Self-limiting Infection Research Articles

P-125. A Single-Center Descriptive Analysis of Cryptosporidiosis in Immunocompromised Patients

Abstract Background Cryptosporidiosis is usually a self-limiting infection caused by a protozoan, Cryptosporidium spp. In immunocompromised, especially with T cell dysfunction, it can cause severe, potentially life-threatening infection. There is limited literature on cryptosporidiosis in patients with malignancies. We aim to look for differences in patient characteristics amongst acute (< 2 weeks) and chronic (≥ 2 weeks) cryptosporidiosis in patients with cancer.Table 1:Baseline Characteristics of Study Population Methods A single-center, retrospective chart review on patients diagnosed with Cryptosporidiosis with the help of Gastrointestinal Multiplex (Biofire) was conducted at UT MD Anderson Cancer Center between November 2016 and November 2023. Data was collected from EPIC electronic medical records and analyzed using Fisher’s exact test.Table 2:Risk factors for Illness Results We identified 55 cases of cryptosporidiosis over 7 years. The date of first diagnosis was included in cases with multiple episodes. Among the 55 patients, 13 were excluded due to later confirmation of false positive results. Of 42 patients, the median age was 61 [IQR 24], 20 (48%) had non-hematologic malignancy and 21 (50%) had hematological malignancy [8 (19%) AML, 4 (9%) ALL, 3 (7%) MDS, 3 (7%) Lymphoma, 3 (7%) Myeloma]. 48% had hematopoietic stem cell transplantation, among which 35% were acute and 63% chronic. Within the last 90 days, 61% and 9% of acute cases, and 74% and 47% of chronic cases had received chemotherapy (p value= 0.514) and immunosuppressants (p value= 0.006), respectively. The median duration of symptoms prior to diagnosis was 3 days. Severe neutropenia was observed in 22% of acute cases and 42% of chronic cases, while severe lymphopenia was present in 57% of acute and 58% of chronic cases. Approximately 17% exhibited co-infection with other enteric pathogens, with most infections occurring in March, followed by October.Table 3:Clinical Presentation with laboratory and imaging, and Duration of therapy Conclusion In patients with cancer and cryptosporidiosis, co-infection with a second enteropathogen was common, and no seasonality was observed. The use of immunosuppressants was associated with diarrhea lasting more than 2 weeks. Cryptosporidiosis cases based on month Disclosures Pablo C. Okhuysen, MD, Astra Zeneca: Stocks/Bonds (Public Company)|Beam therapeutics: Stocks/Bonds (Public Company)|Biontech: Stocks/Bonds (Public Company)|Deinove Pharmaceuticals: Grant/Research Support|Ferring Pharmaceuticals: Honoraria|Glaxo Smith Kline: Stocks/Bonds (Public Company)|Haleon: Stocks/Bonds (Public Company)|Johnson and Johnson: Stocks/Bonds (Public Company)|Melinta pharmaceuticals: Grant/Research Support|Moderna: Stocks/Bonds (Public Company)|Napo Pharmaceuticals: Advisor/Consultant|Napo Pharmaceuticals: Grant/Research Support|Napo Pharmaceuticals: Honoraria|Novavax: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Summit Pharmaceutical: Grant/Research Support

P0881 Effectiveness and Safety of Tofacitinib in Biologic-Naïve Elderly Patients with Ulcerative Colitis

Abstract Background The prevalence of ulcerative colitis (UC) is increasing in elderly populations, yet real-world data on the efficacy and safety of tofacitinib in this demographic remains limited. This study aimed to evaluate the real-world effectiveness and safety of tofacitinib in elderly patients (≥60 years) with moderate-to-severe UC treated at a tertiary care center in North India. Methods This cohort study was conducted at Dayanand Medical College and Hospital, Ludhiana, from July 2022 to June 2024. Elderly patients (aged ≥60 years) with moderate-to-severe UC refractory to conventional therapies were included. Patients received tofacitinib at a dose of 10 mg twice daily for induction, followed by 5 mg twice daily for maintenance, and were assessed at weeks 8 and 52. The primary outcome was steroid-free remission at both weeks 8 and 52. Secondary outcomes included clinical remission (partial Mayo score ≤1), clinical response (≥3-point reduction in partial Mayo score), and steroid-free remission at individual time points. Adverse events were systematically recorded. Results A total of 35 patients (median age: 64 years, 40% male) were analyzed. Most patients (80%, n=28) had left-sided colitis. The primary outcome of steroid-free clinical remission at both weeks 8 and 52 was achieved in 9 patients (25.71%). At week 8, clinical remission, steroid-free remission, and clinical response were observed in 18 (51.42%), 15 (42.85%), and 22 (62.85%) patients, respectively. At week 52, clinical remission and steroid-free remission were each achieved in 22 (62.85%) patients, while 27 (77.14%) patients demonstrated a clinical response. The most common adverse events included hair loss (17.14%, n=6), sadness of mood (11.42%, n=4), and dyslipidemia (8.57%, n=3). Three patients developed self-limiting herpes zoster infection, and one patient reported bilateral retinal vein occlusion. Conclusion Tofacitinib demonstrated favorable efficacy and safety in biologic-naïve elderly patients with moderate-to-severe UC. These findings highlight its potential as a viable treatment option for this growing and often underrepresented patient population.

Leukopenia and thrombocytopenia in dengue patients presenting in the emergency department of a tertiary center in Nepal: a cross-sectional study

IntroductionDengue viruses cause either symptomatic infections or asymptomatic seroconversion. Symptomatic dengue has a wide clinical spectrum ranging from self-limiting infection to severe manifestations, mostly characterized by plasma leakage with or without hemorrhage. World Health Organization classification in 2009 classified dengue into dengue without warning signs, dengue with warning signs, and severe dengue. This study aimed to determine patient characteristics and hematological parameters (leukopenia, and thrombocytopenia) in patients with dengue infection in the emergency department of a tertiary center.MethodsA cross-sectional study was conducted among 252 patients with dengue confirmed by serological testing against dengue-specific nonstructural protein 1 (NS1) antigen and immunoglobulin M (IgM) by enzyme-linked immunosorbent assay from September to November 2022 who presented in the emergency department of a tertiary hospital in Nepal after ethical approval was obtained. Dengue was categorized according to the World Health Organization 2009 classification. Hematological parameters were recorded by reviewing patients’ laboratory records. Data analysis was done using descriptive statistical parameters and a chi-square test.ResultsDengue without warning signs was present in 166 (65.87%) patients, while dengue with warning signs and severe dengue was present in 68 (26.89%) and 18 (7.14%) patients, respectively. Leukopenia (< 4000 cells/mm3) was present among 163 (64.68%) patients. The lowest recorded leukocyte count was 1440. Similarly, thrombocytopenia (< 150000 cells/mm3) was present among 102 patients (40.48%). The lowest recorded platelet count was 26,000 cells/mm3. A significant association was found between the severity of dengue infection and leukopenia (χ2 13.268, p-value 0.001) and thrombocytopenia (χ2 43.924, p value < 0.001).ConclusionsMonitoring of warning signs and clinical parameters is important for identifying the progression of dengue infection to the critical phase. Leukopenia and thrombocytopenia are present among many dengue-infected patients presenting in the emergency department. The severity of the disease will usually only be apparent around defervescence, which often coincides with the onset of the critical phase. Leukopenia and thrombocytopenia could indicate progression to severe disease during emergency department admission.

Zika and Dengue Virus Autoimmunity: An Overview of Related Disorders and Their Potential Mechanisms.

Zika virus (ZIKV) and dengue virus (DENV) are two major mosquito-borne flaviviruses that pose a significant threat to the global public health system, particularly in tropical regions. The clinical outcomes related to these viral pathogens can vary from self-limiting asymptomatic infections to various forms of life-threatening pathological conditions such as haemorrhagic disorders. In addition to the direct effects of the viral pathogens, immune processes play also a significant function in the development of diseases mediated by ZIKV and DENV. Studing these processes is important for developing safer vaccines and targeted therapeutic strategies. These viruses have been reported to trigger various autoimmune disorders affecting different parts of human organ systems. It also has been shown that preexisting immunity to ZIKV or DENV can impact the outcome of subsequent infections caused by another virus. ZIKV and DENV infection can promote the development of autoimmune disorders by different mechanisms, such as molecular mimicry and autoantibody formation. The present review provides an overview of various autoimmune disorders associated with ZIKV and DENV infection and their potential underlying mechanisms.

DETECTION OF SIGNIFICANT RISK FACTORS FOR RECURRENT RESPIRATORY INFECTIONS IN PRESCHOOL CHILDREN

Background. Most often, self-limited recurrent respiratory infections (RRI) are diagnosed among preschool children. On the one hand, these infections pose a significant burden on the healthcare system because of frequent visits to doctors and hospitalizations. At the same time, they have a significant negative impact on the socio-economic situation in countries, caused by parents' prolonged absence from work due to the need to care for frequently ill child. Aim: To identify the most impactful factors contributing to the increased susceptibility of preschool children to self-limited RRI. Materials and methods. A total of 45 children (21 boys and 24 girls) aged 1-6 years, undergoing inpatient treatment on acute respiratory infection (ARI) in Rivne children's hospitals, were involved in the clinical study. The number of ARI episodes during the previous year of their lives, the resistance index and 21 potential risk factors for self-limited RRI were taken into account. The statistical processing of the digital data was performed using IBM SPSS Statistics 28 licensed software with the calculation of the confidence interval for Spearman's rank correlation coefficient and odds ratio. Results. Among the studied dichotomous risk factors for self-limited RRI, the following were the most significant in the observed preschool children: 1) urban residence; 2) presence of other children in a family who have/had a predisposition to RRI; 3) use of antibiotics for therapeutic purposes 3 or more times over the previous year; 4) passive exposure to tobacco smoke; 5) maternal smoking during the pregnancy resulting in the birth of the examined child. Overall, for 9 out of 20 dichotomous factors taken into consideration, the undeniable probability of their effect on children's susceptibility to frequent ARI was found. Also, binary logistic regression showed an association between lower blood hemoglobin concentrations and children belonging to the subgroup with more frequent ARI episodes. The proportion of this hematological indicator in the model presented was 51.7%. Conclusions. There were no significant differences in the list of substantial risk factors for self-limited RRI between preschool children living in the eastern and western regions of Ukraine. The findings will be considered in the integrated prediction of preschoolers' increased susceptibility to frequent ARI episodes.

Onychomadesis and Beau’s Lines- Rare Complications of Hand- foot-and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. Bangladesh J Child Health 2023; Vol 47 (2) : 109-112

What are the general public’s expectations about the likely duration of common acute infections? A cross-sectional survey of Australian residents

ObjectivesTo explore the general public’s expectations about the likely duration of acute infections that are commonly managed in primary care and if care is sought for these infections, reasons for...

Frequency of upper respiratory tract infections in patients with myasthenia gravis compared to the general population

IntroductionPatients with myasthenia gravis (MG) undergoing immunomodulating therapies are at an increased risk of serious infections. However, the risk of developing self-limited infections, particularly upper respiratory tract infections (URTI), remains unclear. This study aimed to determine the frequency of URTI among patients with MG compared to the general population and to identify potential predisposing factors. MethodsA monthly questionnaire was administered to patients with MG and a control group over a period of 6 months. The questionnaire assessed the presence of URTI symptoms within the previous month. Statistical analysis was conducted using a chi-square or Fischer exact test, as appropriate. ResultsThe study included 161 participants (50 MG patients and 111 control subjects). The frequency of URTI was comparable between the MG group (70 %) and controls (82 %) (p = 0.09). Among patients with MG, a higher proportion of patients who received rituximab developed URTI (93 %) than those who did not (61 %), P = 0.04. ConclusionThe frequency of URTI was similar in patients with MG compared to the general population. Due to the small sample size and several other limitations, further research is warranted to validate these findings and explore associations between rituximab and URTI.

Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study)

Background Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs. Objective This study aims to develop and test an intervention to improve the use of POCTs in managing RTIs involving GPs and CPs in Irish primary care, following the UK’s Medical Research Council’s (MRC) framework for complex intervention development, involving five work-packages (WPs). Methods WP1 involves creating best practice guidance for using POCT in managing RTIs, informed by a scoping review and validated with an expert Delphi panel. This guidance will be used to define target behaviour(s) for GPs and CPs related to POCT use. WP2 explores GP and CP perceived barriers and facilitators to these behaviours using the Theoretical Domains Framework, mapping influential domains to Behaviour Change Techniques to develop draft interventions. WP3 gathers patients’ perspectives on using POCTs for RTIs. In WP4, a task group will review and finalise the intervention(s). They will consider patients’ perspectives from WP3 and assess feasibility of the intervention(s). WP5 involves a proof-of-concept study to test the feasibility of the newly developed intervention(s). Conclusion A theoretically informed intervention(s) for using POCT(s) in the management of RTIs in primary care in Ireland will be developed and tested in a proof-of-concept study, following MRC guidance. Further refinement and larger studies will be needed to determine its effectiveness before widespread implementation.

Tackling antibiotic resistance—insights from eHealthResp’s educational interventions

Antibiotic resistance (AR) poses a significant challenging issue in public health worldwide. This phenomenon led to the emergence of antibiotic-resistant bacterial strains, making the treatment of respiratory infections increasingly difficult. Educational interventions targeting healthcare professionals are important to improve prescription practices and promote responsible antibiotic use. Digital tools, including clinical decision support systems and mobile applications, have proven to effectively enhance educational interventions and clinical decision-making. The eHealthResp project is one such initiative that includes an online course and a mobile app designed to improve antibiotic use for upper respiratory tract infections (URTIs). The online course provides clinical information and case studies, whereas the mobile app acts as a clinical decision support system for URTIs diagnosis. The purpose of this study is to analyse the utilization patterns of eHealthResp digital tools among primary care physicians and community pharmacists. Results showed that both physicians and pharmacists (n = 35) had favorable progress and high grades when completing the online course assessment. The mobile app data indicated a diverse range of searched cases with different respiratory symptoms, with the most common being acute nasal discharge and pain when swallowing. Most observations presented mild symptoms for less than seven days, suggesting the occurrence of acute self-limited infections. Despite limitations, digital tools show promise in enhancing patient care outcomes for managing URTIs. Future efforts should focus on expanding participation among health professionals and enhancing educational interventions to promote responsible antibiotic use.

Education on antimicrobial stewardship in community pharmacies to be delivered as a part of a public health campaign

Abstract Introduction Community pharmacies are well-placed to educate the public on antimicrobial stewardship (AMS). Medicines management teams have historically focused on empowering prescribers to practise prudent use of antibiotics; in 2017 there was a lack of education/support to community pharmacy (CP) colleagues on the same topic, although subsequent ESPAUR reports (2) have highlighted the tools and resources that are now available to CP. To address the identified need locally, educational events for CP staff were organised with the aim of increasing knowledge of AMS and increasing confidence in recommending self-care for self-limiting respiratory tract infections (RTIs). Educational material delivered included key AMS messages, an introduction to the local antimicrobial guidelines and a case study. Method In the UK, a Birmingham based commissioning organisation organised a CP public health (PH) campaign promoting AMS. The campaign ran throughout February 2017. All CPs in Birmingham and Sandwell (n=385) were invited to an educational event, with 4 dates through January. The event provided educational presentations on AMS, including fundamentals of antimicrobial resistance (AMR), and management of self-limiting RTIs, with interactive case studies focussing on patients who may initially present to their local pharmacy. Content was delivered by a consultant microbiologist and the antimicrobial lead pharmacist. Learning outcomes included understanding of AMS, AMR, appropriate antibiotic use, and the role of a CP team in raising public awareness. An electronic questionnaire was designed and provided to CP via PharmOutcomes after the campaign, to assess the impact of the events on the knowledge and confidence of the staff in delivering key AMS messages to the public. All responses were completed at the same time after the education session and this may impacted the results. The follow up questionnaire was classed as service evaluation by the organisation as per the NHS Health Research Authority assessment tool and did not require ethical approval. Results There were 226 responses to the questionnaire, from 210 (54.5%) CP. Of the 150 spaces available for the educational events, 144 tickets were reserved. Prior to the session 26% (n/58) of CP staff felt their knowledge of AMS was very good or excellent; after the session this increased to 78% (n/177). Confidence in recommending self-care for self-limiting RTIs also increased, with 79.2% (n/179) rating their confidence as very good or excellent after the session compared to 36.3% (n/82) beforehand. 95% (n/214) of CP staff felt that the education session changed their attitude towards AMS. Discussion / Conclusion This intervention showed a positive outcome of increasing CP knowledge about AMS and confidence in recommending appropriate self-care. The educational events were well attended although not all pharmacies were able to engage with the events and not all the learning outcomes were able to be captured in the evaluation survey. Overall feedback from CP was positive with the majority of staff gaining an increase knowledge and confidence in communicating with the public and recommending self care where appropriate. As the questionnaire was anonymised, we were unable to follow up feedback from individuals, which have useful to inform future sessions.

Onychomadesis and Beau’s Lines- Rare Complications of Handfoot- and-mouth Disease

Hand-foot-and-mouth disease (HFMD) is a common self-limiting viral infection in children caused by Coxsackievirus A16 and human enterovirus 71, presenting with fever, erythematous papulovesicular eruptions/ blisters on the palms, soles, knees, buttocks, and oral mucosa. Although rare, complications may arise in nails e. g. onychomadesis (nail separation) and Beau’s lines (transverse lines on the nails). These typically appear within four to eight weeks of HFMD and persist for around 5-6 weeks. No active treatment is required and these nail changes resolve spontaneously within few weeks as the nail bed remain intact. We present here a boy of 4 years who presented with such nail changes after around 5 weeks of HFM disease and diagnosed as onychomadesis and Beau’s lines after ruling out other possible causes of nail changes. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 47-50

A rare case of respiratory syncytial virus bronchiolitis with spontaneous bilateral pneumothorax in an infant

Abstract: The most common self-limiting viral infection of the lower respiratory tract in the pediatric population is bronchiolitis, which most commonly affects infants. In most cases, respiratory syncytial virus (RSV) is the causative agent. In general, the recovery occurs within 5–7 days without any complications. Spontaneous pneumothorax is one of the rare and less-reported complications of bronchiolitis. We report a case of a male child aged 5 months with bilateral spontaneous pneumothorax (PNO) with subcutaneous emphysema following bronchiolitis. The nasopharyngeal swab was positive for RSV, and all other investigations ruled out any underlying illness causing spontaneous PNO. Although it is a rare complication of bronchiolitis, it may occur late during the disease course. Pediatricians must be aware of this life-threatening complication, which may develop during the disease course despite an early clinical improvement.

Developing a data-enabled nudge intervention for childhood antibiotics in primary care: a qualitative study.

Preschool children (aged≤5 years old) have the highest antibiotic prescribing rate in general practice, mostly for self-limiting acute respiratory tract infections (RTIs). Research from over 250 000 UK children suggests that a child's antibiotic history for RTI may be a good predictor for re-consulting a health professional for the same illness episode and increase clinical workload. To develop a data-enabled nudge intervention to optimise antibiotic prescribing for acute RTI based on a child's antibiotic history in general practice DESIGN & SETTING: Two phase qualitative study with parents/carers of preschool children and primary care clinicians METHOD: In phase 1, through an initial focus group with eight parents/carers and 'think aloud' interviews with 11 clinicians, we co-designed the intervention (computer screen prompt and personalised consultation leaflet). In phase 2, 13 clinicians used the intervention, integrated into the GP computer software, and share their feedback through 'think aloud' interviews. Interviews were audio-recorded, transcribed, and analysed thematically. We co-created a data-driven intervention that automatically integrates a child's antibiotic history for acute RTI and personalised leaflet into the electronic medical records. We found that parents and clinicians found this intervention, in principle, acceptable and feasible to use in primary care consultations. Delivering such interventions, integrated into practice workflow, could be efficiently scaled up to promote effective antimicrobial stewardship and reduce unnecessary antibiotic use in primary care. Further research will test this intervention in a future trial.

Epidemiology of sporadic and outbreak-associated hepatitis A infections in Ontario, Canada: A descriptive summary, 2015-2022.

Hepatitis A is a disease of public health significance that typically causes acute, self-limiting infection. Understanding the risk factors and demographics associated with individual infections and outbreaks can guide public health communication and interventions. To assess the number of hepatitis A cases and outbreaks in Ontario from January 1, 2015, to November 22, 2022, and to identify common risk factors associated with sporadic and outbreak-associated infections in Ontario. Confirmed and probable hepatitis A cases reported between January 1, 2015, and November 22, 2022, were extracted from the Ontario electronic reporting system. Descriptive analyses were used to summarize and compare risk factors reported by sporadic and outbreak-associated hepatitis A cases. Annual rates of infection for individual public health units were calculated using annual population estimates for Ontario health regions. During the study period, 938 cases of hepatitis A were reported in Ontario (an average annual rate of 0.9 cases per 100,000 population), with 31.3% (n=294) of cases linked to one of 18 unique outbreaks of hepatitis A. Four of 13 local outbreaks were associated with elementary school settings. Reported risk factors differed between sporadic cases (predominantly travel-related) and cases linked to known outbreaks (anal-oral contact, illicit drug use, diapering/assisting in toileting, close contact with a case). Rates of sporadic infection differed across public health units in Ontario over the study period. Public health interventions that aim to increase awareness of hepatitis A risk factors and increase vaccine uptake among those at increased risk of exposure could help to reduce the incidence of both locally acquired and travel-related sporadic infections and outbreaks.

Study on extrahepatic manifestations in patients with hepatitis A in a tertiary care hospital

Background: Hepatitis A is a common self-limiting infection of the liver. In recent times, there is a change in the pattern of hepatitis A infection producing extrahepatic manifestations. Aims and Objective: Our aim of the study is to find the profile of extrahepatic manifestations of hepatitis A. The secondary objective is to find a correlation of liver function test values with extrahepatic manifestations. Materials and Methods: A retrospective study was conducted over 3 years. 169 seropositive school-going cases were presented with signs and symptoms of hepatitis A and were clinically assessed. Results: Among 169 immunoglobulin M (+)ve hepatitis A, 36% of patients (61 cases) presented with extrahepatic features. Among the 61 patients, 41 patients presented with aspartate transaminase (AST):alanine transaminase (ALT) &gt;2:1 and 20 patients presented with AST:ALT &lt;2:1. Conclusion: In recent times, there has been a changing pattern in the presentation of hepatitis A producing extrahepatic manifestations in the pediatric age group.

Estimating the risk of gastrointestinal illness associated with drinking tap water in Norway: a prospective cohort study

BackgroundThe delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway.MethodsWe conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.ResultsIn total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2–4% of AGI in Norway is attributable to drinking tap water.ConclusionsThis is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.

Oxysterol binding protein (OSBP) contributes to hepatitis E virus replication

Hepatitis E virus (HEV) is a positive-sense, single-stranded RNA virus and causes primarily acute self-limiting infections. The ORF1 of the HEV genome encodes a polyprotein around 190 kDa, which contains several putative domains, including helicase and RNA-dependent RNA polymerase. The HEV-encoded helicase is a member of the superfamily 1 helicase family and possesses multiple enzymatic functions, such as RNA 5′-triphosphatase, RNA unwinding, and NTPase, which are thought to contribute to viral RNA synthesis. However, the helicase interaction with cellular proteins remains less known. Oxysterol binding protein (OSBP) is a lipid regulator that shuffles between the Golgi apparatus and the endoplasmic reticulum for cholesterol and phosphatidylinositol-4-phosphate exchange and controls the efflux of cholesterol from cells. In this study, the RNAi-mediated silencing of OSBP significantly reduced HEV replication. Further studies indicate that the HEV helicase interacted with OSBP, shown by co-immunoprecipitation and co-localization in co-transfected cells. The presence of helicase blocked OSBP preferential translocation to the Golgi apparatus. These results demonstrate that OSBP contributes to HEV replication and enrich our understanding of the HEV-cell interactions.

Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report

BackgroundAcute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites.Case presentationAn 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed.ConclusionHepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

Beyond the liver: unveiling rhabdomyolysis as a rare complication of hepatitis A

Hepatitis A is a mild self-limiting infection of the liver with spontaneous resolution of symptoms in most cases. However, clinicians should be aware of some commonly encountered complications and extrahepatic manifestations associated with hepatitis A for timely diagnosis and treatment. Rhabdomyolysis, an exceedingly rare complication of hepatitis A, is scarcely documented. We present a case of a 64-year-old man with symptoms consistent with rhabdomyolysis and an evanescent rash secondary to acute hepatitis A. He eventually recovered with conservative management. This case emphasizes the importance of recognizing and treating atypical presentations of acute hepatitis A infection.