Volume 32, Issue 4, 2024
Editorial
Pregnancy Loss, Oropouche Virus and the Lessons from Pernambuco, Brazil
Srivastava Shriyansh,
Sharma Dheeraj,
Kumar Sachin,
Mali Suraj N.,
Mehta Rachana ,
Apostolopoulos Vasso,
Sah Ranjit,
do Socorro Souza Chaves Tania,
Luna Camila,
Rodriguez-Morales Alfonso J.
Not available
Review
Crimean-Congo haemorrhagic fever (CCHF): present and future therapeutic armamentarium
Di Bella Stefano,
Babich Stella,
Luzzati Roberto,
Cavasio Rosario Alessandro,
Massa Barbara,
Braccialarghe Neva,
Zerbato Verena,
Iannetta Marco
Crimean-Congo haemorrhagic fever (CCHF) is an emerging severe tick-borne illness. The expanding habitat of Hyalomma ticks, coupled with migratory birds harbouring CCHF-infected ticks, contributes to an increasing number of potential hosts. The seroprevalence of anti-CCHF virus antibodies in livestock is approximately one-quarter, with a noticeable upward trend in recent years. The management of CCHF patients predominantly relies on supportive therapy, although a potential arsenal of antivirals, convalescent and hyperimmune plasma, monoclonal antibodies, and vaccines exists, both currently and in the future. This review aims to critically examine the current therapeutic approaches to managing CCHF, highlighting both the potential and limitations of existing treatments, and identifying future directions for improving patient outcomes.
Yellow Fever: Global Impact, Epidemiology, Pathogenesis, and Integrated Prevention Approaches
Srivastava Shriyansh,
Dhoundiyal Shivang,
Kumar Sachin,
Kaur Awaneet,
Khatib Mahalaqua Nazli,
Gaidhane Shilpa,
Zahiruddin Quazi Syed,
Mohanty Aroop,
Henao-Martinez Andres F.,
Krsak Martin,
Rodriguez-Morales Alfonso J.,
Montenegro-Idrogo Juan J.,
Bonilla-Aldana D. Katterine,
Sah Ranjit
Yellow fever poses a substantial global health concern as one of the re-emerging diseases with pandemic potential in a scenario of the worldwide distribution of some vectors (such as Aedes aegypti); in the context of climatic change, an unclear knowledge about the immune behaviour of the virus, between other determinants. This review details the historical foundations, intricate evolution of geographical spread, and transmission mechanisms of the disease to understand the behaviour of outbreaks over time in a multifactorial context that could be difficult to understand. This article approaches to epidemiological, pathophysiological, immunological, social determinants, and climatic crisis by understanding possible control mechanisms and anticipating potential future epidemics. This article explores the evidence of yellow fever virus (YFV) pathogenesis and its complex interactions with the immune response in the host, the vector, and in the context of immunisation. These discussions contribute to a more comprehensive understanding of the disease’s progression. Despite the global presence of the vector and other factors that could facilitate an epidemic spread, yellow fever outbreaks have remained confined to specific endemic areas. This limited distribution is not entirely understood. However, it may be influenced by the complex immune interactions between the virus, the vector, and the host, preventing its spread to other regions.
Infectious disease outbreaks in the wake of natural flood disasters: global patterns and local implications
Acosta-España Jaime David,
Romero-Alvarez Daniel,
Luna Camila,
Rodriguez-Morales Alfonso J.
Climate change is an urgent global health challenge, with floods becoming increasingly frequent and exacerbating the spread of infectious diseases. With its diverse climates and recurring natural disasters, Latin America is particularly susceptible to outbreaks following floods. These events disrupt ecosystems and create ideal conditions for the spread of waterborne and vector-borne pathogens. Floods also damage infrastructure, displace populations, and restrict access to clean water and healthcare services, further compounding public health risks. This review assesses the impact of floods on infectious disease outbreaks in Latin America, focusing on key epidemiological trends, vulnerabilities, and strategies for mitigation. This narrative review aims to analyse the incidence and transmission of infectious diseases during and after floods in Latin America. Particular emphasis is placed on waterborne diseases, such as cholera and leptospirosis, vector-borne diseases, including dengue and malaria, and respiratory infections in displaced populations. The review also considers how socioeconomic factors, healthcare limitations, and climate vulnerabilities amplify the public health risks in flood-affected regions. We extensively searched PubMed, Google Scholar, Scopus, Science Direct, and Web of Science from 2010 to May 2024, examining articles in English, Spanish, and Portuguese. The search focused on original descriptive studies on flooding and infectious diseases, particularly in Latin America. Keywords such as ‘flooding,’ ‘waterborne diseases,’ ‘vector-borne diseases,’ ‘skin and soft tissue infections,’ ‘respiratory infections,’ and specific disease names like leishmaniasis and malaria were employed. A descriptive analysis of the relevant articles was performed to synthesise the key findings. The results show a clear association between floods and infectious disease outbreaks in several countries. Waterborne diseases, especially cholera and leptospirosis, are frequently reported following floods due to contaminated water. Vector-borne diseases like dengue and malaria see increased transmission as stagnant water forms ideal breeding grounds for mosquitoes. Respiratory infections are also prevalent in overcrowded, unsanitary shelters for displaced populations. Additionally, fungal infections and skin diseases are notable concerns, especially in areas with prolonged exposure to floodwaters. Floods disproportionately affect vulnerable populations, particularly low-income areas with insufficient infrastructure and limited healthcare access. Climate change is likely to intensify the frequency and severity of floods further, increasing the health risks. Finally, this review underscores the critical need for improved disaster preparedness, enhanced healthcare infrastructure, and better water and sanitation systems in flood-prone regions. Strengthening public health interventions and implementing climate adaptation strategies are essential to mitigating the impact of infectious diseases in future flood events.
Updated WHO list of emerging pathogens for a potential future pandemic: Implications for public health and global preparedness
Ukoaka Bonaventure Michael,
Okesanya Olalekan John,
Daniel Faithful Miebaka,
Ahmed Mohammed Mustaf,
Udam Ntishor Gabriel,
Wagwula Precious Miracle,
Adigun Olaniyi Abideen,
Udoh Raphael Augustine,
Peter Iniubong Godswill,
Lawal Haleema
Historically, pandemics constitute a major nuisance to public health. They have a debilitating impact on global health with previous occurrences causing major mortalities worldwide. The adverse outcomes are not limited to health outcomes but ravage the social, economic, and political landscapes. The World Health Organization (WHO) stands at the front of the pandemic response, strategizing to contain and mitigate the impacts on humans and the environment. It also intervenes in regional disease outbreaks that pose a threat to global health through strategic technical guidance, resource allocations, and expert support. With emerging pathogens, and in the aftermath of the COVID-19 pandemic, discussions are currently underway on global preparedness for a potential future pandemic. The effects of previous pandemics underscore the need to improve global health preparedness for upcoming pandemics. The WHO’s July 2024 updated list of emerging pathogens serves as a potential tool to foster global health readiness for a future pandemic. It represents a change in the world’s approach to emerging and re-emerging pathogens, shifting focus from specific pathogens to adopting a broader family-focused approach. This new list recognizes the shortcomings of previous lists and adopts a more forward-thinking, proactive, and flexible approach to dealing with familiar and unfamiliar pandemic risks, now incorporating ‘Prototype Pathogens’ and ‘Pathogen X’ into its risk classification. The WHO has set the pace, developing tools and guidelines for practice. This updated list of high-priority pathogens seeks to gear research and development toward combating and neutralizing the virulence of these pathogens. Recent outbreaks of Cholera, Mpox, and Dengue fever in Africa, Avian influenza (H5N2) in Mexico, Nipah virus disease in Bangladesh, and Oropouche virus in the Americas necessitate intensifying regional disease surveillance Research organizations and institutions must prioritize incorporating these tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies in the Preparedness and Resilience for Emerging Threats (PRET) Initiative as outlined by WHO.
RSV vaccination as the optimal prevention strategy for older adults
Andreoni Massimo,
Bonanni Paolo,
Gabutti Giovanni,
Maggi Stefania,
Siliquini Roberta,
Ungar Andrea
Respiratory syncytial virus (RSV) is a respiratory virus that usually causes mild upper respiratory tract symptoms. However, it can lead to a severe lower respiratory tract disease in high-risk populations, with severe complications such as pneumonia and respiratory failure. RSV poses a significant public health threat not only to children, but also to adults, particularly those over 75 years of age and individuals with comorbidities. The high incidence and severity of RSV infections in these vulnerable groups highlights the urgent need for effective preventive strategies. Despite advancements in the clinical management of respiratory infections, preventing RSV remains a significant challenge. The symptoms of RSV are often underestimated and misdiagnosed due to their similarity to other respiratory infections like influenza and COVID-19. This leads to a substantial disease burden not only for patients but also for healthcare systems, due to increased hospitalizations and prolonged treatments. In recent years, there has been a significant progress in the development of RSV vaccines, offering new hope for disease prevention. Our aim is to promote RSV vaccination, emphasizing the importance of large-scale prevention efforts to enhance the quality of life for atrisk individuals and optimize healthcare resource allocation. This paper will report efficacy and safety data for the three main vaccines currently available for healthcare practitioners, providing a comprehensive and balanced overview of vaccine options and supporting informed decision-making by healthcare professionals and regulatory authorities.
Original article
Clinical and epidemiological aspects of spondylodiscitis in a tertiary care hospital in South India
Thimmappa Latha,
Hebbar Saraswathi,
Bhat Shyamasunder N
This study aims to bridge the informational gap regarding the clinical and epidemiological aspects of spondylodiscitis in India, addressing the dearth of substantial evidence in this domain. This study was conducted in a tertiary care hospital over three years, involving 145 adult patients diagnosed with spondylodiscitis. Among them, 28 (19.3%) had Brucellar spondylodiscitis with a younger mean age of 40.1 years, 76 (52.4%) had tubercular spondylodiscitis with a higher mean age of 50.7 years, and 27 (18.6%) had pyogenic spondylodiscitis. Common symptoms included pain while walking (82.1% Brucellar, 93.4% TB, 77.8% pyogenic), fever (39.3% Brucellar, 38.2% TB, 33.3% pyogenic), and limb weakness (25% Brucellar, 46.1% TB, 66.7% pyogenic). CRP (mg/L) levels were elevated in Brucellar (mean 58.75) and pyogenic (mean 60.4) spondylodiscitis patients, with debridement and decompression performed in 50% Brucellar, 55.3% tubercular, and 70.4% pyogenic patients. The study reveals the clinical and epidemiological aspects of spondylodiscitis in South India, contributing to the enrichment of existing knowledge in diagnosis and management.
Evaluation of a training program on hand hygiene for healthcare workers in a second-level hospital in southern Italy during the COVID-19 pandemic
D’Agostino Federica,
Bonanno Ester,
Di Santo Giovanni,
Di Santo Danilo S.,
Lamberti Marcello,
de Waure Chiara
Background: Health care-associated infections (HAIs), albeit being the most frequent adverse event in health care, are mostly preventable through hand hygiene (HH). Given the extremely low HH compliance among healthcare workers (HCWs), educational initiatives aimed at this group are crucial. This study used an ultraviolet (UV)-based technology to assess the efficacy of an educational and training program on HH for HCWs in a second-level hospital in southern Italy.
Methods: A quasi-experimental study was conducted between November 2020 and February 2022. Participants were asked to rub their hands with an UV-labelled disinfectant solution before having digital images of both sides of their hands taken under UV-A light, using a device that recorded the solution’s distribution on each surface before and after the training session. The instrument recorded the percentage of surface covered (quantitative data) for each measurement along with the eventual passing of the 95% threshold (qualitative data).
Results: Following the training session, we observed a significant increase in the number of valid procedures as well as the mean coverage (expressed as the percentage of surface covered) for each surface examined. From 16.9% in the pre-interventional phase to 48.7% in the post-interventional phase, the percentage of HCWs who exceeded the 95% threshold on both sides of hands
increased significantly (p<0,001).
Conclusions: The findings of our study show that the training intervention was effective in raising participants HH performance. Secondly, they suggest that giving HCWs immediate visual feedback on their progress throughout the learning process could help increase HH adequacy.
Pediatric invasive pneumococcal disease in Bolívar, Colombia: a descriptive cross-sectional study
Rodríguez Wilfrido Coronell,
Mora-Salamanca Andrés Felipe,
Santacruz-Arias José,
Alvarado-Gonzalez Juan Carlos,
Saavedra Laura,
Pinzón-Redondo Hernando,
Alvis-Guzmán Nelson Rafael,
Alvis-Zakzuk Nelson Rafael,
Zakzuk Josefina
Introduction: Invasive pneumococcal disease (IPD) remains a pediatric health challenge despite national vaccination efforts in Colombia. We described the socio-demographic, epidemiological, and clinical characteristics of children (<18 years of age) with IPD at a pediatric reference center in Bolívar, Colombia.
Methods: Descriptive cross-sectional study of all pediatric patients (under 18 years of age) diagnosed with IPD between 2016 and 2023. Data was collected retrospectively from medical records. IPD was defined as identifying Streptococcus pneumoniae (Spn) in blood, cerebrospinal, pleural, synovial, peritoneal, or pericardial fluid. Spn serotyping data was provided by the Colombian National Institute of Health. Descriptive statistics were performed to describe all variables.
Results: Between 2016-2023, we identified fifty-four pediatric IPD cases. Most cases were reported among children in the 2-9 age group (44.4%), male sex (57.4%), low socio-economic strata (100%), and previous medical conditions (61.1%). Half of the patients were vaccinated. Serotyping data were available from 35 (64.8%) isolates. Fifteen Spn serotypes were identified, Spn19A being the most frequent (20.4%). All Spn isolates were vancomycin sensitive, while 34% had meropenem-decreased sensitivity. Three-quarters of the patients (76.0%) were diagnosed with bacteremia (bacteremic pneumonia/meningitis and bacteremia without known focus). The 79.6% of children were admitted to the pediatric intensive care unit (PICU). The median hospitalization days were 13.5 (IQR 5.5-23.5) while the median PICU length of stay was 9.5 (IQR 4-18) days. Nineteen patients died (35.2%).
Conclusion: IPD disproportionately affects vulnerable children, resulting in high PICU admission and mortality rates and prolonged hospital stay in Bolívar, Colombia. In addition, the emergence of resistance to carbapenems is of concern.
Single dose ivermectin for scabies pre-emptive therapy among healthcare workers in Careggi University Hospital, Florence, Italy
Paggi Riccardo,
Pozzi Marco,
Borchi Beatrice,
Mantengoli Elisabetta,
Bandini Giulia,
Ipponi Alessandra,
Chiarelli Annarita,
Paolini Diana,
Cecchi Michele,
Arcangeli Giulio,
Niccolini Fabrizio,
Moggi Pignone Alberto,
Bartoloni Alessandro,
Zammarchi Lorenzo
Introduction: Scabies is a neglected disease that cause outbreaks in facilities such as hospitals and prisons. In Europe, treatment with 2 doses of ivermectin 200 mcg/kg, 7 days apart, is authorised and recommended especially in population mass treatment. We describe the management of a mass pre-emptive therapy of primary contacts of a confirmed case of classic scabies among health care workers.
Patients and Methods: Hospital personnel were evaluated, and at-risk contacts were treated with oral ivermectin 200 mcg/kg single dose if asymptomatic. Hospital staff were called after 7, 30, and 60 days after the first visit to assess presence of adverse drug reactions (ADRs) or symptoms compatible with scabies.
Results: Among 27 patients evaluated, 19/27 (70.4%) received single dose ivermectin for scabies pre-emptive therapy. A total of 11/13 patients were nurses, and 8/14 were healthcare assistants. A total of 87 tablets of ivermectin were administered, with a total cost of 423.69 euros. Two people reported ADRs at 7 days; one and two patients reported possible ADRs at 30 and 60 days, respectively. The efficacy in preventing scabies was 100%.
Discussion and conclusions: To our knowledge, this is the first Italian experience in which a single dose of ivermectin has been implemented for mass pre-emptive therapy in asymptomatic primary contacts of classical scabies, showing excellent efficacy of the drug even when used as a single dose
Performance of the T-SPOT.TB test in patients with indeterminate QuantiFERON-TB Gold Plus results: proposal for an algorithm for the diagnosis of Latent Tuberculosis Infection
Pagnoncelli Monica,
Arosio Marco,
Genovesi Alessandro,
Napolitano Gavino,
Farina Claudio
Latent Tuberculosis Infection (LTBI) is a state of persistent immune response to Mycobacterium tuberculosis complex antigens without clinical, radiological and microbiological signs of active disease. Effective diagnosis and preventive treatment of LTBI are crucial for tuberculosis (TB) control, especially in high-risk groups. Currently, two main tests are used for LTBI diagnosis: the Tuberculin Skin Test (TST) and the Interferon- Gamma Release Assays (IGRA), including the QuantiFERON-TB Gold Plus (QFT-Plus) and the T-SPOT.TB. Our study evaluated the performance of the T-SPOT.TB test in patients with indeterminate QFT-Plus results, using data from the Clinical Microbiology and Virology Laboratory (M&V) of Papa Giovanni XXIII Hospital in Bergamo, Italy. Blood samples from patients tested for LTBI with QFT-Plus from January 1, 2017 to May 15, 2024 were analyzed. The QFT-Plus is the most widely used test in routine diagnostics for LTBI screening due to the availability of automated systems. Out of 20,995 samples tested with QFT-Plus, 576 (2.7%) gave indeterminate results. In all cases of indeterminate QFT-Plus results, M&V recommends performing the T-SPOT.TB test. However, of the 576 patients who obtained an indeterminate outcome, only 137 (23.8%) followed the indication.
The T-SPOT.TB provided a definitive result in 87.6% of the cases, resolving 120 (80 negative and 40 positive) of 137 indeterminate QFT-Plus outcomes. Specifically, 78 of 92 cases, equal to 84.8%, were settled when the T-SPOT. TB test was performed within 30 days of the QFT-Plus. The T-SPOT.TB test has shown potential effectiveness in addressing indeterminate QFT-Plus results (84.8% resolution), indicating its possible role as a complementary diagnostic tool for LTBI. The proposed algorithm for LTBI screening is based on national and international guidelines recommending the use of the TST and/or an IGRA test for individuals at risk. However, it particularly emphasizes the use of QFT-Plus, due to its practicality and rapid execution, while recommending the addition of the T-SPOT.TB within 30 days in cases of indeterminate QFT-Plus results. Nevertheless, the conclusions should be regarded as preliminary and require confirmation through larger or controlled studies.
Case report
Pasteurella multocida prosthetic joint infection. A case report and review of the literature
Lagadinou Maria,
Antzoulas Panagiotis,
Eleftherakis Georgios,
Chatzigrigoriadis Christodoulos,
Amerali Marina,
Michailides Christos,
Zampakis Petros,
Leonidou Leonidia,
Marangos Markos
Pasteurella multocida is a Gram-negative coccobacillus that is a part of normal oral flora of animals, especially cats and dogs. It is the most common causative agent for soft tissue infections following a bite or scratch from domestic pets. Prosthetic Joint Infections (PJIs) due to Pasteurella multocida are rarely but increasingly reported. Since 1992, only a few cases of PJIs caused by P. multocida have been described. Herein we present a case of a 67-year-old immunocompetent elderly female who developed total hip arthroplasty infection due to P. multocida and was treated successfully with left hip washout, pseudo-tumor removal, and intravenous antibiotics and a review of the literature on prosthetic joint infections caused by P. multocida since 1992.
Leprosy with subsequent type 2 reaction masquerading as cutaneous tuberculosis: a case report and diagnostic pitfalls in a non-endemic area
Alnimr Amani M,
Alsharari Mohammad A,
Alabkari Fatemah M,
Alsalem Fatemah A,
AlShehail Bashayer M,
Alhajri Mashael,
AlKhaleefah Qasim S,
Alwazzeh Marwan J
Leprosy, a chronic infectious disease caused by Mycobacterium leprae complex, remains a significant global health concern despite being curable with multidrug therapy. Delayed diagnosis is common, particularly in non-endemic regions or when presenting with atypical symptoms. This can lead to missed opportunities for early intervention, potential disabilities, and increased transmission. Misdiagnosis is often compounded by leprosy’s ability to mimic other conditions, as illustrated in this case report. We present a 43-year-old Filipino woman residing in Eastern Saudi Arabia, who presented to a dermatology clinic with a four-year history of recurrent skin rashes and a one-year history of painful, itchy nodules on her shins. She denied any systemic symptoms, recent travel, or known tuberculosis (TB) contact. Physical examination revealed multiple erythematous nodules on her shins with hyperpigmentation, but no lymphadenopathy or other skin lesions. Initial laboratory tests, including blood counts, liver and kidney function, inflammatory markers, and HIV screening, were normal. Chest X-ray was unremarkable. The patient’s clinical presentation and laboratory results led to a provisional diagnosis of extrapulmonary TB, and she was started on anti-TB treatment. However, her condition did not improve after several months of treatment. A skin biopsy was performed, and histopathological examination revealed granulomatous inflammation with acid-fast bacilli, raising suspicion for leprosy. Subsequent culture of the skin biopsy unexpectedly yielded Mycobacterium leprae, confirming the diagnosis of lepromatous leprosy. The case study highlights the diagnostic challenges associated with leprosy, especially in non-endemic regions. The patient’s atypical presentation, lack of systemic symptoms, and the unexpected growth of M. leprae in cell-free culture media contributed to the initial misdiagnosis and delayed treatment. Early suspicion, prompt skin biopsy, and appropriate culture techniques are crucial for accurate diagnosis and timely initiation of effective therapy to prevent disability and transmission. This case also underscores the importance of considering leprosy as a differential diagnosis in patients presenting with atypical skin lesions, even in non-endemic areas. Continued awareness and education among healthcare providers are essential to improve early recognition and management of this treatable disease.
The Infections in the History of Medicine
A brief history of Guinea worm research in the modern period, 1698-1931
Roberts Jonathan David
Guinea worm is a debilitating waterborne parasitic disease with a long history. This paper examines the ways guinea worm was understood in English-language scientific literature between 1688 and 1931. In the early eighteenth century, guinea worm was principally understood by English-speaking physicians as an exotic wonder of faraway lands. It became viewed as an African disease over the course of the eighteenth century, as transatlantic slavery exposed enslaved Africans to infection with the worm. Worms acquired in West Africa often emerged after arrival to the Caribbean, where the disease briefly established local transmission. However, British medicine only began to take any significant interest in guinea worm in the early nineteenth century, as British and British-employed troops in India began to contract the worm. This resulted in knowledge and specimens of guinea worm travelling to Britain, where they were used to develop the new science of zoology through the nineteenth century. Zoologists elsewhere, particularly in Germany, benefitted from British-Indian knowledge, which allowed Russian parasitologist Alexei Fedchenko to discover the full mechanism of guinea worm’s transmission in Samarkand. This zoological knowledge, and zoological view of guinea worm, was then incorporated into the emerging tropical medicine of the 1890s and twentieth century. A long history of guinea worm therefore provides important insights into the circulation of knowledge along imperial networks, and into the history of tropical medicine and parasitology.
