Aetiology and Potential Animal Exposure in Central Nervous System Infections in Vietnam

An estimated 73% of emerging infections are zoonotic in origin, with animal contact and encroachment on their habitats increasing the risk of spill-over events. In Vietnam, close exposure to a wide range of animals and animal products can lead to acquisition of zoonotic pathogens, a number of which cause central nervous system (CNS) infections. However, studies show the aetiology of CNS infections remains unknown in around half of cases. We used samples and data from hospitalised patients with CNS infections, enrolled into the Vietnam Initiative on Zoonotic Infections multicentre study, to determine the association between aetiology and animal contact including those in whom the cause was unknown. Among 933 patients, a pathogen or an antibody response to it was identified in 291 (31.2%, 95% CI 28.3-34.3%). The most common pathogens were Streptococcus suis (n = 91 (9.8%, 8.0-11.9%)) and Japanese encephalitis virus (JEV) (n = 72 (7.7%, 6.1-9.7%)). Commonly reported animal contact included keeping, raising or handling (n = 364 (39.0%, 35.9-42.2%)) and handling, cooking or consuming raw meat, blood or viscera in the 2 weeks prior to symptom onset (n = 371 (39.8%, 36.6-43.0%)), with the latter most commonly from pigs (n = 343 (36.9%, 33.8-40.1%). There was no association between an unknown aetiology and exposure to animals in a multivariate logistic regression. Further testing for unknown or undetected pathogens may increase diagnostic yield, however, given the high proportion of zoonotic pathogens and the presence of risk factors, increasing public awareness about zoonoses and preventive measures can be considered.

Efficient and fast degradation of 4-nitrophenol and detection of Fe(III) ions by Poria cocos extract stabilized silver nanoparticles

In this study, a simple and environment-friendly method has been successfully applied for the production of silver nanoparticles (AgNPs) using Poria cocos extract. The reaction time of 60 min, the temperature of 90 °C, and silver ion concentration of 2.0 mM were identified as the best condition for the PC-AgNPs fabrication. The XRD analysis confirmed a highly crystalline face-centered cubic structure of the biosynthesized material. The PC-AgNPs were presented separately in a spherical shape with an average crystal size of 20 nm, as endorsed by the TEM and FE-SEM measurements. The presence and crucial role of biomolecules in stabilizing the nanoparticles were elucidated by FTIR, EDX, and DLS techniques. The prepared biogenic nanoparticles were further applied for the reduction of 4-nitrophenol (4-NP) and colorimetric detection of Fe³⁺ ions. The study results proved that PC-AgNPs exhibited superior catalytic activity and reusability in the conversion of 4-NP by NaBH₄. The complete reduction of 4-NP could be achieved in 10 min with the pseudo-first-order rate constant of 0.466 min^-1, and no significant performance loss was found when the material was reused five times. The colorimetric probe based on PC-AgNPs displayed outstanding sensitivity and selectivity towards Fe³⁺ ions with a detection limit of 1.5 μM in a linear range of 0-250 μM. Additionally, the applicability of the developed assay was explored for testing Fe³⁺ ions in tap water. PC-AgNPs have a great potential for further applications as a promising catalyst for reducing nitrophenols and biosensors for the routine monitoring of Fe³⁺ in water.

Effective reduction of nitrophenols and colorimetric detection of Pb(ii) ions by Siraitia grosvenorii fruit extract capped gold nanoparticles

This study presents a simple and green approach for the synthesis of Siraitia grosvenorii fruit extract capped gold nanoparticles (SG-AuNPs). The SG-AuNPs samples prepared under the optimized conditions were characterized by various techniques (UV-Vis, XRD, FTIR, HR-TEM, EDX, DLS). The biosynthesized nanoparticles were then studied for the reduction of 2-nitrophenol (2-NP) and 3-nitrophenols (3-NP) and for colorimetric detection of Pb2+ ions. The characterization results revealed that the crystals of SG-AuNPs were spherical with an average size of 7.5 nm. The FTIR and DLS analyses proved the presence of the biomolecule layer around AuNPs, which played an important role in stabilizing the nanoparticles. The SG-AuNPs showed excellent catalytic activity in the reduction of 3-NP and 2-NP, achieving complete conversion within 14 min. The catalytic process was endothermic and followed pseudo-first-order kinetics. The activation energy was determined to be 10.64 and 26.53 kJ mol-1 for 2-NP and 3-NP, respectively. SG-AuNPs maintained high catalytic performance after five recycles. The fabricated material was also found to be highly sensitive and selective to Pb2+ ions with the detection limit of 0.018 μM in a linear range of 0-1000 μM. The practicality of the material was validated through the analyses of Pb2+ in mimic pond water samples. The developed nanoparticles could find tremendous applications in environmental monitoring.

Clinical and aetiological study of hand, foot and mouth disease in southern Vietnam, 2013-2015: Inpatients and outpatients

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Multiple serotypes of enterovirus A cause hand, foot and mouth disease in southern Vietnam.

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Clinical characteristics differed slightly between the different pathogen groups.

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CV-A6 and CV-A10 emerged in Vietnam in 2013–2015.

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An unexpected dominance of EV-A71 was found among both inpatients and outpatients.

Background

Hand, foot and mouth disease (HFMD) has been associated with large outbreaks among young children in the Asia-Pacific Region since 1997, including cases of severe illness and death. Severe illness is often associated with enterovirus A71 (EV-A71). Vietnam experienced a large sustained outbreak of 200 000 hospitalized cases and over 200 deaths in 2011–12, the large majority occurring in southern Vietnam.

Methods

A prospective observational study was conducted in the outpatient clinics, infectious diseases wards, and paediatric intensive care units of the three main referral centres for the treatment of HFMD in southern Vietnam. Demographic data, basic laboratory parameters, and clinical data were recorded, and molecular diagnostic tests were performed.

Results

Between July 2013 and July 2015, a total of 1547 children were enrolled. Four serotypes of enterovirus A (EV-A71, Coxsackievirus (CV) A6, A10, and A16) were responsible for 1005 of 1327 diagnosed cases (75.7%). An unexpected dominance of EV-A71 was found among both inpatients and outpatients, as well as a strong association with severe illness. CV-A6 and CV-A10 emerged in Vietnam during the study period and replaced CV-A16. CV-A10 was associated with different clinical and laboratory characteristics. During admission, 119 children developed a more severe illness. It was found that children with a skin rash showed less progression of severity, but when a rash was present, a macular rash was significantly associated with an increased risk of progression.

Conclusions

This study represents the most comprehensive descriptive HFMD study from Vietnam to date. Co-circulation and replacement of different serotypes has implications for vaccine development and implementation. These findings from a severely affected country add to our understanding of the presentation, progression, and aetiology of HFMD.

Appearance of reassortant European avian-origin H1 influenza A viruses of swine in Vietnam

Three subtypes-H1N1, H1N2 and H3N2-of influenza A viruses of swine (IAVs-S) are currently endemic in swine worldwide, but there is considerable genotypic diversity among each subtype and limited geographical distribution. Through IAVs-S monitoring in Vietnam, two H1N2 influenza A viruses were isolated from healthy pigs in Ba Ria-Vung Tau Province, Southern Vietnam, on 2 December 2016. BLAST and phylogenetic analyses revealed that their HA and NA genes were derived from those of European avian-like H1N2 IAVs-S that contained avian-origin H1 and human-like N2 genes, and were particularly closely related to those of IAVs-S circulating in the Netherlands, Germany or Denmark. In addition, the internal genes of these Vietnamese isolates were derived from human A(H1N1)pdm09 viruses, suggesting that the Vietnamese H1N2 IAVs-S are reassortants between European H1N2 IAVs-S and human A(H1N1)pdm09v. The appearance of European avian-like H1N2 IAVs-S in Vietnam marks their first transmission outside Europe. Our results and statistical analyses of the number of live pigs imported into Vietnam suggest that the European avian-like H1N2 IAVs-S may have been introduced into Vietnam with their hosts through international trade. These findings highlight the importance of quarantining imported pigs to impede the introduction of new IAVs-S.

Emergence of an exotic strain of serotype O foot-and-mouth disease virus O/ME-SA/Ind-2001d in South-East Asia in 2015

The O/Middle East-South Asia (ME-SA)/Ind-2001 lineage of foot-and-mouth disease virus (FMDV) is endemic in the Indian subcontinent and has been reported in the Middle East and North Africa, but it had not been detected in South-East Asia (SEA) before 2015. This study reports the recent incursions of this viral lineage into SEA, which caused outbreaks in Vientiane Capital of Lao People's Democratic Republic (PDR) in April 2015, in Dak Nong, Dak Lak and Ninh Thuan Provinces of Vietnam from May to October 2015, and in Rakhine State of Myanmar in October 2015. Disease investigations were conducted during the outbreaks and followed up after laboratory results confirmed the involvement of FMDV O/ME-SA/Ind-2001 sublineage d (O/ME-SA/Ind-2001d). Affected host species included cattle, buffalo and pig, and all the outbreaks resolved within 2 months. Animals with clinical signs were separated, and affected premises were disinfected. However, strict movement restrictions were not enforced, and emergency vaccinations were only implemented in Vientiane Capital of Lao PDR and Dak Nong and Ninh Thuan Provinces of Vietnam. Clinical samples were collected from each outbreak and examined by nucleotide sequencing of the FMDV viral protein 1 coding region. Sequence analysis revealed that the O/ME-SA/Ind-2001d isolates from Lao PDR and Vietnam were closely related to each other and similar to viruses previously circulating in India in 2013. Viruses collected from Myanmar were divergent from viruses of the same sublineage recovered from Lao PDR and Vietnam but were closely related to viruses present in Bangladesh in 2015. These findings imply that at least two independent introductions of O/ME-SA/Ind-2001d into SEA have occurred. Our study highlights the transboundary nature of foot-and-mouth disease (FMD) and reinforces the importance of improved FMD surveillance and promotion of safer cross-border trade in SEA to control the risk of introduction and spread of exotic FMDV strains.

An Integrative Analysis of Foot-and-Mouth Disease Virus Carriers in Vietnam Achieved Through Targeted Surveillance and Molecular Epidemiology

Foot-and-mouth disease (FMD) is a major constraint to transboundary trade in animal products, yet much of its natural ecology and epidemiology in endemic regions is still poorly understood. To address this gap, a multidisciplinary, molecular and conventional epidemiological approach was applied to an investigation of endemic FMD in Vietnam. Within the study space, it was found that 22.3% of sampled ruminants had previously been infected with FMD virus (FMDV), of which 10.8% were persistent, asymptomatic carriers (2.4% of the total population). Descriptive data collected from targeted surveillance and a farm questionnaire showed a significantly lower prevalence of FMDV infection for dairy farms. In contrast, farms of intermediate size and/or history of infection in 2010 were at increased risk of FMD exposure. At the individual animal level, buffalo had the highest exposure risk (over cattle), and there was spatial heterogeneity in exposure risk at the commune level. Conversely, carrier prevalence was higher for beef cattle, suggesting lower susceptibility of buffalo to persistent FMDV infection. To characterize virus strains currently circulating in Vietnam, partial FMDV genomic (VP1) sequences from carrier animals collected between 2012 and 2013 (N = 27) and from FMDV outbreaks between 2009 and 2013 (N = 79) were compared by phylogenetic analysis. Sequence analysis suggested that within the study period, there were two apparent novel introductions of serotype A viruses and that the dominant lineage of serotype O in Vietnam shifted from SEA/Mya-98 to ME-SA/PanAsia. FMDV strains shared close ancestors with FMDV from other South-East Asian countries indicating substantial transboundary movement of the predominant circulating strains. Close genetic relationships were observed between carrier and outbreak viruses, which may suggest that asymptomatic carriers of FMDV contribute to regional disease persistence. Multiple viral sequences obtained from carrier cattle over a 1-year period had considerable within-animal genetic variation, indicating within-host virus evolution.

Limited geographic distribution of the novel cyclovirus CyCV-VN

A novel cyclovirus, CyCV-VN, was recently identified in cerebrospinal fluid (CSF) from patients with central nervous system (CNS) infections in central and southern Vietnam. To explore the geographic distribution of this novel virus, more than 600 CSF specimens from patients with suspected CNS infections in northern Vietnam, Cambodia, Nepal and The Netherlands were screened for the presence of CyCV-VN but all were negative. Sequence comparison and phylogenetic analysis between CyCV-VN and another novel cyclovirus recently identified in CSF from Malawian patients indicated that these represent distinct cycloviral species, albeit phylogenetically closely related. The data suggest that CyCV-VN has a limited geographic distribution within southern and central Vietnam. Further research is needed to determine the global distribution and diversity of cycloviruses and importantly their possible association with human disease.

Phylogenetic and phylogeographic analyses of porcine circovirus type 2 among pig farms in Vietnam

This study demonstrated the prevalence of Porcine circovirus type 2 (PCV2) among pig farms in Vietnam. Analyses of the genome, capsid protein and phylogeny classified all 30 Vietnamese PCV2 strains as the PCV2b genotype, belonging to the clusters of 1A, 1B, 1C and recombinant forms. Each viral genome was 1767 nucleotides long and shared 96.0-100% nucleotide sequence identity. The amino acid substitutions in the capsid protein of the Vietnamese PCV2 strains were in immunodominant regions, and the majority of strains (24/30) contained a lysine extension at the C-terminus. Bayesian phylogeographic analysis revealed epidemic links of the PCV2 recombinant cluster within and among countries, which supports a circulating recombinant form of PCV2. Further analysis by the Jameson-Wolf antigenic index indicated antigenic alterations at important sites in the capsid protein (sites 131-133) among the recombinant cluster and the other clusters of PCV2b.

Viral etiology of encephalitis in children in southern Vietnam: results of a one-year prospective descriptive study

BACKGROUND

Acute encephalitis is an important and severe disease in children in Vietnam. However, little is known about the etiology while such knowledge is essential for optimal prevention and treatment. To identify viral causes of encephalitis, in 2004 we conducted a one-year descriptive study at Children's Hospital Number One, a referral hospital for children in southern Vietnam including Ho Chi Minh City.

METHODOLOGY/PRINCIPAL FINDINGS

Children less than 16 years of age presenting with acute encephalitis of presumed viral etiology were enrolled. Diagnostic efforts included viral culture, serology and real time (RT)-PCRs. A confirmed or probable viral causative agent was established in 41% of 194 enrolled patients. The most commonly diagnosed causative agent was Japanese encephalitis virus (n = 50, 26%), followed by enteroviruses (n = 18, 9.3%), dengue virus (n = 9, 4.6%), herpes simplex virus (n = 1), cytomegalovirus (n = 1) and influenza A virus (n = 1). Fifty-seven (29%) children died acutely. Fatal outcome was independently associated with patient age and Glasgow Coma Scale (GCS) on admission.

CONCLUSIONS/SIGNIFICANCE

Acute encephalitis in children in southern Vietnam is associated with high mortality. Although the etiology remains unknown in a majority of the patients, the result from the present study may be useful for future design of treatment and prevention strategies of the disease. The recognition of GCS and age as predictive factors may be helpful for clinicians in managing the patient.

A picture archiving and communications system featuring multiple monitors using Windows98

We present an effective approach to manage, review, and distribute Digital Imaging and Communications in Medicine (DICOM) images with multiple monitors using Windows98 (Microsoft Corp, Redmond, WA) that can be implemented in an office-based setting. Computed tomography (CT), magnetic resonance imaging (MRI), and angiographic DICOM images were collected, compressed, and stored using Medweb (Medweb, Inc, San Francisco, CA) software. The Medweb server used the Linux/UNIX operating system on a Pentium 333-MHz processor with 128 MB of RAM. Short-term storage capacity was about 2 weeks with routine usage of an 11-GB hard drive. Images were presented for reading on a dual-monitor Windows98 Pentium display station with 160 MB of RAM using a Medweb/Netscape (Netscape Communications Corp, Mountain View, CA) viewer. There was no significant discrepancy in diagnosis between electronic and conventional film images. Mean reading time for 32 cases was 118 seconds. The Medweb JAVA plug-in viewer loaded the first image within 30 seconds of selecting the case for review. Full uncompressed 16-bit images allowed different window settings to better assess for pathology. Multiple monitors allowed viewing various hanging protocols. Cine viewing was also possible. Key diagnostic images were electronically transmitted to referring physicians. On-call radiologists were able to access images through the Internet. By combining Medweb, DICOM, and web-browser software using desktop personal computers (PCs), an easily accessible picture archiving and communications system (PACS) is available to radiologists and referring physicians. Multiple monitors are easily configured and managed using Windows98. This system can sustain changes and can be extended to provide variable functions using inexpensive PCs.

Occupational exposure and chronic respiratory symptoms--a population based study in Vietnam

In order to investigate the relationship between occupational exposure to dust/chemicals (toxic gases/fumes) and chronic respiratory symptoms in Vietnam, the questionnaire standardized by the American Thoracic Society was applied to 368 subjects living in Ha Thai district of Vietnam. According to the results of multiple logistic regression analyses, the odds ratios of chronic respiratory symptoms by occupational exposure are over unity, except for the relationship between chronic cough and occupational exposure to chemicals. Especially for chronic breathlessness, significantly higher odds ratios are observed among people with a history of occupational exposure to dust or chemicals: 2.925 (95% CI: 1.130-7.574) for dust, and 3.721 (95% CI: 1.412-9.803) for chemicals. As for the interaction between occupational exposure to dust and cigarette smoking, it is considered that occupational exposure leads to an increase in chronic respiratory symptoms independent of the effects of cigarette smoking.

Effects of earplugs on catecholamine and cortisol excretion in noise-exposed textile workers

To investigate physiological and psychological effects of industrial noise, a survey was performed on 50 female workers exposed to machinery noise [93-100 dB(A)] (noise group) and 25 female workers in less-noisy environments [71-75 dB(A)] (control group) in a textile factory in Vietnam. Urine was collected for analysis of catecholamines and cortisol. The subjects were also asked to fill out a questionnaire. Each subject was examined over 2 working days. The workers in the noise group were asked to put earplugs in their ears during the working hours of the 2nd day. On the 1st day without earplugs, urinary excretion of catecholamines in the noise group were greater than those in the control group. Cortisol in urine showed a similar tendency. Differences in catecholamine excretion between the noise group and the control group decreased on the 2nd day when the earplugs were used for attenuation of noise level in the noise group. Frequency of subjective fatigue symptoms was lower on the 2nd day than that on the 1st day in noise group, while the control group showed almost no day-difference. The results indicate that the catecholamine response to noise in workers was reduced through the use of earplugs.