Recent Fever Research Articles

Potential role of heterologous flavivirus immunity in preventing urban transmission of yellow fever virus

During the recent yellow fever (YF) epidemics in Brazil, human cases were attributed to spillover infections via sylvatic mosquito transmission. Despite YF virus (YFV) transmission in major urban centers with insufficient vaccination coverage and abundant populations of the domestic vector, Aedes aegypti, there was no evidence of human-amplified transmission. Furthermore, the historic absence of YF in Asia, despite abundant Ae. aegypti and an immunologically naive human population, is unexplained. We tested the hypothesis that pre-existing, heterologous flavivirus immunity, specifically from dengue (DENV) and Zika (ZIKV) viruses, limits YFV viremia and transmission by Ae. aegypti. We infected cynomolgus macaques with DENV or ZIKV, then challenged them 6–9 months later with YFV. We then measured viremia and disease and allowed Ae. aegypti mosquitoes to feed during peak macaque viremia. Although prior heterologous immunity had variable effects on disease, DENV and ZIKV immunity consistently suppressed YFV viremia. Despite no statistical difference due to a small sample size, the suppression in viremia led to a significant reduction in Ae. aegypti infection and a lack of transmission potential. These results support the hypothesis that, in DENV- and ZIKV-endemic regions such as South America and Asia, human flavivirus immunity suppresses YFV human amplification potential, reducing the risk of urban outbreaks.

Macrophage activation syndrome: An unusual complication of brucellosis

Introduction: During acute septicemic brucellosis, macrophage activation syndrome is a rare but serious complication. We report two cases of acute brucellosis complicated by macrophage activation syndrome (MAS). Materials and methods: We conducted a retrospective study on the medical records of patients admitted for brucellosis complicated by SAM between February 2021 and January 2023. The diagnosis of brucellosis is based on the isolation of brucellosis in blood cultures and/or on positivity serology. The SAM was retained based on Henter's diagnostic criteria. Results: During the study period, 30 patients were hospitalized for brucellosis. The average age is 46.7 years. Acute brucellosis complicated by SAM was noted in two immunocompetent male patients aged 47 and 46 years. Both patients were hospitalized for treatment of recent acute fever with deterioration in general condition, chills and diffuse arthromyalgia. The biological assessment revealed an inflammatory syndrome and pancytopenia in our patients. Blood cultures were requested returning positive for Brucella spp. Both patients presented more than five diagnostic criteria for SAM (fever, SPM, severe pancytopenia, hypertriglyceridemia and hyperferritinemia, histological signs of hemophagocytosis). Our patients improved only under antibiotic therapy. Conclusion: Macrophage activation syndrome is a described but rare complication during brucellosis.

8105 Radiation-Induced Hyperthyroidism in the Context of Palliative Radiation Therapy

Abstract Disclosure: A. Randhawa: None. G. Palaguachi: None. J.G. Karam: None. Introduction: Palliative radiotherapy, designed to alleviate focal symptoms in advanced, incurable cancer, aims to enhance quality of life with minimal treatment burden. The thyroid gland's susceptibility to neck radiation is known, primarily leading to hypothyroidism. However, hyperthyroidism is a much less frequently reported adverse effect that is poorly understood. This case report highlights an unusual instance of radiation-induced hyperthyroidism. Case Presentation:The patient is a 53 years-old woman with history of Ewing’s sarcoma of the sacrum diagnosed in August 2022, treated initially with chemotherapy (cyclophosphamide, vincristine, etoposide and ifosfamide), but diagnosed with leptomeningeal metastasis and T12/L1 mass in October 2023 when she presented with lower extremities weakness and urinary incontinence. She underwent T12-L1 laminectomy, resection of tumor and fusion, and was started on palliative intent radiation therapy for the brain and C-spine. A month later, she was admitted for altered mental status and was found to be persistently tachycardic at 140 bpm. Thyroid function testing was sent and revealed hyperthyroidism with TSH of 0.07 mIU/L (0.39-4.08), Free T4 of 1.74 ng/dl (0.58-1.64), T4 of 10.7ug/ml (4.4-9.5), T3 of 0.54 ng/ml (0.72-1.35), with undetectable Thyroid Peroxidase Antibodies and Thyroid Stimulating Immunoglobulin level. Thyroid Ultrasound showed a small and homogenous thyroid gland with no discrete nodules. Radioactive Iodine uptake and scan was not obtained because of exposure to iodized contrast during hospital stay. The patient had no available baseline thyroid function tests. She had no recent fever or viral illness. Unfortunately, her clinical condition deteriorated rapidly, and she passed away on the seventh day of admission. Conclusion: While hypothyroidism is a well-established consequence of high-dose irradiation, the mechanisms behind the rarer radiation-induced hyperthyroidism remain unclear. Speculation includes the release of autoantigens from damaged thyroid glands, triggering an immune response and potentially leading to Graves' hyperthyroidism. However, our case more likely represents a hyperthyroid phase in the triphasic sequence of destructive subacute thyroiditis, given the absence of elevated thyroid antibodies, thyroid nodules, and other causes of thyroiditis. Increasing awareness of radiation-induced hyperthyroidism, unraveling its mechanisms, and refining diagnostic strategies such as obtaining baseline and monitoring thyroid function testing are crucial, particularly in the context of palliative therapy, where striking the delicate balance between efficacy and minimizing toxicity is paramount. Presentation: 6/3/2024

Retrospective study on the dengue fever outbreak in Puntland State, Somalia

BackgroundDengue infection is a mosquito-borne, endemic viral disease, particularly in developing countries. Here, we report the results of the clinicodemographic, serologic profile and the monthly occurrence of a recent dengue fever outbreak in Puntland State (Somalia).MethodologyWe analyzed the data of 956 dengue-suspected patients who were investigated using the rapid diagnostic testing (RDT) method for detecting NS1 (dengue virus non-structural protein) and IgM antibodies employing the SD Biosensor Dengue Dou NS Ag and IgM test kit (Germany) at the Puntland Public Health Referral Laboratory from November 21, 2022, to May 27, 2023.ResultsWe found that 118 cases were positive for dengue among the suspected patients enrolled in the present study. Of these cases, 76.2% were dengue NSI positive, 13.6% were dengue IgM positive, and 10.2% were both NSI and IgM positive. The number of females and males in the confirmed cases was equal, and most (48.3%) were aged 20 years or less. 43.1% of them lived in the Nugal region, particularly in Garowe. Clinically, fever was the most frequent symptom (88.9%). The cases peaked in December 2022 but dropped from January to March, with a slight rise in February, and then increased in April and May 2023.ConclusionThis study highlights the clinicodemographic characteristics, seroprevalence, and monthly occurrence of dengue in Puntland. We recommend improving vector control measures, enhancing case management, strengthening dengue surveillance, developing an early warning system, and conducting future studies to characterize the circulating strains.

Resource‐driven changes in wild boar movement and their consequences for the spread of African Swine Fever in the Russian Far East

Knowledge of animal movement patterns is invaluable to understanding the spread of diseases among wildlife populations. One example is the recent African swine fever (ASF) outbreak among wild boar Sus scrofa populations across East Asia, where there is a lack of information on movements of this species. During a wild boar tracking project to inform abundance estimation methods in the Russian Far East's Sikhote‐Alin Biosphere Zapovednik, the combination of high variability in pulsed resources of acorns and pine nuts between fall 2019 and fall 2020, and the outbreak of ASF during the latter year, offered the unique opportunity to investigate the relationship between wild boar movements to exploit pulsed resources and the potential for disease spread. We analyzed relocation data from GPS‐collared wild boar in fall 2019 and 2020 and compared them to reference data in Belgium, representative of western Europe. We found remarkable differences in movement patterns, with Far East wild boar travelling large distances in fall 2020 (maximum observed of 77 km in four days) when the availability of acorns was low. In our resource selection analysis, we found clear selection for mast‐producing forest types that corresponded with the species of greater mast production (oak or pine) for that year. Comparing the displacement of individual wild boar along a moving window of 1–7 days (time between infection and the onset ASF symptoms) highlighted the potential of rapid ASF spread over long distances when wild boar are in search of pulsed resources. This work demonstrates the capacity of wild boar to move long distances to exploit resources and emphasizes the need to consider resource availability when predicting the speed and extent to which diseases such as ASF can spread.

Restoration of Alouatta guariba populations: building a binational management strategy for the conservation of the endangered brown howler monkey of the Atlantic Forest

The brown howler monkey (Alouatta guariba) is endemic to the Atlantic Forest of eastern Brazil and northeastern Argentina, threatened by extinction due to habitat loss and fragmentation, and hunting. Its reduced and isolated populations dramatically decreased and suffered local extinctions after recent yellow fever outbreaks, recommending the species risk uplist from Vulnerable to Endangered. In Brazil, the species occurs along eight states in sparse populations, including some large protected areas, and is being uplisted to Endangered. Following the National Action Plan for Conservation of the Atlantic Forest Primates and the Maned-sloth, and applying the Guidelines for Reintroductions and other Conservation Translocations (IUCN/CTSG), the Ex Situ Guidelines (IUCN/CPSG) and the One Plan Approach (IUCN/CPSG), a workshop was held on August 2021 to evaluate the need, requisites and roles of an integrated Population Management Program for A. guariba. Such program was developed in June 2022 defining the objectives of (i) restore in situ populations from ex situ populations, prioritizing populations in higher risk to prevent local extinctions, and (ii) establish an ex situ insurance population. This in situ – ex situ integrated management program was approved by ICMBio in February 2023, with actions recommended for all states along the species distribution. In Argentina, the species is Critically Endangered, with a remaining population of 20-50 individuals. Following the National Plan for Primate Conservation in Argentina, in a process similar to that in Brazil, two workshops were held in 2022/2023 to evaluate and define management actions for the long-term recovery of A. guariba. The priorities indicated were (i) reintroduction in ten potential areas in Misiones – due to a lower risk when compared to reinforcement of remaining populations, and (ii) establishing an ex situ management program in Argentina – still non-existent. The progressive collaboration between the initiatives of both countries is promoting the exchange of experiences and the integration of strategies. Here we summarize the planning and management carried out in Brazil and Argentina, highlighting the need for integrated measures. We debate on the progress and challenges, proposing next steps for developing and implementing a binational population management program for the conservation of the brown howler monkey.

Wound care in a child suffering from Stevens-Johnson syndrome in PICU: case report

Stevens-Johnson Syndrome is considered a life-threatening adverse drug reaction. The pathogenesis of these syndromesis still unclear, but several drugs, such as anticonvulsivants and antibiotics, and especially sulfonamides, non-steroidal anti-infiammatorydrugs, and allopurinol were predominantly suspected of triggering this reaction. A 5-year-old boy patient who came to hospital attention for an urticarial reaction developed after taking amoxicillin, then a recent scarlet fever acquired by brother. Due to the worsening of the lesions, he was admitted to our PICU after being intubated for deterioration of the respiratory dynamics and safe treatment of secretions. Nursing care is crucial: care of patient hospitalized with Stevens-Johnson syndrome and Toxic Epidermal Necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and prevention of long-term complications. For all patients with SJS and TEN, it is essential to perform a total body daily evaluation of the skin. If the dressings remain intact, it is advisable to note the appearance of visible skin and any visible exudate or staining on the outside of the intact dressings. If dressings are being removed or need to be reapplied daily, a full skin evaluation is useful.

Prevalence of unqualified sources of antimalarial drug prescription for children under the age of five: A study in 19 low- and middle-income countries.

Antimalarial drug resistance poses a severe danger to global health. In Low- and Middle-Income Countries (LMICs), there is a lack of reliable information on antimalarial prescriptions for recent malarial fever in children under five. Our study aims to determine the prevalence of unqualified sources of antimalarial drug prescription for children under the age of five in 19 low- and middle-income countries. We performed a cross-sectional study of the Malaria Indicator Survey (MIS) datasets (n = 106265) across 19 LMICs. The recent MIS datasets were used, and the study only included children under five who had taken an antimalarial drug for a recent malarial fever. The outcome variable was classified into two distinct categories: those who had taken antimalarial drugs for malarial fever from qualified sources and those who did not. Among LMICs, we found that 87.1% of children under five received an antimalarial prescription from unqualified sources who had recently experienced malarial fever. In several LMICs (Tanzania, Nigeria, and Ghana), a substantial portion of recent antimalarial prescriptions for malaria was taken from unqualified sources (about 60%). Some LMICs (Guinea (31.8%), Mali (31.3%), Nigeria (20.4%), Kenya (2.6%), and Senegal (2.7%)) had low rates of antimalarial drug consumption even though children under five received a high percentage of antimalarial prescriptions from qualified sources for a recent malarial fever. Living in rural areas, having mothers with higher education, and having parents with more wealth were frequently taken antimalarial from qualified sources for recent malarial fever in children under five across the LMICs. The study draws attention to the importance of national and local level preventative strategies across the LMICs to restrict antimalarial drug consumption. This is because antimalarial prescriptions from unqualified sources for recent malarial fever in children under five were shockingly high in most LMICs and had high rates of unqualified prescriptions in certain other LMICs.

An Entomological Investigation during a Recent Rift Valley Fever Epizootic/Epidemic Reveals New Aspects of the Vectorial Transmission of the Virus in Madagascar.

A Rift Valley fever (RVF) outbreak occurred in at least five regions of Madagascar in 2021. The aim of this study was to provide an overview of the richness, abundance, ecology, and trophic preferences of mosquitoes in the Mananjary district and to investigate the distribution of mosquitoes that were RT-PCR-positive for RVFV. Three localities were prospected from 26 April to 4 May 2021, using light traps, BG-Sentinel traps baited with an artificial human odor, Muirhead-Thomson pit traps, and indoor pyrethroid spray catches. A total of 2806 mosquitoes belonging to at least 26 species were collected. Of 512 monospecific pools of mosquitoes tested with real-time RT-PCR, RVFV was detected in 37 pools representing 10 mosquito species. The RVFV-positive species were as follows: Aedes albopictus, Ae. argenteopunctatus, Anopheles coustani, An. gambiae s.l., An. mascarensis, An. squamosus/cydippis, Culex antennatus, Cx. decens, Cx. Tritaeniorhynchus, and Uranotaenia spp. Of the 450 tested engorged females, 78.7% had taken a blood meal on humans, 92.9% on cattle, and 71.6% had taken mixed (human-cattle) blood meals. This investigation suggests the potential role of mosquitoes in RVFV transmission within this epizootic/epidemic context and that the human populations at the three study sites were highly exposed to mosquitoes. Therefore, the use of impregnated mosquito nets as an appropriate prevention method is recommended.

THU601 Massive Pericardial Effusion As Sole Symptom For Uncontrolled Hypothyroidism.

Abstract Disclosure: D.A. Lopez: None. M. Caban: None. C. Camacho: None. Y. Fuentes: None. M. Sanchez: None. K. Velez: None. Hypothyroidism is a common endocrine disorder with worldwide prevalence resulting from deficiency of thyroid hormone that can affect multiple organs. It can be asymptomatic and subclinical or symptomatic with fatal complications. Hypothyroidism can present with symptoms such as fatigue, slow movement and slow speech, cold intolerance, constipation, weight gain, and bradycardia. Hypothyroidism can be the cause of pericardial effusion due to increase membrane permeability. Massive pericardial effusion or pericardial tamponade is rare. Pericardial effusion can also be caused by autoimmune conditions, infections, uremia, medications, iatrogenic, and trauma. This is a case of 68-year-old Hispanic female with past medical history of hypothyroidism that was admitted to the hospital due to large pericardial effusion. These findings were found incidentally by her primary care physician during a preoperative evaluation for cataract surgery. Chest X-ray showed massive enlargement of the cardiac silhouette. Echocardiogram was ordered presenting large circumferential pericardial effusion with moderate diastolic right atrial collapse reason why patient was sent to the hospital. Physical examination showed distant heart sounds but absent jugular venous distention. Vital signs were within normal limits. Beck's triad was absent. Electrocardiogram showed a sinus rhythm with low QRS voltage. Patient denied any recent procedure, trauma, myocardial infarction, malignancy, or fever. Complete blood count was without leukocytosis, normal hemoglobin levels and platelet count. Basic metabolic panel presented without electrolyte disturbances and preserved renal function. Evaluation for causes of pericardial effusion was made including autoimmune conditions. Results showed negative ANA, Rheumatoid factor, Anti-dsDNA antibody, Anti-Scl-70 antibody, anti-U1-ribonucleoprotein, anti-Ro, and anti-La. Inflammatory markers were within normal limits. TSH level were in 22.5μIU/mL (0.03-5.0μIU/mL) with undetectable Free T4 pointing towards uncontrolled hypothyroidism as the cause of her large pericardial effusion. Patient denied other symptoms of hypothyroidism. She agreed not being compliant with levothyroxine. Pericardiocentesis was done and 750ml of pericardial fluid was removed. A catheter was placed and 200ml of fluid was drained on the second day. Catheter was removed and Echocardiogram showed immediate resolution of the diastolic right atrial collapse. She was sent home with adequate medical therapy and intense education of hypothyroidism. As a take home message, this unique case presents the importance of being compliant to medical therapy since the initial presentation of uncontrolled hypothyroidism could be a fatal complication as pericardial effusion. This could’ve been prevented if compliance with medications was encourage since the beginning of this disorder. Presentation: Thursday, June 15, 2023

Quantitative analysis of viremia and viral shedding in pigs infected experimentally with classical swine fever virus isolates obtained from recent outbreaks in Japan

Although classical swine fever occurred in September 2018 for the first time in 26 years, its virulence is thought to be moderate based on field observations by veterinary authorities and our previous experimental infections. We quantified viremia and viral shedding in pigs infected with recent Japanese classical swine fever virus isolates, as well as a highly virulent strain. The results show that pigs infected with the Japanese strains exhibited lower viremia and viral shedding than those infected with the highly virulent strain. However, horizontal transmission occurred in pigs infected with the Japanese strains, similar to those infected with the highly virulent strain. Additionally, viremia and neuralization antibodies coexisted in pigs infected with the Japanese strains, presenting challenges for control measures.

Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric patients with positive viral testing

Study objectiveTo determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection. DesignA prospective cohort study. SettingA tertiary, freestanding pediatric hospital in Dallas, Texas. PatientsChildren <18 years of age with positive respiratory viral testing who underwent general anesthesia. InterventionMeasurement of incidence of PRAE and severe adverse events during the first 7 postoperative days. MeasurementsThe primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death. Main resultsIn this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: −1.9%; 95% CI: −10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection. ConclusionsThere was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.

Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma.

The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis. We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis. Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018). We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.

Delayed Sublingual Edema Following Neonatal Mandibular Distraction Osteogenesis.

The authors aim to report a rare sequela following neonatal mandibular distraction osteogenesis (MDO) involving delayed onset sublingual swelling. They performed a retrospective chart review of 3 patients who presented with delayed onset sublingual edema following neonatal MDO. The 3 patients presented at 2, 4, and 12 months following MDO for micrognathia secondary to Robin sequence with intermittent sublingual swelling associated with sialorrhea and feeding difficulties. There was no associated recent illness, fevers, or purulent drainage. All 3 children underwent magnetic resonance imaging which demonstrated asymmetric sublingual gland edema. The edema was located on the left sublingual gland in 2 children and was bilateral in the third. The symptoms continue to recur 25.5±3.3 months (range, 22.3-28.9) postoperatively and all are being managed conservatively. Chronic delayed onset intermittent sublingual edema is a possible long-term complication following neonatal MDO and further studies should explore the incidence and management of this finding.

Salmonella gallinarum strains from outbreaks of fowl typhoid fever in Southern Africa closely related to SG9R vaccines.

Salmonella enterica subspecies enterica serovar Gallinarum biovar Gallinarum (SG) is associated with fowl typhoid fever, and the attenuated rough strain SG9R is widely used as a vaccine in many regions. Reversion to virulence of vaccine strains was suspected as the cause during recent fowl typhoid fever outbreaks in poultry in South Africa and Eswatini. To compare nine field isolates with global wild-type SG9 strains and the two commercial SG9R vaccines in use, Nobilis® SG9R and Cevac®-SG, we used whole-genome comparison with single-nucleotide polymorphism (SNP) detection. SNP phylogenic analysis showed that all the southern African field isolates were more closely related to the vaccine strains than wild-type SG9 strains. Furthermore, SNPs in the pyruvate dehydrogenase (aceE) and/or lipopolysaccharide 1,2-glucosyltransferase (rfaJ) genes, which are known markers of attenuation, were found in four of the field isolates along with intact spv, SPI-1, and SPI-2 gene clusters, providing conclusive evidence that these four isolates were originally vaccine strains that reverted to virulence. Five other field isolates lacked the SG9R attenuation markers, but variant analysis identified an SNP in the yihX gene, insertions in the ybjX and hydH genes, and deletions in the ftsK and sadA genes that were shared between the field isolates and vaccine strains but absent in wild-type SG9, indicating that these field isolates were also likely revertant vaccines. Overall, this study highlights different mechanisms of reversion of two commercial vaccines, where virulence caused by field isolates closely related to the Nobilis® SG9R vaccine was associated with the restoration of intact virulence gene clusters, and those derived from the Cevac®-SG vaccine were characterized by point mutations resulting in restored aceE and rfaJ genes. A possible new marker of attenuation was identified as a point mutation in the yihX gene, as well as four new candidate genes that could potentially be used to distinguish current vaccine strains from wild-type strains using PCR assays.

Travel vaccines-priorities determined by incidence and impact.

Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.

An Unusual Case of Aortic Leaflet Aneurysm

A 45-year-old female who was a known case of rheumatoid arthritis (RA) on irregular treatment presented with recent onset fever, breathlessness, and clinical features of aortic regurgitation. Echocardiography revealed an aneurysm involving the noncoronary cusp (NCC) of the aortic valve (AV) with probable vegetation attached to the NCC. Repeated fungal and bacterial blood cultures were negative, and the patient continued to have a fever despite empirical antibiotics and antifungals. There was a clinical improvement with steroids; however, in view of recurrent heart failure, she was proposed for AV replacement. Intraoperatively, pericardial layers were noted to be thickened and adherent; thus, she underwent pericardiectomy, followed by AV replacement. Histopathology and microbiological evaluation of the excised specimen showed features compatible with RA as a cause for cardiac involvement. Culture-negative endocarditis needs meticulous evaluation to rule out fastidious bacteria, fungi and rare pathogens, as well as noninfective causes. RA occasionally mimics infective endocarditis and can cause significant cardiac structural derangements.

Seroprofiling of Antibodies Against Endemic Human Coronaviruses and Severe Acute Respiratory Syndrome Coronavirus 2 in a Human Immunodeficiency Virus Cohort in Lesotho: Correlates of Antibody Response and Seropositivity.

Serological data on endemic human coronaviruses (HCoVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in southern Africa are scarce. Here, we report on (1) endemic HCoV seasonality, (2) SARS-CoV-2 seroprevalence, and (3) correlates of SARS-CoV-2 seropositivity and strength of SARS-CoV-2 and endemic HCoV serological responses among adults living with human immunodeficiency virus (HIV). Plasma samples were collected from February 2020 to July 2021 within an HIV cohort in Lesotho. We used the AntiBody CORonavirus Assay (ABCORA) multiplex immunoassay to measure antibody responses to endemic HCoV (OC43, HKU1, NL63, and 229E) and SARS-CoV-2 antigens. Results for 3173 samples from 1403 adults were included. Serological responses against endemic HCoVs increased over time and peaked in winter and spring. SARS-CoV-2 seropositivity reached >35% among samples collected in early 2021 and was associated with female sex, obesity, working outside the home, and recent tiredness or fever. Positive correlations were observed between the strength of response to endemic HCoVs and to SARS-CoV-2 and between older age or obesity and the immunoglobulin G response to SARS-CoV-2. These results add to our understanding of the impact of biological, clinical, and social/behavioral factors on serological responses to coronaviruses in southern Africa.

Supply-side and demand-side factors influencing uptake of malaria testing services in the community: lessons for scale-up from a post-hoc analysis of a cluster randomised, community-based trial in western Kenya

ObjectivesMaximising the impact of community-based programmes requires understanding how supply of, and demand for, the intervention interact at the point of delivery.DesignPost-hoc analysis from a large-scale community health worker (CHW)...

44-year-old Man with Hemoptysis and Hypoxemic Respiratory Failure: A Case Report.

Hemoptysis can be a highly alarming presentation in the emergency department (ED). Even seemingly minor cases may represent potentially lethal underlying pathology. It requires thorough evaluation and careful consideration of a broad differential diagnosis. A 44-year-old man presented to the ED with a concern of hemoptysis in the setting of recent fever and myalgias. This case takes the reader through how to approach the differential diagnosis and diagnostic work-up of hemoptysis in the ED setting and then reveals the surprising final diagnosis.