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Perez-Restrepo LS, Ciuoderis K, Usuga J, Moreno I, Vargas V, Arévalo-Arbelaez AJ, Berg MG, Cloherty GA, Hernández-Ortiz JP, Osorio JE. Mayaro Virus as the cause of Acute Febrile Illness in the Colombian Amazon Basin. Front Microbiol 2024; 15:1419637. [PMID: 39044955 PMCID: PMC11263195 DOI: 10.3389/fmicb.2024.1419637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction Mayaro Fever (MF) is a tropical disease caused by the Mayaro virus (MAYV), with outbreaks documented in Latin America. Methods A hospital-based fever surveillance in Leticia, Colombian Amazon, collected sera from 1,460 patients aged 5-89 between December 2020 and April 2023. Results Dengue and malaria were the main diagnoses (19.4 and 5.8%, respectively), leaving 71.4% of cases unidentified after testing. Metagenomic sequencing and real-time RT-qPCR testing identified MAYV in two patients (25-year-old male and an 80-year-old female) exhibiting typical symptoms, of MF including rash, joint pain, and fever. Phylogenetics analysis of these two viruses revealed a close relationship to Peruvian strains within the MAYV D genotype. Discussion The study of AFI in Leticia, Colombia, identified dengue as prevalent, with malaria, COVID-19, Influenza, and Zika viruses also detected. Despite extensive testing, most cases remained unexplained until metagenomic sequencing revealed MAYV, previously unseen in Colombia but known in neighboring countries. Conclusion This study presents the first near full-length genomes of MAYV in Colombia, highlighting the need for further seroprevalence studies and enhanced surveillance to understand and control the spread of the virus in the region.
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Affiliation(s)
- Laura S. Perez-Restrepo
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Karl Ciuoderis
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Jaime Usuga
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Isabel Moreno
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Vanessa Vargas
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Angela J. Arévalo-Arbelaez
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
| | - Michael G. Berg
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | - Gavin A. Cloherty
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, IL, United States
| | - Juan Pablo Hernández-Ortiz
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
- Faculty of Life Sciences, Universidad Nacional de Colombia, Medellín, Colombia
| | - Jorge E. Osorio
- GHI One Health Colombia, Universidad Nacional de Colombia, Medellín, Colombia
- Abbott Pandemic Defense Coalition, Chicago, IL, United States
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States
- Global Health Institute, University of Wisconsin, Madison, WI, United States
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Ghimire M, Risal UP, Bhandari R. Over-the-counter Medication Use among Patients Presenting with Fever in the Emergency Department in a Tertiary Care Hospital. JNMA J Nepal Med Assoc 2024; 62:30-33. [PMID: 38410010 PMCID: PMC10924499 DOI: 10.31729/jnma.8401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 02/28/2024] Open
Abstract
Introduction Over-the-counter medication use is commonly practised all over the world. However, in a developing country like Nepal, antibiotics form an essential component of OTC drugs. Fever is one of the most common clinical complaints which makes a patient go to the local pharmacy for over-the-counter medication. This study aimed to find out the prevalence of over-the-counter medication use among patients presenting with fever in the Emergency Department in a tertiary care hospital. Methods This descriptive cross-sectional study was conducted among patients who visited the Emergency Department with the complaint of at least one episode of documented or undocumented fever after obtaining ethical approval from the Institutional Review Committee. Data collection was conducted from 24 June 2022 to 30 September 2022. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 332 patients, 314 (94.58%) (92.14-97.02, 95% Confidence Interval) patients used over-the-counter medication. Antibiotic use was seen in 221 (70.38%) patients. Conclusions The prevalence of over-the-counter medication use among patients with fever was found to be higher than the studies conducted in similar studies. Keywords emergency departments; fever; prevalence.
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Affiliation(s)
- Mrikchhya Ghimire
- Department of General Practice and Emergency Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Ujjwol Prasad Risal
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Rabin Bhandari
- Department of General Practice and Emergency Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
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Silva-Ramos CR, Gil-Mora J, Serna-Rivera CC, Martínez Díaz HC, Restrepo-López N, Agudelo-Flórez P, Arboleda M, Díaz FJ, Faccini-Martínez ÁA, Hidalgo M, Melby PC, Aguilar PV, Cabada MM, Tobón-Castaño A, Rodas JD. Etiological characterization of acute undifferentiated febrile illness in Apartadó and Villeta municipalities, Colombia, during COVID-19 pandemic. LE INFEZIONI IN MEDICINA 2023; 31:517-532. [PMID: 38075419 PMCID: PMC10705856 DOI: 10.53854/liim-3104-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/02/2023] [Indexed: 03/28/2024]
Abstract
Background Acute undifferentiated febrile illness (AUFI) is one of the leading causes of illness in tropical regions. Although malaria is the most important cause, other pathogens such as Dengue (DENV), Leptospira and recently, Coronavirus Disease 2019 (COVID-19) have gained importance. In Colombia, few studies aimed to identify the etiology of AUFI. Most of them performed in Apartadó and Villeta municipalities, identifying the active circulation of several pathogens. Thus, we conducted a cross-sectional study in these municipalities to characterize the etiologies of AUFI during COVID-19 pandemic. Methods An active surveillance was conducted between September and December 2021 in local hospitals of Apartadó and Villeta municipalities. Febrile patients were enrolled after voluntarily agreeing to participate in the study. Ten different etiologies were evaluated through direct, serological, molecular and rapid diagnostic methods. Results In Apartadó a confirmed etiology was found in 60% of subjects, DENV (25%) being the most frequent, followed by leptospirosis (16.7%), malaria (10%), COVID-19 (8.3%), spotted fever group (SFG) rickettsiosis (6.7%) and Chikungunya (1.7%). In Villeta, a specific etiology was confirmed in 55.4% of patients, of which SFG rickettsiosis (39.3%) was the most frequent, followed by leptospirosis (21.4%), DENV (3.6%) and malaria (1.8%). No cases due to Mayaro, Yellow Fever, Oropouche and Venezuelan Equine Encephalitis viruses were detected. Conclusion We confirm the relevance of dengue fever, leptospirosis, SFG rickettsiosis, COVID-19 and malaria as causes of AUFI in the municipality of Apartadó, and highlight the great importance of SFG rickettsiosis as the main cause of AUFI in the municipality of Villeta.
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Affiliation(s)
- Carlos Ramiro Silva-Ramos
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juliana Gil-Mora
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Cristian C. Serna-Rivera
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
| | - Heidy-C. Martínez Díaz
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Nicaela Restrepo-López
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
| | - Piedad Agudelo-Flórez
- Grupo de Investigación en Ciencias Básicas, Escuela de Graduados, Universidad CES, Medellín, Colombia
| | - Margarita Arboleda
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Francisco J. Díaz
- Grupo de Inmunovirología, Universidad de Antioquia, Medellin,Colombia
| | - Álvaro A. Faccini-Martínez
- Servicio de Infectología, Hospital Militar Central, Bogotá, Colombia
- Servicios y Asesorías en Infectología - SAI, Bogotá, Colombia
- Facultad de Medicina, Universidad Militar Nueva Granada, Bogotà, Colombia
| | - Marylin Hidalgo
- Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Peter C. Melby
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
| | - Patricia V. Aguilar
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Miguel M. Cabada
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Juan David Rodas
- Grupo de Investigación en Ciencias Veterinarias Centauro, Universidad de Antioquia, Medellín, Colombia
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Kigozi BK, Kharod GA, Bukenya H, Shadomy SV, Haberling DL, Stoddard RA, Galloway RL, Tushabe P, Nankya A, Nsibambi T, Mbidde EK, Lutwama JJ, Perniciaro JL, Nicholson WL, Bower WA, Bwogi J, Blaney DD. Investigating the etiology of acute febrile illness: a prospective clinic-based study in Uganda. BMC Infect Dis 2023; 23:411. [PMID: 37328808 PMCID: PMC10276394 DOI: 10.1186/s12879-023-08335-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Historically, malaria has been the predominant cause of acute febrile illness (AFI) in sub-Saharan Africa. However, during the last two decades, malaria incidence has declined due to concerted public health control efforts, including the widespread use of rapid diagnostic tests leading to increased recognition of non-malarial AFI etiologies. Our understanding of non-malarial AFI is limited due to lack of laboratory diagnostic capacity. We aimed to determine the etiology of AFI in three distinct regions of Uganda. METHODS A prospective clinic-based study that enrolled participants from April 2011 to January 2013 using standard diagnostic tests. Participant recruitment was from St. Paul's Health Centre (HC) IV, Ndejje HC IV, and Adumi HC IV in the western, central and northern regions, which differ by climate, environment, and population density. A Pearson's chi-square test was used to evaluate categorical variables, while a two-sample t-test and Krukalis-Wallis test were used for continuous variables. RESULTS Of the 1281 participants, 450 (35.1%), 382 (29.8%), and 449 (35.1%) were recruited from the western, central, and northern regions, respectively. The median age (range) was 18 (2-93) years; 717 (56%) of the participants were female. At least one AFI pathogen was identified in 1054 (82.3%) participants; one or more non-malarial AFI pathogens were identified in 894 (69.8%) participants. The non-malarial AFI pathogens identified were chikungunya virus, 716 (55.9%); Spotted Fever Group rickettsia (SFGR), 336 (26.2%) and Typhus Group rickettsia (TGR), 97 (7.6%); typhoid fever (TF), 74 (5.8%); West Nile virus, 7 (0.5%); dengue virus, 10 (0.8%) and leptospirosis, 2 (0.2%) cases. No cases of brucellosis were identified. Malaria was diagnosed either concurrently or alone in 404 (31.5%) and 160 (12.5%) participants, respectively. In 227 (17.7%) participants, no cause of infection was identified. There were statistically significant differences in the occurrence and distribution of TF, TGR and SFGR, with TF and TGR observed more frequently in the western region (p = 0.001; p < 0.001) while SFGR in the northern region (p < 0.001). CONCLUSION Malaria, arboviral infections, and rickettsioses are major causes of AFI in Uganda. Development of a Multiplexed Point-of-Care test would help identify the etiology of non-malarial AFI in regions with high AFI rates.
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Affiliation(s)
- Brian K Kigozi
- Uganda Virus Research Institute, Entebbe, Uganda.
- College of Health Sciences, Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.
| | - Grishma A Kharod
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - Sean V Shadomy
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Dana L Haberling
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Robyn A Stoddard
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | - Renee L Galloway
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - Annet Nankya
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Thomas Nsibambi
- Uganda Virus Research Institute, Entebbe, Uganda
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | | | | | - William A Bower
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
| | | | - David D Blaney
- CDC Division of High-Consequence Pathogens and Pathology, Atlanta, USA
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Kavirayani V, Madiyal M, Aroor S, Chhabra S. Clinical profile and role of serology in pediatric acute febrile illness: Experience from a tertiary care hospital in South India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chen Y, Mah MG, Low JG, Ooi EE, Su YC, Moorthy M, Smith GJ, Linster M. Etiology of febrile respiratory infections in the general adult population in Singapore, 2007-2013. Heliyon 2021; 7:e06329. [PMID: 33665466 PMCID: PMC7907478 DOI: 10.1016/j.heliyon.2021.e06329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Pathogens that cause upper respiratory infections are numerous and specific preventive and therapeutic strategies are scarce. In order to ascertain the etiological agents resulting in upper respiratory tract infections (URTI) in adults in Singapore, nasal swab samples were collected from 2057 patients presenting with fever at primary healthcare clinics in Singapore from December 2007 to February 2013. Samples were tested using the Luminex NxTAG Respiratory Pathogen Panel that includes 22 respiratory pathogen targets. Patient-reported symptoms and vital signs were recorded and full blood and differential counts taken. Pathogens were detected in the following order of frequency: influenza viruses, rhino-/enteroviruses, coronaviruses, parainfluenza viruses, pneumoviruses, adenovirus, bocavirus and C. pneumoniae. Fifteen virus species were detected as part of coinfections, in which rhinoviruses were the most commonly observed pathogen. Our results suggest that influenza viruses are the main etiological agents, but multiple other respiratory viruses contribute to the total burden of URTI in adults in Singapore.
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Affiliation(s)
- Yihui Chen
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Marcus G. Mah
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Jenny G.H. Low
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169856, Singapore
| | - Eng Eong Ooi
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yvonne C.F. Su
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Mahesh Moorthy
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Gavin J.D. Smith
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
- SingHealth Duke-NUS Global Health Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina 27708, USA
- Corresponding author.
| | - Martin Linster
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore
- Corresponding author.
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Kerr WT, Zhang X, Hill CE, Janio EA, Chau AM, Braesch CT, Le JM, Hori JM, Patel AB, Allas CH, Karimi AH, Dubey I, Sreenivasan SS, Gallardo NL, Bauirjan J, Hwang ES, Davis EC, D'Ambrosio SR, Al Banna M, Cho AY, Dewar SR, Engel J, Feusner JD, Stern JM. Factors associated with delay to video-EEG in dissociative seizures. Seizure 2021; 86:155-160. [PMID: 33621828 DOI: 10.1016/j.seizure.2021.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/23/2021] [Accepted: 02/12/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE While certain clinical factors suggest a diagnosis of dissociative seizures (DS), otherwise known as functional or psychogenic nonepileptic seizures (PNES), ictal video-electroencephalography monitoring (VEM) is the gold standard for diagnosis. Diagnostic delays were associated with worse quality of life and more seizures, even after treatment. To understand why diagnoses were delayed, we evaluated which factors were associated with delay to VEM. METHODS Using data from 341 consecutive patients with VEM-documented dissociative seizures, we used multivariate log-normal regression with recursive feature elimination (RFE) and multiple imputation of some missing data to evaluate which of 76 clinical factors were associated with time from first dissociative seizure to VEM. RESULTS The mean delay to VEM was 8.4 years (median 3 years, IQR 1-10 years). In the RFE multivariate model, the factors associated with longer delay to VEM included more past antiseizure medications (0.19 log-years/medication, standard error (SE) 0.05), more medications for other medical conditions (0.06 log-years/medication, SE 0.03), history of physical abuse (0.75 log-years, SE 0.27), and more seizure types (0.36 log-years/type, SE 0.11). Factors associated with shorter delay included active employment or student status (-1.05 log-years, SE 0.21) and higher seizure frequency (0.14 log-years/log[seizure/month], SE 0.06). CONCLUSIONS Patients with greater medical and seizure complexity had longer delays. Delays in multiple domains of healthcare can be common for victims of physical abuse. Unemployed and non-student patients may have had more barriers to access VEM. These results support earlier referral of complex cases to a comprehensive epilepsy center.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States.
| | - Xingruo Zhang
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Chloe E Hill
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Emily A Janio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Andrea M Chau
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Chelsea T Braesch
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Justine M Le
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jessica M Hori
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Akash B Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Corinne H Allas
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Ishita Dubey
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Norma L Gallardo
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Janar Bauirjan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Eric S Hwang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon R D'Ambrosio
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Mona Al Banna
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew Y Cho
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Sandra R Dewar
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Leptospiral Culture without 5'-Fluorouracil Revealed Improved Leptospira Isolation from Febrile Patients in North-Eastern Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041307. [PMID: 32085530 PMCID: PMC7068603 DOI: 10.3390/ijerph17041307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 11/17/2022]
Abstract
Objectives: Isolation of Leptospira by culture represents a definitive growth and confirmation of the disease, yet it is hampered with its nature of slow growth. With slight modification of culture method, the study aims to isolate and characterize Leptospira spp. from patients with acute febrile illness. Methods: A total of 109 blood samples were collected from patients with acute febrile illness that presented at the Emergency Department of Hospital Universiti Sains Malaysia, Malaysia. Clinical samples were subjected to Leptospira IgM Rapid test, microscopic agglutination test (MAT), isolation by culture method, and direct real-time PCR test. For leptospiral isolation, the samples (whole blood and deposit from spun plasma) were cultured into modified Ellinghausen McCullough Johnson Harris (EMJH) media with and without 5’-fluorouracil (5-FU). In every culture positive sample, partial 16S rRNA gene sequencing was performed for molecular identification of the isolates. Phylogenetic analysis was carried out to determine the genetic relatedness among the isolates. An inhibition of 5-FU study was performed on Leptospira interrogans serovar Canicola with different concentrations to compare the growth detection of the tested Leptospira with or without 5-FU within 7 days of incubation. Results: Leptospirosis was diagnosed in 14.7% of patients with acute febrile illness. Two Leptospira spp. (n = 2/109, 1.85%) were successfully isolated from whole blood and deposit from spun plasma samples. B004 and B208 samples were positive at day 11 and day 7, respectively, in EMJH media without addition of 5-FU. Sample B004 was identified as Leptospira interrogans and B208 as Leptospira weilli. Phylogenetic analysis confirmed that both of them were within pathogenic group and they were not related. The 5-FU inhibition study revealed that additional of 5-FU at final concentration of 200 µg/mL to EMJH media demonstrated an inhibitory effect on the growth of the tested strain Conclusion: Isolation of Leptospira spp. using EMJH media without addition of 5’-fluorouracil resulted in a better outcome. Two pathogenic Leptospira isolates were successfully cultivated from patients with acute febrile illness that were genetically not related.
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Gupta N, Mittal A, Kutty SV, Kumar A, Wig N. Technical and Alarm signs for referral in adult patients with acute febrile illness: A study from a tertiary care hospital in North India. J Family Med Prim Care 2018; 7:832-835. [PMID: 30234063 PMCID: PMC6132017 DOI: 10.4103/jfmpc.jfmpc_138_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context There is a huge burden of patients with acute febrile illness (AFI) during the post-monsoon season in India. It is very important to have a functioning triage system, whereby patients with high likelihood of developing a severe illness are referred to higher levels of care. Aim The objective of this study was to identify the alarm signs which would help in triaging of those patients with AFI without any specific diagnosis. Methods This was a retrospective review of records, whereby clinical and laboratory parameters of patients with AFI admitted in our tertiary care center between July 2016 and October 2016 were reviewed. Statistical Analysis Used Appropriate tests of significance were applied using SPSS 21(Chicago, IL, USA) to find statistically significant differences between those who required mechanical ventilation, intensive care, ionotropic support, or higher intravenous antibiotics and those who recovered with minimal supportive care. Results Presence of comorbidities, dyspnea, altered sensorium, features of myocarditis, hypotension, leukocytosis (>11,000/μL), and acute kidney injury were significantly associated with requirement of higher levels of care, while presence of arthralgia, serositis, and leucopenia indicated a higher likelihood of recovery with minimal support. Conclusion This article highlights the possibility of identification of simple alarm signs in patients with AFI which would indicate the need for higher levels of care.
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Affiliation(s)
- Nitin Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sharada V Kutty
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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