduate students who have fewer skills. It is suggested to investigate this intervention at other educational levels.

Re-emergence of Diphtheria. A Case Report in a Pediatric Emergency at a Tertiary Care Hospital in Karachi

Diphtheria, caused by Corynebacterium diphtheria, is an acute bacterial infection that primarily affects the respiratory system. With the availability of diphtheria vaccines, the incidence of the disease has significantly decreased globally. However, in recent times, there has been a concerning resurgence of diphtheria in various parts of the world, including Pakistan, and hence presents a unique and pressing public health challenge, as evidenced by our case study exclusively reported from the pediatric emergency department. The study highlights the importance of early recognition and management of diphtheria cases and the need for booster doses in the EPI program to prevent this deadly disease re-emergence.

Sporadic regional re-emergent cholera: a 19th century problem in the 21st century.

Cholera, caused by Vibrio cholerae, is a severe diarrheal disease that necessitates prompt diagnosis and effective treatment. This review comprehensively examines various diagnostic methods, from traditional microscopy and culture to advanced nucleic acid testing like polymerase spiral reaction and rapid diagnostic tests, highlighting their advantages and limitations. Additionally, we explore evolving treatment strategies, with a focus on the challenges posed by antibiotic resistance due to the activation of the SOS response pathway in V. cholerae. We discuss promising alternative treatments, including low-pressure plasma sterilization, bacteriophages, and selenium nanoparticles. The paper emphasizes the importance of multidisciplinary approaches combining novel diagnostics and treatments in managing and preventing cholera, a persistent global health challenge. The current re-emergent 7th pandemic of cholera commenced in 1961 and shows no signs of abeyance. This is probably due to the changing genetic profile of V. cholerae concerning bacterial pathogenic toxins. Given this factor, we argue that the disease is effectively re-emergent, particularly in Eastern Mediterranean countries such as Lebanon, Syria, etc. This review considers the history of the current pandemic, the genetics of the causal agent, and current treatment regimes. In conclusion, cholera remains a significant global health challenge that requires prompt diagnosis and effective treatment. Understanding the history, genetics, and current treatments is crucial in effectively addressing this persistent and re-emergent disease.

Monkeypox: A re-emerging disease.

The virus known as monkeypox is the source of the zoonotic disease monkeypox, which was historically widespread in Central Africa and West Africa. The cases of monkeypox in humans are uncommon outside of West and Central Africa, but copious nonendemic nations outside of Africa have recently confirmed cases. People when interact with diseased animals, then, they may inadvertently contact monkeypox. There are two drugs in the market: brincidofovir and tecovirimat and both of these drugs are permitted for the cure of monkeypox by the US Food and Drug Administration. The present review summarizes the various parameters of monkeypox in context with transmission, signs and symptoms, histopathological and etiological changes, and possible treatment. Monkeypox is clinically similar to that of smallpox infection but epidemiologically, these two are different, the present study also signifies the main differences and similarities of monkeypox to that of other infectious diseases. As it is an emerging disease, it is important to know about the various factors related to monkeypox so as to control it on a very early stage of transmission.

Tips and tools to obtain and assess mosquito viromes.

Due to their vectorial capacity, mosquitoes (Diptera: Culicidae) receive special attention from health authorities and entomologists. These cosmopolitan insects are responsible for the transmission of many viral diseases, such as dengue and yellow fever, causing huge impacts on human health and justifying the intensification of research focused on mosquito-borne diseases. In this context, the study of the virome of mosquitoes can contribute to anticipate the emergence and/or the reemergence of infectious diseases. The assessment of mosquito viromes also contributes to the surveillance of a wide variety of viruses found in these insects, allowing the early detection of pathogens with public health importance. However, the study of mosquito viromes can be challenging due to the number and complexities of steps involved in this type of research. Therefore, this article aims to describe, in a straightforward and simplified way, the steps necessary for obtention and assessment of mosquito viromes. In brief, this article explores: the capture and preservation of specimens; sampling strategies; treatment of samples before DNA/RNA extraction; extraction methodologies; enrichment and purification processes; sequencing choices; and bioinformatics analysis.

Will a re-emergence of ancient infectious diseases pose a new risk to humanity in the coming millennia?

Infectious diseases including smallpox, the black plague, cholera, and others have been responsible for the loss of millions of lives over the past millennia, prior to the development of effective treatment strategies during the recent century. Throughout history, epidemics and pandemics are known to have occurred intermittently throughout the world for over 2,500 years. During the 20th century, many of the causative infectious agents were identified, the evolution of vaccines and antimicrobials were developed, resulting in treatment strategies and public health measures that brought about the resolution and presumed virtual eradication of some of the infectious agents. Cholera is transmitted via the fecal-oral route, and outbreaks continue to occur, with the most recent epidemic in Haiti following the massive earthquake of 2010 despite the development of effective vaccines and supporting public health measures. While smallpox was deemed to have been eradicated by the WHO, the recent discovery of Alaskapox, a novel strain of orthopoxvirus that is genetically similar to ‘old-world’ smallpox claimed its first fatality in January 2024. The bubonic plague also continues to reappear in clusters, most recently in rural Oregon in the USA in early 2024. Thus, the emergence of variants of these and other devastating ancient diseases continues to require diligence in establishing and delivery of public health measures and therapeutic options to ensure the plagues of former millennia remain in the history books and not in the community during the present and future generations.

Exploring the complex interplay: gut microbiome, stress, and leptospirosis.

Leptospirosis, a re-emerging zoonotic disease, remains a significant global health concern, especially amid floods and disasters such as the Kakhovka Dam destruction. As is known, the stress that occurs in the conditions of military conflicts among civilian and military personnel significantly affects susceptibility to infectious diseases and possibly even influences their course. This review aims to explore how the gut microbiome and stress mediators (such as catecholamines and corticosteroids) might impact the leptospirosis disease course. The review opens new horizons for research by elucidating the connections between the gut microbiome, stress, and leptospirosis.

Climate drivers of migration and neglected tropical disease burden in Latin American and Caribbean immigrants: A pilot study in Atlanta, Georgia

IntroductionClimate change has negatively impacted the agricultural and socioeconomic infrastructure of Latin American and Caribbean (LAC) countries leading to conditions that promote human migration. It has also led to emergence and reemergence of infectious diseases. This pilot study aimed to identify climate-related drivers of migration and to describe the burden of climate-sensitive neglected tropical diseases (NTD) in immigrants living in Atlanta, Georgia, USA. MethodsFirst generation immigrants from LAC countries living in the Atlanta-metro area were recruited between May and December 2021. Participants completed a survey concerning demographics, socioeconomics, living conditions in their country of origin and living conditions in Atlanta, and motivations for migration. Blood and stool samples were collected to identify Chagas disease and soil-transmitted helminths, and skin exams screened for leprosy and leishmaniasis. Descriptive, univariate, and multivariable analyses of this dataset looked at the association between a climate-driven motivation to migrate and geographic and socioeconomic factors. ResultsFifty-seven individuals were recruited representing 11 LAC countries of origin. Most originated from Central America (n = 32; 56 %) and Mexico (n = 13; 23%). Forty-two participants reported a change in climate or weather in their country of origin prior to moving and direct climate drivers of migration (e.g., floods, drought, etc.) were identified by 12 participants (21.1%). Infectious diseases screening found one definitive case of Chagas (2.5%) out of 40 blood samples screened. Food insecurity was significantly associated with a climate-related factor for migrating: aOR = 6.3 (95 % CI 1.1, 35.5). ConclusionsWhile most participants did not directly identify “climate change” as a reason for migration, our study reveals many factors such as food insecurity, agricultural occupations, and region of origin that may underlie climate-motivated migration. Finding one case of Chagas was also noteworthy and shows the need for improved surveillance for this important NTD.

A fuzzy inference system for predicting outbreaks in emerging infectious diseases

The world population is vulnerable to emerging and possibly re-emerging infectious diseases. Climate change, globalization, increased travelling, and urbanization are dynamic factors behind disease emergence and reemergence. This study formulates and analyzes a model with five inputs, viz. Change of Landscape (CoL), Gateway of Travel (GoT), Hygiene, Sanitization, Housing (HSH), Health Infrastructure (HI), and Regularity of Surveillance (RoS) and one output, viz. Possibility of Outbreak to determine the effect of these variables on disease emergence using a Mamdani fuzzy inference system. We study the impact of these factors on disease emergence and the possibility of an outbreak in a particular region.

Body lice: a vector for re-emerging disease outbreak in a rehabilitation camp in Northwestern Iran

ObjectiveThe report of the outbreak of body louse in northwestern Iran after three decades reminds us again of the danger of the re-emerging of previous epidemics.ResultsThe results of the study that nearly 70% of the patients in a rehabilitation Centre were infected with body louse. In this study, scientific measures were taken to prevent the spread of body lice to healthy people, including isolation of the patients, washing the clothes of those infected at high temperatures, and spraying the rest area, beddings, and blankets. This is a more recent report on an outbreak of body louse in Iran in 2023.

Diagnosis of Rickettsial infection by Multiplex Real-time PCR in Febrile Pediatric Patients Admitted in a Tertiary Care Hospital at Chennai, South India

Rickettsioses caused by Rickettsia and Orientia spp. are the re-emerging diseases in India, which are grossly underdiagnosed, particularly among children. They usually present as mild-febrile illness but may extend to severe life-threatening complications. Early diagnosis followed by proper treatment reduces the morbidity and mortality. Non-specific clinical symptoms and lack of point of care diagnosis may delay the treatment. Molecular assays like PCR may helpful in the early diagnosis and confirmation of rickettsial diseases. In this study, we used multiplex real-time PCR to detect Rickettsia spp. and Orientia spp. in febrile pediatric patients. Whole blood was collected from 239 clinically suspected febrile pediatric patients aged between 6 months to 12 years admitted in tertiary care hospital at Chennai, South India. Multiplex real-time PCR was used to target the gltA gene for Rickettsia spp. and the 47kDa gene for Orientia tsutsugamushi. To compare the sensitivity, nested PCR was performed on the 56kDa antigen gene of O. tsutsugamushi and the Rickettsia genus specific gltA gene. By multiplex real-time PCR, 15 samples were positive for O. tsutsugamushi and 3 were positive for Rickettsia spp. Nested PCR identified 35 positive samples for O. tsutsugamushi and 4 positive samples for Rickettsia spp. Even though multiplex real-time PCR had lower positivity than nPCR, it was effective in diagnosing O. tsutsugamushi and Rickettsia spp. in a single assay.

CD19-Specific CAR-T Cell Treatment of 115 Children and Young Adults with Acute B Lymphoblastic Leukemia: Long-term Follow-up.

Chemotherapy has been the primary treatment for patients with B-cell acute lymphoblastic leukemia (B-ALL). However, there are still patients who are not sensitive to chemotherapy, including those with refractory/relapse (R/R) disease and those experiencing minimal residual disease (MRD) re-emergence. Chimeric antigen receptor-T lymphocytes (CAR-T) therapy may provide a new treatment option for these patients. Our institution conducted a single-arm prospective clinical trial (ChiCTR-OPN-17013507) using CAR-T-19 to treat R/R B-ALL and MRD re-emergent patients. One hundred and fifteen patients, aged 1-25 years (median age, 8 years), were enrolled, including 67 R/R and 48 MRD re-emergent CD19-positive B-ALL patients. All patients achieved morphologic complete remission (CR), and within 1 month after infusion, 111 out of 115 (96.5%) patients achieved MRD-negative CR. With a median follow-up time of 48.4 months, the estimated 4-year leukemia-free survival (LFS) rate and overall survival (OS) rate were 68.7%±4.5% and 70.7%±4.3%, respectively. There were no significant differences in long-term efficacy observed among patients with different disease statuses before infusion (4-year OS: MRD re-emergence vs. R/R B-ALL, 70.6%±6.6% vs. 66.5%±6.1%, p=0.755; 4-year LFS: MRD re-emergence vs. R/R B-ALL, 67.3%±7.0% vs. 63.8%±6.2%, p=0.704). R/R B-ALL patients bridging to transplantation after CAR-T treatment had a superior OS and LFS compared to those who did not. However, for MRD re-emergent patients, there was no significant difference in OS and LFS, regardless of whether they underwent hematopoietic stem cell transplantation or not. CD19 CAR-T therapy effectively and safely cures both R/R B-ALL and MRD re-emergent patients.

Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study.

Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox. The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section. The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years (p < 0.001), married participants (p < 0.001), and doctors (p < 0.001). The positive attitude was significantly observed among the male sex (p = 0.045), urban residents (p = 0.002), and nurses (p = 0.002). Conversely, married participants (p = 0.013), doctors (p < 0.001), and individuals employed in pharmacy and laboratory departments (p < 0.001) experienced an increase in positive perception. Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission.

Leptospirosis Relative Risk Estimates based on Continuous-Time, Discrete-Space Stochastic SIR-L-SI Transmission Model

Leptospirosis is a re-emerging global disease that has become endemic in Malaysia. The transmissions usually occur between animals especially rats to rats and rats to humans. Since, it is an easily contractable disease that can be transmitted directly through contact with infected rat’s urine or indirectly from the environment such as via water and soil, it is very challenging to curb this disease from infecting humans. Poor understanding of the disease and lack of epidemiological data also made leptospirosis is difficult to control. To cope with this problem, a leptospirosis disease transmission model is developed to study the mechanism of leptospirosis disease spread over continuous-time that may help to predict future caused of an outbreak. This study aims to construct a continuous-time and discrete-space stochastic SIR-L-SI (Susceptible, Infected, Recovered Humans-Leptospires in the Environment-Susceptible, Infectious Rats) of leptospirosis disease transmission to estimate the risk involved. A simple method of asymptotic and numerical analyses is applied as an alternative approach for solving simultaneous differential equations in the leptospirosis SIR-L-SI transmission model. The application of the proposed model is demonstrated using leptospirosis data for Malaysia. The results of asymptotic behaviour and numerical analysis provide useful information about susceptible and infective rat and human populations as well as offer relative risk estimates that can be used as one of the control measures in identifying hot-spot areas for this disease.

Burdening Perspectives and Treatment Modalities of Monkeypox: A Central Dogma.

The monkeypox virus (MPXV), belonging to the genus Orthopoxvirus, is responsible for causing the zoonotic illness known as Monkeypox. The virus was initially identified during an outbreak at a Danish Zoo in 1958 and has since been found to infect various mammal species worldwide. While African squirrels and other rodents are believed to be the primary hosts, determining the natural host has proven challenging. While MPXV can be studied using different animal models in laboratory settings, understanding its natural transmission routes remains complex and species-dependent. Recent developments have elevated the global health concern surrounding Monkeypox, leading to its designation as a Global Health Emergency of International Concern on 23 July 2022. Enhancing surveillance and case detection is crucial in navigating the unpredictable epidemiology of this re-emerging disease. Human infections with the monkeypox virus are becoming less frequent due to population growth and economic improvements. Monkeypox, similar to smallpox, can potentially be controlled and eradicated in the future through vaccines, appropriate treatment, and personal protective equipment.