Typhus Research Articles

S3810 Murine Typhus or Still's Disease? A Definitive Diagnosis From Liver Biopsy

S3810 Murine Typhus or Still's Disease? A Definitive Diagnosis From Liver Biopsy

Some indicators of the blood cytokine status
 in patients with tick-borne rickettsiosis caused by Rickettsiaе heilongjiangensis identified in the Khabarovsk territory

Some indicators of the blood cytokine status
 in patients with tick-borne rickettsiosis caused by Rickettsiaе heilongjiangensis identified in the Khabarovsk territory

Coinfection With Severe Fever With Thrombocytopenia Syndrome and Scrub Typhus in Korea.

Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the 2 most common tick-borne infectious diseases in Korea. Every year, an increasing number of cases are reported, which is a public health concern. Therefore, we aimed to investigate the prevalence of SFTS-scrub typhus coinfection in patients with SFTS. Clinical samples were collected from 129 patients with SFTS. One-step reverse-transcription polymerase chain reaction (PCR) was performed to identify the SFTS virus (SFTSV), and real-time PCR followed by nested PCR was performed to detect the Orientia tsutsugamushi gene for scrub typhus. Phylogenetic analysis was conducted to confirm the evolutionary relationships among different species. Among 129 SFTS cases, 2 patients with SFTSV were positive for O. tsutsugamushi with a prevalence of coinfection of 1.6% (95% confidence interval, .001-.06). Phylogenetic analysis confirmed these as O. tsutsugamushi strain Boryong. Our study found that 1.6% of patients were coinfected with SFTS and scrub typhus infection. We believe that this information will add a new dimension to clinical diagnosis, which should be considered for better public health management. Further research is needed to better understand the ecological transmission dynamics and geographical distribution of SFTSV and O. tsutsugamushi in endemic countries.

Review on the recent infectious diseases in the State of God’s own country

The burden of communicable and non-communicable diseases is increasing in Kerala. Despite the State’s past success in keeping a variety of communicable diseases under control, the recent research of Dengue, Malaria, Leptospirosis, Hepatitis, Chikungunya and H5N1 has resulted in a marked rise in morbidity and mortality. Infectious diseases continue to be the main causes of morbidity and mortality in humans and animals with enormous healthcare costs in India. Over the past few years, Kerala, a state in the nation of India, has conflicted with nature. The nation’s diverse terrains, extreme geoclimatic variations, and unequal population distribution exhibit distinctive patterns of viral illness dispersion. The state of Kerala has faced a significant public health issue over the past decade due to the resurgence of infectious illnesses, resulting in elevated rates of both mortality and morbidity. Methodology: This review article aims to investigate and discuss epidemics that are known to have happened during the 21st century. For this purpose, the investigator has done a literature review through Google Scholar and PubMed. All articles pertaining to reported infections in the state of Kerala and factors contributing to the outbreak of an infection were chosen for inclusion in the review. Results: From a number of sources, we culled a selection of articles covering the topic of viral infections. We found that many people in the Kerala state have fallen victim to and suffered many deaths from bacterial infectious diseases like chikungunya fever, scrub typhus fever, rotavirus diarrhea, the break bone fever, Nipah virus, Kyasanur Forest Disease (KFDV), leptospirosis, COVID-19 and monkeypox in the past decade. The people of Kerala are fortunate to have access to excellent medical care, and the government has recently begun to prioritize illness prevention and control. Conclusion: This report emphasizes the Kerala’s infectious disease management strategy and the necessity for other Indian states to emulate it. States can prevent disease spread and protect residents by taking comparable steps.

Diagnosis and Management of Rickettsial Infections among Febrile Patients Attending in Inpatients and Outpatient Department in a District Hospital in Bangladesh

Background: Numerous obligatory intracellular bacteria from the Alphaproteobacteria genus Rickettsia can cause rickettsial infection. The most prevalent newly emerging and reemerging diseases are rickettsial infections. Objectives: The aim of the study was diagnosis and management of rickettsial infections among febrile patients attending in inpatient and outpatient department in a district hospital in Bangladesh. Methods: This cross-section observational study was carried out in the 250 Beded District Hospital, Joypurhat. The duration of the period from March 2022 to February 2023. A total of 250 patients participated in the study. Both male and female with any age, patients with elevated body temperature, headache, malaise, rash, nausea, and vomiting and gave consent to be included in the study. Severely ill patients, not willing to participate were excluded from the study. Weil Felix test was used in this study and a titre of 1:80 was considered to be positive. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: The mean age of the patients was 39 ± 1.9. 8% of the patients had ≤18 years of age. 16% were within the age group of 19-29 years, 28% were within the age group of 30-39 years, 24% were within the age group of 40-49 years, 14.4% were within the age group of 50-59 years and 9.6% were ≥60 years and 52% of the patients were male. 100% of the respondents had fever, 20% had generalized weakness, 15.2% had headache, 16% had cough and cold, 24% had body ache, 8% had vomiting and abdominal pain respectively, 4% had per nasal watery discharge, 36% had rash, 16% had nausea, 24% had anorexia and 4% had other symptoms. CBC & ESR and Weil Felix test were the most common (100%) investigation among the patients, Urine R/M/E in 68%, serum creatinine in 18%, USG of W/A in 15%, CRP in 18%, PBF in 7, Urine C/S in 10%, S. Electrolytes in 4% cases. We found 90 Rickettsial Infection positive patients. Doxycycline and Paracetamol and Esomeprazole were prescribed to all patients 90(100%) and followed by Linagliptin+Metformin to 20(22.22%), Glimipiride to 19(21.11%), Azithromycin to 18(20%) and Domperidon to 10(1.11%), Montelukast 9 (10%), Pantoprazole to 8(8.89%), Rupatadine to 7(7.77%), Ondansetron to 6(6.67%), Tiemonium to 5 5.57%), Fexofenadin to4(4.44%) and other treatment along with the prescribed medicines was given to 40(44.44%) patients. Authors studied the response of Doxycycline which showed 85(94.44%) cases improved within 48 hours of start of treatment. Remaining 5(5.55%) cases showed delayed response due to late presentation. Conclusion: Rickettsial illness is inextricably linked to the sociocultural life of the majority of metropolitan residents. However, a lack of medical facilities and qualified doctors makes it challenging to identify rickettsial disease in febrile patients. It's important to make an early diagnosis when treating rickettsial illness.

Molecular evidence of Rickettsia canadensis in ticks, Hebei, China

China was affected severely by tick-borne rickettsiosis, and more than 10 Rickettsia species pathogenic to humans have been identified. In recent years, several Rickettsia members, with unknown pathogenicity, firstly identified abroad have been found in China. In this study, parasitic and questing ticks were recovered from two sampling sites in Hebei, China. Specific primers targeting outer membrane protein B (ompB) gene were designed to test the presence of Rickettsia canadensis by nested Polymerase Chain Reaction (PCR). As a result, a total of 428 ticks, including 232 ticks (including 230 Haemaphysalis longicornis and two H. japonica) from Laiyuan County and 196 (H. longicornis) from Luanping County, were collected. Sequencing of PCR products with the expected size and subsequently BLAST showed that 38H. longicornis ticks tested positive for R. canadensis, with an overall positive rate of 8.8%. In addition, 800-bp ompB gene and nearly complete citrate synthase (gltA) gene were recovered from six randomly selected positive samples to better understand their genetic characteristics. Nucleotide identity and phylogenetic analyses showed that R. canadensis presented geographical clustering with evidence that variants identified in the current study presented closer genetic relationship with others identified in Asian than those found in North America. In addition, epidemiological data suggested that H. longicornis may be the competent vector, and more attention should be paid to R. canadensis due to its zoonotic potential. In sum, R. canadensis was confirmed to be present in Hebei Province, China, and its surveillance in ticks should be strengthened due to potential pathogenicity, higher positive rate in ticks and wide distribution of possible vector tick species.

Evidence on the prevalence of emerging and re-emerging tick- and flea-borne rickettsial agents in acute encephalitis syndrome endemic areas of northeast Uttar Pradesh, India.

Outbreaks of acute encephalitis syndrome (AES) with unknown aetiology are reported every year in Gorakhpur district, Uttar Pradesh, India, and Orientia tsutsugamushi, the rickettsial pathogen, responsible for scrub typhus has been attributed as the primary cause of AES problem. However, information on the prevalence of other rickettsial infections is lacking. Hence, this study was carried out to assess any occurrence of tick- and flea-borne rickettsial agents in villages reporting AES cases in this district. In total, 825 peridomestic small mammals were trapped, by setting 9254 Sherman traps in four villages with a trap success rate of 8.9%. The Asian house shrew, Suncus murinus, constituted the predominant animal species (56.2%) and contributed to the maximum number (87.37%) of ectoparasites. In total, 1552 ectoparasites comprising two species of ticks and one species each of flea and louse were retrieved from the trapped rodents/shrews. Rhipicephalus sanguineus, the brown dog tick, was the predominant species retrieved from the trapped rodents/shrews, and the overall infestation rate was 1.75 per animal. In total, 4428 ectoparasites comprising five tick species, three louse species and one flea species were collected from 1798 domestic animals screened. Rhipicephalus microplus was the predominant tick species collected from the domestic animals. The cat flea, Ctenocephalides felis, constituted 1.5% of the total ectoparasites. Of all the ectoparasite samples (5980) from domestic animals and rodents, tested as 1211 pools through real-time PCR assays, 64 pools were positive for 23S rRNA gene of rickettsial agents. The PCR-positive samples were subjected to multi-locus sequence typing (MLST). In BLAST and phylogenetic analysis, the ectoparasites were found to harbour Rickettsia asembonensis (n = 9), Rickettsia conorii (n = 3), Rickettsia massiliae (n = 29) and Candidatus Rickettsia senegalensis (n = 1). A total of 22 pools were detected to have multiple rickettsial agents. The prevalence of fleas and high abundance of tick vectors with natural infections of rickettsial agents indicates the risk of transmission of tick- and flea-borne rickettsial diseases in rural villages of Gorakhpur. Further epidemiological studies are required to confirm the transmission of these agents to humans.

An interesting case of scrub typhus meningoencephalits

Rickettsial diseases are a re-emerging group of illnesses that are known to show a good response to treatment if diagnosed in time. Here we report a case of Scrub Typhus-related Meningoencephalitis in a young gentleman and the importance of high clinical suspicion with early empirical treatment in patients with consistent epidemiological context.

History and Current Status of Mediterranean Spotted Fever (MSF) in the Crimean Peninsula and Neighboring Regions along the Black Sea Coast.

Mediterranean spotted fever (MSF) is a tick-borne rickettsiosis caused by Rickettsia conorii subspecies conorii and transmitted to humans by Rhipicephalus sanguineus ticks. The disease was first discovered in Tunisia in 1910 and was subsequently reported from other Mediterranean countries. The first cases of MSF in the former Soviet Union were detected in 1936 on the Crimean Peninsula. This review summarizes the historic information and main features of MSF in that region and contemporary surveillance and control efforts for this rickettsiosis. Current data pertinent to the epidemiology of the disease, circulation of the ticks and distribution of animal hosts are discussed and compared for each of the countries in the Black Sea basin where MSF occurs.

Tworzenie systemowych rozwiązań w zakresie zwalczania tyfusu plamistego 1918-1924 w odradzającej się Polsce

Materiały i metody Badania oparto na kwerendzie archiwalnej (przede wszystkim w Centralnym Archiwum Wojskowym), chociaż wiele dokumentów administracji rządowej zostało opublikowanych w bazach cyfrowych, których weryfikacja jest łatwiejsza ze względu na dostępność. Analizowano przede wszystkim materiały z lat 1918-1924. Analizowano również informacje uzyskane ze źródeł historycznych, w tym czasopism medycznych z tego okresu, a Głównego Urzędu Statystycznego. Ze względu na to, iż jest to praca poglądowa, przyjęto perspektywę analizy wpływu epidemii tyfusu plamistego, na tworzenie systemowych rozwiązań w kwestii zwalczania chorób zakaźnych. Wyniki Powołane instytucje, w tym Polski Zakład Higieny, pozwoliły na większy monitoring zdrowia publicznego. Doświadczenie tyfusu ułatwiło rozwój sieci szpitali i zapewniło opiekę medyczną społeczeństwu. Co więcej, ze względu na pilną potrzebę kształcenia kadr medycznych, w 1921 r. rozpoczęto kształcenie lekarzy, pielęgniarek i innych pracowników medycznych w pierwszej w Europie Szkole Higieny. Dodatkowo, w związku z epidemią tyfusu, stworzono podwaliny pod funkcjonującą do dziś Państwową Inspekcję Sanitarną (1954 r.) oraz różne ustawy sanitarne. Wnioski W konsekwencji zagrożenia jakim było rozprzestrzenianie się chorób zakaźnych, przede wszystkim tyfusu na odradzających się ziemiach polskich, zaczęto prowadzić statystyki zachorowalności i śmiertelności oraz instytucjonalizować urzędy oraz ośrodki w celu tworzenia infrastruktury medycznej. Przeanalizowanie chronologii zwalczania tyfusu plamistego ukazuje także skuteczność wprowadzania wielu środków zapobiegawczych, trudność z organizowaniem masowych szczepień, powodowane nieufnością znacznej części społeczeństwa. Stąd de facto powołanie instytucji o charakterze wojskowym Naczelnego Komisariatu do Walki z Epidemiami. W warunkach kryzysu powojennego, chaosie migracyjnym wydanie ustaw sanitarnych okazało się niewystarczające. Warto zaznaczyć jednak, że dwie ustawy sanitarne z 1919 roku, stanowiły bazę do wydania ustawy z 1935 roku, stanowiącej fundament programu zwalczania epidemii aż do początków lat 60. XX wieku.

Serological profile of patients suspected with non-scrub typhus rickettsioses

BackgroundRickettsial pathogens are Gram-negative, obligate intracellular bacteria. They are transmitted by arthropods and are responsible for a wide variety of disease, from minor to life-threatening, which have a global effect on human health. Limited data are available on the prevalence of rickettsial diseases from India, and the disease epidemiology is not fully described. This study aimed to diagnose non-scrub typhus rickettsioses including spotted fever and typhus group of Rickettsia in clinically suspected patients by using standard serological tests and recognition of common epidemiological conditions and clinical manifestations. MethodsDuring the study period, a total of 700 patients of all ages with acute febrile illness were enrolled. Patients were screened for rickettsial infection using IgM Enzyme-linked immunosorbent assay (ELISA) and Immunofluorescence assay (IFA) was performed to confirm the ELISA positive results. The relevant demographic, clinical, and laboratory details of patients were documented and analyzed. ResultsOf 700 samples tested, 141 (20.2%) were found to be positive for IgM antibodies against rickettsioses using ELISA and IFA. SFGR was positive in 15 (2.2%), TGR was positive in 112 (16%) and 14 (2%) samples were positive for both groups. 20 (14.2%) patients required admission to the intensive care unit (ICU), and 24 (17%) in-hospital deaths occurred. ConclusionsThe prevalence of rickettsioses in India appears to be underestimated; therefore, increased awareness and improved diagnostic testing could facilitate early detection of cases, pathogen-targeted appropriate treatment, and improved outcomes for patients. Despite the fact that Rickettsiae can be isolated or detected using molecular techniques in clinical specimens, serology still remains the most commonly used diagnostic method for rickettsioses around the world. Our study helps bridge the gap of limited data on Rickettsia in north India and could be useful for future epidemiological investigation of rickettsial diseases and outbreaks.

First detection and genetic identification of Rickettsia spp. from ticks collected from rodents in north India

BackgroundChanging climatic conditions and invasion of ticks in urban areas have led to a greater number of cases of tick-borne diseases, thus, becoming a matter of increasing concern. Tick borne rickettsioses are one of the important emerging diseases worldwide. Knowledge of epidemiology of the vector and pathogen in the community is essential in order to understand and prevent the transmission of the disease to healthy population. MethodsIn our present study, we trapped rodents in selected areas of Chandigarh and Punjab in north India. The rodents were screened for the presence of ticks which were further screened for the presence of rickettsial agents. PCRs targeting 17 ​kDa and gltA genes were carried out followed by Sanger sequencing of the positive amplicons followed by phylogenetic analysis of the sequences. ResultsA total of 17 ticks were collected out of which one (Rhipicephalus sanguineus) was found to be harboring a Rickettsia sp. PCR targeting gltA and 17 ​kDa genes of rickettsia were put up and Sanger sequencing was performed. Phylogenetic analysis revealed the sequences to be closely related to Rickettsia rhipicephali. ConclusionThe current study establishes the presence of rickettsial agents in the community. Although Rickettsia rhipicephali is a non-pathogenic agent, the study encourages more vigorous community surveillance should be carried out in order to determine the exact burden of rickettsial agents in our community. To our knowledge, this is the first study reporting Rickettsia rhipicephali in India.

Rickettsial Disease Outbreak, Mexico, 2022.

Beginning in 2022, Nuevo Leon, Mexico, experienced an outbreak of rickettsioses that is still ongoing despite multidisciplinary control efforts. A total of 57 cases have been confirmed, particularly affecting children. We report a high mortality rate among hospitalized persons in Nuevo Leon. Continuing efforts are required to control the outbreak.

Clinical Trends of Malaria in Abbasia Fever Hospital over a Period of Two Years

Background Malaria is an acute systemic illness caused by infection with Plasmodium parasites that lives part of its life in humans and part in female Anopheles mosquitoes. It remains one of the major killers of humans, population worldwide. Objective To study clinical trends and prevalance of malaria in Abbasia Fever hospital over a period of two years. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Faculty of Medicine, Ain Shams University and Abbasia Fever hospital. The current study was conducted on 200 Malarial patients admitted to Abbasia fever Hospital in Cairo (time) to be treated according to the protocol of treatment of malaria which was approved by Ministry of Health in Egypt. Results According to the treatment of malaria, the present study revealed that the best response in studied cases was to the mono-therapy. Concerning the clinical outcome of the studied cases, most of the studied cases (189 patients) were cured in the sense of clinical and parasitological improvement. Regarding comparative results among the studied cases, complicated malaria was more frequent in male and non-Egyptian and pregnant women. Conclusion Malaria should be considered as a cause of fever in relevant target patients. Malaria disease is commoner in the younger ago group. In Egypt, no endogenous malaria cases have been reported since1998 until 2014 a malaria outbreak was discovered in Aswan. Malaria cases in Egypt are usually coming from endemic area in Africa. Mortality due to malaria disease is unusual, and may result from improper chemoprophylaxis and missed diagnosis or late treatment. Monotherapy is preferable than Combined therapy (polytherapy) as it is more effective among the studied malarial cases. Tools of prophylaxis are insect repellents, protective clothes, bed nets and chemoprophylaxis.

Characteristics of Helicobacter pylori-Seropositive Subjects According to: A) The Stool Antigen Test Findings. B) Serum Pepsinogen Level. C) Upper Endoscopic Findings

Abstract Background Helicobacter pylori infection can be diagnosed by invasive methods using the gastric biopsied specimens or non-invasively by examining serum, urine, breath, or stool. Histological examination by Giemsa staining is usually recommended for the diagnosis, but it is difficult to visualize the bacterium when there is alow density of H.Pylori on the gastric mucosa with atrophic and metaplastic changes, Limitations of histological examination include increased false negative test findings due to various density of H. pylori at a different sites, high cost, long turn-around time, and inter observer variability. Therefore, in endemic countries like Egypt with s higher risk of chronic atrophic gastritis (CAG), intestinal metaplasia, and gastric cancer, noninvasive tests need to be added for a more reliable diagnosis of H.Pylori infection. Aim of the Work The aim of this study is to compare between the prevalence of chronic atrophic gastritis (CAG) and gastric corpus atrophy in Helicobacter pyloriseropositive subjects according to the stool antigen test, serum pepsinogen(PG) level and upper endoscopic findings. Patients and Methods The current study represents Cross- sectional study -Descriptive -Diagnostic study. This study had been carried at Ain Shams University and Abbasia fever hospital on 80 seropositive- patients attending to endoscopy ward for a regular check-up, All patients subjected to full history, clinical examination and investigation in the form of; complete blood count, serum antiH.Pylori immunoglobulin G (IgG), stool antigen test and serum pepsinogen. Results The current study showed that there was a significant difference between positive and negative H. pylori regarding pepsinogen I & II and endoscopic finding regarding CAG and CSG. Conclusion In conclusion, there is a link between positive stool H. pylori antigen test findings and a serum PG assay and upper endoscopic findings in seropositive subjects. Positive stool H. pylori antigen test findings are common in seropositive subjects with increased serum PG I levels indicating an ongoing H. pylori infection. Our study findings further suggest that, to reduce the infected subjects with H. pylori in their fecal material, seropositive subjects with increased gastric secreting ability need to be treated.

Incidence of Reactivation of Hepatitis B in Co-Infected HB V/HCV Patients Treated with Regiments of Sofosbuvir and Daclatasvir with or without Ribavirin

Abstract Background HCV management was dramatically changed by the recent advent of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection, where DAA regimens are associated with a sustained virological response (SVR) rate of > 90–95% and are considered safe; nevertheless, a few complications have been reported including reactivation of hepatitis B virus (HBV). Aim of the Work To evaluate the incidence of re activation of HBV among patients treated by sof/dac with or without RBV Patients and Methods This study was held in out in centers for treatment of HCV in –Ain- Shams University Hospital and Aswan Fever Hospital from May 2019 to October 2020., All patients were subjected to history taking, clinical examination, abdominal ultrasound, laboratory investigations (CBC, liver function, HCV Ab, HBsAg, HBV eAg PCR for HCV RNAand PCR for HBV DNA. All patients were positive for HCVAb, HCV PCR, HBVsAg with HBV DNA less than 2000IU/ML and negative for HBVeAg. This study was conducted on 90 patients who were selected according to National Committee for Control of Viral Hepatitis (NCCVH) protocol were divided according to treatment protocol into two groups. Results In our study, 57% of cases aged < 50 years, 33% aged > 50 years, and 61% were males and 39% were females; In the present study, there were 23 patients were smokers,16 patients were diabetics and 21 patients were hypertensives. All treated patients were negative PCR for HCV RNA at week 12 with 100% (SVR12)response in all treated patients which is still negative till end of treatment and 12 week after end of treatment (SVR 24), AS regard HBV DNA, no statistically significant difference was found at the beginning, at the end of 12 weeks, and at the end of 24 week of treatment by DAAs (p-value > 0.05), except for one patient who was treated with SOF/DAC/RBV. This patient, with compensated cirrhosis at baseline, developed fatigue and anorexia at week 12, with HBV reactivation (HBV DNA levels increased from245 IU/mL at baseline to 532000IU/mL), after which entecavir was added to the SOF/RBV regimen. This patient did not show significant increase in ALT level. Conclusion Our study confirmed the importance of screening for HBV in patients undergoing DAA therapy and importance of follow. For those for positive HBsAg, to avoid HBV reactivation and particularly HBV-related hepatitis. Our study limits the benefit of systematic nucleoside analogue prophylaxis for all HBsAg-positive patients. In our Egyptian cohort, for example, if we had followed the EASL recommendation (ie, starting nucleos(t)ide analogue prophylaxis for all 90 HBsAg-positive patients irrespective of their HBV DNA levels at baseline), this could have prevented 1 case of HBV-related reactivation during the course of DAAs, but resulted in overtreatment in the rest of patients

Effect of Direct Acting Antiviral Therapy on Lipid Profile in Egyptian Patients with Chronic Hepatitis C Infection

Background Chronic hepatitis viral infection is associated with wide metabolic disarrangements. HCV interacts with lipid metabolism leading to steatosis, hepatitis c virus infection is linked to the lower lipid profiles and progression of the chronic liver disease. Aim of the Work The aim of this study was to evaluate the Effect of Direct Acting Antivirals therapy on serum lipid profile in egyptian patients with chronic hepatitis C infection. Patients and Methods This study was prospective Cohort clinical study and carried out on 60 patients have chronic infection with hepatitis C who was treated with direct acting antiviral therapy on patients admitted to Aswan Fever Hospital. Results The results of this study showed that the basic demographic and clinical data in the two studied groups including age, sex, smoking habitat, comorbidity, BMI, and pre treatment laboratory findings which include blood picture, FBS and liver function, show insignificant difference between the two studied groups, this results was important to eliminate the effect of demographic and clinical data on the net results and the only variable affected on the net results was the type of treatment. In our results, the lipid profile show the following result, regarding triglyceride and cholesterol, it was found that there was no significant difference between the two groups pre treatment and all over the period of follow up, on the other hand at end of follow up after three months it was found that there was a significant increase in triglyceride and cholesterol in the two groups, but the increasing in group I (Sof+Dacal) was more than the increase in group II (sof+dacal+ribavirin). Regarding LDL and HDL, the levels of two variables pre treatment was matched without significant difference, the increase in LDL and decrease in HDL in group II was significantly higher than the increase in group II after one and three months, on the other hand on comparing the level of LDL and HDL pre treatment with the final follow up after 3 months, it was found that there was a significant increase in LDL and decrease in HDL in the two groups. Conclusion In this study, we could conclude that there was a significant increase in lipid profile in patients with chronic HCV infection treated with Sofosbuvir & Daclatasvir + Ribavirin and Sofosbuvir & Daclatasvir.

Role of Interleukin 6 as Predictive Factor for the Severity of COVID 19

Abstract Background Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. Excessive interleukin-6 signaling is a key factor contributing to the cytokine release syndrome implicated in clinical manifestations of COVID-19. Aim of the Work To determine the Role of interleukin 6 as predictive factor for the severity of Covid-19. Patients and Methods This was Case Control study, conducted at Abassia Fever hospital and El Demerdash University Hospital on 75 participants (50 patients with Covid-19 disease manifestation and 25 controls) during a period of 6 months. Results There was no statistically significant difference between cases with less than 50% and more than 50% lung affection among mild cases groups as regard serum IL-6. Conclusion The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.

Seroprevalence and risk factors of Borrelia burgdorferi sensu lato and Rickettsia species infection in humans in Mongolia, 2016-2020.

Borrelia burgdorferi sensu lato and Rickettsia spp. are worldwide causes of tick-borne infections. We aimed to estimate the seroprevalence of immunoglobulin G (IgG) antibodies against different tick-borne diseases (TBDs) and determine risk factors among Mongolians from 2016 to 2020. Blood samples were obtained from voluntary participants with a history of suspected tick bite who visited our hospital, and IgG antibodies against Rickettsia and Borrelia were detected using enzyme-linked immunosorbent assay (ELISA). The IgG antibody seropositivity rate against Rickettsia was 21.8% (1032/4724), while 3.4% (162/4724) of participants tested positive for serum IgG antibodies against Borrelia by ELISA.Binary logistic regression analysis was performed to evaluate risk factors for tick-borne rickettsiosis (TBR) and tick-borne borreliosis (TBB) using IgG serum sample. Age, occupation, and residence were significantly associated with these diseases; however, sex did not show any significant association. Seroprevalence was significantly higher among herders (40.6%, 95% confidence interval [CI]: 35.5-45.8; odds ratio [OR] 0.61; P < 0.001) and students (32.8%, 95% CI: 30.2-35.4; OR 0.75; P < 0.001) than among individuals with other occupations. The 25-29 age group had a slightly higher seroprevalence (35.1%, 95% CI: 28.1-42.6; OR 0.61; P < 0.006) than those in other age groups. Province was a stronger predictor of TBR than occupation and age group. In univariate subgroup analysis by age group, occupation, and residence were significantly associated with TBR seroprevalence, whereas age and province were associated with TBB seroprevalence. Thus, risk factors for TBD include residence, occupation, and age group. This study was conducted using samples from all Mongolian provinces and the capital city, and the risk factors and prevalence of Rickettsia and Borreliaare highlighted.

Phenotypic and Genotypic Analysis of Bacterial Pathogens Recovered from Patients Diagnosed with Fever of Unknown Origin in Egypt.

Fever of unknown origin (FUO) is a medical term describing fever that lasts for at least three weeks without a diagnosis being reached after extensive diagnostic evaluation. Therefore, this study aimed to identify the common pathogens causing FUO in patients admitted to Abbasia Fever Hospital in Egypt from January 2020 to December 2022, their antimicrobial susceptibility profiles, and associated resistance genes. The study also aimed to investigate the burden of multidrug-resistant (MDR) pathogens and the priority pathogens nominated by the World Health Organization (WHO) for posing the greatest threat to human health due to antibiotic resistance. During the study period, about 726 patients were diagnosed with FUO. After extensive investigations, the cause of the FUO was found to be infectious diseases in 479/726 patients (66.0%). Of them, 257 patients had positive bacterial cultures, including 202 Gram-negative isolates that comprised Klebsiella pneumoniae (85/202; 42.1%), Escherichia coli (71/202; 35.1%), Acinetobacter baumannii (26/202; 12.9%), and Pseudomonas aeruginosa (14/202; 6.9%) and 55 Gram-positive isolates, including Staphylococcus aureus (23/55; 41.8%), Streptococcus pneumoniae (7/55; 12.7%), and Enterococcus spp. (25/55; 45.5%). The MDR phenotype was shown by 68.3% and 65.5% of the Gram-negative and Gram-positive isolates, respectively. Carbapenem resistance (CR) was shown by 43.1% of the Gram-negative isolates. Of the 23 S. aureus isolates obtained from research participants, 15 (65.2%) were methicillin-resistant S. aureus (MRSA). A high-level aminoglycoside resistance (HLAR) phenotype was found in 52.0% of the Enterococcus sp. isolates. The PCR screening of resistance genes in the MDR isolates showed that blaOXA-48 was the most prevalent (84%) among the carbapenemase-coding genes, followed by blaVIM (9%) and then blaIMP (12%). The ESBL-coding genes blaTEM, blaCTX-M,aac(6')-Ib, and blaSHV, were prevalent in 100%, 93.2%, 85,% and 53.4% of the MDR isolates, respectively. This study updates the range of bacteria that cause FUO and emphasizes the burden of multidrug resistance and priority infections in the region. The obtained data is of relevant medical importance for the implementation of evidence-based antimicrobial stewardship programs and tailoring existing empirical treatment guidelines.