Triple Infection Research Articles

Triple positivity of HBsAg, anti-HCV antibody, and HIV and their influence on CD4+ lymphocyte levels in the highly HIV infected population of Abeokuta, Nigeria.

Few studies exist on hospital-based seroprevalence of triple positivity of HIV/HBV/HCV in Nigeria. The study aimed at determining the triple positivity of HIV, HBsAg and HCV among HIV-infected individuals in Abeokuta, Nigeria and defining the influence of these triple infections on CD4+ counts of HIV-infected individuals as antiretroviral therapy improves in Nigeria. Enumeration of CD4+ levels in 183 HIV-infected persons was done with Partec Flow Cytometer. Seropositivity of HBsAg and anti-HCV antibody was detected with rapid kits. From the result obtained, significance variance (p<0.05) existed between HIV positive persons and persons who tested positive to HIV/HBV/HCV triple infection before and after the commencement of HAART. Of these infections, 31(16.9%) had HBV/HCV/HIV triple infection, while 152(83.1%) had HIV mono infection only, 56(30.6%) had HBV/HIV dual infection only and 43(23.5%) had HCV/HIV dual infection only. Significant variance (p<0.05) also existed between subjects with CD4 counts of <200 cells/µl, 200-499 cells/µl and >500 cells/µl. Highest seroprevalence of HIV (35.0%) was found in age groups 35-44 years and >65 years had the least (2.7%). Significant variance (p<0.05) also existed in the progression of CD4+ lymphocytes cells between subjects with persistent decrease (32.3%) in CD4+ lymphocytes cells and those with fluctuation in their CD4+ lymphocytes cells (12.9%) after the commencement of ART. The study further confirms that triple positivity of HIV/HBV/HCV infection is common in Abeokuta, Nigeria. Testing of these triple infections should be a big concern in the best choice and commencement of ART. Also, the study showed that consistent and prolonged use of HAART had a positive impact on the CD4 count of HIV-infected individuals.

Prevalence and associated risk factors of intestinal parasites among children of farm workers in the southeastern Anatolian region of Turkey.

To determine the species, prevalence, and associated risk factors of intestinal parasites in farm workers' children in a representative sample in the southeastern Anatolian region of Turkey. A total of 333 farm workers' children, under the age of six years, were selected using the probability sampling method. Mean age of the children was 3.63 ± 0.5; 55.5% were female. Data were collected using a structured questionnaire and laboratory analysis of faecal samples. The overall prevalence was 44.6% and the infected children had single, double, and triple parasitic infections at 72.3%, 23.0%, and 4.7%, respectively. The most common parasite was G. intestinalis (47.97%), followed by E. vermicularis (37.84%), T. saginata (27.03%), H. nana (12.16%), and A. lumbricoides (7.43%), respectively. Age, gender, illiteracy of the households, poverty, absence of toilets, bathrooms, and kitchens at the place of residence, lack of safe potable water, geophagia (soil eating habit), and being a child of a seasonal farmworker were the most significant factors associated with intestinal parasitic infection (P<0.05). G. intestinalis and E. vermicularis were found as the most common parasites that cause salivation, abdominal pain, and tiredness (P<0.05). The study revealed that health education programmes for farm workers and farmers should be improved to increase awareness about living and working conditions, in order to control intestinal parasites. However, early diagnosis and treatment services for intestinal parasites should be provided by primary health care staff in the national child screening programme in agricultural populations.

P12.12 Bacteria aetiology of sexually transmitted infections at sexually transmitted infection clinic in kumasi, ghana; use of multiplex real time polymerase chain reaction

Introduction Most sexually transmitted infection (STI) management efforts focus on the syndrome approach to diagnose and treat patients who are symptomatic. However, most women with STIs are known to be entirely asymptomatic or if symptoms exist are often unrecognised either clinically or bacteriologically. We determine the true prevalence and aetiology of STIs among these women in Ghana. Methods This cross sectional study conducted between February and April 2014 employed a sensitive multiplex real time Polymerase chain reaction (PCR) assay that simultaneously detects seven STI bacteria pathogens in 200 women attending a Specialist STI clinic at Suntreso Government Hospital in Kumasi, Ghana. Data was captured and analysed using Stata version 12. Results A total 156 (78.00%) of the women were asymptomatic. Overall, 175 (87.5%) of the women tested positive for at least one bacteria STI pathogen of which 50 (25.0%) had single infections, 76 (38.0%) and 39 (19.5%) had double and triple infections respectively. Mycoplasma hominis was the most commonly detectable pathogen present in 135 (67.5%) women. Altogether, 135 (86.54%) and 40 (90.91%) of the symptomatic and asymptomatic women tested positive for at least one pathogen (p < 0.05). There were no significant associations (p < 0.05) between the clinical manifestations as presented by the symptomatic women and the pathogens detected in their samples. Conclusion Our study confirmed the importance of complementing the syndromic approach with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is. Disclosure of interest statement No conflict of interest.

Combining the Sterile Insect Technique with Wolbachia-Based Approaches: II--A Safer Approach to Aedes albopictus Population Suppression Programmes, Designed to Minimize the Consequences of Inadvertent Female Release.

Due to the absence of a perfect method for mosquito sex separation, the combination of the sterile insect technique and the incompatible insect technique is now being considered as a potentially effective method to control Aedes albopictus. In this present study first we examine the minimum pupal irradiation dose required to induce complete sterility in Wolbachia triple-infected (HC), double-infected (GUA) and uninfected (GT) female Ae. albopictus. The HC line is a candidate for Ae. albopictus population suppression programmes, but due to the risk of population replacement which characterizes this triple infected line, the individuals to be released need to be additionally irradiated. After determining the minimum irradiation dose required for complete female sterility, we test whether sterilization is sufficient to prevent invasion of the triple infection from the HC females into double-infected (GUA) populations. Our results indicate that irradiated Ae. albopictus HC, GUA and GT strain females have decreased fecundity and egg hatch rate when irradiated, inversely proportional to the dose, and the complete sterilization of females can be acquired by pupal irradiation with doses above 28 Gy. PCR-based analysis of F1 and F2 progeny indicate that the irradiated HC females, cannot spread the new Wolbachia wPip strain into a small cage GUA population, released at a 1:5 ratio. Considering the above results, we conclude that irradiation can be used to reduce the risk of population replacement caused by an unintentional release of Wolbachia triple-infected Ae. albopictus HC strain females during male release for population suppression.

A comparison of Luminex xTAG® Gastrointestinal Pathogen Panel (xTAG GPP) and routine tests for the detection of enteropathogens circulating in Southern China

To investigate whether Luminex xTAG® Gastrointestinal Pathogen Panel (xTAG GPP) is applicable for the diagnosis of diarrhea and surveillance of enteropathogens circulating in Southern China, 290 stool samples were tested for 15 kinds of enteropathogens using xTAG GPP and compared to the results from the routine tests, including culture; immunochromatography; real-time PCR; microscopy; and a third method, gene sequencing. One hundred fifty-nine samples were positive, yielding a total of 181 enteropathogens (69 bacteria and 112 viruses), with rotavirus being most prevalent (39.0%, 62/159). The overall sensitivity and specificity of xTAG GPP were 96.3% (93.3–98.2%) and 99.8% (99.6–99.9%), respectively, with a combination of the methods as the gold standard. The coinfection rates detected by the routine tests and xTAG GPP were 10.0% (25 double and 4 triple infections) and 12.1% (29 double, 4 triple and 2 quadruple infections), respectively. xTAG GPP is a powerful tool for the identification of multiple enteropathogens.

English

Tuberculosis, human immunodeficiency virus and hepatitis B and C infections are serious public health problems in Ethiopia. This study was conducted to assess the prevalence of triple viral infections and associated factors among tuberculosis patients who were on anti-tuberculosis treatment in the year 2011/12 in West Arsi Zone, Ethiopia. A cross sectional study design was conducted among 374 TB patients who were on first line anti-TB treatment. Simple random sampling technique was employed to draw the study subjects until the calculated sample size was achieved. Blood samples were collected to determine the HIV serostatus by rapid HIV testing kits; whereas the hepatitis B and C sero-status was determined by instant one step HBsAg and Flavicheck-HCVWB kits, respectively. Socio-demographic and risk factors information was collected and analysed using univariate and multivariate logistic regression. Injection drug users were excluded from this study. From a total of 374 tuberculosis patients enrolled, TB-HIV co-infection was found to be 56 (14.97%) among which 5 (8.92%) hepatitis B and 4 (7.14%) were hepatitis C triple infected. The overall TB-HIV-Hepatitis triple infection prevalence was 2.4% (9/374). Though the current level of triple viral infections among TB patients seems to be low, an integrated program for treatment, prevention and control strategy is crucial to be considered in TB patient management. Key words: Co-infection, HBV, HCV, HIV, TB, triple infection, West Arsi Zone, Ethiopia.

Occurrence of viral pathogens in Penaeus monodon post-larvae from aquaculture hatcheries.

Viral pathogens appear to exert the most significant constraints on the growth and survival of crustaceans under culture conditions. The prevalence of viral pathogens White Spot Syndrome Virus (WSSV), Hepatopancreatic Parvo Virus (HPV), Monodon Baculo Virus (MBV) and Infectious Hypodermal and Hematopoietic Necrosis Virus (IHHNV) in Penaeus monodon post-larvae was studied. Samples collected from different hatcheries and also samples submitted by farmers from Kerala were analyzed. Out of 104 samples collected, WSSV was detected in 12.5% of the post-larvae samples. Prevalence of concurrent infections by HPV, MBV and WSSV (either dual or triple infection) was present in 60.6% of the total post-larvae tested. Out of the 51 double positives, 98% showed either HPV or IHHNV infection. HPV or IHHNV was detected in 11 post-larval samples showing triple viral infection. This is the first report of IHHNV from India. Result of this study reveals the lack of efficient screening strategies to eradicate viruses in hatchery reared post-larvae.

Immunological response to re-infections with clones of the Colombian strain of Trypanosoma cruzi with different degrees of virulence: influence on pathological features during chronic infection in mice.

Re-infections with Trypanosoma cruzi are an aggravating factor for Chagas disease morbidity. The Colombian strain of T. cruzi represents multiclonal populations formed by clonally propagating organisms with different tropisms and degrees of virulence. In the present study, the influence of successive inoculations with clones of the Colombian strain, exhibiting different degrees of virulence, on chronic myocarditis and the humoral and cellular immune responses (Col-C1 high virulence, Col-C8 medium virulence and Col-C5 low virulence) were demonstrated. Mice from three groups with a single infection were evaluated during the acute (14th-30th day) and chronic phases for 175 days. An immunofluorescence assay, ELISA and delayed type hypersensitivity (DTH) cutaneous test were also performed. Mice with a triple infection were studied on the 115th-175th days following first inoculation. The levels of IgM and IgG2a were higher in the animals with a triple infection. DTH showed a higher intensity in the inflammatory infiltrate based on the morphometric analysis during a 48 h period of the triple infection and at 24 h with a single infection. The histopathology of the heart demonstrated significant exacerbation of cardiac inflammatory lesions confirmed by the morphometric test. The humoral responses indicate a reaction to the triple infection, even with clones of the same strain.

Four-year study of viruses that cause diarrhea in Japanese pediatric outpatients

Acute gastroenteritis continues to be a major public health problem worldwide. A wide variety of viruses associated with diarrhea disease is being reported continually. This study investigated the epidemiological situation of viruses that cause diarrhea in Japanese pediatric patients. This study enrolled a total of 2,381 fecal specimens collected between 2009 and 2013 from Japanese children with acute gastroenteritis. There is currently a 70.4% prevalence of viruses causing diarrhea among these Japanese pediatric outpatients. Norovirus was detected in 39.3% of the patients, whereas the prevalence of rotavirus, human parechovirus, enterovirus, adenovirus, sapovirus, astrovirus, and Aichi virus was 20.1, 6.6, 6.1, 5.6, 4.8, 2.3, and 0.1%, respectively. Co-infections were observed at the prevalence rates of 13.4 and 0.5% for double infections and triple infections, respectively. Mixed viral infections were found commonly in Japanese outpatients, and the norovirus seemed to play a major role in co-infections. Viral diarrhea cases were detected mostly in children younger than 3 years of age. The norovirus and rotavirus can be detected throughout the year, with a peak during the cold and dry seasons, whereas other common viruses are found during no specific season. Surveillance data revealed that a wide variety of viruses has caused diarrhea to circulate currently in Japanese pediatric outpatients, with very high detection rates; and norovirus and rotavirus are the most important pathogens. The data obtained from this study are valuable for compiling the overall picture of several viruses that causes diarrhea and associates with acute gastroenteritis in the Japanese pediatric population.

Co-infection of two criniviruses and a begomovirus enhances the disease severity in cucumber

In the past two decades, viruses in the genera Crinivirus and Begomovirus, transmitted by whiteflies, have emerged as threatening diseases to cucurbit cultivation. The criniviruses Cucurbit chlorotic yellows virus (CCYV) and Cucurbit yellow stunting disorder virus (CYSDV) occur in mixed infection at high rates in cucumber greenhouses in Lebanon. The begomovirus Squash leaf curl virus (SLCV) is also present in the country infecting cucumber but at a lower incidence. The effect of single, dual or triple virus infections on cucumber was studied. Single infection by SLCV did not lead to any symptoms or yield reduction. CYSDV or CCYV infections led to development of characteristic yellowing symptoms. In single infections, CYSDV caused the greatest reductions in height and yield that ranged from 25 to 62 % and 52 to 63 %, respectively, depending on season and variety. CCYV induced less severe reduction in height, 10 to 33 %, and in fruit number, 10 to 12 %. Yellowing symptoms induced by dual infections in any combination were similar to those of singly-infected plants. Triple infections resulted in substantial reductions in plant height and yield as compared to single or dual infections. This is the first report that characterizes a significant increase in disease severity upon co-infection between cucurbit-infecting criniviruses and begomoviruses. The implications of these observations on integrated disease management strategies are discussed.

Triple Infection in Chickenpox Outbreak in Unvaccinated Population of Gopalpur Block, Palampur of Himanchal, India

Background: In an outbreak setting, in co-educational school, we investigated suspected triple outbreak in April, 2009: varicella first and then, with chance detection of measles and german measles to confirm diagnosis and recommend remedial measures to prevent further outbreaks. Methods: We defined a case of varicella with maculopapulovesicular rash without other apparent cause in students/staff of the school and residents of neighbouring nutritionally poor villages of Khalet and Roady since 23 rd March to 14 th October, 2009. We line listed case patients to collect information on age, sex, residence, date of onset, symptoms, signs, traveling, treatment history and vaccination status. The outbreak was described by time, place and person characteristics. Diagnosis was confirmed epidemiologically and serologically; first to chickenpox, measles and german measles viruses. Results: We identified 505 case patients from mixed outbreaks of varicella, measles and german measles (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280. We investigated the suspected outbreak with case definition of chickenpox but measles 20/3280 (0.60%) and german measles 34/3280 (1.03%) cases were also observed. The overall all attack rate (AR) was 15% while in school, it was 22% but highest (56%) in Nursery upto 4 th standard with index case in first standard. Sex specific AR was (23%) more in boys. Triple concurrent infection caused 05% complications but no death reported. Severity of the symptoms was more in 5 th standard onwards with 49-249 lesions and severer in poor villages Roady and Khalet (p Conclusions: Triple infection of varicella, measles and rubella was confirmed epidemiologically and serologically. We recommended local authorities for MMRV in the school and near villages with aggressive information, education and communication (IEC) activities in affected areas.

Prevalence of Hepatitis B and Hepatitis C Infections in HIV Infected Patients Attending a Tertiary Care Hospital in North-East India

Aims: To study the co infection of Hepatitis B (HBV) and/or Hepatitis C virus (HCV) in Human Immunodeficiency Virus (HIV) infected patients attending tertiary care teaching hospital in North East India. Study Design: This study was a cross sectional study. Place and Duration of the Study: Department of Microbiology, Guwahati Medical College & Hospital, Guwahati, Assam, India for a period of one year (August 2010July 2011). Methodology: Serum samples of 180 HIV positive patients were collected randomly who gave consent to participate in the study and were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by enzyme linked immunosorbent assay (ELISA) method. The retrospective demographic data of the subjects were collected. Original Research Article Gogoi et al.; BJMMR, 10(4): 1-7, 2015; Article no.BJMMR.19155 2 Results: Out of 180 HIV positive patients (126 males and 54 females), 22 (12.2%) cases were HBsAg positive and 8 (4.4%) were anti-HCV positive. Triple infection with HBV, HCV and HIV was not found in any patient. The commonest mode of transmission for HIV alone (113/180; 75.3%) and HIV-HBV co infection (18/22; 81.8%) was sexual route, and for HIV-HCV co infected patients, Intravenous Drug Use (IDU) was the commonest route of transmission (4/8; 50%). Concomitant infection of HIV and HBV was found to be significantly more in the symptomatic group (59.1%) compared to asymptomatic group (4.5%) (P value < 0.001). CD4+ T-lymphocyte count less than 200/μl was seen in 11 of 30 co-infected cases (36.7%). Conclusion: Co infection with HBV and HCV is a common problem in HIV infected patients in India. Hence, all HIV patients need to be routinely screened for markers such as HbsAg for hepatitis B and Anti HCV for HCV infection so as to take early treatment initiative to prevent the morbidities.

The prevalence of intestinal parasitic infections among foreign workers in Madinah, Kingdom of Saudi Arabia

Background: The Kingdom of Saudi Arabia has a high number of foreign workers, especially those coming from endemic areas with intestinal parasites. Objective: The aim of this study was to determine the prevalence of parasitic infection among foreign workers in Madina, Kingdom of Saudi Arabia. Materials and Methods: There was direct microscopic examination of stool samples by wet smears for parasitic stages. This was followed by the formalin-ethyl acetate concentration technique to confirm and detect parasites not recovered by the wet mount. Results: The total number of foreign workers was 120, 47.5% of whom were males and 52.5% females. They were within the age group of 20-60 years. A total of 53 cases (44.2 %) were infected with IPs. Some samples had double or triple infections, with a total of 69 parasitic infections detected (57.5%). These included Entamoeba histolytica (27.5%), Giardia lamblia (18.8%), hookworm (14.5%), Ascaris lumbricoides (11.6%), Entamoeba coli (7.2%), Trichuris trichiura (5.8%), Strongyloides stercoralis (5.8%) and Hymenolepis nana (4.3%). Furthermore, 1.4% each of Enterobius vermicularis, Schistosoma mansoni and Taenia eggs were found. Conclusion: Foreign workers newly arrived from Asia and Africa carry high rates of IPs infection. It is necessary to increase awareness about occupational health, and the risks of parasite transmission to the local population. Moreover, strict adherence to infection prevention policies is recommended.

A Molecular and Serological Survey of Rickettsiales Bacteria in Wild Sika Deer (Cervus nippon nippon) in Shizuoka Prefecture, Japan: High Prevalence of Anaplasma Species.

We surveyed Rickettsiales bacteria, including Rickettsia, Ehrlichia, Anaplasma, and Neoehrlichia, in wild sika deer (Cervus nippon nippon) from Shizuoka prefecture, Japan. In spleen samples from 187 deer, Anaplasma phagocytophilum (deer type), A. bovis, and A. centrale were successfully detected by PCR assay targeting to 16S rDNA or p44/msp2, and their positive rates were 96.3% (180/187), 53.5% (100/187), and 78.1% (146/187), respectively. Additionally, 2 or 3 Anaplasma species could be detected from a single deer in 165 spleen samples (88.2%), indicating dual or triple infection. In contrast, A. phagocytophilum (human type) 16S rDNA, Rickettsia gltA, Ehrlichia p28/omp-1, and Neoehrlichia 16S rDNA could not be amplified. The serological test of 105 deer serum samples by immunofluorescence assay showed that the detection of antibodies against antigens of A. phagocytophilum HZ (US-human isolate) and Rickettsia japonica YH were 29.5% (31/105) and 75.2% (79/105), respectively. These findings suggest that A. phagocytophilum (deer type), A. centrale, and A. bovis are highly dominant and prevalent in wild sika deer from Shizuoka, a central region of Japan, and that the antibodies against some Rickettsiales bacteria have also been retained in deer blood.

Coexistence of Borrelia burgdorferi s.l. genospecies within Ixodes ricinus ticks from central and eastern Poland.

The purpose of the study was to assess the prevalence and coinfection rates of Borrelia burgdorferi sensu lato genotypes in Ixodes ricinus (L.) ticks sampled from diverse localities in central and eastern regions of Poland. In years 2009-2011, questing nymphs and adults of I. ricinus were collected using a flagging method at 18 localities representing distinct ecosystem types: urban green areas, suburban forests and rural woodlands. Molecular detection of B. burgdorferi s.l. genospecies was based on amplification of a fla gene using nested PCR technique, subsequent PCR-RFLP analysis and bidirectional sequencing. It was revealed that 45 samples (2.1%) harboured two different B. burgdorferi s.l. genospecies, whereas triple infections with various spirochetes was found in 11 (0.5%) individuals. Generally, the highest average coinfection rates were evidenced in arachnids gathered at rural woodlands, intermediate at suburban forests, while the lowest were recorded at urban green areas. Overall, single spirochete infections were noted in 16.3% (n = 352/2,153) ticks. Importantly, it is the first report evidencing the occurrence of Borrelia miyamotoi (0.3%, n = 7/2153) in I. ricinus populations within central Poland. Circumstantial variability of B. burgdorferi s.l. genospecies in the common tick individuals sampled at various habitat types in central and eastern Poland was displayed. The coexistence of two or three different spirochete genospecies in single adult ticks, as well as the presence of B. miyamotoi were demonstrated. Therefore, further studies uncovering the co-circulation of the tested bacteria and other human pathogens in I. ricinus ticks are required.

Prevalence of Intestinal Parasitic Infections among Patients with Diarrhea at Wonago Health Center, Southern Ethiopia: A Retrospective Study

Background: Intestinal parasitic infections are among the most common infections worldwide. High prevalence is found in people with low socio-economic status, poor living condition, overcrowded areas, poor environmental sanitation, improper garbage disposal, unsafe water supply and unhygienic personal habits. Thus, the objective of this retrospective study was to determine the prevalence of intestinal parasitosis among patients with diarrhea who visited Wonago health center Southern Ethiopia. Methodology: Institution based retrospective study design was employed. Stool examination records of all patients with diarrhea who visited Wonago health center from September 2010 to September 2012 were included. A total of 10694 stool examination results of those diarrheic patients were analyzed for this study. Samples were examined using direct saline wet mount technique. Statistical analysis was done by SPSS version 16 and results were shown in percent and prevalence rates. Results: The overall prevalence of intestinal parasite for at least one parasite in this retrospective study was 1776/10694(16.6%). Furthermore, 5.7% of those positive patients were infected by two species of parasites and 4.6%of patients had triple infections. The most prevalent parasites were E. histolytica/dispar 956/1776(53.8%) followed by G. lamblia 420/1776(23.7%) and Taenia species 140/1776(7.9%) respectively. Conclusion: Intestinal parasitosis is highly prevalent in varying magnitude among diarrheic patients who visited Wonago health Center, Southern Ethiopia. E. histolytica/dispar was the most prevalent parasite infecting patients followed by, G. lamblia, Taenia species and H. nana. Because of absence of molecular diagnosis for E. histolytica, over diagnosis might be possible for the high prevalence of amoebiasis.

Detection of sweet potato virus C, sweet potato virus 2 and sweet potato feathery mottle virus in Portugal.

Field sweet potato plants showing virus-like symptoms, as stunting, leaf distortion, mosaic and chlorosis, were collected in southwest Portugal and tested for the presence of four potyviruses, sweet potato virus C(SPVC), sweet potato virus 2 (SPV2), sweet potato feathery mottle virus (SPFMV), sweet potato virus G(SPVG), and the crinivirus sweet potato chlorotic stunt virus (SPCSV). DsRNA fractions were extracted from symptomatic leaves and used as templates in single and multiplex RT-PCR assays using previously described specific primers for each analyzed virus. The amplified reaction products for SPVC, SPV2 and SPFMV were of expected size, and direct sequencing of PCR products revealed that they correspond to the coat protein gene (CP) and showed 98%, 99% and 99% identity, respectively, to those viruses. Comparison of the CP genomic and amino acid sequences of the Portuguese viral isolates recovered here with those of ten other sequences of isolates obtained in different countries retrieved from the GenBank showed very few differences. The application of the RT-PCR assays revealed for the first time the presence of SPVC and SPFMV in the sweet potato crop in Portugal, the absence of SPVG and SPCSV in tested plants, as well as the occurrence of triple virus infections under field conditions.

Concurrent multiple outbreaks of varicella, rubeola, german measles in unvaccinated children of co-educational mount carmel senior secondary school, thakurdwara palampur of northern himachal, India.

Background:In April, 2009, in a co-education school, we investigated suspected triple outbreak; varicella first and then with chance detection of rubeola and rubella. The aim was to confirm diagnosis and recommend remedial measures to prevent further outbreaks.Materials and Methods:We defined a case of varicella with maculopapulovesicular rash without other apparent cause in students or staff of the school and residents of neighboring villages of Khalet and Roady since 23rd March to 14th October, 2009. We line listed case patients and collected information on age, sex, residence, date of onset, symptoms, signs, traveling, treatment history, and vaccination status. The outbreak was described by time, place, and person characteristics. Diagnosis was confirmed epidemiologically and serologically; first to chickenpox, measles, and german measles viruses.Results:We identified 505 case patients from mixed outbreaks of varicella, measles, and german measles (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280. We investigated the suspected outbreak with case definition of varicella but measles 20/3280 (0.60%) and rubella 34/3280 (1.03%) cases were also observed. The overall attack rate (AR) was 15% while in school; it was 22% but highest (56%) in Nursery up to 4th standard with index case in first standard. Sex-specific AR was (23%) more in boys. Triple concurrent infection caused 05% complications but no death was reported. Severity of the symptoms was more in 5th standard onwards with 49–249 lesions and severer in poor villages Roady and Khalet (P < 0.05). Only 4% were immunized against varicella/german measles privately. Seventeen percent of the cases went for traditional treatment vs modern medicine (P < 0.001). 5/10 samples for IgM antibodies for chickenpox and 2/10 samples were positive for rubella.Conclusions:Triple infection of varicella, measles, and rubella was confirmed epidemiologically and serologically. We recommended local authorities for MMRV in the school and near villages with aggressive IEC activities in affected areas.

Triple Co-Infection of Malaria, Dengue and Hepatitis E- a Rare Entity: Case Report

Concurrent malaria and dengue infection have been reported, but concurrent infection with malaria, dengue & hepatitis E is very rare. We are going to report a case of triple co infection, which presented in emergency with fever, shock and multiorgan dysfunction.

Human immunodeficiency virus and viral hepatitis among high-risk groups: Understanding the knowledge gap in the Middle East and North Africa Region.

To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners. We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors' replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies. HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis among male sex workers selling or exchanging sex for money. The MENA countries are in urgent need of advanced research and strengthening of the data collection systems and reporting practices of these infections among key populations.