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... tropical and subtropical areas in South America and Africa. The virus is transmitted to humans by the ... Maps Maps of yellow fever endemic areas in Africa and South America Links & References Publications and links ...
... liver, and kidney. Bleeding disorders, seizures, coma, and delirium may also occur. Symptoms may include: Irregular heartbeats ( ... Bleeding (may progress to hemorrhage) Coma Decreased urination Delirium Fever Headache Yellow skin and eyes (jaundice) Muscle ...
Imported yellow fever in a United States citizen.
The last imported case of yellow fever seen in this country was in 1924. We report a case of yellow fever acquired by an American tourist who visited the jungles of Brazil along the Rio Negro and Amazon Rivers. The patient died 6 days after hospital admission and 10 days after his first symptoms appeared. Yellow fever virus was recovered from clinical specimens, and the isolate was genetically similar to the E genotype IIB of South American yellow fever viruses. This patient's illness represents a case of vaccine-preventable death since he failed to be immunized with a recommended preexposure yellow fever vaccine. PMID:9402373
McFarland, J M; Baddour, L M; Nelson, J E; Elkins, S K; Craven, R B; Cropp, B C; Chang, G J; Grindstaff, A D; Craig, A S; Smith, R J
A sequential and quantitative survey of brain and liver of suckling mice for infective virus and complement-fixing antigen, after infection with yellow fever virus, showed that while there was progressive increase of infective virus content in both organs, only the brain showed a corresponding rise in CF antigen. Histopathological examination revealed that the liver was not significantly involved. The target organ was the brain, where the progressive pathological changes culminated in an acute encephalitis by the 3rd day of experiment. Organ destruction began with the molecular layer of the grey matter. But by the 4th day after infection the entire cerebral cortex was involved. At the initial stages the hippocampus was particularly affected. Tissue damage did not appear to be entirely due to the differential quantitative localization of infective virus. It was hypothesized that the CF antigen acting singly or in conjunction with some hypothetical proteins may be principally involved in the pathological outcome of the disease. ImagesFigs. 7-9Figs. 3-6
David-West, Tam. S.; Smith, J. A.
Neurologic disease associated with 17D-204 yellow fever vaccination: a report of 15 cases.
Yellow fever (YF), can be prevented by an attenuated vaccine (YEL). We reviewed neurologic adverse events (AE) following YEL that were reported to the national Vaccine Adverse Events Reporting System (VAERS). VAERS is a passive reporting system with inherent limitations for causality assessment. Based on defined criteria, five cases of encephalitis were classified as 'definitely' and one of acute disseminated encephalomyelitis (ADEM) as 'probably' caused by YEL. Six cases of Guillain-Barre Syndrome (GBS), one of encephalitis, and two of ADEM, were classified as 'suspect' vaccine-associated disease. Laboratory and epidemiological evidence suggests that YEL caused encephalitis. Additional studies will be required to confirm whether YEL can rarely result in GBS and/or ADEM. PMID:17240001
McMahon, Ann W; Eidex, Rachel B; Marfin, Anthony A; Russell, Michelle; Sejvar, James J; Markoff, Lewis; Hayes, Edward B; Chen, Robert T; Ball, Robert; Braun, M Miles; Cetron, Martin
Yellow fever vaccine-associated viscerotropic disease.
Yellow fever is a mosquito-transmitted hemorrhagic viral disease that is endemic to tropical regions in South America and Africa. It remains a significant health concern for deploying military personnel, accordingly vaccination is frequently performed on troops. Although the vaccine is generally administered with only minor complications, rare severe complications are also reported. Herein, we report a mild case of yellow fever vaccine-associated viscerotropic disease 4 days after administration of the vaccine. The various complications of the vaccine and their pathogenesis are also reviewed. PMID:22594140
Rowland, Michael; Plackett, Timothy P; Smith, Richard
Epidemiological aspects of the 1969 yellow fever epidemic in Nigeria.
The Virus Research Laboratory of the University of Ibadan, Nigeria, was notified on 23 October 1969 that cases of suspected yellow fever had occurred in the Jos area. The diagnosis was confirmed by virus isolation and the existence of a widespread outbreak on the Jos Plateau and adjacent areas was established. This was the first recognized epidemic of yellow fever in Nigeria since 1953. Between September and the end of December 1969, an estimated total of 252 patients with yellow fever were hospitalized. The case-fatality ratio for hospitalized patients was approximately 40%. The diagnosis of yellow fever was confirmed by virus isolation, serology, or pathology in 55 patients. It is estimated that up to 100 000 cases of yellow fever may have occurred during the epidemic. PMID:4538037
Carey, D E; Kemp, G E; Troup, J M; White, H A; Smith, E A; Addy, R F; Fom, A L; Pifer, J; Jones, E M; Br�s, P; Shope, R E
Epidemiological aspects of the 1969 yellow fever epidemic in Nigeria
The Virus Research Laboratory of the University of Ibadan, Nigeria, was notified on 23 October 1969 that cases of suspected yellow fever had occurred in the Jos area. The diagnosis was confirmed by virus isolation and the existence of a widespread outbreak on the Jos Plateau and adjacent areas was established. This was the first recognized epidemic of yellow fever in Nigeria since 1953. Between September and the end of December 1969, an estimated total of 252 patients with yellow fever were hospitalized. The case�fatality ratio for hospitalized patients was approximately 40%. The diagnosis of yellow fever was confirmed by virus isolation, serology, or pathology in 55 patients. It is estimated that up to 100 000 cases of yellow fever may have occurred during the epidemic.
Carey, D. E.; Kemp, G. E.; Troup, J. M.; White, H. A.; Smith, E. A.; Addy, R. F.; Fom, A. L. M. D.; Pifer, J.; Jones, E. M.; Bres, P.; Shope, R. E.
Assessing Yellow Fever Risk in the Ecuadorian Amazon
This study reports results of a cross-sectional study based on interviews and seroepidemiological methods to identify risk factors for yellow fever infection among personnel of a military garrison in the Amazonian rainforest. Clinical symptoms and signs observed among yellow fever cases are also described. Humoral immune response to yellow fever, Mayaro, Venezuelan equine encephalitis, Oropouche, and dengue 2 infection was assessed by evaluating IgM and IgG specific antibodies. A yellow fever attack rate of 13% (44/341, with 3 fatal cases) was observed among military personnel. Signs of digestive track bleeding (14.6%) and hematuria (4.9%) were observed among the yellow fever cases. In 32.2% of the cases, we measured high levels of serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase with maximum levels of 6,830 and 3,500, respectively. Signs of bleeding or jaundice were observed in some cases, and high levels of transaminases were seen. The epidemiological and laboratory investigations demonstrated that the military personnel were affected by a yellow fever outbreak. The association between clearing the rainforest and also being at the detachments with yellow fever infection confirms that clearing is the main factor in the jungle model of transmission, which takes place deep in the Amazonian rainforest.
Izurieta, Ricardo O; Macaluso, Maurizio; Watts, Douglas M; Tesh, Robert B; Guerra, Bolivar; Cruz, Ligia M; Galwankar, Sagar; Vermund, Sten H
Marylanders defeat Philadelphia: yellow fever updated.
Those strategic points which influence this amateur historian to declare a victory for Baltimore and Maryland over Philadelphia are: I. Based upon clinical and epidemiological data, two Marylanders, Potter and Davidge, were among the first to contest Rush and his contagion theory; they told him so and published their views. To prove this point, Potter went to the extreme of inoculating himself with presumedly infected material. Stubbins Ffirth, a young University of Pennsylvania medical student, did the same four years later. To Rush's credit was ultimate abandonment of his originally held views. II. John Crawford, of Baltimore, although not the originator of the insect concept of transmission of infectious agents, published his concepts in 1811. III. Henry Rose Carter, a Maryland graduate, clearly delineated, in 1898, that after identification of an index case of yellow fever an extrinsic incubation period was necessary before the evolution of secondary cases. IV. James Carroll, another University of Maryland graduate, who worked as Deputy under Walter Reed with Lazear and Agramonte, helped prove Finlay's original concept that the Aedes aegypti mosquito was the natural vector of yellow fever. Carroll himself was the first experimentally induced case. V. Studies in primates provide new approaches for management of yellow fever. Nutritional support and treatment with specific anti-viral agents may be useful for therapy of human yellow fever. Maryland members of the Climatological are mindful of Philadelphia's rich medical heritage and of the many battles won in the City of Brotherly Love. Physicians in colonial and early America experienced The best and worst of times, theirs was an age of foolishness and belief, of incredulity and light, of darkness, despair and hope. This tale of two cities ends in peace. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 10 Fig. 11
Woodward, T. E.; Beisel, W. R.; Faulkner, R. D.
Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) and corticosteroid therapy: eleven United States cases, 1996-2004.
During 1996 through 2004, 29 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been reported worldwide; 17 were fatal. Stress-dose corticosteroid (SDS) therapy has recently been found to improve survival among patients with septic shock but benefit for the treatment of YEL-AVD patients in septic shock is unknown. We retrospectively reviewed medical records of 11 U.S. YEL-AVD cases reported to the Vaccine Adverse Event Reporting System (VAERS) from 1996 through 2004. Four of 11 case-patients received SDS; 3 of these 4 (75%) survived. Seven patients did not receive SDS and 2 (29%) survived. Altered mental status was documented on admission for 5 of the 11 patients; 4 of these 5 did not receive SDS and died, whereas one received SDS and survived. The use of stress-dose steroids might be a factor that influenced the survival of these YEL-AVD patients and should be further evaluated in the management of both YEL-AVD and wild-type yellow fever septic shock. PMID:16896144
Vellozzi, Claudia; Mitchell, Tarissa; Miller, Elaine; Casey, Christine G; Eidex, Rachel Barwick; Hayes, Edward B
A clinicopathological study of human yellow fever.
During an epidemic of yellow fever in the Jos Plateau area of Nigeria, 9 adult males with clinically diagnosed yellow fever were studied by haematological, biochemical, virological, serological, and liver biopsy methods. The ages of the patients ranged from 20 to 55 years and the duration of illness was 3-62 days. No virus was isolated from any patient but all patients should biochemical evidence of severe hepatocellular damage. Leucopenia was a feature of the late acute stage of the disease. Five sera had antibodies to yellow fever at titres greater than 1: 32, 3 of them being monospecific for yellow fever. The classical histological features of yellow fever were present only in the acute or late acute stages, when complement-fixation tests may be negative. With convalescence and the production of complement-fixing antibodies in high titres, the histological features resembled those of a persisting nonspecific hepatitis. In an endemic area, the histological features of yellow fever will depend on the stage of the disease and a picture of nonspecific hepatitis would not exclude yellow fever in the absence of confirmation from serological tests. PMID:4538039
Francis, T I; Moore, D L; Edington, G M; Smith, J A
A clinicopathological study of human yellow fever*
During an epidemic of yellow fever in the Jos Plateau area of Nigeria, 9 adult males with clinically diagnosed yellow fever were studied by haematological, biochemical, virological, serological, and liver biopsy methods. The ages of the patients ranged from 20 to 55 years and the duration of illness was 3-62 days. No virus was isolated from any patient but all patients should biochemical evidence of severe hepatocellular damage. Leucopenia was a feature of the late acute stage of the disease. Five sera had antibodies to yellow fever at titres greater than 1: 32, 3 of them being monospecific for yellow fever. The classical histological features of yellow fever were present only in the acute or late acute stages, when complement-fixation tests may be negative. With convalescence and the production of complement-fixing antibodies in high titres, the histological features resembled those of a persisting nonspecific hepatitis. In an endemic area, the histological features of yellow fever will depend on the stage of the disease and a picture of nonspecific hepatitis would not exclude yellow fever in the absence of confirmation from serological tests. ImagesFig. 1Fig. 2AFig. 2BFig. 3Fig. 4Fig. 5Fig. 6
Francis, T. I.; Moore, D. L.; Edington, G. M.; Smith, J. A.
Clara Maass, yellow fever and human experimentation.
Clara Louise Maass, a 25-year-old American nurse, died of yellow fever on August 24, 1901, following experimental inoculation by infected mosquitoes in Havana, Cuba. The human yellow fever experiments were initially conducted by MAJ Walter Reed, who first used written informed consent and proved the validity of Finlay's mosquito-vector hypothesis. Despite informed consent form and an incentive of $100 in U.S. gold, human subjects were exposed to a deadly virus. The deaths of Clara Maass and two Spanish immigrants resulted in a public outcry and the immediate cessation of yellow fever human experiments in Cuba. PMID:23756016
Chaves-Carballo, Enrique
Present status of yellow fever: Memorandum from a PAHO Meeting*
An international seminar on the treatment and laboratory diagnosis of yellow fever, sponsored by the Pan American Health Organization (PAHO) and held in 1984, differed from previous meetings on yellow fever because of its emphasis on the care and management of patients and because the participants included specialists from several branches of medicine, such as hepatology, haematology, cardiology, infectious diseases, pathology and nephrology. The meeting reviewed the current status of yellow fever and problems associated with case-finding and notification; features of yellow fever in individual countries of Latin America; health services and facilities for medical care as they relate to diagnosis and management of cases; prevention strategies for and current status of immunization programmes; clinical and pathological aspects of yellow fever in humans; pathogenesis and pathophysiology of yellow fever in experimental animal models; clinical and specific laboratory diagnosis; treatment of the disease and of complications in the functioning of individual organ systems; prognosis and prognostic indicators; and directions for future clinical and experimental research on pathophysiology and treatment.
Lost Trust: A Yellow Fever Patient Response
In the 19th century, yellow fever thrived in the tropical, urban trade centers along the American Gulf Coast. Industrializing and populated, New Orleans and Memphis made excellent habitats for the yellow fever-carrying Aedes aegypti mosquitoes and the virulence they imparted on their victims. Known for its jaundice and black, blood-filled vomit, the malady terrorized the region for decades, sometimes claiming tens of thousands of lives during the near annual summertime outbreaks. In response to the failing medical community, a small, pronounced population of sick and healthy laypeople openly criticized the efforts to rid the Gulf region of yellow jack. Utilizing newspapers and cartoons to vocalize their opinions, these critics doubted and mocked the medical community, contributing to the regional and seasonal dilemma yellow fever posed for the American South. These sentient expressions prove to be an early example of patient distrust toward caregivers, a current problem in clinical heath care.
Runge, John S.
Lost trust: a yellow fever patient response.
In the 19th century, yellow fever thrived in the tropical, urban trade centers along the American Gulf Coast. Industrializing and populated, New Orleans and Memphis made excellent habitats for the yellow fever-carrying Aedes aegypti mosquitoes and the virulence they imparted on their victims. Known for its jaundice and black, blood-filled vomit, the malady terrorized the region for decades, sometimes claiming tens of thousands of lives during the near annual summertime outbreaks. In response to the failing medical community, a small, pronounced population of sick and healthy laypeople openly criticized the efforts to rid the Gulf region of yellow jack. Utilizing newspapers and cartoons to vocalize their opinions, these critics doubted and mocked the medical community, contributing to the regional and seasonal dilemma yellow fever posed for the American South. These sentient expressions prove to be an early example of patient distrust toward caregivers, a current problem in clinical heath care. PMID:24348220
Runge, John S
Timeliness of Yellow Fever Surveillance, Central African Republic
During January 2007�July 2012, a total of 3,220 suspected yellow fever cases were reported in the Central African Republic; 55 were confirmed and 11 case-patients died. Mean delay between onset of jaundice and case confirmation was 16.6 days. Delay between disease onset and blood collection could be reduced by increasing awareness of the population.
Rachas, Antoine; Nakoune, Emmanuel; Bouscaillou, Julie; Paireau, Juliette; Selekon, Benjamin; Senekian, Dominique; Fontanet, Arnaud
Is it time for a new yellow fever vaccine?
An inexpensive live attenuated vaccine (the 17D vaccine) against yellow fever has been effectively used to prevent yellow fever for more than 70 years. Interest in developing new inactivated vaccines has been spurred by recognition of rare but serious, sometimes fatal adverse events following live virus vaccination. A safer inactivated yellow fever vaccine could be useful for vaccinating people at
Edward B. Hayes
Adverse event reports following yellow fever vaccination
Yellow fever (YF) vaccine has been used for prevention of YF since 1937 with over 500 million doses administered. However, rare reports of severe adverse events following vaccination have raised concerns about the vaccine�s safety. We reviewed reports of adverse events following YF vaccination reported to the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2000 to 2006. We used
Nicole P. Lindsey; Betsy A. Schroeder; Elaine R. Miller; M. Miles Braun; Alison F. Hinckley; Nina Marano; Barbara A. Slade; Elizabeth D. Barnett; Gary W. Brunette; Katherine Horan; J. Erin Staples; Phyllis E. Kozarsky; Edward B. Hayes
Anamnestic immune response to dengue and decreased severity of yellow Fever.
A protective immunity against yellow fever, from cross-reactive dengue antibodies, has been hypothesized as an explanation for the absence of yellow fever in Southern Asia where dengue immunity is almost universal. This study evaluates the association between protective immunity from cross-reactive dengue antibodies with yellow fever infection and severity of the disease. The study population consisted of military personnel of a jungle garrison and its detachments located in the Ecuadorian Amazonian rainforest. The cross-sectional study employed interviews as well as seroepidemiological methods. Humoral immune response to yellow fever, Mayaro, Venezuelan equine encephalitis, Oropouche, and dengue 2 infections was assessed by evaluating IgM and IgG specific antibodies. Log-linear regression analysis was used to evaluate age and presence of antibodies, against dengue type 2 virus, as predictors of yellow fever infection or severe disease. During the seroepidemiological survey, presence of dengue antibodies among yellow fever cases were observed in 77.3% cases from the coastal region, where dengue is endemic, 14.3% cases from the Amazon and 16.7 % cases from the Andean region. Dengue cross-reactive antibodies were not significantly associated with yellow fever infection but significantly associated with severity of the disease. The findings of this study suggest that previous exposure to dengue infection may have induced an anamnestic immune response that did not prevent yellow fever infection but greatly reduced the severity of the disease. PMID:20300401
Izurieta, Ricardo O; Macaluso, Maurizio; Watts, Douglas M; Tesh, Robert B; Guerra, Bolivar; Cruz, Ligia M; Galwankar, Sagar; Vermund, Sten H
Genomic and Phylogenetic Characterization of Brazilian Yellow Fever Virus Strains
Globally, yellow fever virus infects nearly 200,000 people, leading to 30,000 deaths annually. Although the virus is endemic to Latin America, only a single genome from this region has been sequenced. Here, we report 12 Brazilian yellow fever virus complete genomes, their genetic traits, phylogenetic characterization, and phylogeographic dynamics. Variable 3? noncoding region (3?NCR) patterns and specific mutations throughout the open reading frame altered predicted secondary structures. Our findings suggest that whereas the introduction of yellow fever virus in Brazil led to genotype I-predominant dispersal throughout South and Central Americas, genotype II remained confined to Bolivia, Peru, and the western Brazilian Amazon.
Palacios, Gustavo; Cardoso, Jedson F.; Martins, Livia C.; Sousa, Edivaldo C.; de Lima, Clayton P. S.; Medeiros, Daniele B. A.; Savji, Nazir; Desai, Aaloki; Rodrigues, Sueli G.; Carvalho, Valeria L.; Lipkin, W. Ian
Rapid Detection and Quantification of RNA of Ebola and Marburg Viruses, Lassa Virus, Crimean-Congo Hemorrhagic Fever Virus, Rift Valley Fever Virus, Dengue Virus, and Yellow Fever Virus by Real-Time Reverse Transcription-PCR
Viral hemorrhagic fevers (VHFs) are acute infections with high case fatality rates. Important VHF agents are Ebola and Marburg viruses (MBGV\\/EBOV), Lassa virus (LASV), Crimean-Congo hemorrhagic fever virus (CCHFV), Rift Valley fever virus (RVFV), dengue virus (DENV), and yellow fever virus (YFV). VHFs are clinically difficult to diagnose and to distinguish; a rapid and reliable laboratory diagnosis is required in
Christian Drosten; Stephan G�ttig; Stefan Schilling; Marcel Asper; Marcus Panning; Herbert Schmitz; Stephan G�nther
Advances and controversies in yellow fever vaccination
Ever since its development in 1937, the live-attenuated 17D yellow fever (YF) vaccine has been one of the most effective vaccines available to man. In this review we highlight the major steps in the development of 17D YF vaccine. We discuss the use of neutralizing antibodies as a surrogate marker for protection, and explore the strengths and weaknesses of the current plaque reduction neutralization test (PRNT), a technique developed in the 1960s that continues to be superior to every modern test in both sensitivity and specificity. The neutralizing antibodies demonstrated by the PRNT can be detected for several decades after vaccination, possibly even for the remainder of the recipient�s natural life. We review the available evidence on the duration of protection after primary vaccination, a topic that has been the subject of controversy over the last few months. For persons who are immunocompromised due to disease, medication or advancing age, the duration of protection may be shorter: they should always have their vaccine response checked by PRNT. Due to the higher risk of severe adverse events after vaccination with 17D YF in this group, the development of a new, inactivated vaccine will have substantial benefits in this population.
Jonker, Emile F. F.; Visser, Leonardus G.
Neurological adverse events temporally associated to mass vaccination against yellow fever in Juiz de Fora, Brazil, 1999�2005
The identification of adverse events following immunization (AEFI) and their prompt investigation are important to allow a timely and scientifically based response to the users of immunization services. This article presents an analysis of notified AEFI cases between 1999 and 2005 and their temporal association with 2001 yellow fever vaccination campaign, AEFI notification attributed to yellow fever vaccination rose from
Guilherme C�rtes Fernandes; Luiz Antonio Bastos Camacho; Marilia S� Carvalho; Maristela Batista; Sonia Maria Rodrigues de Almeida
1. It was possible to study in the ultracentrifuge by optical methods the behavior of yellow fever virus particles directly in the unaltered serum from infected monkeys. 2. The virus showed an extremely high light absorption in the spectral range of 320 to 440 m�, which seemed to be its intrinsic property. In a 1 cm. thickness of fluid, the small amount of virus present in unaltered infective serum absorbed about as much light (approximately 25 per cent) in the middle of this range as did all the normal serum proteins present in a combined concentration some 1000 times as great. 3. The concentration of virus in the unaltered serum was found to be of the order of 0.00005 gm. per cc. 1 cc. of a 10�9 dilution, which, as has been shown, may constitute a minimal infective dose for monkeys, would contain approximately 10,000 virus particles. The probability that most of the virus particles were in the inactive form is discussed. 4. In infective serum having a viscosity of 14 millipoises, the particles sediment with a blurred boundary at rates lying between approximately 18 and 30 x 10�13 cm./sec./dyne. Evidence indicates that this spread is the result of an aggregation or association phenomenon. 5. Computations of size are in approximate agreement with those made from ultrafiltration studies. On the assumption that the density of the virus particle is near that of protein, its volume is computed to be at least that of a spherical particle having a diameter of 12 m�. An assumed density of 1.15 gm. per cc. yields a diameter of 19 m�, considering the shape as spherical.
Pickels, Edward G.; Bauer, Johannes H.
Case of Yellow Fever Vaccine-Associated Viscerotropic Disease with Prolonged Viremia, Robust Adaptive Immune Responses, and Polymorphisms in CCR5 and RANTES Genes
Background The live attenuated yellow fever vaccine 17D (YF-17D) is one of the most effective vaccines. Despite its excellent safety record, some cases of viscerotropic adverse events develop, which are sometimes fatal. The mechanisms underlying such events remain a mystery. Here, we present an analysis of the immunologic and genetic factors driving disease in a 64-year-old male who developed viscerotropic symptoms. Methods We obtained clinical, serologic, virologic, immunologic and genetic data on this case patient. Results Viral RNA was detected in the blood 33 days after vaccination, in contrast to the expected clearance of virus by day 7 after vaccination in healthy vaccinees. Vaccination induced robust antigen-specific T and B cell responses, which suggested that persistent virus was not due to adaptive immunity of suboptimal magnitude. The genes encoding OAS1, OAS2, TLR3, and DC-SIGN, which mediate antiviral innate immunity, were wild type. However, there were heterozygous genetic polymorphisms in chemokine receptor CCR5, and its ligand RANTES, which influence the migration of effector T cells and CD14+CD16bright monocytes to tissues. Consistent with this, there was a 200-fold increase in the number of CD14+CD16bright monocytes in the blood during viremia and even several months after virus clearance. Conclusion; In this patient, viscerotropic disease was not due to the impaired magnitude of adaptive immunity but instead to anomalies in the innate immune system and a possible disruption of the CCR5-RANTES axis.
Pulendran, Bali; Miller, Joseph; Querec, Troy D.; Akondy, Rama; Moseley, Nelson; Laur, Oscar; Glidewell, John; Monson, Nathan; Zhu, Tuofu; Zhu, Haiying; Staprans, Sylvija; Lee, David; Brinton, Margo A.; Perelygin, Andrey A.; Vellozzi, Claudia; Brachman, Philip; Lalor, Susan; Teuwen, Dirk; Eidex, Rachel B.; Cetron, Marty; Priddy, Frances; del Rio, Carlos; Altman, John; Ahmed, Rafi
Yellow fever, Asia and the East African slave trade.
Yellow fever is endemic in parts of sub-Saharan Africa and South America, yet its principal vectors--species of mosquito of the genus Aedes--are found throughout tropical and subtropical latitudes. Phylogenetic analyses indicate that yellow fever originated in Africa and that its spread to the New World coincided with the slave trade, but why yellow fever has never appeared in Asia remains a mystery. None of several previously proposed explanations for its absence there is considered satisfactory. We contrast the trans-Atlantic slave trade, and trade across the Sahara and to the Arabian Peninsula and Mesopotamia, with that to Far East and Southeast Asian ports before abolition of the African slave trade, and before the scientific community understood the transmission vector of yellow fever and the viral life cycle, and the need for shipboard mosquito control. We propose that these differences in slave trading had a primary role in the avoidance of yellow fever transmission into Asia in the centuries before the 20(th) century. The relatively small volume of the Black African slave trade between Africa and East and Southeast Asia has heretofore been largely ignored. Although focal epidemics may have occurred, the volume was insufficient to reach the threshold for endemicity. PMID:24743951
Cathey, John T; Marr, John S
Yellow fever and Japanese encephalitis vaccines: indications and complications.
Appropriate administration of yellow fever or Japanese encephalitis vaccines to travelers requires an assessment of the traveler's risk for infection with these vector-borne flaviviruses during their travels and the presence of risk factors for adverse events following immunization. Japanese encephalitis and yellow fever vaccines have been more frequently associated with serious adverse events following immunization since the early 1980s and the late 1990s, respectively. This article describes the adverse events, the magnitude of their risk, and associated risk factors. PMID:15701552
Marfin, Anthony A; Eidex, Rachel S Barwick; Kozarsky, Phyllis E; Cetron, Martin S
Encephalitis in a 13-year-old boy following 17D yellow fever vaccine.
We report a case of encephalitis following yellow fever vaccine in a healthy 13 year-old-boy. This is the first reported case in a child older than 3 years of age and the second over the age of 9 months, before which time the vaccine is contraindicated for routine immunisation. PMID:2384674
Schoub, B D; Dommann, C J; Johnson, S; Downie, C; Patel, P L
Proved and potential vectors of yellow fever in South Africa
This paper, based on records obtained from the Entomology Department of the South African Institute for Medical Research, Johannesburg, gives a summary of the distribution, adult habits, and breeding-places of the proved and potential vectors of yellow fever in South Africa.
De Meillon, Botha
1. The yellow fever virus was found in infectious form in Aedes �gypti throughout the entire period of the extrinsic incubation, as demonstrated by the injection of the bodies of mosquitoes into normal rhesus monkeys at daily intervals after the insects had fed on an infected animal. 2. The virus was transmitted through the bite of the mosquitoes, in one experiment on and after the 9th day, and in two experiments on the 12th day after the initial infecting feed. 3. The pathologic changes produced by the injection of the infected mosquitoes into normal monkeys during the extrinsic incubation were in every respect those of typical experimental yellow fever. 4. The monkeys withstand easily the subcutaneous injection of the mosquito emulsion. No acute inflammatory reaction was observed at the site of injection in any of the seventeen animals inoculated with this material in these three experiments.
Bauer, Johannes H.; Hudson, N. Paul
Progress in mapping the yellow fever mosquito genome.
Mosquito-borne diseases cause significant problems for the human health. For this reason, the genomes of three most dangerous species of mosquitoes, including the yellow fever mosquito Aedes aegypti, were sequenced in last decade. The efficient vector of arboviruses. Ae. aegypti, is also a convenient model for laboratory research. The intensive genetic mapping of morphological and molecular markers conducted for this mosquito in the past was very successful. This mapping was also used as a tool to localize a number of quantitative trait loci related to the mosquito's ability to transmit various pathogens. However, physical mapping of the Ae. aegypti genome is difficult due to the lack of high-quality polytene chromosomes. Here, we review different mapping approaches that help improving genome sequence assembly and also integrate linkage, chromocome and genome maps the yellow fever mosquito. PMID:23875456
Sharakhova, M V; Sharakhov, I V
The 1970 yellow fever epidemic in Okwoga District, Benue Plateau State, Nigeria*
Serological surveys undertaken to define the geographic limits of the 1970 rural yellow fever epidemic in Okwoga District, Nigeria, indicated that surrounding areas of Benue Plateau State and East Central State were not involved. However, the surveys uncovered a separate focus of unrecognized, recent epidemic yellow fever in Mbawsi, in southern East Central State. The highest proportions of yellow-fever-immune sera outside the Okwoga and Mbawsi foci were found in zones of Guinea savannah in the Benue River basin.
Monath, T. P.; Wilson, D. C.; Stroh, G.; Lee, V. H.; Smith, E. A.
Using next generation sequencing to identify yellow fever virus in Uganda
In October and November 2010, hospitals in northern Uganda reported patients with suspected hemorrhagic fevers. Initial tests for Ebola viruses, Marburg virus, Rift Valley fever virus, and Crimean Congo hemorrhagic fever virus were negative. Unbiased PCR amplification of total RNA extracted directly from patient sera and next generation sequencing resulted in detection of yellow fever virus and generation of 98%
Laura K. McMullan; Mike Frace; Scott A. Sammons; Trevor Shoemaker; Stephen Balinandi; Joseph F. Wamala; Julius J. Lutwama; Robert G. Downing; Ute Stroeher; Adam MacNeil; Stuart T. Nichol
The changing epidemiology of yellow fever and dengue, 1900 to 2003: full circle?
Yellow fever and dengue are old diseases, having caused major epidemics in centuries past. Both were effectively controlled in the mid 1900s, yellow fever in Francophone Africa by vaccination and yellow fever and dengue in the Americas by effective control of the principal urban vector of both viruses, Aedes aegypti. In the last 25 years of the 20th century, however, there was a resurgence of yellow fever in Africa, and of dengue worldwide. The factors responsible for this resurgence are discussed, as are current options for prevention and control. PMID:15225982
Gubler, D J
NSDL National Science Digital Library
The University of Pittsburgh School of Medicine's Department of Pathology has compiled a series of case studies to help both students and instructors in the health sciences field. In this case, a 68-year-old male patient experiencing fevers, chills, an associated non-productive cough, and weight loss was admitted to the hospital for examination. The �Gross Description,� �Microscopic Description,� and � Microbiology� sections provide key information and images that contributed to the patient�s diagnosis. Clicking on the �Final Diagnosis� provides a thorough explanation of the diagnosis and treatment from the contributing doctors.
Kulich, Scott; Pasculle, A. W.
Yellow Fever Virus in Haemagogus leucocelaenus and Aedes serratus Mosquitoes, Southern Brazil, 2008
Yellow fever virus (YFV) was isolated from Haemagogus leucocelaenus mosquitoes during an epizootic in 2001 in the Rio Grande do Sul State in southern Brazil. In October 2008, a yellow fever outbreak was reported there, with nonhuman primate deaths and human cases. This latter outbreak led to intensification of surveillance measures for early detection of YFV and support for vaccination programs. We report entomologic surveillance in 2 municipalities that recorded nonhuman primate deaths. Mosquitoes were collected at ground level, identified, and processed for virus isolation and molecular analyses. Eight YFV strains were isolated (7 from pools of Hg. leucocelaenus mosquitoes and another from Aedes serratus mosquitoes); 6 were sequenced, and they grouped in the YFV South American genotype I. The results confirmed the role of Hg. leucocelaenus mosquitoes as the main YFV vector in southern Brazil and suggest that Ae. serratus mosquitoes may have a potential role as a secondary vector.
Cardoso, Jader da C.; de Almeida, Marco A.B.; dos Santos, Edmilson; da Fonseca, Daltro F.; Sallum, Maria A.M.; Noll, Carlos A.; Monteiro, Hamilton A. de O.; Cruz, Ana C.R.; Carvalho, Valeria L.; Pinto, Eliana V.; Castro, Francisco C.; Neto, Joaquim P. Nunes; Segura, Maria N.O.
The yellow fever 17D vaccine and risk of malignant melanoma in the United States military.
Previous studies show that the tuberculosis and smallpox vaccine protect against melanoma because of sequence homologies they have with the melanoma antigen, HERV-K-MEL. The yellow fever 17D (YF 17D) vaccine is thought to have this property, so there is a possibility that the YF17D vaccine is able to protect against melanoma. This nested case-control study used the Defense Medical Surveillance System to assess the association between the YF17D vaccine and risk of malignant melanoma in active members of the United States military. Although point estimates hinted at a protective effect, none of the values reached a significant level. Therefore, this study concluded that in the ten year period following vaccination there is no association between the yellow fever 17D vaccine and risk of malignant melanoma in active members of the US armed forces. PMID:22561488
Hodges-Vazquez, Meredith; Wilson, James P; Hughes, Hayley; Garman, Patrick
First report of yellow fever virus in non-human primates in the State of Paran�, Brazil.
Sylvatic yellow fever is a zoonosis associated mainly with wild animals, especially those in the genus Alouatta, that act as the source of infection. Once infected, these animals pass the disease on to humans by way of an infected mosquito belonging to the genera Aedes, Haemagogus, or Sabethes. The present study is the first report of a case of yellow fever in non-human primates (NHP) in the State of Paran�, Brazil. After the case was diagnosed, several prophylactic measures were adopted to prevent outbreaks of the disease in humans. PMID:23982102
Tranquilin, Marcos Vin�cius; Lehmkuhl, Ricardo Coelho; Maron, Angela; Silva, Lineu Roberto da; Ziliotto, Liane; Seki, Meire Christina; Salomon, Gabriela Ronchi; Carrasco, Adriano de Oliveira Torres
Yellow Fever Virus Vaccine-associated Deaths in Young Women1
Yellow fever vaccine�associated viscerotropic disease is a rare sequela of live-attenuated virus vaccine. Elderly persons and persons who have had thymectomies have increased susceptibility. A review of published and other data suggested a higher than expected number of deaths from yellow fever vaccine�associated viscerotropic disease among women 19�34 years of age without known immunodeficiency.
Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data
Background Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Methods and Findings Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000�380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000�180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%�31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. Conclusions With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns. Please see later in the article for the Editors' Summary
Garske, Tini; Van Kerkhove, Maria D.; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F.; Staples, J. Erin; Perea, William; Ferguson, Neil M.
Structure of yellow fever virus envelope protein domain III.
The structure of recombinant domain III of the envelope protein (rED3) of yellow fever virus (YFV), containing the major neutralization site, was determined using NMR spectroscopy. The amino acid sequence and structure of the YFV-rED3 shows differences from ED3s of other mosquito-borne flaviviruses; in particular, the partially surface-exposed BC loop where methionine-304 and valine-324 were identified as being critical for the structure of the loop. Variations in the structure and surface chemistry of ED3 between flaviviruses affect neutralization sites and may affect host cell receptor interactions and play a role in the observed variations in viral pathogenesis and tissue tropism. PMID:19818466
Volk, David E; May, Fiona J; Gandham, Sai H A; Anderson, Anjenique; Von Lindern, Jana J; Beasley, David W C; Barrett, Alan D T; Gorenstein, David G
Structure of Yellow Fever Virus Envelope Protein Domain III
The structure of recombinant domain III of the envelope protein (rED3) of yellow fever virus (YFV), containing the major neutralization site, was determined using NMR spectroscopy. The amino acid sequence and structure of the YFV-rED3 shows differences from ED3s of other mosquito-borne flaviviruses; in particular, the partially surface-exposed BC loop where methionine-304 and valine-324 were identified as being critical for the structure of the loop. Variations in the structure and surface chemistry of ED3 between flaviviruses affect neutralization sites and may affect host cell receptor interactions and play a role in the observed variations in viral pathogenesis and tissue tropism.
Volk, David E.; May, Fiona J.; Gandham, Sai H. A.; Anderson, Anjenique; Von Lindern, Jana J.; Beasley, David W. C.; Barrett, Alan D. T.; Gorenstein, David G.
Enzootic transmission of yellow fever virus in Peru.
The prevailing paradigm of yellow fever virus (YFV) ecology in South America is that of wandering epizootics. The virus is believed to move from place to place in epizootic waves involving monkeys and mosquitoes, rather than persistently circulating within particular locales. After a large outbreak of YFV illness in Peru in 1995, we used phylogenetic analyses of virus isolates to reexamine the hypothesis of virus movement. We sequenced a 670-nucleotide fragment of the prM/E gene region from 25 Peruvian YFV samples collected from 1977 to 1999, and delineated six clades representing the states (Departments) of Puno, Pasco, Junin, Ayacucho, San Martin/Huanuco, and Cusco. The concurrent appearance of at least four variants during the 1995 epidemic and the genetic stability of separate virus lineages over time indicate that Peruvian YFV is locally maintained and circulates continuously in discrete foci of enzootic transmission. PMID:12967489
Bryant, Julie; Wang, Heiman; Cabezas, Cesar; Ramirez, Gladys; Watts, Douglas; Russell, Kevin; Barrett, Alan
[Entomological evaluation of the risk of urban outbreak of yellow fever in 2008 in Abidjan, C�te d'Ivoire].
In April 2008, seven years after the outbreak of 2001, Abidjan faced another epidemic of yellow fever. Three weeks after the case detected in the commune of Treichville at 28(th) of April 2008, two other cases were notified, the first one in Port-Bouet and the second one in Cocody located respectively in the south and north of the city of Abidjan. In order to determine a large-scale risk of urban yellow fever epidemic, epidemiological and entomological investigations were conducted by the Ministry of Health and Public Hygiene of Cote d'Ivoire with the support of the Global Outbreak Alert and Response Network. Entomological investigations revealed the predominance of Aedes �gypti, urban vector of yellow fever in neighborhood visited with larval density indices between 2 and 5, indicating the existence of a sufficient density of the vector for cause an explosion of the epidemic. In fact, the massive influx of people from inside cities towards Abidjan caused by the socio-political crisis occurred in the country in 2002, the deterioration of environment with the creation of more breeding sites of Ae.��gypti as corollary and the circulation of the virus at mosquito level were many factors favorable to the yellow fever outbreak in Abidjan city. PMID:23693032
Kone, A B; Konan, Y L; Coulibaly, Z I; Fofana, D; Guindo-Coulibaly, N; Diallo, M; Doannio, J M C; Ekra, K D; Odehouri-Koudou, P
NMR assignments of the yellow fever virus envelope protein domain III.
Nearly complete backbone and sidechain resonance assignments have been obtained for the third domain, residues S288-K398, of the envelope protein from the Asibi strain of yellow fever virus using double- and triple-resonance spectroscopy. PMID:19636823
Volk, David E; Gandham, Sai H A; May, Fiona J; Anderson, Anjenique; Barrett, Alan D T; Gorenstein, David G
42 CFR 71.3 - Designation of yellow fever vaccination centers; Validation stamps.
Code of Federal Regulations, 2013 CFR
...health department, may revoke designation. (b) Validation stamps. International Certificates of Vaccination against cholera and yellow fever issued for vaccinations performed in the United States shall be validated by: (1) The Seal of the...
Using Local History To Understand National Themes: The Yellow Fever Epidemic in Philadelphia in 1793.
ERIC Educational Resources Information Center
Provides background information for a local history project about the 1793 Philadelphia (Pennsylvania) yellow fever outbreak. Offers potential project topics to help students learn about local history and understand life in the eighteenth century United States. (CMK)
Westbury, Susan
Fatal multiorgan failure due to yellow fever vaccine-associated viscerotropic disease.
Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a rare complication of yellow fever (YF) vaccination. A previously healthy 22-year-old female died following YF vaccination despite aggressive measures. Serial viral load titers, cytokine levels and host genetic factors were evaluated in an attempt to understand this unusual and lethal outcome. The patient's high-titer vaccine viremia and possibly related minor genetic anomalies provide clues to exploring the etiology of YEL-AVD. PMID:18023511
Belsher, Jon L; Gay, Peter; Brinton, Margo; DellaValla, Joseph; Ridenour, Robert; Lanciotti, Robert; Perelygin, Andrey; Zaki, Sherif; Paddock, Christopher; Querec, Troy; Zhu, Tuofu; Pulendran, Bali; Eidex, Rachel B; Hayes, Edward
[Blackwater fever: a case report].
The first case of blackwater fever was reported in Cuban medical literature. It is an uncommon complication of paludism due to Plasmodium falciparum, characterized by fever, hemoglobinuria, and kidney failure, with dramatic development and high mortality. The patient came from the People's Republic of Angola, where he stayed 7 years, with history of various episodes of malaria. He was admitted with fever, icterus and thick film test positive for P. falciparum. Treatment with quinine was started, but dark red urine and an increase of icterus were observed 12 hours later. Treatment with quinine was suspended. Red blood cells and platelets were transfused and hemodialysis and plasmapheresis were performed. The patient was discharged 2 weeks later asymptomatic and with negative thick film test. The pathogeny of this disease was discussed, specially kidney failure, making emphasis on the importance of the symptomatic and maintenance treatment in the patient's evolution. PMID:15849955
Olga, Pomier Su�rez; Correa, Daniel F Pe?ez
Suspected Yellow Fever Vaccine-Associated Viscerotropic Adverse Events (1973 and 1978), United States
Two cases of yellow fever vaccine-associated viscerotropic adverse events (YEL-AVD) were identified by review of correspondence received at the Centers for Disease Control and Prevention (CDC; Ft. Collins, CO). The cases occurred in Indiana and Maryland in 1973 and 1978, respectively. One patient, a 75-year-old man with multi-organ failure died, and the other, a 31-year-old woman, was hospitalized for 14 days. Onset was 3�6 days after vaccination. The illness was characterized by fever, headache, myalgia, gastrointestinal symptoms, hepatic and renal dysfunction, and (in the fatal case), shock and coagulopathy, compatible with YEL-AVD. Liver pathology showed diffuse, spotty necrosis, acidophilic degeneration, Kupffer cell hyperplasia, and microvesicular fat. No virological confirmation was obtained, so that both cases remain classified as �suspect.� The 1973 case is the earliest record of YEL-AVD; until now, the earliest known case of YEL-AVD had been in 1975 in Brazil, and most subsequent cases have been reported after 1995.
Monath, Thomas P.
Risk of yellow fever vaccine-associated viscerotropic disease among the elderly: a systematic review.
Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a rare and serious adverse event of the yellow fever (YF) vaccine that mimics wild-type YF. Research shows there may be an increased risk of YEL-AVD among the elderly population (? 60-65 years old), however this research has yet to be accumulated and reviewed in order to make policy recommendations to countries currently administering the YF vaccine. This paper systematically reviewed all information available on YEL-AVD to determine if there is an increased risk among the elderly, for both travelers and endemic populations. Age-specific reporting rates (RRs) were re-calculated from the literature using the Brighton Collaboration case definition for YEL-AVD and were then analyzed to determine if there was a significant difference between the RRs of younger and older age groups. Two out of the five studies found a significantly higher rate of YEL-AVD among the elderly population. Our findings suggest unexposed elders may be at an increased risk of developing YEF-AVD, however the evidence remains limited. Therefore, our findings for YF vaccination of elderly populations support the recommendations made by the Strategic Advisory Group of Experts (SAGE) in their April 2013 meeting, mainly vaccination of the elderly should be based on a careful risk-benefit analysis. PMID:24079979
Rafferty, Ellen; Duclos, Philippe; Yactayo, Sergio; Schuster, Melanie
Advanced Yellow Fever Virus Genome Detection in Point-of-Care Facilities and Reference Laboratories
Reported methods for the detection of the yellow fever viral genome are beset by limitations in sensitivity, specificity, strain detection spectra, and suitability to laboratories with simple infrastructure in areas of endemicity. We describe the development of two different approaches affording sensitive and specific detection of the yellow fever genome: a real-time reverse transcription-quantitative PCR (RT-qPCR) and an isothermal protocol employing the same primer-probe set but based on helicase-dependent amplification technology (RT-tHDA). Both assays were evaluated using yellow fever cell culture supernatants as well as spiked and clinical samples. We demonstrate reliable detection by both assays of different strains of yellow fever virus with improved sensitivity and specificity. The RT-qPCR assay is a powerful tool for reference or diagnostic laboratories with real-time PCR capability, while the isothermal RT-tHDA assay represents a useful alternative to earlier amplification techniques for the molecular diagnosis of yellow fever by field or point-of-care laboratories.
Patel, Pranav; Yillah, Jasmin; Weidmann, Manfred; Mendez, Jairo A.; Nakoune, Emmanuel Rivalyn; Niedrig, Matthias
1. In a search for suitable tissues for the cultivation of yellow fever virus in vitro, mouse embryos were inoculated with this virus in utero. A titration for virus content of the various organs of the embryos indicated that the virus was present in the brain in greatest concentration. 2. Unmodified strains of yellow fever virus were readily adapted to cultivation in vitro in a medium consisting of minced mouse embryo brain tissue and Tyrode solution containing 10 per cent normal monkey serum. 3. After a continued cultivation in mouse embryo brain tissue cultures for twenty to twenty-five subcultures, these strains were readily adapted to cultivation in whole mouse embryo tissue medium. 4. There is evidence to indicate that a prolonged cultivation of the virus in mouse embryo brain medium increases its neurotropic properties. 5. Attempts to employ monkey tissues for in vitro cultivation of yellow fever virus gave entirely negative results. PMID:19870635
Smith, H H; Theiler, M
1. In a search for suitable tissues for the cultivation of yellow fever virus in vitro, mouse embryos were inoculated with this virus in utero. A titration for virus content of the various organs of the embryos indicated that the virus was present in the brain in greatest concentration. 2. Unmodified strains of yellow fever virus were readily adapted to cultivation in vitro in a medium consisting of minced mouse embryo brain tissue and Tyrode solution containing 10 per cent normal monkey serum. 3. After a continued cultivation in mouse embryo brain tissue cultures for twenty to twenty-five subcultures, these strains were readily adapted to cultivation in whole mouse embryo tissue medium. 4. There is evidence to indicate that a prolonged cultivation of the virus in mouse embryo brain medium increases its neurotropic properties. 5. Attempts to employ monkey tissues for in vitro cultivation of yellow fever virus gave entirely negative results.
Smith, Hugh H.; Theiler, Max
"In the interest of humanity and the cause of science": the yellow fever volunteers.
The scientific discoveries of the U.S. Army Yellow Fever Board of 1900 are well known as are the Army physicians who led the board. Walter Reed, of course, is the best known, but James Carroll, Aristides Agramonte, and Jesse Lazear are also known, if not nationally, to their local communities. This article deals not with the known but with the unknown, meaning the volunteers who subjected themselves to the ravages of yellow fever and the real possibility of death. The year 1900 was known as a "yellow fever year" among the locals in Cuba because in the preceding year the epidemics had been relatively mild. Beginning its work in June 1900 in the midst of a deadly epidemic, the board conducted a truly remarkable set of experiments that set a benchmark for controlled clinical trials and informed consent. Because no animal model was known to be susceptible to yellow fever, they used human volunteers for their experiments. These volunteers were recruited from among Spanish immigrants and were accepted from soldiers and two civilians who volunteered. Over 30 men participated in the experiments, and 22 developed yellow fever. With expected death rates of 20% to 40%, it is incredible that none of these volunteers died. In 1929, the U.S. government honored the Americans who volunteered by placing their names on a Roll of Honor published annually in the Army Register. The successes of the 1900 U.S. Army Yellow Fever Board were truly remarkable, and many of the successes were made possible by the men who volunteered, some repeatedly, to risk their lives "in the interest of humanity and the cause of science." PMID:14680037
Pierce, John R
Yellow fever and Max Theiler: the only Nobel Prize for a virus vaccine
In 1951, Max Theiler of the Rockefeller Foundation received the Nobel Prize in Physiology or Medicine for his discovery of an effective vaccine against yellow fever�a discovery first reported in the JEM 70 years ago. This was the first, and so far the only, Nobel Prize given for the development of a virus vaccine. Recently released Nobel archives now reveal how the advances in the yellow fever vaccine field were evaluated more than 50 years ago, and how this led to a prize for Max Theiler.
Norrby, Erling
Yellow fever 17D vaccine virus isolated from healthy vaccinees accumulates very few mutations.
The live attenuated yellow fever (YF) vaccine strain 17D is one of the safest vaccines in use today with only 22 cases of reversion to virulence documented from over 300 million doses administered. We have isolated virus in cell culture from sera of six volunteers who received 17D vaccine and found that very few nucleotide mutations were detected in the consensus sequence of the entire genome of each of the serum viruses. Moreover, most of these mutations accumulated in the non-structural protein genes, especially the NS5 protein gene. Although no nucleotide change was identified in the structural protein genes of any of these six serum viruses, minor sequence heterogeneity existed in the serum virus population. Our results indicate that 17D vaccine virus accumulates mutations at a very low frequency and may explain in part the excellent safety record of 17D vaccine. PMID:9712515
Xie, H; Cass, A R; Barrett, A D
Original Article Yellow Fever Virus Infection in Syrian Golden Hamsters: Relationship between Cytokine Expression and Pathologic Changes
Infection of primates by yellow fever virus (YFV) often results in severe multi-organ failure with marked histologic abnormalities. However, the role of host's immune response, particularly innate immunity, in disease process is unclear. In this study, we used a well established hamster model of yellow fever to examine the dynamic changes of cytokine expression and histopathology in the liver, spleen,
Guangyu Li; Tao Duan; Xiaoyan Wu; Robert B. Tesh; Lynn Soong; Shu-Yuan Xiao
Yellow fever vaccine: an updated assessment of advanced age as a risk factor for serious adverse events.
Since 1996, the scientific community has become aware of 14 reports of yellow fever vaccine (YEL)-associated viscerotropic disease (YEL-AVD) cases and four reports of YEL-associated neurotropic disease (YEL-AND) worldwide, changing our understanding of the risks of the vaccine. Based on 722 adverse event reports after YEL submitted to the U.S. Vaccine Adverse Event Reporting System in 1990-2002, we updated the estimates of the age-adjusted reporting rates of serious adverse events, YEL-AVD and YEL-AND. We found that the reporting rates of serious adverse events were significantly higher among vaccinees aged > or =60 years than among those 19-29 years of age (reporting rate ratio = 5.9, 95% CI 1.6-22.2). Yellow fever is a serious and potentially fatal disease. For elderly travelers, the risk for severe illness and death due to yellow fever infection should be balanced against the risk of a serious adverse event due to YEL. PMID:15837230
Khromava, Alena Y; Eidex, Rachel Barwick; Weld, Leisa H; Kohl, Katrin S; Bradshaw, Robert D; Chen, Robert T; Cetron, Martin S
Entomological profile of yellow fever epidemics in the Central African Republic, 2006-2010
Background The causative agent of yellow fever is an arbovirus of the Flaviviridae family transmitted by infected Aedes mosquitoes, particularly in Africa. In the Central African Republic since 2006, cases have been notified in the provinces of Ombella-Mpoko, Ouham-Pende, Basse-Kotto, Haute-Kotto and in Bangui the capital. As the presence of a vector of yellow fever virus (YFV) represents a risk for spread of the disease, we undertook entomological investigations at these sites to identify potential vectors of YFV and their abundance. Findings Between 2006 and 2010, 5066 mosquitoes belonging to six genera and 43 species were identified. The 20 species of the Aedes genus identified included Ae. aegypti, the main vector of YFV in urban settings, and species found in tropical forests, such as Ae. africanus, Ae. simpsoni, Ae. luteocephalus, Ae. vittatus and Ae. opok. These species were not distributed uniformly in the various sites studied. Thus, the predominant Aedes species was Ae. aegypti in Bangui (90.7?%) and Basse-Kotto (42.2?%), Ae. africanus in Ombella-Mpoko (67.4?%) and Haute-Kotto (77.8?%) and Ae. vittatus in Ouham-Pende (62.2?%). Ae. albopictus was also found in Bangui. The distribution of these dominant species differed significantly according to study site (P?0.0001). None of the pooled homogenates of Aedes mosquitoes analysed by polymerase chain reaction contained the YFV genome. Conclusion The results indicate a wide diversity of vector species for YFV in the Central African Republic. The establishment of surveillance and vector control programs should take into account the ecological specificity of each species.
Phylogenetic and Evolutionary Relationships among Yellow Fever Virus Isolates in Africa
Previous studies with a limited number of strains have indicated that there are two genotypes of yellow fever (YF) virus in Africa, one in west Africa and the other in east and central Africa. We have examined the prM\\/M and a portion of the E protein for a panel of 38 wild strains of YF virus from Africa representing different
JOHN-PAUL MUTEBI; HEIMAN WANG; L. Li; J. E. Bryant; A. D. T. Barrett
The 1970 yellow fever epidemic in Okwoga District, Benue Plateau State, Nigeria. I. Epidemiological observations.
A focal epidemic of yellow fever occurred in late 1970 in southern Benue Plateau State, Nigeria, 1 year after a much larger outbreak in northern Nigeria. Like its predecessor, the 1970 epidemic was associated with virus transmission by wild-breeding Stegomyia mosquitos. Epidemiological data on the outbreak are reported in this paper. PMID:4545318
Monath, T P; Wilson, D C; Lee, V H; Stroh, G; Kuteyi, K; Smith, E A
The 1970 yellow fever epidemic in Okwoga District, Benue Plateau State, Nigeria
A focal epidemic of yellow fever occurred in late 1970 in southern Benue Plateau State, Nigeria, 1 year after a much larger outbreak in northern Nigeria. Like its predecessor, the 1970 epidemic was associated with virus transmission by wild-breeding Stegomyia mosquitos. Epidemiological data on the outbreak are reported in this paper.
Monath, T. P.; Wilson, D. C.; Lee, V. H.; Stroh, G.; Kuteyi, K.; Smith, E. A.
The Aquaporin Gene Family of the Yellow Fever Mosquito, Aedes aegypti
BackgroundThe mosquito, Aedes aegypti, is the principal vector of the Dengue and yellow fever viruses. During feeding, an adult female can take up more than its own body weight in vertebrate blood. After a blood meal females excrete large amounts of urine through their excretion system, the Malpighian tubules (MT). Diuresis starts within seconds after the mosquito starts feeding. Aquaporins
Lisa L. Drake; Dmitri Y. Boudko; Osvaldo Marinotti; Victoria K. Carpenter; Angus L. Dawe; Immo A. Hansen; Pedro Lagerblad Oliveira
The centennial of the Yellow Fever Commission and the use of informed consent in medical research
The year 2000 marked the centennial of the discovery of the mode of transmission of yellow fever. Informed consent was systematically used for the first time in research. This process was the result of a complex social phenomenon involving the American Public Health Association, the US and Spanish Governments, American and Cuban scientists, the media, and civilian and military volunteers.
Fernando G�ere�a-Burgue�o
Alterations in the Aedes aegypti Transcriptome during Infection with West Nile, Dengue and Yellow Fever Viruses
West Nile (WNV), dengue (DENV) and yellow fever (YFV) viruses are (re)emerging, mosquito-borne flaviviruses that cause human disease and mortality worldwide. Alterations in mosquito gene expression common and unique to individual flaviviral infections are poorly understood. Here, we present a microarray analysis of the Aedes aegypti transcriptome over time during infection with DENV, WNV or YFV. We identified 203 mosquito
Tonya M. Colpitts; Jonathan Cox; Dana L. Vanlandingham; Fabiana M. Feitosa; Gong Cheng; Sebastian Kurscheid; Penghua Wang; Manoj N. Krishnan; Stephen Higgs; Erol Fikrig
Gestational exposure to yellow fever vaccine at different developmental stages induces behavioral alterations in the progeny.
The most effective method to prevent yellow fever and control the disease is a vaccine made with attenuated live virus. Due to the neurological tropism of the virus, preventive vaccination is not recommended for infants under 6 months and for pregnant women. However there is a paucity of data regarding the safety for pregnant women and there are no experimental studies investigating adverse effects to the offspring after maternal exposure to the vaccine. This study aimed to investigate, in mice, the effects of maternal exposure to the yellow fever vaccine at three different gestational ages on the physical and behavioral development of the offspring. Pregnant Swiss mice received a single subcutaneous injection of water for injection (control groups) or 2 log Plaque Forming Units (vaccine-treated groups) of the yellow fever vaccine on gestational days (GD) 5, 10 or 15. Neither maternal signs of toxicity nor alterations in physical development and reflex ontogeny of the offspring were observed in any of the groups. Data from behavioral evaluation indicated that yellow fever vaccine exposure induced motor hypoactivity in 22-day-old females independent of the day of exposure; and in 60-day-old male and female pups exposed at GD 10. Moreover, 22-day-old females also presented with a deficit in habituation memory. Altogether, these results indicate that in utero exposure to the yellow fever vaccine may induce behavioral alterations in the pups that may persist to adulthood in the absence of observed maternal toxicity or disruption of physical development milestones or reflex ontogeny. PMID:23277188
Marianno, P; Salles, M J S; Sonego, A B; Costa, G A; Galv�o, T C; Lima, G Z; Moreira, E G
Yellow fever epizootics in non-human primates, S�o Paulo state, Brazil, 2008-2009.
Since 2000, the expansion of Sylvatic Yellow Fever (YF) has been observed in the southeast of Brazil, being detected in areas considered silent for decades. Epizootics in non-human primates (NHPs) are considered sentinel events for the detection of human cases. It is important to report epizootic events that could have impact on the conservation status of susceptible species. We describe the epizootics in NHPs, notified in state of S�o Paulo, Brazil, between September 2008 to August 2009. Ninety-one epizootic events, involving 147 animals, were reported in 36 counties. Samples were obtained from 65 animals (44.2%). Most of the epizootics (46.6%) were reported between March and April, the same period during which human cases of YF occurred in the state. Biological samples were collected from animals found dead and were sent to Instituto Adolfo Lutz, in S�o Paulo. Two samples, collected in two counties without an indication for YF vaccination, were positive for the virus. Another 48 animals were associated with YF by clinical-epidemiological linkage with laboratory confirmed cases. Because the disease in human and NHPs occurred in the same period, the detection of the virus in NHPs did not work as sentinel, but aided in the delineation of new areas of risk. PMID:23328725
Moreno, Eduardo Stramandinoli; Spinola, Roberta; Tengan, Cilea Hatsumi; Brasil, Roosecelis Araujo; Siciliano, Melissa Mascheratti; Coimbra, Terezinha Lisieux Moraes; Silveira, Vivian Regina; Rocco, Iray Maria; Bisordi, Ivani; Souza, Renato Pereira de; Petrella, Selma; Pereira, Luiz Eloy; Maeda, Adriana Yurika; Silva, Fernanda Giselle da; Suzuki, Akemi
Human Genetic Variation and Yellow Fever Mortality during 19th Century U.S. Epidemics
ABSTRACT We calculated the incidence, mortality, and case fatality rates for Caucasians and non-Caucasians during 19th century yellow fever (YF) epidemics in the United States and determined statistical significance for differences in the rates in different populations. We evaluated nongenetic host factors, including socioeconomic, environmental, cultural, demographic, and acquired immunity status that could have influenced these differences. While differences in incidence rates were not significant between Caucasians and non-Caucasians, differences in mortality and case fatality rates were statistically significant for all epidemics tested (P < 0.01). Caucasians diagnosed with YF were 6.8 times more likely to succumb than non-Caucasians with the disease. No other major causes of death during the 19th century demonstrated a similar mortality skew toward Caucasians. Nongenetic host factors were examined and could not explain these large differences. We propose that the remarkably lower case mortality rates for individuals of non-Caucasian ancestry is the result of human genetic variation in loci encoding innate immune mediators.
Simultaneous administration of smallpox, measles, yellow fever, and diphtheria-pertussis-tetanus antigens to Nigerian children.
Children receiving smallpox, measles, and yellow fever vaccines simultaneously at separate sites responded adequately to all three vaccines. In those children, 9 months of age and older, who received these three vaccines in addition to diphtheria-pertussis-tetanus vaccine, there was a decrease in measles seroconversion rates from 89% to 70%. Possible interactions between live and killed vaccines should be considered when the administration of multiple antigens is planned. PMID:4541683
Ruben, F L; Smith, E A; Foster, S O; Casey, H L; Pifer, J M; Wallace, R B; Atta, A I; Jones, W L; Arnold, R B; Teller, B E; Shaikh, Z Q; Lourie, B; Eddins, D L; Doko, S M; Foege, W H
Simultaneous administration of smallpox, measles, yellow fever, and diphtheria--pertussis--tetanus antigens to Nigerian children*
Children receiving smallpox, measles, and yellow fever vaccines simultaneously at separate sites responded adequately to all three vaccines. In those children, 9 months of age and older, who received these three vaccines in addition to diphtheria�pertussis�tetanus vaccine, there was a decrease in measles seroconversion rates from 89% to 70%. Possible interactions between live and killed vaccines should be considered when the administration of multiple antigens is planned.
Ruben, F. L.; Smith, E. A.; Foster, S. O.; Casey, H. L.; Pifer, J. M.; Wallace, R. B.; Atta, A. I.; Jones, W. L.; Arnold, R. B.; Teller, B. E.; Shaikh, Z. Q.; Lourie, B.; Eddins, D. L.; Doko, S. M.; Foege, W. H.
Yellow fever vector live-virus vaccines: West Nile virus vaccine development
By combining molecular-biological techniques with our increased understanding of the effect of gene sequence modification on viral function, yellow fever 17D, a positive-strand RNA virus vaccine, has been manipulated to induce a protective immune response against viruses of the same family (e.g. Japanese encephalitis and dengue viruses). Triggered by the emergence of West Nile virus infections in the New World
Juan Arroyo; Charles A Miller; John Catalan; Thomas P Monath
Yellow fever vaccination in Malaya by subcutaneous injection and multiple puncture
In view of the risk of introduction of yellow fever into South-East Asia, comparative studies have been made of yellow fever vaccination in Malayan volunteers with a high prevalence of antibody to related viruses and in volunteers without related antibody. In a previous paper the neutralizing antibody responses of these volunteers were reported. The present paper describes the haemagglutinin-inhibiting (HI) antibody responses of the same groups of volunteers and discusses the relationship of these responses to the neutralizing antibody responses. The HI responses to yellow fever following vaccination closely paralleled the neutralizing antibody responses whether vaccination was subcutaneous or by multiple puncture. Volunteers with a high level of YF HI antibody due to infection with other group B viruses were found to be less likely to show a significant YF HI response than those without antibody. 90% of HI responses could be detected by the 21st day after vaccination. As with neutralizing antibody responses, volunteers given vaccine doses of 50-500 mouse intracerebral LD50 subcutaneously gave greater responses than those given higher doses.
Smith, C. E. Gordon; McMahon, Dolores A.; Turner, L. H.
Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella.
A randomized trial was conducted to assess the immunogenicity and reactogenicity of yellow fever vaccines (YFV) given either simultaneously in separate injections, or 30 days or more after a combined measles-mumps-rubella (MMR) vaccine. Volunteers were also randomized to YFV produced from 17DD and WHO-17D-213 substrains. The study group comprised 1769 healthy 12-month-old children brought to health care centers in Brasilia for routine vaccination. The reactogenicity was of the type and frequency expected for the vaccines and no severe adverse event was associated to either vaccine. Seroconversion and seropositivity 30 days or more after vaccination against yellow fever was similar across groups defined by YFV substrain. Subjects injected YFV and MMR simultaneously had lower seroconversion rates--90% for rubella, 70% for yellow fever and 61% for mumps--compared with those vaccinated 30 days apart--97% for rubella, 87% for yellow fever and 71% for mumps. Seroconversion rates for measles were higher than 98% in both comparison groups. Geometric mean titers for rubella and for yellow fever were approximately three times higher among those who got the vaccines 30 days apart. For measles and mumps antibodies GMTs were similar across groups. MMR's interference in immune response of YFV and YFV's interference in immune response of rubella and mumps components of MMR had never been reported before but are consistent with previous observations from other live vaccines. These results may affect the recommendations regarding primary vaccination with yellow fever vaccine and MMR. PMID:21640779
Nascimento Silva, Juliana Romualdo; Camacho, Luiz Antonio B; Siqueira, Marilda M; Freire, Marcos de Silva; Castro, Yvone P; Maia, Maria de Lourdes S; Yamamura, Anna Maya Y; Martins, Reinaldo M; Leal, Maria de Luz F
The 1970 yellow fever epidemic in Okwoga District Benue Plateau State, Nigeria. 2. Immunity survey to determine geographic limits and origins of the epidemic.
Serological surveys undertaken to define the geographic limits of the 1970 rural yellow fever epidemic in Okwoga District, Nigeria, indicated that surrounding areas of Benue Plateau State and East Central State were not involved. However, the surveys uncovered a separate focus of unrecognized, recent epidemic yellow fever in Mbawsi, in southern East Central State. The highest proportions of yellow-fever-immune sera outside the Okwoga and Mbawsi foci were found in zones of Guinea savannah in the Benue River basin. PMID:4545319
Monath, T P; Wilson, D C; Stroh, G; Lee, V H; Smith, E A
[Yellow fever in Senegal from 1976 to 1980 (author's transl)].
The isolation of a YF strain in Kedougou (eastern region) in December 1976 from Aedes gr. furcifer taylori lead to a mass vaccination campaign in Senegal. In 1977, 67 strains were isolated from different mosquitoes (essentially A. luteocephalus and A. gr. furcifer taylori). Among these strains, 3 were isolated from males and this very important phenomenon might explain the virus conservation during the dry season. In 1978, 55 strains were isolated from mosquitoes of the same species, but not from males, and five from monkeys (E. patas and C. aethiops). But no increase of morbidity or mortality was observed in humans. In December 1978, a YF outbreak occurred in the Gambia with 271 suspect cases and 63 deaths; 2 strains were isolated from A. aegypti. In 1979, the epidemic seemed to have disappeared. Up to now, one single strain has been isolated from mosquitoes. But danger remains, and 3 YF human cases with 2 deaths were observed in Sine-Saloum, among French unvaccinated tourists. PMID:6792455
Salaun, J J; Germain, M; Robert, V; Robin, Y; Monath, T P; Camicas, J L; Digoutte, J P
A recombinant Yellow Fever 17D vaccine expressing Lassa virus glycoproteins
The Yellow Fever Vaccine 17D (YFV17D) has been used as a vector for the Lassa virus glycoprotein precursor (LASV-GPC) resulting in construction of YFV17D/LASV-GPC recombinant virus. The virus was replication-competent and processed the LASV-GPC in cell cultures. The recombinant replicated poorly in guinea pigs but still elicited specific antibodies against LASV and YFV17D antigens. A single subcutaneous injection of the recombinant vaccine protected strain 13 guinea pigs against fatal Lassa Fever. This study demonstrates the potential to develop an YFV17D-based bivalent vaccine against two viruses that are endemic in the same area of Africa.
Bredenbeek, Peter J.; Molenkamp, Richard; Spaan, Willy J.M.; Deubel, Vincent; Marianneau, Phillippe; Salvato, Maria S.; Moshkoff, Dmitry; Zapata, Juan; Tikhonov, Ilia; Patterson, Jean; Carrion, Ricardo; Ticer, Anysha; Brasky, Kathleen; Lukashevich, Igor S.
Possible contributing factors to the paucity of yellow fever epidemics in the Ashanti region of Ghana, west Africa.
Yellow fever virus vectors identified in the Ashanti region of Ghana included Aedes aegypti, Aedes africanus, Aedes luteocephalus and Aedes vittatus. Other mosquito species, unrelated to yellow fever transmission, identified in this study included Culex tigripes, Culex thalassius, Culex decens, Culex tarsalis, Anopheles gambiae, Anopheles stephansi and Toxorynchites brevipalpis. Factors generally known to influence yellow fever transmission were also studied in the Ashanti region. These included Aedes mosquito larval indices, biting or man-contact rates, rainfall, relative humidity and duration of sunshine. Calculated values for these factors were found to be far below internationally accepted threshold values, due, perhaps, to the vast distribution, resilience and preferential predatory propensity of the larvae of T. brevipalpis, a mosquito species we found exclusively in the Ashanti region of Ghana, for A. aegypti larvae. Other predators of mosquito larvae encountered included Notonecta (Nepa species), Hydromerta, Culex tigripes, Belostoma and Lispa. The observed paucity of yellow fever outbreaks in the Ashanti region of Ghana may, in the main, be due to the preponderance resilience and selective predatory propensity and preference of T. brevipalpis for A. aegypti larvae. Furthermore, the observed presence of other predators which prey on A. aegypti larvae in the study areas, the low larval indices and the low man-vector contact rates recorded as well as the high prevalence of Group B antibodies found in the blood of the population of this region may also be contributory to the paucity of yellow fever outbreaks in the Ashanti region. PMID:8625858
Addy, P A; Esena, R K; Atuahene, S K
Development of a membrane adsorber based capture step for the purification of yellow fever virus.
Yellow fever (YF) is an endemic disease in some tropical areas of South America and Africa that presents lethality rate between 20 and 50%. There is no specific treatment and to control this disease a highly effective live-attenuated egg based vaccine is widely used for travelers and residents of areas where YF is endemic. However, recent reports of rare, sometimes fatal, adverse events post-vaccination have raised concerns. In order to increase safety records, alternative strategies should be considered, such as developing a new inactivated vaccine using a cell culture based technology, capable of meeting the demands in cases of epidemic. With this goal, the production of YF virus in Vero cells grown on microcarriers and its subsequent purification by chromatographic techniques was studied. In this work we investigate the capture step of the purification process of the YF virus. At first, virus stability was studied over a wide pH range, showing best results for the alkaline region. Considering this result and the pI of the envelope protein previously determined in silico, a strong anion exchanger was considered most suitable. Due to the easy scalability, simplicity to handle, absence of diffusional limitations and suitability for virus handling of membrane adsorbers, a Q membrane was evaluated. The amount of antigen adsorbed onto the membrane was investigated within the pH range for virus stability, and the best pH for virus adsorption was considered to be 8.5. Finally, studies on gradient and step elution allowed to determine the most adequate salt concentration for washing (0.15M) and virus elution (0.30M). Under these operating conditions, it was shown that this capture step is quite efficient, showing high product recovery (93.2�30.3%) and efficient DNA clearance (0.9�0.3ng/dose). PMID:24631080
Pato, T�nia P; Souza, Marta Cristina O; Silva, Andr�a N M R; Pereira, Renata C; Silva, Marlon V; Caride, Elena; Gaspar, Luciane P; Freire, Marcos S; Castilho, Leda R
The response of rhesus monkeys to a subcutaneous inoculation with varying amounts of virus modified by prolonged cultivation in vitro has been studied. The tissue components of the medium consisted of chick embryo tissue containing minimal amounts of nervous tissue. The immunity produced in monkeys, as measured by the antibody titer developed, has no relation to the amount of virus inoculated. Monkeys inoculated subcutaneously with the tissue culture virus are rendered immune to a subsequent injection of a highly virulent yellow fever virus. This resistance is already present 7 days after vaccination. The subcutaneous inoculation of the culture virus into immune persons leads to a substantial increase of the serum antibody titer. The results of vaccinating eight normal persons with culture virus are presented. The reactions were minimal. The highest temperature recorded following vaccination was 37.4 degrees C. The sera taken from the eight vaccinated persons 2 to 4 weeks after inoculation with the tissue culture virus showed the presence of yellow fever antibodies. PMID:19870634
Theiler, M; Smith, H H
Yellow fever vaccination in Malaya by subcutaneous injection and multiple puncture
Because of the risk of introduction of yellow fever to South-East Asia, comparative studies were made of yellow fever vaccination in Malayans who had a high prevalence of antibody to related viruses and in volunteers without related antibody. The proportions of positive neutralizing antibody responses to subcutaneous vaccination with 17D vaccine were not significantly different between volunteers with and without heterologous antibody but the degree of antibody response was greater in those without. The ID50 of 17D in both groups was about 5 mouse intracerebral LD50. Multiple puncture vaccination with 17D gave a much lower response rate than subcutaneous vaccination in volunteers with heterologous antibody. In both groups subcutaneous doses of about 50 mouse intracerebral LD50 gave larger antibody responses than higher doses. The neutralizing indices and analysis of results were calculated by a method based on the survival time of the mice. This method, which has advantages over that of Reed & Muench, is fully described in an annex to this paper.
Smith, C. E. Gordon; Turner, L. H.; Armitage, P.
The response of rhesus monkeys to a subcutaneous inoculation with varying amounts of virus modified by prolonged cultivation in vitro has been studied. The tissue components of the medium consisted of chick embryo tissue containing minimal amounts of nervous tissue. The immunity produced in monkeys, as measured by the antibody titer developed, has no relation to the amount of virus inoculated. Monkeys inoculated subcutaneously with the tissue culture virus are rendered immune to a subsequent injection of a highly virulent yellow fever virus. This resistance is already present 7 days after vaccination. The subcutaneous inoculation of the culture virus into immune persons leads to a substantial increase of the serum antibody titer. The results of vaccinating eight normal persons with culture virus are presented. The reactions were minimal. The highest temperature recorded following vaccination was 37.4�C. The sera taken from the eight vaccinated persons 2 to 4 weeks after inoculation with the tissue culture virus showed the presence of yellow fever antibodies.
Theiler, Max; Smith, Hugh H.
Rapid detection and quantification of RNA of Ebola and Marburg viruses, Lassa virus, Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, dengue virus, and yellow fever virus by real-time reverse transcription-PCR.
Viral hemorrhagic fevers (VHFs) are acute infections with high case fatality rates. Important VHF agents are Ebola and Marburg viruses (MBGV/EBOV), Lassa virus (LASV), Crimean-Congo hemorrhagic fever virus (CCHFV), Rift Valley fever virus (RVFV), dengue virus (DENV), and yellow fever virus (YFV). VHFs are clinically difficult to diagnose and to distinguish; a rapid and reliable laboratory diagnosis is required in suspected cases. We have established six one-step, real-time reverse transcription-PCR assays for these pathogens based on the Superscript reverse transcriptase-Platinum Taq polymerase enzyme mixture. Novel primers and/or 5'-nuclease detection probes were designed for RVFV, DENV, YFV, and CCHFV by using the latest DNA database entries. PCR products were detected in real time on a LightCycler instrument by using 5'-nuclease technology (RVFV, DENV, and YFV) or SybrGreen dye intercalation (MBGV/EBOV, LASV, and CCHFV). The inhibitory effect of SybrGreen on reverse transcription was overcome by initial immobilization of the dye in the reaction capillaries. Universal cycling conditions for SybrGreen and 5'-nuclease probe detection were established. Thus, up to three assays could be performed in parallel, facilitating rapid testing for several pathogens. All assays were thoroughly optimized and validated in terms of analytical sensitivity by using in vitro-transcribed RNA. The >or=95% detection limits as determined by probit regression analysis ranged from 1,545 to 2,835 viral genome equivalents/ml of serum (8.6 to 16 RNA copies per assay). The suitability of the assays was exemplified by detection and quantification of viral RNA in serum samples of VHF patients. PMID:12089242
Drosten, Christian; G�ttig, Stephan; Schilling, Stefan; Asper, Marcel; Panning, Marcus; Schmitz, Herbert; G�nther, Stephan
Biological activity of certain botanical extracts as larvicides against the yellow fever mosquito, Aedes aegypti.L
As a part of a programme on possible utilization of indigenous plant extracts in pest management practices, acetone extracts of eight plant species collected in the state of Andhra Pradesh, India, were tested for their larvicidal activity against the yellow fever mosquito, Aedes aegypti L. The buds of Tail Pepper, Piper cubeba L, Capers Capparis spinosa L and Indian Black
Joish Madhasudhana Murthy; Pathipati Usha Rani
[Microeconomic evaluation of a mass preventive immunisation campaign against meningococcal meningitis and yellow fever in Senegal in 1997].
Large epidemics of group A meningococcal meningitis occurred in 1995 and 1996 in several countries of the Sub-Saharan Africa zone known as the "meningitis belt", and more particularly in West Africa. Most of these countries affected by the epidemics met difficulties to set up the strategy recommended by the World Health Organization and which includes: Epidemiological surveillance and epidemic incidence threshold calculation to detect early meningitis epidemics and emergency vaccination campaigns with meningococcal A + C polysaccharide vaccine, if possible within the 4-to-6 weeks following the moment the threshold is reached. In this context of epidemics, notably in Mali, and in front of the risk of resurgence of yellow fever, the Ministry of Health of Senegal decided to conduct mass preventive immunization campaigns in 1997 against meningo- coccal meningitis and yellow fever in the districts located in the eastern part of the country and where emergency vaccination would have been difficult in case of epidemic because these area are difficult to reach. A short-term microeconomic evaluation of additional costs that are necessary to organize one of these mass preventive immunization campaigns was conducted in 1997 in the Matam District, in the Northeast part of Senegal. The method rested on value attribution and accounting procedure. The cost was defined as the monetary value of all mobilized resources to product the campaign corresponding to a plurality of charges and representing all of the effective expenses and donations. During this campaign, 85,925 people were vaccinated and a total number of 163,981 doses of both polysaccharide A + C meningococcal and yellow fever vaccines were administered within 3 weeks. Four intervention strategies were involved: Three for vaccination (mobile, fixed and outreach strategy) and one for coordination, information and training. The total cost of the campaign was 55,322.75 euros. Vaccines and solvents represented 60% of the total cost of the campaign, materiel for injection and safety of injection 26%, vaccination staff 7%, and logistics 7%. The mean cost was 0.34 euro per administered dose and 0.64 euro per vaccinee. The mean cost per administered dose of meningococcal vaccine was 0.44 euro. The mean cost of preventive meningococcal immunization was not higher than the mean cost of meningococcal vaccination during mass emergency immunization campaigns in other countries. The addition of yellow fever antigen brought down the campaign mean cost by 0.11 euro and it allowed economies of scales. Direct unit costs per administered dose were higher when people were vaccinated through the outreach strategy (0.35 euro) than when fixed and mobile strategies were used (0.318 and 0.323 euro, respectively). Costs related to transportation and staff were proportionally higher for the outreach strategy. Direct unit costs per administered dose were higher when vaccinations were done in rural areas (0.32 euro) than when done in urban areas (0.31 euro). Direct unit costs increased when the size of target communities decreased (in communities with less than 100 people to vaccinate versus 0.38 euro in communities with more than 2,000 people to vaccinate). This study allowed us to set up a method to measure, describe and analyze the costs of a mass preventive campaign. It demonstrated the economic impact of using multiple antigens during a single preventive campaign. PMID:15047438
da Silva, Alfred; Parent du Ch�telet, Isabelle; Beckr Gaye, Abou; Dompnier, Jean-Pierre; Seck, Ibrahima
Systems biology approach predicts immunogenicity of the yellow fever vaccine in humans
A major challenge in vaccinology is to prospectively determine vaccine efficacy. Here we have used a systems biology approach to identify early gene �signatures� that predicted immune responses in humans vaccinated with yellow fever vaccine YF-17D. Vaccination induced genes that regulate virus innate sensing and type I interferon production. Computational analyses identified a gene signature, including complement protein C1qB and eukaryotic translation initiation factor 2 alpha kinase 4�an orchestrator of the integrated stress response�that correlated with and predicted YF-17D CD8+ T cell responses with up to 90% accuracy in an independent, blinded trial. A distinct signature, including B cell growth factor TNFRS17, predicted the neutralizing antibody response with up to 100% accuracy. These data highlight the utility of systems biology approaches in predicting vaccine efficacy.
Lee, Eva K; Cao, Weiping; Nakaya, Helder I; Teuwen, Dirk; Pirani, Ali; Gernert, Kim; Deng, Jiusheng; Marzolf, Bruz; Kennedy, Kathleen; Wu, Haiyan; Bennouna, Soumaya; Oluoch, Herold; Miller, Joseph; Vencio, Ricardo Z; Mulligan, Mark; Aderem, Alan; Ahmed, Rafi; Pulendran, Bali
Evaluation of two molecular methods for the detection of Yellow fever virus genome
Yellow fever virus (YFV), a member of the family Flaviviridae, genus Flavivirus is endemic to tropical areas of Africa and South America and is among the arboviruses that pose a threat to public health. Recent outbreaks in Brazil, Bolivia, and Paraguay and the observation that vectors capable of transmitting YFV are presenting in urban areas underscore the urgency of improving surveillance and diagnostic methods. Two novel methods (RT-hemi-nested-PCR and SYBR�Green qRT-PCR) for efficient detection of YFV strains circulating in South America have been developed. The methods were validated using samples obtained from golden hamsters infected experimentally with wild-type YFV strains as well as human serum and tissue samples with acute disease.
Nunes, Marcio R. T.; Palacios, Gustavo; Nunes, Keley N. B.; Casseb, Samir M. M.; Martins, Livia C.; Quaresma, Juarez A.S.; Savji, Nazir; Lipkin, W. Ian; Vasconcelos, Pedro F. C.
Sensorineural hearing loss in Lassa fever: two case reports
INTRODUCTION: Lassa fever is an acute arena viral haemorrhagic fever with varied neurological sequelae. Sensorineural hearing loss is one of the rare complications which occur usually during the convalescent stage of the infection. CASE PRESENTATION: The cases of two female patients aged 19 and 43 years old, respectively, with clinical features suggestive of Lassa fever and confirmed by immunoserological\\/Lassa-virus-specific reverse
Peter O Okokhere; Titus S Ibekwe; George O Akpede
An Integrated Linkage, Chromosome, and Genome Map for the Yellow Fever Mosquito Aedes aegypti
Background Aedes aegypti, the yellow fever mosquito, is an efficient vector of arboviruses and a convenient model system for laboratory research. Extensive linkage mapping of morphological and molecular markers localized a number of quantitative trait loci (QTLs) related to the mosquito's ability to transmit various pathogens. However, linking the QTLs to Ae. aegypti chromosomes and genomic sequences has been challenging because of the poor quality of polytene chromosomes and the highly fragmented genome assembly for this species. Methodology/Principal Findings Based on the approach developed in our previous study, we constructed idiograms for mitotic chromosomes of Ae. aegypti based on their banding patterns at early metaphase. These idiograms represent the first cytogenetic map developed for mitotic chromosomes of Ae. aegypti. One hundred bacterial artificial chromosome clones carrying major genetic markers were hybridized to the chromosomes using fluorescent in situ hybridization. As a result, QTLs related to the transmission of the filarioid nematode Brugia malayi, the avian malaria parasite Plasmodium gallinaceum, and the dengue virus, as well as sex determination locus and 183 Mbp of genomic sequences were anchored to the exact positions on Ae. aegypti chromosomes. A linear regression analysis demonstrated a good correlation between positions of the markers on the physical and linkage maps. As a result of the recombination rate variation along the chromosomes, 12 QTLs on the linkage map were combined into five major clusters of QTLs on the chromosome map. Conclusion This study developed an integrated linkage, chromosome, and genome map�iMap�for the yellow fever mosquito. Our discovery of the localization of multiple QTLs in a few major chromosome clusters suggests a possibility that the transmission of various pathogens is controlled by the same genomic loci. Thus, the iMap will facilitate the identification of genomic determinants of traits responsible for susceptibility or refractoriness of the mosquito to diverse pathogens.
Timoshevskiy, Vladimir A.; Severson, David W.; deBruyn, Becky S.; Black, William C.; Sharakhov, Igor V.; Sharakhova, Maria V.
Unusual manifestation of the yellow nail syndrome - Case report.
The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region. PMID:24937826
Papaiordanou, Francine; Epstein, Marina Gabrielle; Miyaoka, Mariana Yumi; Yang, Jeane Jeong Hoon; Pires, Mario Cezar
Unusual manifestation of the yellow nail syndrome - Case report*
The yellow nail syndrome is a rare disorder characterized by the classic triad of yellow and dystrophic nails, lymphedema and pleural effusion. We report in this paper a case of yellow nail syndrome, presenting the classic triad of the disease, associated with an unusual lymph accumulation in the abdomen region.
Papaiordanou, Francine; Epstein, Marina Gabrielle; Miyaoka, Mariana Yumi; Yang, Jeane Jeong Hoon; Pires, Mario Cezar
Fulminant hepatic failure in northern Brazil: morphological, immunohistochemical and pathogenic aspects of L�brea hepatitis and yellow fever.
A morphological evaluation of histopathological liver samples from 42 fulminant hepatic failure cases from the Amazon Basin was undertaken in order to differentiate yellow fever (YF) from L�brea hepatitis (LH) and other entities. The pattern and distribution of liver cell death as well as ballooning degeneration and midzonal apoptotic bodies were the most distinctive features of YF, whereas morula cells were the major finding for LH. Nineteen well characterised cases were further submitted to immunohistochemical studies for expression of YF antigen, hepatitis B surface antigen (HBsAg) and delta virus antigen. In both diseases, but particularly in LH, portal vein branch phlebitis was evident and might have played a role in the pathogenesis of hepatic injury, leading to hepatic extinction and portal tract approximation. The regeneration pattern was remarkable: a high proliferative index was detected in YF, whereas in LH multinucleation and pseudoacinar transformation, associated with portal type I collagen deposition and portal elastic fibre proliferation, was seen. In conclusion, midzonal apoptosis, portal phlebitis and a high proliferative index in patients without evidence of previous liver injury was the dominant picture in YF. On the other hand, LH cases showed extensive, predominantly lytic hepatocytic necrosis, portal and hepatic vein phlebitis and morula cells in patients with a morphological background of chronic liver disease. PMID:17568643
Dias, L B; Alves, V A F; Kanamura, C; Oikawa, R T C; Wakamatsu, A
Viral haemorrhagic fevers of man*
This article reviews the current state of knowledge on the viral haemorrhagic fevers that infect man, namely smallpox, chikungunya fever, dengue fever, Rift Valley fever, yellow fever, Crimean haemorrhagic fever, Kyasanur Forest disease, Omsk haemorrhagic fever, Argentinian haemorrhagic fever (Junin virus), Bolivian haemorrhagic fever (Machupo virus), Lassa fever, haemorrhagic fever with renal syndrome, and Marburg and Ebola virus diseases.
Simpson, D. I. H.
Characterization of an Enantioselective Odorant Receptor in the Yellow Fever Mosquito Aedes aegypti
Enantiomers differ only in the left or right handedness (chirality) of their orientations and exhibit identical chemical and physical properties. In chemical communication systems, enantiomers can be differentially active at the physiological and behavioral levels. Only recently were enantioselective odorant receptors demonstrated in mammals while their existence in insects has remained hypothetical. Using the two-microelectrode voltage clamp of Xenopus oocytes, we show that the yellow fever mosquito, Aedes aegypti, odorant receptor 8 (AaOR8) acts as a chiral selective receptor for the (R)-(�)-enantiomer of 1-octen-3-ol, which in the presence of other kairomones is an attractant used by blood-sucking insects to locate their hosts. In addition to steric constraints, chain length and degree of unsaturation play important roles in this recognition process. This is the first characterization of an enantioselective odorant receptor in insects and the results demonstrate that an OR alone, without helper proteins, can account for chiral specificity exhibited by olfactory sensory neurons (OSNs).
Bohbot, Jonathan D.; Dickens, Joseph C.
Biological and Phylogenetic Characteristics of Yellow Fever Virus Lineages from West Africa
The yellow fever virus (YFV), the first proven human-pathogenic virus, although isolated in 1927, is still a major public health problem, especially in West Africa where it causes outbreaks every year. Nevertheless, little is known about its genetic diversity and evolutionary dynamics, mainly due to a limited number of genomic sequences from wild virus isolates. In this study, we analyzed the phylogenetic relationships of 24 full-length genomes from YFV strains isolated between 1973 and 2005 in a sylvatic context of West Africa, including 14 isolates that had previously not been sequenced. By this, we confirmed genetic variability within one genotype by the identification of various YF lineages circulating in West Africa. Further analyses of the biological properties of these lineages revealed differential growth behavior in human liver and insect cells, correlating with the source of isolation and suggesting host adaptation. For one lineage, repeatedly isolated in a context of vertical transmission, specific characteristics in the growth behavior and unique mutations of the viral genome were observed and deserve further investigation to gain insight into mechanisms involved in YFV emergence and maintenance in nature.
Laraway, Hewad; Faye, Ousmane; Diallo, Mawlouth; Niedrig, Matthias
Is There a Risk of Yellow Fever Virus Transmission in South Asian Countries with Hyperendemic Dengue?
The fact that yellow fever (YF) has never occurred in Asia remains an �unsolved mystery� in global health. Most countries in Asia with high Aedes aegypti mosquito density are considered �receptive� for YF transmission. Recently, health officials in Sri Lanka issued a public health alert on the potential spread of YF from a migrant group from West Africa. We performed an extensive review of literature pertaining to the risk of YF in Sri Lanka/South Asian region to understand the probability of actual risk and assist health authorities to form evidence informed public health policies/practices. Published data from epidemiological, historical, biological, molecular, and mathematical models were harnessed to assess the risk of YF in Asia. Using this data we examine a number of theories proposed to explain lack of YF in Asia. Considering the evidence available, we conclude that the probable risk of local transmission of YF is extremely low in Sri Lanka and for other South Asian countries despite a high Aedes aegypti density and associated dengue burden. This does not however exclude the future possibility of transmission in Asia, especially considering the rapid influx travelers from endemic areas, as we report, arriving in Sri Lanka.
Agampodi, Suneth B.; Wickramage, Kolitha
Patterns of a sylvatic yellow Fever virus amplification in southeastern senegal, 2010.
During the wet season of 2010, yellow fever virus (YFV) was detected in field-collected mosquitoes in the K�dougou region in southeastern Senegal. During this outbreak, we studied the association of the abundance of YFV-infected mosquitoes and land cover features to try and understand the dynamics of YFV transmission within the region. In total, 41,234 mosquito females were collected and tested for virus infection in 5,152 pools. YFV was detected in 67 pools; species including Aedes furcifer (52.2% of the infected pools), Ae. luteocephalus (31.3% of the infected pools), Ae. taylori (6.0% of the infected pools) and six other species (10.4% of the infected pools) captured in September (13.4%), October (70.1%), and November (16.4%). Spatially, YFV was detected from mosquitoes collected in all land cover classes but mainly, forest canopies (49.2%). Human infection is likely mediated by Ae. furcifer, the only species found infected with YFV within villages. Villages containing YFV-infected mosquitoes were significantly closer to large forests (> 2 ha) than villages in which no infected mosquitoes were detected. PMID:24615140
Diallo, Diawo; Sall, Amadou A; Diagne, Cheikh T; Faye, Oumar; Hanley, Kathryn A; Buenemann, Michaela; Ba, Yamar; Faye, Ousmane; Weaver, Scott C; Diallo, Mawlouth
Description of a Prospective 17DD Yellow Fever Vaccine Cohort in Recife, Brazil
From September 2005 to March 2007, 238 individuals being vaccinated for the first time with the yellow fever (YF) -17DD vaccine were enrolled in a cohort established in Recife, Brazil. A prospective study indicated that, after immunization, anti-YF immunoglobulin M (IgM) and anti-YF IgG were present in 70.6% (IgM) and 98.3% (IgG) of the vaccinated subjects. All vaccinees developed protective immunity, which was detected by the plaque reduction neutralization test (PRNT) with a geometric mean titer of 892. Of the 238 individuals, 86.6% had IgG antibodies to dengue virus; however, the presence of anti-dengue IgG did not interfere significantly with the development of anti-YF neutralizing antibodies. In a separate retrospective study of individuals immunized with the 17DD vaccine, the PRNT values at 5 and 10 years post-vaccination remained positive but showed a significant decrease in neutralization titer (25% with PRNT titers < 100 after 5 years and 35% after 10 years).
de Melo, Andrea Barbosa; da Silva, Maria da Paz C.; Magalhaes, Maria Cecilia F.; Gonzales Gil, Laura Helena Vega; Freese de Carvalho, Eduardo M.; Braga-Neto, Ulisses M.; Bertani, Giovani Rota; Marques, Ernesto T. A.; Cordeiro, Marli Tenorio
Larval nutritional stress affects vector immune traits in adult yellow fever mosquito Aedes aegypti (Stegomyia aegypti).
We report key physiological traits that link larval nutritional experience to adult immune status in the yellow fever mosquito Aedes aegypti L. (Stegomyia aegypti) (Diptera: Culicidae). Many lines of defence make up the innate immune system of mosquitoes. Among defences, the epithelium-lined midgut is the first barrier, circulating haemocytes are cellular components of innate immunity and, when triggered, the Toll and Imd pathways signal production of antimicrobial peptides (AMP) as part of humoral defences. We quantified three lines of defence in Ae. aegypti in response to larval nutritional stress, and our data show that important female immune functions are modified by the larval rearing environment. Adult midgut basal lamina thickness was not affected by larval nutrient stress as has been observed in another Aedes sp. However, nutrient stresses experienced by larvae lead to a reduced number of haemocytes in females. Transcripts of Spaetzle (upstream regulator of Toll pathway that leads to induction of AMPs) and some immune-related genes were less abundant in stressed larvae but showed increased expression in females derived from stressed larvae. Results indicate a potential for compensation by the humoral branch for a reduced cellular branch of innate immunity in adults in response to larval nutrient stress. PMID:22112201
Telang, A; Qayum, A A; Parker, A; Sacchetta, B R; Byrnes, G R
Identification of inhibitors of yellow fever virus replication using a replicon-based high-throughput assay.
Flaviviruses cause severe disease in humans and are a public health priority worldwide. However, no effective therapies or drugs are commercially available yet. Several flavivirus replicon-based assays amenable to high-throughput screening of inhibitors have been reported recently. We developed and performed a replicon-based high-throughput assay for screening small-molecule inhibitors of yellow fever virus (YFV) replication. This assay utilized packaged pseudoinfectious particles containing a YFV replicon that expresses Renilla luciferase in a replication-dependent manner. Several small-molecule compounds with inhibitory activity at micromolar concentrations were identified in the high-throughput screen. These compounds were subsequently tested for their inhibitory activities against YFV replication and propagation in low-throughput assays. Furthermore, YFV mutants that escaped inhibition by two of the compounds were isolated, and in both cases, the mutations were mapped to the NS4B coding region, suggesting a novel inhibitory target for these compounds. This study opens up new avenues for pursuing the nonenzymatic nonstructural proteins as targets for antivirals against YFV and other flaviviruses. PMID:19651907
Patkar, Chinmay G; Larsen, Martha; Owston, Michael; Smith, Janet L; Kuhn, Richard J
Identification of Inhibitors of Yellow Fever Virus Replication Using a Replicon-Based High-Throughput Assay?
Flaviviruses cause severe disease in humans and are a public health priority worldwide. However, no effective therapies or drugs are commercially available yet. Several flavivirus replicon-based assays amenable to high-throughput screening of inhibitors have been reported recently. We developed and performed a replicon-based high-throughput assay for screening small-molecule inhibitors of yellow fever virus (YFV) replication. This assay utilized packaged pseudoinfectious particles containing a YFV replicon that expresses Renilla luciferase in a replication-dependent manner. Several small-molecule compounds with inhibitory activity at micromolar concentrations were identified in the high-throughput screen. These compounds were subsequently tested for their inhibitory activities against YFV replication and propagation in low-throughput assays. Furthermore, YFV mutants that escaped inhibition by two of the compounds were isolated, and in both cases, the mutations were mapped to the NS4B coding region, suggesting a novel inhibitory target for these compounds. This study opens up new avenues for pursuing the nonenzymatic nonstructural proteins as targets for antivirals against YFV and other flaviviruses.
Patkar, Chinmay G.; Larsen, Martha; Owston, Michael; Smith, Janet L.; Kuhn, Richard J.
[Entomological investigation following the re-emergence of yellow fever in 2008 in Abidjan area (C�te d'Ivoire)].
In April 2008, Abidjan was again faced with another case of yellow fever after the epidemic of 2001 causing mass immunization campaign. In order to evaluate the extent of amaril virus circulation and the risk for local people, an entomological investigation was carried out by the Ministry of Health and Public Hygiene of C�te d'Ivoire. At "Entent" area of Treichville, Breteau index was estimated at 34, recipient index at 20% and house index at 25%. Those indexes were respectively 53, 21 and 31% at "Vridi canal" of Port Bouet. In the both neighborhood, Aedes aegypti accounted for more than 80% of mosquitoes caught and more than 90% of mosquitoes adults obtained from larval breeding. This new situation of epidemic risk could be explained by several factors including the reception of 70% of forced migration people caused by the crisis in the country occurred in 2002, the probable drop of preventive immunization, the environment deterioration creating of more breeding sites of Ae. aegypti. PMID:19585894
Konan, Y L; Kon�, A B; Ekra, K D; Doannio, J M C; Od�houri, K P
IT would seem to me that the great difficulty of conceiving yellow as a compound colour is the brightness or lightness of yellow, as compared with its components. In the spectrum, we have the maximum of light in the yellow, and it is against our experience to put two dark colours together and form one light one, as, for example,
C. J. Woodward
The first cases of Lassa fever in Ghana.
Lassa fever is a zoonotic disease endemic in West Africa but with no previous case reported in Ghana. We describe the first two laboratory confirmed cases of Lassa fever from the Ashanti Region of Ghana detected in October and December, 2011. PMID:23661832
Dzotsi, E K; Ohene, S-A; Asiedu-Bekoe, F; Amankwa, J; Sarkodie, B; Adjabeng, M; Thouphique, A M; Ofei, A; Oduro, J; Atitogo, D; Bonney, J H K; Paintsil, S C N; Ampofo, W
Stability of Yellow Fever Virus under Recombinatory Pressure as Compared with Chikungunya Virus
Recombination is a mechanism whereby positive sense single stranded RNA viruses exchange segments of genetic information. Recent phylogenetic analyses of naturally occurring recombinant flaviviruses have raised concerns regarding the potential for the emergence of virulent recombinants either post-vaccination or following co-infection with two distinct wild-type viruses. To characterize the conditions and sequences that favor RNA arthropod-borne virus recombination we constructed yellow fever virus (YFV) 17D recombinant crosses containing complementary deletions in the envelope protein coding sequence. These constructs were designed to strongly favor recombination, and the detection conditions were optimized to achieve high sensitivity recovery of putative recombinants. Full length recombinant YFV 17D virus was never detected under any of the experimental conditions examined, despite achieving estimated YFV replicon co-infection levels of ?2.4�106 in BHK-21 (vertebrate) cells and ?1.05�105 in C710 (arthropod) cells. Additionally YFV 17D superinfection resistance was observed in vertebrate and arthropod cells harboring a primary infection with wild-type YFV Asibi strain. Furthermore recombination potential was also evaluated using similarly designed chikungunya virus (CHIKV) replicons towards validation of this strategy for recombination detection. Non-homologus recombination was observed for CHIKV within the structural gene coding sequence resulting in an in-frame duplication of capsid and E3 gene. Based on these data, it is concluded that even in the unlikely event of a high level acute co-infection of two distinct YFV genomes in an arthropod or vertebrate host, the generation of viable flavivirus recombinants is extremely unlikely.
McGee, Charles E.; Tsetsarkin, Konstantin A.; Guy, Bruno; Lang, Jean; Plante, Kenneth; Vanlandingham, Dana L.; Higgs, Stephen
Mutagenesis analysis of T380R mutation in the envelope protein of yellow fever virus
Background The RGD motif in the mosquito-borne flaviviruses envelope protein domain III (EDIII) FG loop was shown to bind negatively charged cellular molecules and mediate virus entry in mammals. However, its importance in virus entry in the mosquito has not yet been defined. The sequences of RGD motifs are conserved in JEV-serocomplex members primarily transmitted by Culex mosquitoes but absent from members of the DENV serocomplex, which utilize Aedes mosquitoes as vectors. Interestingly, the RGD sequence is present in the attenuated 17D strain of yellow fever virus as a result of the T380R mutation in the EDIII of Asibi strain following extensive in vitro passage in mice and chicken embryos and was found to contribute to the more rapid clearance in mice challenged with 17D. However, viral infectivity and dissemination in mosquitoes had not been evaluated for this mutant. Findings The study utilized the reverse genetics system of YFV and Ae. aegypti RexD WE mosquitoes to assess the impact of a T380R mutation in YFV Asibi and 17D/Asibi M-E chimera. The T380R mutation led to higher infection rates but similar dissemination rates when introduced into the YFV Asibi strain and 17D/Asibi M-E chimera. Conclusions While the increase of the positive charge in EDIII may reduce the virulence of YFV in mice, this mutation favored the establishment of the viral infection in Ae. aegypti. However, such gain in viral infectivity did not increase dissemination in infected mosquitoes.
The Aquaporin Gene Family of the Yellow Fever Mosquito, Aedes aegypti
Background The mosquito, Aedes aegypti, is the principal vector of the Dengue and yellow fever viruses. During feeding, an adult female can take up more than its own body weight in vertebrate blood. After a blood meal females excrete large amounts of urine through their excretion system, the Malpighian tubules (MT). Diuresis starts within seconds after the mosquito starts feeding. Aquaporins (AQPs) are a family of membrane transporters that regulate the flow of water, glycerol and other small molecules across cellular membranes in both prokaryotic and eukaryotic cells. Our aim was to identify aquaporins that function as water channels, mediating transcellular water transport in MTs of adult female Ae. aegypti. Methodology/Principal Findings Using a bioinformatics approach we screened genome databases and identified six putative AQPs in the genome of Ae. aegypti. Phylogenetic analysis showed that five of the six Ae. aegypti AQPs have high similarity to classical water-transporting AQPs of vertebrates. Using microarray, reverse transcription and real time PCR analysis we found that all six AQPs are expressed in distinct patterns in mosquito tissues/body parts. AaAQP1, 4, and 5 are strongly expressed in the adult female MT. RNAi-mediated knockdown of the MT-expressed mosquito AQPs resulted in significantly reduced diuresis. Conclusions/Significance Our results support the notion that AQP1, 4, and 5 function as water transporters in the MTs of adult female Ae. aegypti mosquitoes. Our results demonstrate the importance of these AQPs for mosquito diuresis after blood ingestion and highlight their potential as targets for the development of novel vector control strategies.
Drake, Lisa L.; Boudko, Dmitri Y.; Marinotti, Osvaldo; Carpenter, Victoria K.; Dawe, Angus L.; Hansen, Immo A.
Transfusion-related transmission of yellow fever vaccine virus--California, 2009.
In the United States, yellow fever (YF) vaccination is recommended for travelers and active duty military members visiting endemic areas of sub-Saharan Africa and Central/South America. The American Red Cross recommends that recipients of YF vaccine defer blood product donation for 2 weeks because of the theoretical risk for transmission from a viremic donor. On April 10, 2009, a hospital blood bank supervisor learned that, on March 27, blood products had been collected from 89 U.S. active duty trainees who had received YF vaccine 4 days before donation. This report summarizes the subsequent investigation by the hospital and CDC to identify lapses in donor deferral and to determine whether transfusion-related transmission of YF vaccine virus occurred. The investigation found that a recent change in the timing of trainee vaccination had occurred and that vaccinees had not reported recent YF vaccination status at time of donation. Despite a prompt recall, six units of blood products were transfused into five patients. No clinical evidence or laboratory abnormalities consistent with a serious adverse reaction were identified in four recipients within the first month after transfusion; the fifth patient, who had prostate cancer and end-stage, transfusion-dependent, B-cell lymphoma, died while in hospice care. Three of the four surviving patients had evidence of serologic response to YF vaccine virus. This report provides evidence that transfusion-related transmission of YF vaccine virus can occur and underscores the need for careful screening and deferral of recently vaccinated blood donors. PMID:20094025
Immune activation alters cellular and humoral responses to yellow fever 17D vaccine
Background. Defining the parameters that modulate vaccine responses in African populations will be imperative to design effective vaccines for protection against HIV, malaria, tuberculosis, and dengue virus infections. This study aimed to evaluate the contribution of the patient-specific immune microenvironment to the response to the licensed yellow fever vaccine 17D (YF-17D) in an African cohort. Methods. We compared responses to YF-17D in 50 volunteers in Entebbe, Uganda, and 50 volunteers in Lausanne, Switzerland. We measured the CD8+ T cell and B cell responses induced by YF-17D and correlated them with immune parameters analyzed by flow cytometry prior to vaccination. Results. We showed that YF-17D�induced CD8+ T cell and B cell responses were substantially lower in immunized individuals from Entebbe compared with immunized individuals from Lausanne. The impaired vaccine response in the Entebbe cohort associated with reduced YF-17D replication. Prior to vaccination, we observed higher frequencies of exhausted and activated NK cells, differentiated T and B cell subsets and proinflammatory monocytes, suggesting an activated immune microenvironment in the Entebbe volunteers. Interestingly, activation of CD8+ T cells and B cells as well as proinflammatory monocytes at baseline negatively correlated with YF-17D�neutralizing antibody titers after vaccination. Additionally, memory T and B cell responses in preimmunized volunteers exhibited reduced persistence in the Entebbe cohort but were boosted by a second vaccination. Conclusion. Together, these results demonstrate that an activated immune microenvironment prior to vaccination impedes efficacy of the YF-17D vaccine in an African cohort and suggest that vaccine regimens may need to be boosted in African populations to achieve efficient immunity. Trial registration. Registration is not required for observational studies. Funding. This study was funded by Canada�s Global Health Research Initiative, Defense Threat Reduction Agency, National Institute of Allergy and Infectious Diseases, Bill & Melinda Gates Foundation, and United States Agency for International Development.
Muyanja, Enoch; Ssemaganda, Aloysius; Ngauv, Pearline; Cubas, Rafael; Perrin, Helene; Srinivasan, Divya; Canderan, Glenda; Lawson, Benton; Kopycinski, Jakub; Graham, Amanda S.; Rowe, Dawne K.; Smith, Michaela J.; Isern, Sharon; Michael, Scott; Silvestri, Guido; Vanderford, Thomas H.; Castro, Erika; Pantaleo, Giuseppe; Singer, Joel; Gillmour, Jill; Kiwanuka, Noah; Nanvubya, Annet; Schmidt, Claudia; Birungi, Josephine; Cox, Josephine; Haddad, Elias K.; Kaleebu, Pontiano; Fast, Patricia; Sekaly, Rafick-Pierre; Trautmann, Lydie
Immune activation alters cellular and humoral responses to yellow fever 17D vaccine.
Background. Defining the parameters that modulate vaccine responses in African populations will be imperative to design effective vaccines for protection against HIV, malaria, tuberculosis, and dengue virus infections. This study aimed to evaluate the contribution of the patient-specific immune microenvironment to the response to the licensed yellow fever vaccine 17D (YF-17D) in an African cohort. Methods. We compared responses to YF-17D in 50 volunteers in Entebbe, Uganda, and 50 volunteers in Lausanne, Switzerland. We measured the CD8+ T cell and B cell responses induced by YF-17D and correlated them with immune parameters analyzed by flow cytometry prior to vaccination. Results. We showed that YF-17D-induced CD8+ T cell and B cell responses were substantially lower in immunized individuals from Entebbe compared with immunized individuals from Lausanne. The impaired vaccine response in the Entebbe cohort associated with reduced YF-17D replication. Prior to vaccination, we observed higher frequencies of exhausted and activated NK cells, differentiated T and B cell subsets and proinflammatory monocytes, suggesting an activated immune microenvironment in the Entebbe volunteers. Interestingly, activation of CD8+ T cells and B cells as well as proinflammatory monocytes at baseline negatively correlated with YF-17D-neutralizing antibody titers after vaccination. Additionally, memory T and B cell responses in preimmunized volunteers exhibited reduced persistence in the Entebbe cohort but were boosted by a second vaccination. Conclusion. Together, these results demonstrate that an activated immune microenvironment prior to vaccination impedes efficacy of the YF-17D vaccine in an African cohort and suggest that vaccine regimens may need to be boosted in African populations to achieve efficient immunity. Trial registration. Registration is not required for observational studies. Funding. This study was funded by Canada's Global Health Research Initiative, Defense Threat Reduction Agency, National Institute of Allergy and Infectious Diseases, Bill & Melinda Gates Foundation, and United States Agency for International Development. PMID:24911151
Muyanja, Enoch; Ssemaganda, Aloysius; Ngauv, Pearline; Cubas, Rafael; Perrin, Helene; Srinivasan, Divya; Canderan, Glenda; Lawson, Benton; Kopycinski, Jakub; Graham, Amanda S; Rowe, Dawne K; Smith, Michaela J; Isern, Sharon; Michael, Scott; Silvestri, Guido; Vanderford, Thomas H; Castro, Erika; Pantaleo, Giuseppe; Singer, Joel; Gillmour, Jill; Kiwanuka, Noah; Nanvubya, Annet; Schmidt, Claudia; Birungi, Josephine; Cox, Josephine; Haddad, Elias K; Kaleebu, Pontiano; Fast, Patricia; Sekaly, Rafick-Pierre; Trautmann, Lydie
Yellow fever virus maintenance in Trinidad and its dispersal throughout the Americas.
Trinidad, like many other American regions, experiences repeated epizootics of yellow fever virus (YFV). However, it is unclear whether these result from in situ evolution (enzootic maintenance) or regular reintroduction of YFV from the South American mainland. To discriminate between these hypotheses, we carried out a Bayesian phylogeographic analysis of over 100 prM/E gene sequences sampled from 8 South American countries. These included newly sequenced isolates from the recent 2008-2009 Trinidad epizootic and isolates derived from mainland countries within the last decade. The results indicate that the most recent common ancestor of the 2008-2009 epizootic existed in Trinidad 4.2 years prior to 2009 (95% highest probability density [HPD], 0.5 to 9.0 years). Our data also suggest a Trinidad origin for the progenitor of the 1995 Trinidad epizootic and support in situ evolution of YFV between the 1979 and 1988-1989 Trinidad epizootics. Using the same phylogeographic approach, we also inferred the historical spread of YFV in the Americas. The results suggest a Brazilian origin for YFV in the Americas and an overall dispersal rate of 182 km/year (95% HPD, 52 to 462 km/year), with Brazil as the major source population for surrounding countries. There is also strong statistical support for epidemiological links between four Brazilian regions and other countries. In contrast, while there were well-supported epidemiological links within Peru, the only statistically supported external link was a relatively weak link with neighboring Bolivia. Lastly, we performed a complete analysis of the genome of a newly sequenced Trinidad 2009 isolate, the first complete genome for a genotype I YFV isolate. PMID:20631128
Auguste, Albert J; Lemey, Philippe; Pybus, Oliver G; Suchard, Marc A; Salas, Rosa Alba; Adesiyun, Abiodun A; Barrett, Alan D; Tesh, Robert B; Weaver, Scott C; Carrington, Christine V F
Yellow Fever Virus Maintenance in Trinidad and Its Dispersal throughout the Americas? �
Trinidad, like many other American regions, experiences repeated epizootics of yellow fever virus (YFV). However, it is unclear whether these result from in situ evolution (enzootic maintenance) or regular reintroduction of YFV from the South American mainland. To discriminate between these hypotheses, we carried out a Bayesian phylogeographic analysis of over 100 prM/E gene sequences sampled from 8 South American countries. These included newly sequenced isolates from the recent 2008-2009 Trinidad epizootic and isolates derived from mainland countries within the last decade. The results indicate that the most recent common ancestor of the 2008-2009 epizootic existed in Trinidad 4.2 years prior to 2009 (95% highest probability density [HPD], 0.5 to 9.0 years). Our data also suggest a Trinidad origin for the progenitor of the 1995 Trinidad epizootic and support in situ evolution of YFV between the 1979 and 1988-1989 Trinidad epizootics. Using the same phylogeographic approach, we also inferred the historical spread of YFV in the Americas. The results suggest a Brazilian origin for YFV in the Americas and an overall dispersal rate of 182 km/year (95% HPD, 52 to 462 km/year), with Brazil as the major source population for surrounding countries. There is also strong statistical support for epidemiological links between four Brazilian regions and other countries. In contrast, while there were well-supported epidemiological links within Peru, the only statistically supported external link was a relatively weak link with neighboring Bolivia. Lastly, we performed a complete analysis of the genome of a newly sequenced Trinidad 2009 isolate, the first complete genome for a genotype I YFV isolate.
Auguste, Albert J.; Lemey, Philippe; Pybus, Oliver G.; Suchard, Marc A.; Salas, Rosa Alba; Adesiyun, Abiodun A.; Barrett, Alan D.; Tesh, Robert B.; Weaver, Scott C.; Carrington, Christine V. F.
Size Heterogeneity in the 3? Noncoding Region of South American Isolates of Yellow Fever Virus
The 3? noncoding region (3? NCR) of flaviviruses contains secondary and tertiary structures essential for virus replication. Previous studies of yellow fever virus (YFV) and dengue virus have found that modifications to the 3? NCR are sometimes associated with attenuation in vertebrate and/or mosquito hosts. The 3? NCRs of 117 isolates of South American YFV have been examined, and major deletions and/or duplications of conserved RNA structures have been identified in several wild-type isolates. Nineteen isolates (designated YF-XL isolates) from Brazil, Trinidad, and Venezuela, dating from 1973 to 2001, exhibited a 216-nucleotide (nt) duplication, yielding a tandem repeat of conserved hairpin, stem-loop, dumbbell, and pseudoknot structures. YF-XL isolates were found exclusively within one subclade of South American genotype I YFV. One Brazilian isolate exhibited, in addition to the 216-nt duplication, a deletion of a 40-nt repeated hairpin (RYF) motif (YF-XL-?RYF). To investigate the biological significance of these 3? NCR rearrangements, YF-XL-?RYF and YF-XL isolates, as well as other South American YFV isolates, were evaluated for three phenotypes: growth kinetics in cell culture, neuroinvasiveness in suckling mice, and ability to replicate and produce disseminated infections in Aedes aegypti mosquitoes. YF-XL-?RYF and YF-XL isolates showed growth kinetics and neuroinvasive characteristics comparable to those of typical South American YFV isolates, and mosquito infectivity trials demonstrated that both types of 3? NCR variants were capable of replication and dissemination in a laboratory-adapted colony of A. aegypti.
Bryant, Juliet E.; Vasconcelos, Pedro F. C.; Rijnbrand, Rene C. A.; Mutebi, J. P.; Higgs, Stephen; Barrett, Alan D. T.
Yellow Fever/Japanese Encephalitis Chimeric Viruses: Construction and Biological Properties
A system has been developed for generating chimeric yellow fever/Japanese encephalitis (YF/JE) viruses from cDNA templates encoding the structural proteins prM and E of JE virus within the backbone of a molecular clone of the YF17D strain. Chimeric viruses incorporating the proteins of two JE strains, SA14-14-2 (human vaccine strain) and JE Nakayama (JE-N [virulent mouse brain-passaged strain]), were studied in cell culture and laboratory mice. The JE envelope protein (E) retained antigenic and biological properties when expressed with its prM protein together with the YF capsid; however, viable chimeric viruses incorporating the entire JE structural region (C-prM-E) could not be obtained. YF/JE(prM-E) chimeric viruses grew efficiently in cells of vertebrate or mosquito origin compared to the parental viruses. The YF/JE SA14-14-2 virus was unable to kill young adult mice by intracerebral challenge, even at doses of 106 PFU. In contrast, the YF/JE-N virus was neurovirulent, but the phenotype resembled parental YF virus rather than JE-N. Ten predicted amino acid differences distinguish the JE E proteins of the two chimeric viruses, therefore implicating one or more residues as virus-specific determinants of mouse neurovirulence in this chimeric system. This study indicates the feasibility of expressing protective antigens of JE virus in the context of a live, attenuated flavivirus vaccine strain (YF17D) and also establishes a genetic system for investigating the molecular basis for neurovirulence determinants encoded within the JE E protein.
Chambers, Thomas J.; Nestorowicz, Ann; Mason, Peter W.; Rice, Charles M.
... by four families of viruses. These include the Ebola and Marburg, Lassa fever, and yellow fever viruses. ... Some VHFs cause mild disease, but some, like Ebola or Marburg, cause severe disease and death. VHFs ...
The transmembrane domains of the prM and E proteins of yellow fever virus are endoplasmic reticulum localization signals.
The immature flavivirus particle contains two envelope proteins, prM and E, that are associated as a heterodimer. Virion morphogenesis of the flaviviruses occurs in association with endoplasmic reticulum (ER) membranes, suggesting that there should be accumulation of the virion components in this compartment. This also implies that ER localization signals must be present in the flavivirus envelope proteins. In this work, we looked for potential subcellular localization signals in the yellow fever virus envelope proteins. Confocal immunofluorescence analysis of the subcellular localization of the E protein in yellow fever virus-infected cells indicated that this protein accumulates in the ER. Similar results were obtained with cells expressing only prM and E. Chimeric proteins containing the ectodomain of CD4 or CD8 fused to the transmembrane domains of prM or E were constructed, and their subcellular localization was studied by confocal immunofluorescence and by analyzing the maturation of their associated glycans. Although a small fraction was detected in the ER-to-Golgi intermediate and Golgi compartments, these chimeric proteins were located mainly in the ER. The C termini of prM and E form two antiparallel transmembrane alpha-helices. Interestingly, the first transmembrane passage contains enough information for ER localization. Taken altogether, these data indicate that, besides their role as membrane anchors, the transmembrane domains of yellow fever virus envelope proteins are ER retention signals. In addition, our data show that the mechanisms of ER retention of the flavivirus and hepacivirus envelope proteins are different. PMID:15507646
Op De Beeck, Anne; Rouill�, Yves; Caron, M�lanie; Duvet, Sandrine; Dubuisson, Jean
Dengue fever mimicking acute appendicitis: A case report?
INTRODUCTION Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. PRESENTATION OF CASE A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. DISCUSSION This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. CONCLUSION This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis.
Mcfarlane, M.E.C.; Plummer, J.M.; Leake, P.A.; Powell, L.; Chand, V.; Chung, S.; Tulloch, K.
Lassa fever presenting as acute abdomen: a case series.
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024
Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O
Lassa fever presenting as acute abdomen: a case series
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.
Yellow fever outbreak affecting Alouatta populations in southern Brazil (Rio Grande do Sul State), 2008-2009.
The natural transmission cycle of Yellow Fever (YF) involves tree hole breeding mosquitoes and a wide array of nonhuman primates (NHP), including monkeys and apes. Some Neotropical monkeys (howler monkeys, genus Alouatta) develop fatal YF virus (YFV) infections similar to those reported in humans, even with minimum exposure to the infection. Epizootics in wild primates may be indicating YFV circulation, and the surveillance of such outbreaks in wildlife is an important tool to help prevent human infection. In 2001, surveillance activities successfully identified YF-related death in a black-and-gold howler monkey (Alouatta caraya), Rio Grande do Sul State (RGS) in southern Brazil, and the YFV was isolated from a species of forest-dwelling mosquito (Haemagogus leucocelaenus). These findings led the State Secretariat of Health to initiate a monitoring program for YF and other 18 arboviral infections in Alouatta monkeys. The monitoring program included monkey captures, reporting of monkey casualties by municipalities, and subsequent investigations. If monkey carcasses were found in forests, samples were collected in a standardized manner and this practice resulted in increased reporting of outbreaks. In October 2008, a single howler monkey in a northwestern RGS municipality was confirmed to have died from YF. From October 2008 to June 2009, 2,013 monkey deaths were reported (830 A. caraya and 1,183 A. guariba clamitans). Viruses isolation in blood, viscera, and/or immunohistochemistry led to the detection of YF in 204 of 297 (69%) (154 A. g. clamitans and 50 A. caraya) dead Alouatta monkeys tested. The number of municipalities with confirmed YFV circulation in howlers increased from 2 to 67 and 21 confirmed human cases occurred. This surveillance system was successful in identifying the largest YF outbreak affecting wild NHP ever recorded. PMID:22020690
de Almeida, Marco Ant�nio Barreto; Dos Santos, Edmilson; da Cruz Cardoso, Jader; da Fonseca, Daltro Fernandes; Noll, Carlos Alberto; Silveira, Vivian Regina; Maeda, Adriana Yurika; de Souza, Renato Pereira; Kanamura, Cristina; Brasil, Roosecelis Ara�jo
1. Experimental evidence is presented to show that prolonged cultivation of yellow fever virus in vitro results in a change in its pathogenicity, and that this change varies with the type of tissues used for the cultivation. 2. In the tissue cultures used for the propagation of the virus, three different types of tissues were used. They included whole mouse embryo, chick embryo from which the head and spinal cord had been removed, and testicular tissues of mice and guinea pigs. 3. The changes in the pathogenicity of the virus cultivated for a period of over 3 years in a medium containing the tissues of whole mouse embryo were not striking. The viscerotropic virulence of the virus appeared somewhat diminished, in that when injected subcutaneously into rhesus monkeys or hedgehogs it failed to produce a fatal infection, although there is evidence to indicate that a generalized infection takes place as demonstrated by the appearance of virus in the circulating blood in relatively high concentration during infection. The neurotropic virulence of the virus remained unaltered during the cultivation in this medium. 4. The changes in the pathogenicity of the virus cultivated in medium containing tissues of chick embryo from which the head and spinal cord had been removed were very pronounced. The viscerotropic virulence of the virus was lost to a large extent. When injected subcutaneously into monkeys there was as a rule a very mild generalized infection, as demonstrated by the minimal quantities of virus found in the circulating blood. Its neurotropism was also much diminished. When injected into monkeys intracerebrally, it no longer produced a fatal encephalitis but only a moderate febrile reaction, followed by recovery and solid immunity to reinoculation with a highly virulent strain of virus. When injected intracerebrally into mice, the mortality ratio was not diminished but the incubation period was markedly prolonged. 5. The changes in the pathogenicity of the virus cultivated in medium containing testicular tissues were somewhat similar to those observed after cultivation in chick embryo medium which contained only a minimal amount of nervous tissue. Its viscerotropic affinity had been largely lost and only very small amounts of virus were found in the circulating blood of monkeys inoculated subcutaneously. Given intracerebrally, it produced death from encephalitis in monkeys. The incubation period in mice inoculated intracerebrally with this virus was also prolonged but somewhat less so than with the virus grown in chick embryo tissues without the central nervous system.
Theiler, Max; Smith, Hugh H.
1. Experimental evidence is presented to show that prolonged cultivation of yellow fever virus in vitro results in a change in its pathogenicity, and that this change varies with the type of tissues used for the cultivation. 2. In the tissue cultures used for the propagation of the virus, three different types of tissues were used. They included whole mouse embryo, chick embryo from which the head and spinal cord had been removed, and testicular tissues of mice and guinea pigs. 3. The changes in the pathogenicity of the virus cultivated for a period of over 3 years in a medium containing the tissues of whole mouse embryo were not striking. The viscerotropic virulence of the virus appeared somewhat diminished, in that when injected subcutaneously into rhesus monkeys or hedgehogs it failed to produce a fatal infection, although there is evidence to indicate that a generalized infection takes place as demonstrated by the appearance of virus in the circulating blood in relatively high concentration during infection. The neurotropic virulence of the virus remained unaltered during the cultivation in this medium. 4. The changes in the pathogenicity of the virus cultivated in medium containing tissues of chick embryo from which the head and spinal cord had been removed were very pronounced. The viscerotropic virulence of the virus was lost to a large extent. When injected subcutaneously into monkeys there was as a rule a very mild generalized infection, as demonstrated by the minimal quantities of virus found in the circulating blood. Its neurotropism was also much diminished. When injected into monkeys intracerebrally, it no longer produced a fatal encephalitis but only a moderate febrile reaction, followed by recovery and solid immunity to reinoculation with a highly virulent strain of virus. When injected intracerebrally into mice, the mortality ratio was not diminished but the incubation period was markedly prolonged. 5. The changes in the pathogenicity of the virus cultivated in medium containing testicular tissues were somewhat similar to those observed after cultivation in chick embryo medium which contained only a minimal amount of nervous tissue. Its viscerotropic affinity had been largely lost and only very small amounts of virus were found in the circulating blood of monkeys inoculated subcutaneously. Given intracerebrally, it produced death from encephalitis in monkeys. The incubation period in mice inoculated intracerebrally with this virus was also prolonged but somewhat less so than with the virus grown in chick embryo tissues without the central nervous system. PMID:19870633
Theiler, M; Smith, H H
Immune correlates of protection against yellow fever determined by passive immunization and challenge in the hamster model
Live, attenuated yellow fever (YF) 17D vaccine is highly efficacious but causes rare, serious adverse events resulting from active replication in the host and direct viral injury to vital organs. We recently reported development of a potentially safer ?-propiolactone-inactivated whole virion YF vaccine (XRX-001) which was highly immunogenic in mice, hamsters, monkeys, and humans (Vaccine 2010; 28:3827�40; New Engl J Med 2011;364:1326�33). To characterize the protective efficacy of neutralizing antibodies stimulated by the inactivated vaccine, graded doses of serum from hamsters immunized with inactivated XRX-001 or live 17D vaccine were transferred to hamsters by the intraperitoneal (IP) route 24 hours prior to virulent, viscerotropic YF virus challenge. Neutralizing antibody (PRNT50) titers were determined in the sera of treated animals 4 hours before challenge and 4 and 21 days after challenge. Neutralizing antibodies were shown to mediate protection. Animals having 50% plaque reduction neutralization test (PRNT50) titers of ?40 four hours before challenge were completely protected from disease as evidenced by viremia, liver enzyme elevation, and protection against illness (weight change) and death. Passive titers of 10�20 were partially protective. Immunization with the XRX-001 vaccine stimulated YF neutralizing antibodies that were equally effective (based on dose response) as antibodies stimulated by live 17D vaccine. The results will be useful in defining the level of seroprotection in clinical studies of new yellow fever vaccines.
Julander, Justin G.; Trent, Dennis W.; Monath, Thomas P.
Limited replication of yellow fever 17DD and 17D-Dengue recombinant viruses in rhesus monkeys.
For the development of safe live attenuated flavivirus vaccines one of the main properties to be established is viral replication. We have used real-time reverse transcriptase-polymerase chain reaction and virus titration by plaque assay to determine the replication of yellow fever 17DD virus (YFV 17DD) and recombinant yellow fever 17D viruses expressing envelope proteins of dengue virus serotypes 2 and 4 (17D-DENV-2 and 17D-DENV-4). Serum samples from rhesus monkeys inoculated with YFV 17DD and 17D-DENV chimeras by intracerebral or subcutaneous route were used to determine and compare the viremia induced by these viruses. Viral load quantification in samples from monkeys inoculated by either route with YFV 17DD virus suggested a restricted capability of the virus to replicate reaching not more than 2.0 log10 PFU mL(-1) or 3.29 log10 copies mL(-1). Recombinant 17D-dengue viruses were shown by plaquing and real-time PCR to be as attenuated as YF 17DD virus with the highest mean peak titer of 1.97 log10 PFU mL(-1) or 3.53 log10 copies mL(-1). These data serve as a comparative basis for the characterization of other 17D-based live attenuated candidate vaccines against other diseases. PMID:18506257
Trindade, Gisela F; Marchevsky, Renato S; Fillipis, Ana M B de; Nogueira, Rita M R; Bonaldo, Myrna C; Acero, Pedro C; Caride, Elena; Freire, Marcos S; Galler, Ricardo
Survival and swimming behavior of insecticide-exposed larvae and pupae of the yellow fever mosquito Aedes aegypti
Background The yellow fever mosquito Aedes aegypti is essentially a container-inhabiting species that is closely associated with urban areas. This species is a vector of human pathogens, including dengue and yellow fever viruses, and its control is of paramount importance for disease prevention. Insecticide use against mosquito juvenile stages (i.e. larvae and pupae) is growing in importance, particularly due to the ever-growing problems of resistance to adult-targeted insecticides and human safety concerns regarding such use in human dwellings. However, insecticide effects on insects in general and mosquitoes in particular primarily focus on their lethal effects. Thus, sublethal effects of such compounds in mosquito juveniles may have important effects on their environmental prevalence. In this study, we assessed the survival and swimming behavior of A. aegypti 4th instar larvae (L4) and pupae exposed to increasing concentrations of insecticides. We also assessed cell death in the neuromuscular system of juveniles. Methods Third instar larvae of A. aegypti were exposed to different concentrations of azadirachtin, deltamethrin, imidacloprid and spinosad. Insect survival was assessed for 10�days. The distance swam, the resting time and the time spent in slow swimming were assessed in 4th instar larvae (L4) and pupae. Muscular and nervous cells of L4 and pupae exposed to insecticides were marked with the TUNEL reaction. The results from the survival bioassays were subjected to survival analysis while the swimming behavioral data were subjected to analyses of covariance, complemented with a regression analysis. Results All insecticides exhibited concentration-dependent effects on survival of larvae and pupae of the yellow fever mosquito. The pyrethroid deltamethrin was the most toxic insecticide followed by spinosad, imidacloprid, and azadirachtin, which exhibited low potency against the juveniles. All insecticides except azadirachtin reduced L4 swimming speed and wriggling movements. A similar trend was also observed for swimming pupa, except for imidacloprid, which increased the swimming activity of pupa. Curiously, the insecticides did not affect cell damage in the neuromuscular system of larvae and pupae. Conclusions Deltamethrin and spinosad were the main compounds to exhibit lethal effects, which allowed the control of A. aegypti larvae and pupae, and impair their swimming potentially compromising foraging and predation likelihood.
Fine Mapping of a cis-Acting Sequence Element in Yellow Fever Virus RNA That Is Required for RNA Replication and Cyclization
We present fine mapping of a cis-acting nucleotide sequence found in the 5? region of yellow fever virus genomic RNA that is required for RNA replication. There is evidence that this sequence interacts with a complementary sequence in the 3? region of the genome to cyclize the RNA. Replicons were constructed that had various deletions in the 5? region encoding the capsid protein and were tested for their ability to replicate. We found that a sequence of 18 nucleotides (residues 146 to 163 of the yellow fever virus genome, which encode amino acids 9 to 14 of the capsid protein) is essential for replication of the yellow fever virus replicon and that a slightly longer sequence of 21 nucleotides (residues 146 to 166, encoding amino acids 9 to 15) is required for full replication. This region is larger than the core sequence of 8 nucleotides conserved among all mosquito-borne flaviviruses and contains instead the entire sequence previously proposed to be involved in cyclization of yellow fever virus RNA.
Corver, Jeroen; Lenches, Edith; Smith, Kayla; Robison, R. Aaron; Sando, Trisha; Strauss, Ellen G.; Strauss, James H.
Fine mapping of a cis-acting sequence element in yellow fever virus RNA that is required for RNA replication and cyclization.
We present fine mapping of a cis-acting nucleotide sequence found in the 5' region of yellow fever virus genomic RNA that is required for RNA replication. There is evidence that this sequence interacts with a complementary sequence in the 3' region of the genome to cyclize the RNA. Replicons were constructed that had various deletions in the 5' region encoding the capsid protein and were tested for their ability to replicate. We found that a sequence of 18 nucleotides (residues 146 to 163 of the yellow fever virus genome, which encode amino acids 9 to 14 of the capsid protein) is essential for replication of the yellow fever virus replicon and that a slightly longer sequence of 21 nucleotides (residues 146 to 166, encoding amino acids 9 to 15) is required for full replication. This region is larger than the core sequence of 8 nucleotides conserved among all mosquito-borne flaviviruses and contains instead the entire sequence previously proposed to be involved in cyclization of yellow fever virus RNA. PMID:12525663
Corver, Jeroen; Lenches, Edith; Smith, Kayla; Robison, R Aaron; Sando, Trisha; Strauss, Ellen G; Strauss, James H
E Protein Domain III Determinants of Yellow Fever Virus 17D Vaccine Strain Enhance Binding to Glycosaminoglycans, Impede Virus Spread, and Attenuate Virulence
The yellow fever virus (YFV) 17D strain is one of the most effective live vaccines for human use, but the in vivo mechanisms for virulence attenuation of the vaccine and the corresponding molecular determinants remain elusive. The vaccine differs phenotypically from wild-type YFV by the loss of viscerotropism, despite replicative fitness in cell culture, and genetically by 20 amino acid
Eva Lee; Mario Lobigs
Yellow Fever Vaccination Elicits Broad Functional CD4+ T Cell Responses That Recognize Structural and Nonstructural Proteins
Yellow fever virus (YFV) can induce acute, life-threatening disease that is a significant health burden in areas where yellow fever is endemic, but it is preventable through vaccination. The live attenuated 17D YFV strain induces responses characterized by neutralizing antibodies and strong T cell responses. This vaccine provides an excellent model for studying human immunity. While several studies have characterized YFV-specific antibody and CD8+ T cell responses, less is known about YFV-specific CD4+ T cells. Here we characterize the epitope specificity, functional attributes, and dynamics of YFV-specific T cell responses in vaccinated subjects by investigating peripheral blood mononuclear cells by using HLA-DR tetramers. A total of 112 epitopes restricted by seven common HLA-DRB1 alleles were identified. Epitopes were present within all YFV proteins, but the capsid, envelope, NS2a, and NS3 proteins had the highest epitope density. Antibody blocking demonstrated that the majority of YFV-specific T cells were HLA-DR restricted. Therefore, CD4+ T cell responses could be effectively characterized with HLA-DR tetramers. Ex vivo tetramer analysis revealed that YFV-specific T cells persisted at frequencies ranging from 0 to 100 cells per million that are detectable years after vaccination. Longitudinal analysis indicated that YFV-specific CD4+ T cells reached peak frequencies, often exceeding 250 cells per million, approximately 2 weeks after vaccination. As frequencies subsequently declined, YFV-specific cells regained CCR7 expression, indicating a shift from effector to central memory. Cells were typically CXCR3 positive, suggesting Th1 polarization, and produced gamma interferon and other cytokines after reactivation in vitro. Therefore, YFV elicits robust early effector CD4+ T cell responses that contract, forming a detectable memory population.
James, Eddie A.; LaFond, Rebecca E.; Gates, Theresa J.; Mai, Duy T.; Malhotra, Uma
[Two cases of acute hepatitis associated with Q fever].
Q fever which is caused by Coxiella burnetii, is a worldwide zoonosis. Many species of wild and domestic mammals, birds, and arthropods, are reservoirs of C.burnetii in nature, however farm animals are the most frequent sources of human infection. The most frequent way of transmission is by inhalation of contaminated aerosols. The clinical presentation of Q fever is polymorphic and nonspecific. Q fever may present as acute or chronic disease. In acute cases, the most common clinical syndromes are selflimited febrile illness, granulomatous hepatitis, and pneumonia, but it can also be asymptomatic. Fever with hepatitis associated with Q fever has rarely been described in the literature. Herein we report two cases of C.burnetii hepatitis presented with jaundice. In May 2011, two male cases, who inhabited in Malkara village of Tekirdag province (located at Trace region of Turkey), were admitted to the hospital with the complaints of persistent high grade fever, chills and sweats, icterus, disseminated myalgia and headache. Physical examination revealed fever, icterus and the patient appeared to be mildly ill but had no localizing signs of infection. Radiological findings of the patients were in normal limits. Laboratory findings revealed leukocytosis, increased hepatic and cholestatic enzyme levels, and moderate hyperbilirubinemia- mainly direct bilirubin, whereas serum C-reactive protein and erythrocyte sedimentation rate were found normal. Blood and urine cultures of the patients yielded no bacterial growth. Serological markers for acute viral hepatitis, citomegalovirus and Epstein-Barr virus infections, brucellosis, salmonellosis, toxoplasmosis and leptospirosis were found negative. Acute Q fever diagnosis of the cases were based on the positive results obtained by C.burnetii Phase II IgM and IgG ELISA (Vircell SL, Spain) test, and the serological diagnosis were confirmed by Phase I and II immunofluorescence (Vircell SL, Spain) method. Both cases were treated with doxycycline for 14 days and became afebrile within four days. These cases were presented to emphasize that C.burnetii infection should be considered in the differential diagnosis of patients with fever and elevated serum transaminase levels, irrespective of the presence of abdominal pain and exposure to potentially infected animals. PMID:22951661
Ye?ilyurt, Murat; K?l?�, Sel�uk; G�rsoy, Bensu; Celebi, Bekir; Yerer, Mehmet
Yellow-nail syndrome: report of three cases.
The yellow nail syndrome, a combination of yellow discolouration of and dystrophic changes in the nails, pleural effusions and lymphedema, is thought to be relatively rare; to date 44 cases have been reported. Of a further three patients with this syndrome, one had all three features, one had the yellow nails alone and the other had pleural effusions and lymphedema without classic nail changes. Each had recurrent lower respiratory tract infections; and of all 47, chronic pulmonary infections occurred in approximately one quarter and were frequently associated with chronic sinus infections. The underlying abnormality is presumed to be a congenital defect of the lymphatics, but so far this has not been demonstrated to be the cause of the nail changes, the pathogenesis of which remains obscure. Images FIG. 1
Nakielna, E. M.; Wilson, J.; Ballon, H. S.
Case report of African tick-bite fever from Poland.
A confirmed case of rickettsiosis acquired in South Africa and recognized in Poland was described. The patient fulfilled clinical criteria highly suggestive of African tick bite fever, such as eschars, regional lymphadenitis, cutaneous rash within 10 days after his return from sub-Saharan Africa. Infection with Rickettsia africae was confirmed by polymerase chain reaction and sequencing. PMID:24494003
Chmielewski, Tomasz; Szymanek, Anna; M?czka, Ilona; Fiecek, Beata; Simon, Krzysztof; Tylewska-Wierzbanowska, Stanis?awa
Rhabdomyolysis and Dengue Fever: A Case Report and Literature Review
The medical literature contains only a few reports of rhabdomyolysis occurring in patients with dengue fever. We report the case of a 25-year-old Jamaican man who was admitted to a private hospital four days after the onset of an acute febrile illness with fever, myalgia, and generalized weakness. Dengue fever was confirmed with a positive test for the dengue antigen, nonstructural protein 1. He remained well and was discharged on day 6 of his illness. On day 8, he started to pass red urine and was subsequently admitted to the University Hospital of the West Indies. On admission he was found to have myoglobinuria and an elevated creatine phosphokinase (CPK) of 325,600?U/L, leading to a diagnosis of rhabdomyolysis. Dengue IgM was positive. He was treated with aggressive hydration and had close monitoring of his urine output, creatinine, and CPK levels. His hospital course was uneventful without the development of acute renal failure and he was discharged after 14 days in hospital, with a CPK level of 2463?U/L. This case highlights that severe rhabdomyolysis may occur in patients with dengue fever and that early and aggressive treatment may prevent severe complications such as acute renal failure and death.
Sargeant, Tanya; Harris, Tricia; Wilks, Rohan; Barned, Sydney; Galloway-Blake, Karen; Ferguson, Trevor
Q fever osteoarticular infection: four new cases and a review of the literature
Q fever is a worldwide-occurring zoonosis caused by Coxiella burnetii. Better knowledge of the disease and of evolving diagnostics can enable recognition of unusual manifestations. Reported here\\u000a are four cases of Q fever osteoarticular infections in adults: two cases of Q fever tenosynovitis, which represent the first\\u000a two reports of this infection, and two cases of Q fever spondylodiscitis complicated
C. Landais; F. Fenollar; A. Constantin; C. Cazorla; C. Guilyardi; H. Lepidi; A. Stein; J. M. Rolain; D. Raoult
Reference gene selection for quantitative real-time PCR analysis in virus infected cells: SARS corona virus, Yellow fever virus, Human Herpesvirus6, Camelpox virus and Cytomegalovirus infections
Ten potential reference genes were compared for their use in experiments investigating cellular mRNA expression of virus infected cells. Human cell lines were infected with Cytomegalovirus, Human Herpesvirus-6, Camelpox virus, SARS coronavirus or Yellow fever virus. The expression levels of these genes and the viral replication were determined by real-time PCR. Genes were ranked by the BestKeeper tool, the GeNorm
Aleksandar Radoni?; Stefanie Thulke; Hi-Gung Bae; Marcel A M�ller; Wolfgang Siegert; Andreas Nitsche
In view of the risk of introduction of yellow fever into South-East Asia, comparative studies have been made of yellow fever vaccination in Malayan volunteers with a high prevalence of antibody to related viruses and in volunteers without related antibody. In a previous paper the neutralizing antibody responses of these volunteers were reported. The present paper describes the haemagglutinin-inhibiting (HI) antibody responses of the same groups of volunteers and discusses the relationship of these responses to the neutralizing antibody responses.The HI responses to yellow fever following vaccination closely paralleled the neutralizing antibody responses whether vaccination was subcutaneous or by multiple puncture. Volunteers with a high level of YF HI antibody due to infection with other group B viruses were found to be less likely to show a significant YF HI response than those without antibody. 90% of HI responses could be detected by the 21st day after vaccination.As with neutralizing antibody responses, volunteers given vaccine doses of 50-500 mouse intracerebral LD(50) subcutaneously gave greater responses than those given higher doses. PMID:14043754
A Possible Connection between the 1878 Yellow Fever Epidemic in the Southern United States and the 1877-78 El Nin??o Episode
One of the most severe outbreaks of yellow fever, a viral disease transmitted by the Aedes aegypti mosquito, affected the southern United States in the summer of 1878. The economic and human toll was enormous, and the city of Memphis, Tennessee, was one of the most affected. The authors suggest that as a consequence of one of the strongest El Nin??o episodes on record - that which occurred in 1877-78 - exceptional climate anomalies occurred in the United States (as well as in many other parts of the world), which may have been partly responsible for the widespread nature and severity of the 1878 yellow fever outbreak. This study documents some of the extreme climate anomalies that were recorded in 1877 and 1878 in parts of the eastern United States, with particular emphasis on highlighting the evolution of these anomalies, as they might have contributed to the epidemic. Other years with major outbreaks of yellow fever in the eighteenth and nineteenth centuries also occurred during the course of El Nin??o episodes, a fact that appears not to have been noted before in the literature.
Diaz, H. F.; McCabe, G. J.
First report on invasion of yellow fever mosquito, Aedes aegypti, at Narita International Airport, Japan in August 2012.
The invasion of the yellow fever mosquito Aedes aegypti at Narita International Airport, Japan was detected for the first time. During the course of routine vector surveillance at Narita International Airport, 27 Ae. aegypti adults emerged from larvae and pupae collected from a single larvitrap placed near No. 88 spot at passenger terminal 2 on August 8, 2012. After the appearance of Ae. aegypti in the larvitrap, we defined a 400-m buffer zone and started an intensive vector survey using an additional 34 larvitraps and 15 CO2 traps. International aircraft and passenger terminal 2 were also inspected, and one Ae. aegypti male was collected from the cargo space of an international aircraft from Darwin via Manila on August 28, 2012. Larvicide treatment with 1.5% fenitrothion was conducted in 64 catch basins and one ditch in the 400-m buffer zone. Twenty-four large water tanks were also treated at least once with 0.5% pyriproxyfen, an insect growth regulator. No Ae. aegypti eggs or adults were found during the 1-month intensive vector survey after finding larvae and pupae in the larvitrap. We concluded that Ae. aegypti had failed to establish a population at Narita International Airport. PMID:23698478
Sukehiro, Nayu; Kida, Nori; Umezawa, Masahiro; Murakami, Takayuki; Arai, Naoko; Jinnai, Tsunesada; Inagaki, Shunichi; Tsuchiya, Hidetoshi; Maruyama, Hiroshi; Tsuda, Yoshio
Human impacts have shaped historical and recent evolution in Aedes aegypti, the dengue and yellow fever mosquito.
Although anthropogenic impacts are often considered harmful to species, human modifications to the landscape can actually create novel niches to which other species can adapt. These "domestication" processes are especially important in the context of arthropod disease vectors, where ecological overlap of vector and human populations may lead to epidemics. Here, we present results of a global genetic study of one such species, the dengue and yellow fever mosquito, Aedes aegypti, whose evolutionary history and current distribution have been profoundly shaped by humans. We used DNA sequences of four nuclear genes and 1504 single nucleotide polymorphism (SNP) markers developed with restriction-site associated DNA (RAD) sequencing to test the hypothesis that Ae. aegypti originated in Africa, where a domestic form arose and spread throughout the tropical and subtropical world with human trade and movement. Results confirmed African ancestry of the species, and supported a single subspeciation event leading to the pantropical domestic form. In addition, genetic data strongly supported the hypothesis that human trade routes first moved domestic Ae. aegypti out of Africa into the New World, followed by a later invasion from the New World into Southeast Asia and the Pacific. These patterns of domestication and invasion are relevant to many species worldwide, as anthropogenic forces increasingly impact evolutionary processes. PMID:24111703
Brown, Julia E; Evans, Benjamin R; Zheng, Wei; Obas, Vanessa; Barrera-Martinez, Laura; Egizi, Andrea; Zhao, Hongyu; Caccone, Adalgisa; Powell, Jeffrey R
Prevalence of larvae of potential yellow fever vectors in domestic water containers in south-east Nigeria.
The seasonal variation in prevalence of Aedes (Stegomyia) mosquitos breeding in peridomestic water containers was assessed in an urban quarter of Enugu, Nigeria, and in two rural villages located among forest relicts in the neighbouring Udi Hills. A large number of earthenware pots, most of which contained water in the wet season, were present in the compounds around houses. Monthly determinations of the presence or absence of Aedes larvae in these containers were made for 13 consecutive months. The average Breteau index (positive containers per 100 houses) for A. aegypti during the 7-month wet season was 53 in one of the villages and 76 in the other, suggesting a high risk of yellow fever transmission; the dry-season averages were 11 and 23. In the urban quarter the wet-season average was 29; the dry-season average was 4.7, a level at which transmission is unlikely to occur. A. luteocephalus were occasionally found in containers in both the urban and rural localities, and A. africanus larvae occurred in one of the villages. Although Culex larvae were common, mixed infestations of Aedes and Culex were so uncommon that the simplified "single larva" method of sampling for Aedes gave similar results to the conventional method. The multiplicity of peridomestic containers in this part of Nigeria made the container index inadequate as a measure of larval density. PMID:6973413
Bang, Y H; Bown, D N; Onwubiko, A O
Impact of Wolbachia on Infection with Chikungunya and Yellow Fever Viruses in the Mosquito Vector Aedes aegypti
Incidence of disease due to dengue (DENV), chikungunya (CHIKV) and yellow fever (YFV) viruses is increasing in many parts of the world. The viruses are primarily transmitted by Aedes aegypti, a highly domesticated mosquito species that is notoriously difficult to control. When transinfected into Ae. aegypti, the intracellular bacterium Wolbachia has recently been shown to inhibit replication of DENVs, CHIKV, malaria parasites and filarial nematodes, providing a potentially powerful biocontrol strategy for human pathogens. Because the extent of pathogen reduction can be influenced by the strain of bacterium, we examined whether the wMel strain of Wolbachia influenced CHIKV and YFV infection in Ae. aegypti. Following exposure to viremic blood meals, CHIKV infection and dissemination rates were significantly reduced in mosquitoes with the wMel strain of Wolbachia compared to Wolbachia-uninfected controls. However, similar rates of infection and dissemination were observed in wMel infected and non-infected Ae. aegypti when intrathoracic inoculation was used to deliver virus. YFV infection, dissemination and replication were similar in wMel-infected and control mosquitoes following intrathoracic inoculations. In contrast, mosquitoes with the wMelPop strain of Wolbachia showed at least a 104 times reduction in YFV RNA copies compared to controls. The extent of reduction in virus infection depended on Wolbachia strain, titer and strain of the virus, and mode of exposure. Although originally proposed for dengue biocontrol, our results indicate a Wolbachia-based strategy also holds considerable promise for YFV and CHIKV suppression.
van den Hurk, Andrew F.; Hall-Mendelin, Sonja; Pyke, Alyssa T.; Frentiu, Francesca D.; McElroy, Kate; Day, Andrew; Higgs, Stephen; O'Neill, Scott L.
Pathology Case Study: Severe Headache and Fever
NSDL National Science Digital Library
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 55-year-old male transplant patient is suffering severe headaches. Visitors are given the hospital course record, radiographic and histologic findings, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in clinical microbiology and transplant pathology.
Anhalt, John P.; Dorvault, Christine; Pasculle, A. W.; Richert, Charles A.
[Acute myocarditis complicating Mediterranean spotted fever. A case report].
Mediterranean spotted fever (MSF) due to Rickettsia conorii is the most important tick-borne disease occurring in North Africa. The first description of MSF was made by Conor and Brush in 1910 in Tunisia. Clinical diagnosis relies on the association of fever, rash and inoculation's scar during summertime. Prognosis in MSF is usually good, however malignant forms were described. These forms occur in patients with comorbidities. G6PD deficiency is a classic ground for severe forms of MSF. Myocarditis is an uncommon complication in MSF; only few cases were reported in the literature. We report a new case of myocarditis complicating MSF in a 15-year-old patient with G6PD deficiency. The patient presented with fever and rash, evocative of MSF; he reported chest pain and the electrocardiogram showed ST segment elevation in anterior leads. Troponin level was elevated. Echocardiogram showed left ventricular dysfunction with 40% ejection fraction. Serologic tests confirmed R. conorii recent infection. Antibiotic treatment with vibramycine and rifadine was started. Patient also received classic treatment of myocarditis with left ventricular dysfunction associating CEI, �-bloquers and diuretics. Evolution was favourable with complete recovery of left ventricular function. Myocarditis is an uncommon but severe complication of MSF. Early diagnosis and treatment allow favorable evolution. PMID:21664598
Ben Mansour, N; Barakett, N; Hajlaoui, N; Haggui, A; Filali, T; Dahmen, R; Fehri, W; Haouala, H
Severe fever with thrombocytopenia syndrome in children: a case report
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus (SFTSV) in China. Humans of all ages living in endemic areas have high risk of acquiring SFTS. Most clinical data so far have been from adults and no clinical study was available from children yet. The present study identified four SFTSV infected children through hospital based surveillance. A prospective observational study was performed to obtain their clinical and laboratory characteristics. Case presentation The patients� age ranged from 4�15 years old and two were male. On hospitalization, fever, malaise and gastrointestinal syndromes were the most commonly presenting symptoms. Hemorrhagic symptoms or neurological manifestation was not recorded in any of the four pediatric patients. Hematological abnormalities at admission into hospital included leucopenia (4 cases), thrombocytopenia (1 case) and bicytopenia (1 case). The abnormal parameters included elevated aminotransferase (1 case), alanine transaminase (2 case), and lactate dehydrogenase (3 case). Laboratory parameters indicative of renal damage was not observed during the hospitalization. All the patients recovered well without sequelae being observed. Conclusion Compared with adults, pediatric patients with SFTSV infection seem to have less vague subjective complaints and less aggressive clinical course. Thrombocytopenia is suggested to be used less rigorously in recognizing SFTSV infection in pediatric patients, especially at early phase of disease.
Characterization of the yellow fever mosquito sterol carrier protein-2 like 3 gene and ligand-bound protein structure
The sterol carrier protein-2 like 3 gene (AeSCP-2L3), a new member of the SCP-2 protein family, is identified from the yellow fever mosquito, Aedes aegypti. The predicted molecular weight of AeSCP-2L3 is 13.4 kDa with a calculated pI of 4.98. AeSCP-2L3 transcription occurs in the larval feeding stages and the mRNA levels decrease in pupae and adults. The highest levels of AeSCP-2L3 gene expression are found in the body wall, and possibly originated in the fat body. This is the first report of a mosquito SCP-2-like protein with prominent expression in tissue other than the midgut. The X-ray protein crystal structure of AeSCP-2L3 reveals a bound C16 fatty acid whose acyl tail penetrates deeply into a hydrophobic cavity. Interestingly, the ligand-binding cavity is slightly larger than previously described for AeSCP-2 (Dyer et al. J Biol Chem 278:39085-39091, 2003) and AeSCP-2L2 (Dyer et al. J Lipid Res M700460-JLR200, 2007). There are also an additional 10 amino acids in SCP-2L3 that are not present in other characterized mosquito SCP-2s forming an extended loop between {beta}3 and {beta}4. Otherwise, the protein backbone is exceedingly similar to other SCP-2 and SCP-2-like proteins. In contrast to this observed high structural homology of members in the mosquito SCP2 family, the amino acid sequence identity between the members is less than 30%. The results from structural analysis imply that there have been evolutionary constraints that favor the SCP-2 C{alpha} backbone fold while the specificity of ligand binding can be altered.
Dyer, David H.; Vyazunova, Irina; Lorch, Jeffery M.; Forest, Katrina T.; Lan, Que; (UW)
NHE8 is an intracellular cation/H+ exchanger in renal tubules of the yellow fever mosquito Aedes aegypti
The goal of this study was to identify and characterize the hypothesized apical cation/H+ exchanger responsible for K+ and/or Na+ secretion in the renal (Malpighian) tubules of the yellow fever mosquito Aedes aegypti. From Aedes Malpighian tubules, we cloned �AeNHE8,� a full-length cDNA encoding an ortholog of mammalian Na+/H+ exchanger 8 (NHE8). The expression of AeNHE8 transcripts is ubiquitous among mosquito tissues and is not enriched in Malpighian tubules. Western blots of Malpighian tubules suggest that AeNHE8 is expressed primarily as an intracellular protein, which was confirmed by immunohistochemical localizations in Malpighian tubules. AeNHE8 immunoreactivity is expressed in principal cells of the secretory, distal segments, where it localizes to a subapical compartment (e.g., vesicles or endosomes), but not in the apical brush border. Furthermore, feeding mosquitoes a blood meal or treating isolated tubules with dibutyryl-cAMP, both of which stimulate a natriuresis by Malpighian tubules, do not influence the intracellular localization of AeNHE8 in principal cells. When expressed heterologously in Xenopus laevis oocytes, AeNHE8 mediates EIPA-sensitive Na/H exchange, in which Li+ partially and K+ poorly replace Na+. The expression of AeNHE8 in Xenopus oocytes is associated with the development of a conductive pathway that closely resembles the known endogenous nonselective cation conductances of Xenopus oocytes. In conclusion, AeNHE8 does not mediate cation/H+ exchange in the apical membrane of Aedes Malpighian tubules; it is more likely involved with an intracellular function.
Piermarini, Peter M.; Weihrauch, Dirk; Meyer, Heiko; Huss, Markus; Beyenbach, Klaus W.
Functional Characterization of the Octenol Receptor Neuron on the Maxillary Palps of the Yellow Fever Mosquito, Aedes aegypti
Background 1-Octen-3-ol (octenol) is a common attractant released by vertebrates which in combination with carbon dioxide (CO2) attracts hematophagous arthropods including mosquitoes. A receptor neuron contained within basiconic sensilla on the maxillary palps of adult mosquitoes responds selectively to 1-octen-3-ol. Recently, an odorant receptor (AaegOR8) known to occur on the maxillary palps was expressed in a heterologous system and demonstrated to be selectively sensitive to (R)-(?)-1-octen-3-ol, one of two enantiomeric forms. Lesser responses were elicited by stimulation with the (S)-enantiomer and various structural analogs. Methodology/Principal Findings Here we characterize the specificity of the octenol receptor neuron in the yellow fever mosquito, Aedes aegypti (L.), in vivo using single cell recordings. The octenol neuron is exquisitely sensitive to (R)-(?)-1-octen-3-ol; comparable responses to (S)-(+)-1-octen-3-ol were elicited only at stimulus doses over 100� that required for the (R)-enantiomer. An intermediate response closer to that elicited by the (R)-(?)-enantiomer was elicited by racemic 1-octen-3-ol. Small structural changes in (R)-(?)-1-octen-3-ol resulted in large decreases in responses. Increases in spike activity were also elicited in the octenol neuron by 2-undecanone, a known repellent; other repellents (DEET, IR3535 and picaridin) were inactive. Conclusions/Significance The results of our electrophysiological studies of the octenol receptor neuron in vivo approximates results of a previous study of the octenol receptor (AaegOR8 with its obligate partner Aaeg\\ORco) expressed heterologously in Xenopus oocytes. By comparison of our current results with those of the heterologous expression study, we conclude that specificity of the octenol receptor neuron can be explained largely by characteristics of the OR alone without other associated proteins present in vivo. Our findings show that repellents may have specific stimulatory effects on receptor neurons and support the notion of repellents as modulators of mosquito odorant receptor activity.
Grant, Alan J.; Dickens, Joseph C.
Transcellular and Paracellular Pathways of Transepithelial Fluid Secretion in Malpighian (renal) Tubules of the Yellow Fever Mosquito Aedes aegypti
Isolated Malpighian tubules of the yellow fever mosquito secrete NaCl and KCl from the peritubular bath to the tubule lumen via active transport of Na+ and K+ by principal cells. Lumen-positive transepithelial voltages are the result. The counter-ion Cl? follows passively by electrodiffusion through the paracellular pathway. Water follows by osmosis, but specific routes for water across the epithelium are unknown. Remarkably, the transepithelial secretion of NaCl, KCl and water is driven by a H+ V-ATPase located in the apical brush border membrane of principal cells and not the canonical Na/K ATPase. A hypothetical cation/H+ exchanger moves Na+ and K+ from the cytoplasm to the tubule lumen. Also remarkable is the dynamic regulation of the paracellular permeability with switch-like speed which mediates in part the post-blood-meal diuresis in mosquitoes. For example, the blood meal the female mosquito takes to nourish her eggs triggers the release of kinin diuretic peptides that 1) increases the Cl? conductance of the paracellular pathway, and 2) assembles V1 and V0 complexes to activate the H+ V-ATPase and cation/H+ exchange close by. Thus, transcellular and paracellular pathways are both stimulated to quickly rid the mosquito of the unwanted salts and water of the blood meal. Stellate cells of the tubule appear to serve a metabolic support role, exporting the HCO3? generated during stimulated transport activity. Septate junctions define the properties of the paracellular pathway in Malpighian tubules, but the proteins responsible for the permselectivity and barrier functions of the septate junction are unknown.
Beyenbach, Klaus W.; Piermarini, Peter M.
Infection of hepatocytes with 17-D vaccine-strain yellow fever virus induces a strong pro-inflammatory host response.
Yellow fever virus (YFV) causes serious disease in endemic areas of South America and Africa, even though a very well tolerated vaccine is available. YFV primarily targets the liver where as many as 80?% of hepatocytes may be involved during infection. The objective of this project was to compare and contrast the cytokine response from hepatocytes infected with either wild-type (Asibi) or vaccine (17-D-204) strains of YFV, with the goal of identifying responses that might be correlated with disease severity or vaccine efficacy. We report here that PH5CH8 hepatocytes support a productive infection with both wild-type and vaccine-strain YFV. Infection with either virus resulted in elevated expression of several pro- and anti-inflammatory cytokines [interleukin (IL)-1?, IL-4, IL-6, IL-8, IL-10 and tumour necrosis factor-?) with a corresponding increase in transcription. Hepatocytes infected with vaccine virus had a more profound response than did cells infected with wild-type virus. Pre-stimulation of hepatocytes with IL-6 resulted in reduced viral titres, elevated concentrations of cytokines released from Asibi virus-infected cells and improved cell viability in cells infected with 17-D virus. Data reported here suggest that 17-D virus stimulates an appropriate antiviral inflammatory response in hepatocytes, while Asibi virus can attenuate the host response. These data identify potential mechanisms that are associated with increased virulence in wild-type virus infections and also provide clues towards potential immune-response limitations that may be associated with vaccine-related adverse events. PMID:21697351
Woodson, Sara E; Holbrook, Michael R
Amplified Fragment Length Polymorphism Mapping of Quantitative Trait Loci for Malaria Parasite Susceptibility in the Yellow Fever Mosquito Aedes aegypti
The yellow fever mosquito Aedes aegypti has been the subject of extensive genetic research due to its medical importance and the ease with which it can be manipulated in the laboratory. A molecular genetic linkage map was constructed using 148 amplified fragment length polymorphism (AFLP) and six single-strand conformation polymorphism (SSCP) markers. Eighteen AFLP primer combinations were used to genotype two reciprocal F2 segregating populations. Each primer combination generated an average of 8.2 AFLP markers eligible for linkage mapping. The length of the integrated map was 180.9 cM, giving an average marker resolution of 1.2 cM. Composite interval mapping revealed a total of six QTL significantly affecting Plasmodium susceptibility in the two reciprocal crosses of Ae. aegypti. Two common QTL on linkage group 2 were identified in both crosses that had similar effects on the phenotype, and four QTL were unique to each cross. In one cross, the four main QTL accounted for 64% of the total phenotypic variance, and digenic epistasis explained 11.8% of the variance. In the second cross, the four main QTL explained 66% of the variance, and digenic epistasis accounted for 16% of the variance. The actions of these QTL were either dominance or underdominance. Our results indicated that at least three new QTL were mapped on chromosomes 1 and 3. The polygenic nature of susceptibility to P. gallinaceum and epistasis are important factors for significant variation within or among mosquito strains. The new map provides additional information useful for further genetic investigation, such as identification of new genes and positional cloning.
Zhong, Daibin; Menge, David M.; Temu, Emmanuel A.; Chen, Hong; Yan, Guiyun
A derivate of the antibiotic doxorubicin is a selective inhibitor of dengue and yellow fever virus replication in vitro.
A doxorubicin derivate, SA-17, that carries a squaric acid amide ester moiety at the carbohydrate (?-l-daunosaminyl) group was identified as a selective inhibitor of in vitro dengue virus (DENV) serotype 2 replication (50% effective concentration [EC(50)] = 0.34 � 0.20 ?g/ml [0.52 � 0.31 ?M]). SA-17 is markedly less cytostatic than the parent compound, resulting in a selectivity index value of ?100. SA-17 also inhibits yellow fever virus 17D (YFV-17D) replication (EC(50) = 3.1 � 1.0 ?g/ml [4.8 � 1.5 ?M]), although less efficiently than DENV replication, but proved inactive against a variety of enveloped and nonenveloped viruses. SA-17 inhibits in vitro flavivirus replication in a dose-dependent manner, as was assessed by virus yield reduction assays and quantification of viral RNA by means of real-time quantitative reverse transcriptase PCR (RT-qPCR) (?2 to 3 log reduction). The anti-DENV activity was confirmed using a Renilla luciferase-expressing dengue reporter virus. Time-of-drug-addition studies revealed that SA-17 acts at the very early stages of the viral replication cycle (i.e., virus attachment and/or virus entry). This observation was corroborated by the observation that SA-17, unlike the nucleoside analogue ribavirin, does not inhibit the replication of DENV subgenomic replicons. Preincubation of high-titer stocks of DENV or YFV-17D with ?5 ?g/ml SA-17 resulted in 100% inhibition of viral infectivity (?3 log reduction). SA-17, however, did not prove virucidal. PMID:20837762
Kaptein, Suzanne J F; De Burghgraeve, Tine; Froeyen, Mathy; Pastorino, Boris; Alen, Marijke M F; Mondotte, Juan A; Herdewijn, Piet; Jacobs, Michael; de Lamballerie, Xavier; Schols, Dominique; Gamarnik, Andrea V; Sztaricskai, Ferenc; Neyts, Johan
Phylogeographic Reconstruction of African Yellow Fever Virus Isolates Indicates Recent Simultaneous Dispersal into East and West Africa
Yellow fever virus (YFV) is a mosquito-borne flavivirus that is a major public health problem in tropical areas of Africa and South America. There have been detailed studies on YFV ecology in West Africa and South America, but current understanding of YFV circulation on the African continent is incomplete. This inadequacy is especially notable for East and Central Africa, for which the unpredictability of human outbreaks is compounded by limitations in both historical and present surveillance efforts. Sparse availability of nucleotide sequence data makes it difficult to investigate the dispersal of YFV in these regions of the continent. To remedy this, we constructed Bayesian phylogenetic and geographic analyses utilizing 49 partial genomic sequences to infer the structure of YFV divergence across the known range of the virus on the African continent. Relaxed clock analysis demonstrated evidence for simultaneous divergence of YFV into east and west lineages, a finding that differs from previous hypotheses of YFV dispersal from reservoirs located on edges of the endemic range. Using discrete and continuous geographic diffusion models, we provide detailed structure of YFV lineage diversity. Significant transition links between extant East and West African lineages are presented, implying connection between areas of known sylvatic cycling. The results of demographic modeling reinforce the existence of a stably maintained population of YFV with spillover events into human populations occurring periodically. Geographically distinct foci of circulation are reconstructed, which have significant implications for studies of YFV ecology and emergence of human disease. We propose further incorporation of Bayesian phylogeography into formal GIS analyses to augment studies of arboviral disease.
Beck, Andrew; Guzman, Hilda; Li, Li; Ellis, Brett; Tesh, Robert B.; Barrett, Alan D. T.
Nonclassical yellow nail syndrome in six-year-old girl: a case report
Introduction The yellow nail syndrome is usually described as the combination of yellow nails with lymphoedema and often with respiratory manifestations such as pleural effusions, chronic sinusitis and bronchiectasis. The syndrome is most often seen in the middle-aged individuals. Case presentation We present a 6-year-old girl with yellow nail syndrome having pansinusitis and bronchiectasis. Conclusion The components comprising the classical triad of yellow nail syndrome in children may not necessarily be present altogether. Therefore, yellow nail syndrome should be suspected in children having only typical nail changes.
Pathology Case Study: Recurrent Fevers of Unknown Origin
NSDL National Science Digital Library
This is a renal pathology case study presented by the University of Pittsburgh Department of Pathology in which a 32-year-old male has recurrent fevers. Visitors are given laboratory data and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using laboratory results to diagnose. It is also a helpful site for educators to use to introduce or test student learning in renal pathology medicine.
Bastacky, Sheldon; Hanchett, James; Torbenson, Michael
Pathology Case Study: History of Bilateral Back Pain and Fever
NSDL National Science Digital Library
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 68-year-old woman with a history of bilateral back pain and fever has been admitted to the hospital with agitation, confusion, and delirium. Visitors are given both the histologic and laboratory findings, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pathology and clinical microbiology.
Chung, Wen-Wei; Fernandes, Shaila; Pasculle, A. W.; Wang, Jianzhou
Pathology Case Study: Fever, Chills, Shortness of Breath
NSDL National Science Digital Library
This is a case study presented by the University of Pittsburgh Department of Pathology in which a man experienced fever, chills, and shortness of breath a year after having received a lung transplant. Visitors can view CT images, and have the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to introduce or test students of pathology and clinical microbiology.
Grant, Maurice R.; Pasculle, A. W.; Shaeffer, James
A case of crimean-congo hemorrhagic Fever in oman.
In the summer of June 2011, the first case of Crimean-Congo hemorrhagic fever (CCHF) was observed in Oman since the last fifteen years. The first blood sample using reverse transcriptase polymerase chain reaction (PCR) test were sent looking for CCHF, tick-borne encephalitis, dengue, Japanese encephalitis, Chikungunya and West Nile. All resulted as negative. The repeated serology for CCHF came strongly positive after five days from the initial negative test, and accordingly patient started on ribavirin and he responded to it. His condition improved dramatically. PMID:23772290
Al-Zadjali, Matllooba; Al-Hashim, Hakeem; Al-Ghilani, Mohammad; Balkhiar, Abdullah
A Case of Crimean-Congo Hemorrhagic Fever in Oman
In the summer of June 2011, the first case of Crimean-Congo hemorrhagic fever (CCHF) was observed in Oman since the last fifteen years. The first blood sample using reverse transcriptase polymerase chain reaction (PCR) test were sent looking for CCHF, tick-borne encephalitis, dengue, Japanese encephalitis, Chikungunya and West Nile. All resulted as negative. The repeated serology for CCHF came strongly positive after five days from the initial negative test, and accordingly patient started on ribavirin and he responded to it. His condition improved dramatically.
Al-Zadjali, Matllooba; Al-Hashim, Hakeem; Al-Ghailani, Mohammad; Balkhair, Abdullah
[Clinical investigation of nine pediatric Japanese spotted fever cases].
To clarify the clinical manifestations of pediatric Japanese spotted fever (JSF), which remain unclear, we retrospectively reviewed the records of 9 consecutive hospitalized children 5 boys and 4 girls aged 0-15 years (median: 2.3) whose diagnosis was patients with JSF who were serologically confirmed from April 2008 to October 2009. We initially studied the polymerase chain reaction (PCR) assay validity for specific Rickettsia japonica DNA in the blood. We also studied febrile duration, the history of contact with tick-infested areas, body temperature, eschars at tick bite sites, skin rash, treatment drugs, and laboratory data. Five of the 9 (56%) had positive PCR tests. Prehospitalization febrile duration was 1-5 days. Five had had contact with tick-infested areas and 4 had not despite living near such areas. Body temperature was 40 degrees C in 7. Only 4 had eschars at bite sites. Characteristic spotted palmar and/or plantar erythema seen in 8 was useful in diagnosis. Laboratory studies showed typical hyponatremia of < 135mEq/L in 6 JSF was diagnosed easily at hospitalization in 7. Diagnosis in a 2-month-old infant proved difficults, however, worsening the child's condition and causing hepatosplenomegaly, thrombocytopenia, anemia, and hyperferritinema. The infant was treated with high-dose gamma-globulin and azithromycin (AZM) followed by minocycline (MINO). Another case was difficult to diagnose due to clinical manifestations consistent with Kawasaki disease. The child was treated with high-dose gamma-globulin and AZM. Three of the 9 were treated with MINO alone and 4 with combined MINO and new quinolones. Fever was resolved within 2 days of treatment in all cases. Our findings show that children with high fever and spotted palmar and/or plantar erythema should be treated immediately for JSF in prevalent areas, even in the absence of eschars. PMID:22250454
Nashida, Yuji; Higashigawa, Masamune; Maegawa, Kayoko; Fujiwara, Takashi; Inoue, Masakazu
Yellow nail syndrome associated with thiol compound therapy for rheumatoid arthritis. Two case reports.
Yellow nail syndrome is characterized by ungual dystrophy, lower limb lymphedema, and pleural effusions or bronchiectasis. Rheumatoid arthritis is the autoimmune disorder most often associated with yellow nail syndrome. We report two new cases of yellow nail syndrome in patents receiving thiol compound therapy for rheumatoid arthritis. Eight similar cases have been reported since 1979, suggesting a possible causative effect of this class of drugs. PMID:12184439
Lehu�d�, Ga�lle; Toussirot, Eric; Despaux, Jacques; Michel, Fabrice; Wendling, Daniel
Characterization of yellow fever virus proteins E and NS1 expressed in Vero and Spodoptera frugiperda cells.
The cDNA encoding the E and NS1 proteins of the yellow fever virus (YFV) was expressed in Spodoptera frugiperda cells via the recombinant baculovirus Ac-E. NS1 as a gp100 precursor which was cleaved to generate the recombinant proteins E and NS1 similar in size, folding and antigenicity to the authentic ones. Recombinant protein E exhibited immunodominant epitopes as judged by its reactivity with YFV-neutralizing MAbs. Using the Triton X-114 phase separation system, authentic and recombinant E proteins as well as the gp100 precursor exhibited hydrophobic properties similar to those of integral membrane proteins. Recombinant protein E was found neither in the extracellular medium nor on the cell surface, suggesting that it did not migrate within the secretory pathway of insect cells. Analysis of protein NS1 expressed in primate and insect cells revealed that the newly synthesized 48K NS1 glycoprotein was converted to a heat-labile gp72 homo-oligomeric form. This phenomenon did not require the presence of carbohydrate groups. Using the Triton X-114 phase separation system, the oligomeric form of NS1 was shown to be associated with cellular membranes although it appeared less hydrophobic than protein E and gp100. A small fraction of YFV NS1 oligomers were transported throughout the secretory pathway to be shed into the extracellular medium of primate cells. YFV NS1 oligomers migrated from the endoplasmic reticulum to the Golgi complex, whereas their N-oligosaccharides of the high-mannose type are processed to the complex-mannose type. Protein NS1 expressed by recombinant baculovirus-infected insect cells was not found in the extracellular medium but associated with the plasma membrane of the cells. Two recombinant NS1 forms were detected in insect cells: a major one with an apparent Mr of 48K and a minor one of 47K in which N-linked glycans were probably processed to a trimannosyl core without further elongation. Thus, it appears that the transport strategy as well as the N-glycosylation of NS1 in insect cells infected with recombinant baculovirus were different from those of the NS1 in primate cells infected with YFV. PMID:1710649
Despr�s, P; Girard, M; Bouloy, M
17DD and 17D-213/77 Yellow Fever Substrains Trigger a Balanced Cytokine Profile in Primary Vaccinated Children
Background This study aimed to compare the cytokine-mediated immune response in children submitted to primary vaccination with the YF-17D-213/77 or YF-17DD yellow fever (YF) substrains. Methods A non-probabilistic sample of eighty healthy primary vaccinated (PV) children was selected on the basis of their previously known humoral immune response to the YF vaccines. The selected children were categorized according to their YF-neutralizing antibody titers (PRNT) and referred to as seroconverters (PV-PRNT+) or nonseroconverters (PV-PRNT?). Following revaccination with the YF-17DD, the PV-PRNT? children (YF-17D-213/77 and YF-17DD groups) seroconverted and were referred as RV-PRNT+. The cytokine-mediated immune response was investigated after short-term in vitro cultures of whole blood samples. The results are expressed as frequency of high cytokine producers, taking the global median of the cytokine index (YF-Ag/control) as the cut-off. Results The YF-17D-213/77 and the YF-17DD substrains triggered a balanced overall inflammatory/regulatory cytokine pattern in PV-PRNT+, with a slight predominance of IL-12 in YF-17DD vaccinees and a modest prevalence of IL-10 in YF-17D-213/77. Prominent frequency of neutrophil-derived TNF-? and neutrophils and monocyte-producing IL-12 were the major features of PV-PRNT+ in the YF-17DD, whereas relevant inflammatory response, mediated by IL-12+CD8+ T cells, was the hallmark of the YF-17D-213/77 vaccinees. Both substrains were able to elicit particular but relevant inflammatory events, regardless of the anti-YF PRNT antibody levels. PV-PRNT? children belonging to the YF-17DD arm presented gaps in the inflammatory cytokine signature, especially in terms of the innate immunity, whereas in the YF-17D-213/77 arm the most relevant gap was the deficiency of IL-12-producing CD8+T cells. Revaccination with YF-17DD prompted a balanced cytokine profile in YF-17DD nonresponders and a robust inflammatory profile in YF-17D-213/77 nonresponders. Conclusion Our findings demonstrated that, just like the YF-17DD reference vaccine, the YF-17D-213/77 seed lot induced a mixed pattern of inflammatory and regulatory cytokines, supporting its universal use for immunization.
Luiza-Silva, Maria; Batista, Mauricio Azevedo; Martins, Marina Angela; Sathler-Avelar, Renato; da Silveira-Lemos, Denise; Camacho, Luiz Antonio Bastos; de Menezes Martins, Reinaldo; de Lourdes de Sousa Maia, Maria; Farias, Roberto Henrique Guedes; da Silva Freire, Marcos; Galler, Ricardo; Homma, Akira; Ribeiro, Jose Geraldo Leite; Lemos, Jandira Aparecida Campos; Auxiliadora-Martins, Maria; Caldas, Iramaya Rodrigues; Eloi-Santos, Silvana Maria; Teixeira-Carvalho, Andrea; Martins-Filho, Olindo Assis
Yellow fever vaccination in Malaya by subcutaneous injection and multiple puncture. Neutralizing antibody responses in persons with and without pre-existing antibody to related viruses.
Because of the risk of introduction of yellow fever to South-East Asia, comparative studies were made of yellow fever vaccination in Malayans who had a high prevalence of antibody to related viruses and in volunteers without related antibody. The proportions of positive neutralizing antibody responses to subcutaneous vaccination with 17D vaccine were not significantly different between volunteers with and without heterologous antibody but the degree of antibody response was greater in those without. The ID(50) of 17D in both groups was about 5 mouse intracerebral LD(50). Multiple puncture vaccination with 17D gave a much lower response rate than subcutaneous vaccination in volunteers with heterologous antibody. In both groups subcutaneous doses of about 50 mouse intracerebral LD(50) gave larger antibody responses than higher doses. The neutralizing indices and analysis of results were calculated by a method based on the survival time of the mice. This method, which has advantages over that of Reed & Muench, is fully described in an annex to this paper. PMID:13993152
The Synergistic Effect of Combined Immunization with a DNA Vaccine and Chimeric Yellow Fever/Dengue Virus Leads to Strong Protection against Dengue
The dengue envelope glycoprotein (E) is the major component of virion surface and its ectodomain is composed of domains I, II and III. This protein is the main target for the development of a dengue vaccine with induction of neutralizing antibodies. In the present work, we tested two different vaccination strategies, with combined immunizations in a prime/booster regimen or simultaneous inoculation with a DNA vaccine (pE1D2) and a chimeric yellow fever/dengue 2 virus (YF17D-D2). The pE1D2 DNA vaccine encodes the ectodomain of the envelope DENV2 protein fused to t-PA signal peptide, while the YF17D-D2 was constructed by replacing the prM and E genes from the 17D yellow fever vaccine virus by those from DENV2. Balb/c mice were inoculated with these two vaccines by different prime/booster or simultaneous immunization protocols and most of them induced a synergistic effect on the elicited immune response, mainly in neutralizing antibody production. Furthermore, combined immunization remarkably increased protection against a lethal dose of DENV2, when compared to each vaccine administered alone. Results also revealed that immunization with the DNA vaccine, regardless of the combination with the chimeric virus, induced a robust cell immune response, with production of IFN-? by CD8+ T lymphocytes.
Azevedo, Adriana S.; Goncalves, Antonio J. S.; Archer, Marcia; Freire, Marcos S.; Galler, Ricardo; Alves, Ada M. B.
Dobrava virus carried by the yellow-necked field mouse Apodemus flavicollis, causing hemorrhagic fever with renal syndrome in Romania.
Hemorrhagic fever with renal syndrome (HFRS) has been confirmed by serological methods during recent years in Romania. In the present study, focus-reduction neutralization tests (FRNT) confirmed Dobrava hantavirus (DOBV) as the causative agent in some HFRS cases, but could not distinguish between DOBV and Saaremaa virus (SAAV) infections in other cases. DOBV was detected by a DOBV-specific TaqMan assay in sera of nine patients out of 22 tested. Partial sequences of the M genomic segment of DOBV were obtained from sera of three patients and revealed the circulation of two DOBV lineages in Romania. Investigation of rodents trapped in Romania found three DOBV-positive Apodemus flavicollis out of 83 rodents tested. Two different DOBV lineages were also detected in A. flavicollis as determined from partial sequences of the M and S genomic segments. Sequences of DOBV in A. flavicollis were either identical or closely related to the sequences obtained from the HFRS patients. The DOBV strains circulating in Romania clustered in two monophyletic groups, together with strains from Slovenia and the north of Greece. This is the first evidence for the circulation of DOBV in wild rodents and for a DOBV etiology of HFRS in Romania. PMID:24746107
Panculescu-Gatej, Raluca Ioana; Sirbu, Anca; Dinu, Sorin; Waldstrom, Maria; Heyman, Paul; Murariu, Dimitru; Petrescu, Angela; Szmal, Camelia; Oprisan, Gabriela; Lundkvist, Ake; Ceianu, Cornelia S
Treatment of field cases of East Coast fever with halofuginone lactate
In a series of field trials 48 (55%) of 88 field cases of East Coast fever treated with halofuginone lactate recovered and survived and 40 (45%) died while 31 (86%) of 36 untreated control animals died of East Coast fever and five (14%) recovered. For cases diagnosed and treated early a 100% recovery rate was achieved. A single dose at
B. C. Njau; P. A. Mkonyi; W. C. H. Mleche; J. I. Kitaly; N. C. Maiseli
Yellow fever 17D-vectored vaccines expressing Lassa virus GP1 and GP2 glycoproteins provide protection against fatal disease in guinea pigs
Yellow Fever (YF) and Lassa Fever (LF) are two prevalent hemorrhagic fevers co-circulating in West Africa and responsible for thousands of deaths annually. The YF vaccine 17D has been used as a vector for the Lassa virus glycoprotein precursor (LASV-GPC) or their subunits, GP1 (attachment glycoprotein) and GP2 (fusion glycoprotein). Cloning shorter inserts, LASV GP1 and GP2, between YF17D E and NS1 genes enhanced genetic stability of recombinant viruses, YF17D/LASV-GP1 and �GP2, in comparison with YF17D/LASV-GPC recombinant. The recombinant viruses were replication competent and properly processed YF and LASV GP proteins in infected cells. YF17D/LASV-GP1&GP2 induced specific CD8+ T cell responses in mice and protected strain 13 guinea pigs against fatal LF. Unlike immunization with live attenuated reassortant vaccine ML29, immunization with YF17D/LASV-GP1&GP2 did not provide sterilizing immunity. This study demonstrates the feasibility of YF17D-based vaccine to control LF in West Africa.
Jiang, Xiaohong; Dalebout, Tim J.; Bredenbeek, Peter J.; Carrion, Ricardo; Brasky, Kathleen; Patterson, Jean; Goicochea, Marco; Bryant, Joseph; Salvato, Maria S.; Lukashevich, Igor S.
[Investigation of dengue virus and yellow fever virus seropositivities in blood donors from Central/Northern Anatolia, Turkey].
Dengue virus (DENV) and yellow fever virus (YFV) are two of the globally prevalent vector-borne flaviviruses. Data on these viruses from Turkey is limited to a single study originating from the western, Aegean region of Turkey, where evidence for DENV exposure had been confirmed in residents and presence of hemagglutination inhibiting antibodies against YFV had been revealed. The aim of this study was to investigate the rates of seropositivity of DENV and YFV in blood donors from Central/Northern Anatolia, Turkey, for the demonstration of possible human exposure. Serum samples were collected by the Turkish Red Crescent Middle Anatolia Regional Blood Center from donation sites at Ankara, Konya, Eski?ehir and Zonguldak provinces and included in the study after informed consent. Ankara is the capital and second most-populated city in Turkey. All samples were previously evaluated for West Nile and tick-borne encephalitis virus antibodies and found to be negative. A total of 2435 and 1502 sera have been evaluated for IgG antibodies against DENV and YFV, respectively. Commercial enzymelinked immunosorbent assays (ELISAs) and indirect immunofluorescence tests (IIFTs) were applied (Euroimmun, Germany) for DENV/YFV IgG surveillance. DENV IgG reactive sera were further evaluated for IgM by ELISA and a commercial mosaic IIFT to determine DENV subtypes. IgM positive samples were also analyzed by a commercial NS1 antigen detection assay (Bio-Rad Laboratories, France). YFV IgG reactive samples were evaluated by IIFT for IgM and via mosaic IIFT and antibody specificity were confirmed by plaque reduction neutralization test (PRNT). Anti-DENV IgGs were demonstrated in repeated assays in 0.9% (21/2435) of the sera. In two samples with borderline IgG results, presence of DENV IgM was detected, one of which was also borderline positive for DENV NS1 antigen. In 14.3% (3/21) of the IgG reactive sera, mosaic IIFT was evaluated as positive and displayed prominent reactivity for DENV-2 in all samples. From five donors with DENV reactivity, new samples were obtained after at least six months which revealed the continuing presence of DENV IgG activity in four. One sample which was initially positive for IgM, borderline for NS1 antigen and borderline for IgG was observed to be positive for IgG and negative for IgM in redonation. IIFT results in three redonation samples also indicated reactivity for DENV-1 and DENV-2 subtypes. Anti-YFV IgGs were detected in 0.6% (9/1502) of the sera. YFV IgM could not be demonstrated in any of the IgG reactive samples and PRNT was evaluated as negative. In conclusion, evidence for DENV exposure, presumably to DENV-2, was identified in residents from Central Anatolian provinces of Ankara and Konya for the first time, however, seroreactivity detected against YFV could not be confirmed by PRNT. These findings indicated that DENV or an antigenically-similar flavivirus was probably present in the study region and sporadic human exposure might have occurred. PMID:21063991
Erg�nay, Koray; Saygan, Mehmet B; Aydo?an, Sibel; Litzba, Nadine; Niedrig, Matthias; P?nar, Ahmet; Us, D�rdal
Primary dengue fever associated with hemophagocytic syndrome: a report of three imported cases, Bordeaux, France.
The dengue virus is responsible for a wide range of symptoms that can be classified into two distinct syndromes: classical dengue fever and severe dengue fever. Among the complicating forms, hemophagocytic syndrome (HPS) has been previously reported in case series of patients with secondary dengue fever outside of endemic settings. Of note, the occurrence of HPS has not yet been included among the criteria for defining severe dengue fever. We herein present three patients with HPS related to confirmed primary dengue virus infection. Clinicians should therefore consider hemophagocytosis as a complication during severe dengue infection in na�ve patients. PMID:24739615
Ribeiro, Emmanuel; Kassab, Somar; Pistone, Thierry; Receveur, Marie-Catherine; Fialon, Pierre; Malvy, Denis
Child-Invented Health Education Games: A Case Study for Dengue Fever
ERIC Educational Resources Information Center
The study's goal was to demonstrate the ability of an 8-year-old child to create educational games for the topic of dengue fever control. A naturalistic descriptive case study method was employed. The child had two dengue fever educational game creation activities. The study demonstrated that a child could develop functional games related to�
Lennon, Jeffrey L.; Coombs, David W.
El Ni�o Southern Oscillation and vegetation dynamics as predictors of dengue fever cases in Costa Rica
Dengue fever (DF) and dengue hemorrhagic fever (DHF) are growing health concerns throughout Latin America and the Caribbean. This study focuses on Costa Rica, which experienced over 100 000 cases of DF\\/DHF from 2003 to 2007. We utilized data on sea-surface temperature anomalies related to the El Ni�o Southern Oscillation (ENSO) and two vegetation indices derived from the Moderate Resolution
D O Fuller; A Troyo; J C Beier
Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report
Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.
Choi, Hee Seok; Hwang, Jae Cheol; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup
Monitoring of clinical and laboratory data in two cases of imported Lassa fever
During 2000, four cases of fatal Lassa fever were imported from Africa to Europe. In two patients, consecutive serum samples were available for monitoring of virus load and cytokine levels in addition to standard laboratory data. Both patients had non-specific early clinical symptoms including high fever. Patient 1 developed multi-organ failure and died of hemorrhagic shock on day 15 of
Herbert Schmitz; Bernhard K�hler; Thomas Laue; Christian Drosten; Peter J. Veldkamp; Stephan G�nther; Petra Emmerich; Hans P. Geisen; Klaus Fleischer; Matthias F. C. Beersma; Achim Hoerauf
Cracked mercury dental amalgam as a possible cause of fever of unknown origin: a case report
INTRODUCTION: Sudden fever of unknown origin is quite a common emergency and may lead to hospitalization. A rise in body temperature can be caused by infectious diseases and by other types of medical condition. This case report is of a woman who had fever at night for several days and other clinical signs which were likely related to cracked dental
Fabrizia Bamonti; Gianpaolo Guzzi; Maria Elena Ferrero
Randomized Double-Blind Phase III Pivotal Field Trial of the Comparative Immunogenicity Safety and Tolerability of Two Yellow Fever 17D Vaccines (ARILVAX(Trademark) and YF-VAX(Trademark)) in Healthy Infants and Children in Peru.
National Technical Information Service (NTIS)
We conducted a randomized, double-blind, phase III yellow fever (YF) vaccine trial among 1,107 healthy children in Sullana in northern Peru. The safety and efficacy (by measurement of geometric mean neutralizing antibody titer responses) were determined f...
C. T. Baustista J. L. Sanchez K. McCarthy R. Nichols V. E. Belmusto-Worn
Priming effect of dengue and yellow fever vaccination on the immunogenicity, infectivity, and safety of a tetravalent dengue vaccine in humans.
A dengue vaccine effective against all four serotypes is urgently needed. However, safety and immunogenicity could be affected by prior exposure to flaviviruses. This open, controlled, phase IIa study was conducted in 35 healthy adults who had received monovalent, live attenuated Vero cell-derived dengue vaccine against dengue virus 1 (VDV1) or 2 (VDV2) or yellow fever (YF) vaccine 1 year before or who were flavivirus-na�ve. All participants received one subcutaneous injection of tetravalent dengue vaccine (TDV) and were followed for 180 days. Previous vaccination did not increase reactogenicity, laboratory abnormalities, or incidence of vaccine viremia, but it did increase the neutralizing antibody response to dengue virus that persisted at day 180. There was no increase in YF antibodies in participants previously immunized with YF vaccine. Prior exposure to YF or monovalent dengue vaccines had no adverse effects on the safety or incidence of viremia associated with this TDV, but it increased immunogenicity. PMID:21976579
Qiao, Ming; Shaw, David; Forrat, Remi; Wartel-Tram, Anh; Lang, Jean
Priming Effect of Dengue and Yellow Fever Vaccination on the Immunogenicity, Infectivity, and Safety of a Tetravalent Dengue Vaccine in Humans
A dengue vaccine effective against all four serotypes is urgently needed. However, safety and immunogenicity could be affected by prior exposure to flaviviruses. This open, controlled, phase IIa study was conducted in 35 healthy adults who had received monovalent, live attenuated Vero cell-derived dengue vaccine against dengue virus 1 (VDV1) or 2 (VDV2) or yellow fever (YF) vaccine 1 year before or who were flavivirus-na�ve. All participants received one subcutaneous injection of tetravalent dengue vaccine (TDV) and were followed for 180 days. Previous vaccination did not increase reactogenicity, laboratory abnormalities, or incidence of vaccine viremia, but it did increase the neutralizing antibody response to dengue virus that persisted at day 180. There was no increase in YF antibodies in participants previously immunized with YF vaccine. Prior exposure to YF or monovalent dengue vaccines had no adverse effects on the safety or incidence of viremia associated with this TDV, but it increased immunogenicity.
Qiao, Ming; Shaw, David; Forrat, Remi; Wartel-Tram, Anh; Lang, Jean
Spatial and temporal abundance of three sylvatic yellow fever vectors in the influence area of the Manso hydroelectric power plant, Mato Grosso, Brazil.
Human biting catches of sylvatic yellow fever (SYF) vectors were conducted at eight stations in the influence area of the Manso hydroelectric power plant (Central Brazil) in sampling campaigns every 2 mo from July 2000 to November 2001. In total, 206 individuals were captured and classified as one of three species important for the transmission of SYF in Mato Grosso state: Haemagogus (Haemagogus) janthinomys (Dyar, 1921); Haemagogus (Conopostegus) leucocelaenus (Dyar & Shannon, 1924); and Sabethes (Sabethoides) chloropterus (Humboldt, 1819). The highest vector abundance was observed during the rainy season (November through March) and SYF vectors were present in all sampling points throughout the year, mainly in riparian and shadowed transitional forests at shadowed ramps. PMID:22308793
Ribeiro, A L M; Miyazaki, R D; Silva, M; Zeilhofer, P
A case of yellow nail syndrome with dramatically improved nail discoloration by oral clarithromycin.
An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM. PMID:22220146
Suzuki, Manabu; Yoshizawa, Atsuto; Sugiyama, Haruhito; Ichimura, Yasunori; Morita, Akane; Takasaki, Jin; Naka, Gou; Hirano, Satoshi; Izumi, Shinyu; Takeda, Yuichiro; Hoji, Masayuki; Kobayashi, Nobuyuki; Kudo, Koichiro
Fever in returning travellers due to a noninfectious disease: Two case reports.
Each year, increasing numbers of people from developed countries travel to developing countries. It is not rare for these travellers to experience illness during or following their trips. It has been estimated that fever is present in 25% of those who seek medical attention following travel. In the majority of cases, the focus of the investigations centre around an infectious etiology, which can lead to a delay in establishing the noninfectious cause of fever. Two cases of fever, which were due to a noninfectious disease, are reported in returning travellers. PMID:19412384
Miller, Saul; Gabel, Kevin; Lee, Christine H
Molecular characterization of dengue virus 1 from autochthonous dengue fever cases in Croatia.
In the summer of 2010, two autochthonous dengue fever cases were detected in Croatia. Here we report the retrospective detection of an additional case of dengue fever, representing the first sustained autochthonous transmission in Europe since 1928. In addition, we present the phylogenetic analyses based on two sequences from the Pelje�ac peninsula, southern Croatia. The sequences were identified as dengue virus genotype 1 and recovered from two out of the three Pelje�ac patients in whom infection occurred. PMID:23279586
Kurolt, I C; Betica-Radi?, L; Dakovi?-Rode, O; Franco, L; Zelen�, H; Tenorio, A; Markoti?, A
Spatiotemporal analysis of indigenous and imported dengue fever cases in Guangdong province, China
Background Dengue fever has been a major public health concern in China since it re-emerged in Guangdong province in 1978. This study aimed to explore spatiotemporal characteristics of dengue fever cases for both indigenous and imported cases during recent years in Guangdong province, so as to identify high-risk areas of the province and thereby help plan resource allocation for dengue interventions. Methods Notifiable cases of dengue fever were collected from all 123 counties of Guangdong province from 2005 to 2010. Descriptive temporal and spatial analysis were conducted, including plotting of seasonal distribution of cases, and creating choropleth maps of cumulative incidence by county. The space-time scan statistic was used to determine space-time clusters of dengue fever cases at the county level, and a geographical information system was used to visualize the location of the clusters. Analysis were stratified by imported and indigenous origin. Results 1658 dengue fever cases were recorded in Guangdong province during the study period, including 94 imported cases and 1564 indigenous cases. Both imported and indigenous cases occurred more frequently in autumn. The areas affected by the indigenous and imported cases presented a geographically expanding trend over the study period. The results showed that the most likely cluster of imported cases (relative risk?=?7.52, p?0.001) and indigenous cases (relative risk?=?153.56, p?0.001) occurred in the Pearl River Delta Area; while a secondary cluster of indigenous cases occurred in one district of the Chao Shan Area (relative risk?=?471.25, p?0.001). Conclusions This study demonstrated that the geographic range of imported and indigenous dengue fever cases has expanded over recent years, and cases were significantly clustered in two heavily urbanised areas of Guangdong province. This provides the foundation for further investigation of risk factors and interventions in these high-risk areas.
Clinical and virological characterization of imported cases of Chikungunya fever.
A Chikungunya virus (CHIKV) epidemic emerged in the Indian Ocean islands of the Comores, Reunion, Mayotte, Mauritius, the Seychelles and Madagascar in 2005 resulting in the infection of about 250.000 inhabitants and travellers in only one year. Beginning in March 2006 increasing numbers of CHIKV-like febrile illnesses were reported from various parts of India. We investigated 70 consecutive German travellers returning from the affected areas and presenting with arthralgia and/or fever suggestive of CHIKV infection. Eleven patients had serological evidence of CHIKV infection. Real-time RT-PCR for CHIKV was positive in two cases, one who returned from Mauritius and the other who came back from Rajasthan, Northern India. In both cases CHIKV was isolated and sequencing of the entire viral genome was performed. The nucleotide sequence data obtained for both CHIKV strains revealed a high level of identity to CHIKV isolates from the ongoing epidemic. In detail, we found only 18 nucleotide exchanges between the isolates from Mauritius and Rajasthan, resulting in only six amino acid changes (nsP1 T128K, T376M, nsP3 S472N, capsid P23S, V27I and E1-protein A226V). Although the excessive dimension of the 2005/2006 outbreak in the Indian Ocean islands was at least in part accounted to the na�ve population affected, our results of the Rajasthan isolate support that the emergence of this CHIKV subtype may rather be a result of a better viral fitness. This has been previously accounted to a A226V change in the E1 protein of the new CHIKV variant when compared to other CHIKV data available. This mutation, supposedly resulting in high-titred viremia in humans and/or an enhanced adaptation to the vector population resulting in increased transmission rates, was also found in our CHIKV isolate from Mauritius. The spread of an African CHIKV to Asia further demonstrates how fast viruses can emerge and establish in places where competent vectors are prevalent. PMID:19066782
Pfeffer, Martin; Z�ller, Gudrun; Essbauer, Sandra; Tomaso, Herbert; Behrens-Riha, Nicole; L�scher, Thomas; Dobler, Gerhard
A case of Lassa fever: clinical and virological findings
Five days after arriving in London from Jos a young Nigerian women developed a severe and prolonged illness that proved to be Lassa fever. Virus was not detected in urine during the first three weeks but then appeared and reached a peak during the sixth week, with continuing excretion for 67 days after the onset of illness. Laboratory investigations showed
R T Emond; B Bannister; G Lloyd; T J Southee; E T Bowen
Haemophagocytosis in dengue haemorrhagic fever: a case report.
Virus associated haemophagocytic syndrome (VAHS), a distinct clinico-pathologic entity, is characterised by systemic proliferation of non-neoplastic histotiocytes showing haemophagocytosis resulting in blood cytopaenia. It has been described in relation to several viruses earlier. Here we describe a young girl who developed this reactive process during the course of dengue haemorrhagic fever (DHF). PMID:1803975
Ramanathan, M; Duraisamy, G
Pharmacological Validation of an Inward-Rectifier Potassium (Kir) Channel as an Insecticide Target in the Yellow Fever Mosquito Aedes aegypti
Mosquitoes are important disease vectors that transmit a wide variety of pathogens to humans, including those that cause malaria and dengue fever. Insecticides have traditionally been deployed to control populations of disease-causing mosquitoes, but the emergence of insecticide resistance has severely limited the number of active compounds that are used against mosquitoes. Thus, to improve the control of resistant mosquitoes there is a need to identify new insecticide targets and active compounds for insecticide development. Recently we demonstrated that inward rectifier potassium (Kir) channels and small molecule inhibitors of Kir channels offer promising new molecular targets and active compounds, respectively, for insecticide development. Here we provide pharmacological validation of a specific mosquito Kir channel (AeKir1) in the yellow fever mosquito Aedes aegypti. We show that VU590, a small-molecule inhibitor of mammalian Kir1.1 and Kir7.1 channels, potently inhibits AeKir1 but not another mosquito Kir channel (AeKir2B) in vitro. Moreover, we show that a previously identified inhibitor of AeKir1 (VU573) elicits an unexpected agonistic effect on AeKir2B in vitro. Injection of VU590 into the hemolymph of adult female mosquitoes significantly inhibits their capacity to excrete urine and kills them within 24 h, suggesting a mechanism of action on the excretory system. Importantly, a structurally-related VU590 analog (VU608), which weakly blocks AeKir1 in vitro, has no significant effects on their excretory capacity and does not kill mosquitoes. These observations suggest that the toxic effects of VU590 are associated with its inhibition of AeKir1.
Rouhier, Matthew F.; Raphemot, Rene; Denton, Jerod S.; Piermarini, Peter M.
Autopsy findings in fatal dengue haemorrhagic fever - 06 Cases
Background During recent outbreak of dengue fever in Delhi, there has been a significant increase in dengue-associated admission in hospitals. To better understand the pathology of dengue haemorrhagic fever, we conducted autopsies of dengue infections deaths within our hospital. Method This was an autopsy study of dengue-associated deaths at a large tertiary care hospital. Results From Sep 2009 to Dec 2010, a total of 1032 patients with serological evidence of dengue infection were admitted to our hospital. There were twelve deaths and autopsies were conducted in six. Adult respiratory distress syndrome, bleeding diathesis, hypotension, hepatic failure and acute renal failure were the common causes of death despite early hospitalization, intravenous fluid, and blood-product support. Conclusion Dengue is associated with severe disease, and deaths do occur despite current supportive management. Early predictors of disease severity and better clinical interventions are needed.
Rathi, K.R.; Arora, M.M.; Sahai, K.; Tripathi, S.; Singh, S.P.; Raman, D.K.; Anand, K.B.
Alboserpin, a Factor Xa Inhibitor from the Mosquito Vector of Yellow Fever, Binds Heparin and Membrane Phospholipids and Exhibits Antithrombotic Activity*
The molecular mechanism of factor Xa (FXa) inhibition by Alboserpin, the major salivary gland anticoagulant from the mosquito and yellow fever vector Aedes albopictus, has been characterized. cDNA of Alboserpin predicts a 45-kDa protein that belongs to the serpin family of protease inhibitors. Recombinant Alboserpin displays stoichiometric, competitive, reversible and tight binding to FXa (picomolar range). Binding is highly specific and is not detectable for FX, catalytic site-blocked FXa, thrombin, and 12 other enzymes. Alboserpin displays high affinity binding to heparin (KD ? 20 nm), but no change in FXa inhibition was observed in the presence of the cofactor, implying that bridging mechanisms did not take place. Notably, Alboserpin was also found to interact with phosphatidylcholine and phosphatidylethanolamine but not with phosphatidylserine. Further, annexin V (in the absence of Ca2+) or heparin outcompetes Alboserpin for binding to phospholipid vesicles, suggesting a common binding site. Consistent with its activity, Alboserpin blocks prothrombinase activity and increases both prothrombin time and activated partial thromboplastin time in vitro or ex vivo. Furthermore, Alboserpin prevents thrombus formation provoked by ferric chloride injury of the carotid artery and increases bleeding in a dose-dependent manner. Alboserpin emerges as an atypical serpin that targets FXa and displays unique phospholipid specificity. It conceivably uses heparin and phosphatidylcholine/phosphatidylethanolamine as anchors to increase protein localization and effective concentration at sites of injury, cell activation, or inflammation.
Calvo, Eric; Mizurini, Daniella M.; Sa-Nunes, Anderson; Ribeiro, Jose M. C.; Andersen, John F.; Mans, Ben J.; Monteiro, Robson Q.; Kotsyfakis, Michail; Francischetti, Ivo M. B.
Substitution of Wild-Type Yellow Fever Asibi Sequences for 17D Vaccine Sequences in ChimeriVax-Dengue 4 Does Not Enhance Infection of Aedes aegypti Mosquitoes
To address concerns that a flavivirus vaccine/wild-type recombinant virus might have a high mosquito infectivity phenotype, the yellow fever virus (YFV) 17D backbone of the ChimeriVax� dengue 4 virus was replaced with the corresponding gene sequences of the virulent YFV Asibi strain. Field-collected and laboratory-colonized Aedes aegypti mosquitoes were fed on blood containing each of the viruses under investigation and held for 14 days after infection. Infection and dissemination rates were based on antigen detection in titrated body or head triturates. Our data indicate that, even in the highly unlikely event of recombination or substantial backbone reversion, virulent sequences do not enhance the transmissibility of ChimeriVax viruses. In light of the low-level viremias that have been observed after vaccination in human volunteers coupled with low mosquito infectivity, it is predicted that the risk of mosquito infection and transmission of ChimeriVax vaccine recombinant/revertant viruses in nature is minimal.
McGee, Charles E.; Tsetsarkin, Konstantin; Vanlandingham, Dana L.; McElroy, Kate L.; Lang, Jean; Guy, Bruno; Decelle, Thierry; Higgs, Stephen
A Randomized, Double-Blind, Controlled Trial of the 17D Yellow Fever Virus Vaccine Given in Combination with Immune Globulin or Placebo: Comparative Viremia and Immunogenicity
We evaluated whether coadministration of the yellow fever (YF) virus vaccine with human immunoglobulin (Ig) that contained YF virus-neutralizing antibodies would reduce post-vaccination viremia without compromising immunogenicity and thus, potentially mitigate YF vaccine-associated adverse events. We randomized 80 participants to receive either YF vaccine and Ig or YF vaccine and saline placebo. Participants were followed for 91 days for safety and assessments of viremia and immunogenicity. There were no differences found between the two groups in the proportion of vaccinated participants who developed viremia, seroconversion, cluster of differentiation (CD)-8+ and CD4+ T-cell responses, and cytokine responses. These results argue against one putative explanation for the increased reporting of YF vaccine side effects in recent years (i.e., a change in travel clinic practice after 1996 when hepatitis A prophylaxis with vaccine replaced routine use of pre-travel Ig, thus potentially removing an incidental YF vaccine-attenuating effect of anti-YF virus antibodies present in Ig) (ClinicalTrials.gov identifier: NCT00254826).
Edupuganti, Srilatha; Eidex, Rachel B.; Keyserling, Harry; Akondy, Rama S.; Lanciotti, Robert; Orenstein, Walter; del Rio, Carlos; Pan, Yi; Querec, Troy; Lipman, Harvey; Barrett, Alan; Ahmed, Rafi; Teuwen, Dirk; Cetron, Martin; Mulligan, Mark J.
Flight height preference for oviposition of mosquito (Diptera: Culicidae) vectors of sylvatic yellow fever virus near the hydroelectric reservoir of Simpl�cio, Minas Gerais, Brazil.
In this study, the oviposition behavior of mosquito species exhibiting acrodendrophilic habits was investigated. The study was conducted near the Simplicio Hydroelectic Reservoir (SHR) located on the border of the states of Minas Gerais and Rio de Janeiro, Brazil. Samples were collected using oviposition traps installed in forest vegetation cover between 1.70 and 4.30 m above ground level during the months of April, June, August, October, and December of 2011. Haemagogus janthinomys (Dyar), Haemagogus leucocelaenus (Dyar and Shannon), Aedes albopictus (Skuse), and Aedes terrens (Walker) specimens were present among the collected samples, the first two of which being proven vectors of sylvatic yellow fever (SYF) in Brazil and the latter is a vector of dengue in mainland Asia. As the data set was zero-inflated, a specific Poisson-based model was used for the statistical analysis. When all four species were considered in the model, only heights used for egg laying and months of sampling were explaining the distribution. However, grouping the species under the genera Haemagogus Williston and Aedes Meigen showed a significant preference for higher traps of the former. Considering the local working population of SHR is very large, fluctuating, and potentially exposed to SYF, and that this virus occurs in almost all Brazilian states, monitoring of Culicidae in Brazil is essential for assessing the risk of transmission of this arbovirus. PMID:23926776
Alencar, Jeronimo; Morone, Fernanda; De Mello, Cec�lia Ferreira; D�gallier, Nicolas; Lucio, Paulo S�rgio; de Serra-Freire, Nicolau Mau�s; Guimar�es, Anthony Erico
Functional classification and central nervous projections of olfactory receptor neurons housed in antennal trichoid sensilla of female yellow fever mosquitoes, Aedes aegypti
Mosquitoes are highly dependent on their olfactory system for, e.g. host location and identification of nectar-feeding and oviposition sites. Odours are detected by olfactory receptor neurons (ORNs) housed in hair-shaped structures, sensilla, on the antennae and maxillary palps. In order to unravel the function of the olfactory system in the yellow fever vector, Aedes aegypti, we performed single-sensillum recordings from trichoid sensilla on female antennae. These sensilla are divided into four distinct morphological types. Based on the response to a set of 16 odour compounds, we identified 18 different ORN types, housed in 10 sensillum types. The ORNs responded to behaviourally relevant olfactory cues, such as oviposition attractants and sweat-borne compounds, including 4-methylcyclohexanol and indole, respectively. Two ORNs housed in these sensilla, as well as two ORNs housed in an additional sensillum type, did not respond to any of the compounds tested. The ORNs housed in individual sensilla exhibited stereotypical pairing and displayed differences in signalling mode (excitatory and inhibitory) as well as in temporal response patterns. In addition to physiological characterization, we performed anterograde neurobiotin stainings of functionally identified ORNs in order to define the functional map among olfactory glomeruli in the primary olfactory centre, the antennal lobe. The targeted glomeruli were compared with an established 3D map. Our data showed that the ORN types sent their axons to defined antennal lobe glomeruli in a stereotypic pattern.
Ghaninia, Majid; Ignell, Rickard; Hansson, Bill S.
Pathology Case Study: Intermittent Fevers in a 43-Year-Old Black Male
NSDL National Science Digital Library
The University of Pittsburgh School of Medicine's Department of Pathology has compiled a series of case studies to help students and instructors. In this particular study the patient is complaining of intermittent fevers. The case provides test results and data as well as microscopic photos and description. Clicking on the final diagnosis provides a thorough explanation of the diagnosis as well as treatment.
Dorvault, Christine; Richert, Charles A.
Viral haemorrhagic fever in Sweden: experiences from management of a case.
The first recognized case in Scandinavia with potential man to man transmission of viral haemorrhagic fever occurred in Link�ping, Sweden, in January 1990. Following a visit to Kenya a 21-year-old male student suffered a very severe illness including extremely prolonged high grade fever, rash, disseminated intravascular coagulation with thrombocytopenia and severe bleedings. This necessitated one month of intensive care support including respirator treatment. The patient was discharged after 2 1/2 months in good condition, with a partial femoral nerve paresis. About 100 medical personnel were exposed to aerosol or blood before a strict containment regimen was established. No secondary cases occurred. PMID:1853161
Foberg, U; Fryd�n, A; Isaksson, B; Jahrling, P; Johnson, A; McKee, K; Niklasson, B; Normann, B; Peters, C; Bengtsson, M
Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians.
Viral haemorrhagic fevers (VHFs) represent a challenge for public health because of their epidemic potential, and their possible use as bioterrorism agents poses particular concern. In 1999 the World Health Organization (WHO) proposed a case definition for VHFs, subsequently adopted by other international institutions with the aim of early detection of initial cases/outbreaks in western countries. We applied this case definition to reports of Ebola and Marburg virus infections to estimate its sensitivity to detect cases of the disease. We analyzed clinical descriptions of 795 reported cases of Ebola haemorrhagic fever: only 58.5% of patients met the proposed case definition. A similar figure was obtained reviewing 169 cases of Marburg diseases, of which only 64.5% were in accordance with the case definition. In conclusion, the WHO case definition for hemorrhagic fevers is too specific and has poor sensitivity both for case finding during Ebola or Marburg outbreaks, and for early detection of suspected cases in western countries. It can lead to a hazardous number of false negatives and its use should be discouraged for early detection of cases. PMID:20128442
Pittalis, Silvia; Fusco, Francesco Maria; Lanini, Simone; Nisii, Carla; Puro, Vincenzo; Lauria, Francesco Nicola; Ippolito, Giuseppe
A difficult case of fever of unknown origin
A 57-year-old holidaymaker in Madeira was airlifted to England with a 4-week history of fever, limb weakness and hypophonia. Having undergone a range of investigations during his hospital admission abroad � including ultrasound, CT, echocardiogram and lumbar puncture � the patient arrived without any explanatory diagnosis. At presentation, the only investigatory positives were raised blood inflammatory markers and a, previously unidentified, �old left frontal infarct� found on head CT. A broad infective and immunological screen proved negative, raising the possibility of vasculitis. Finally, the presence of subacute cerebral and renal infarcts identified on MRI and CT in combination with a negative antineutrophil cytoplasmic antibodies (ANCA) test and distinctive muscle biopsy features confirmed the clinical suspicion of polyarteritis nodosa. An immunosuppressive regime of glucocorticoid therapy and cyclophosphamide were initiated with immediate significant clinical improvement.
Pang, Chun Lap; Richardson, Peter; Makkuni, Damodar
[Fulminant Japanese spotted fever--the second fatal case in Japan].
A 77-year-old woman who have no past history, was admitted in a local hospital in Muroto City, Kochi, Japan, after several days of fever and severe general fatigue and generalized skin erythema. She was suspected to have Japanease spotted fever, which was a local pandemic disease. She was treated with minocycline immediately. The next day, she had consciousness disturbance and low blood pressure. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiple organ failure. She was referred to our hospital. An eschar was identified in the back of It. femur. Treatment included minocycline, ciprofloxain, gabexate mesilate, methylprednisolone, hemodialysis and mechanical ventilation. In spite of the avobe treatment, she died 3 days after admission of the local hospital. Though the serological test showed no positive antibody titer against Rickettsia japonica, Rickettsia japonica was isoleted from blood culture, to confirm Japanese spotted fever, Japanese spotted fever is generaly a curative disease with early diagnosis and minocycline. In this case, the patient died 3 days after proper diagnosis and treatment was started. We reported the second fatal Japanese spotted fever case in Japan. PMID:18411764
Wada, Kayoko; Sakaeda, Hiroshi; Aono, Rei; Chiya, Seizou
[An imported dengue Fever case in Turkey and review of the literature].
Dengue fever is an acute viral disease that can affect all age groups in tropical and subtropical countries. The predominant vectors are the mosquitoes namely Aedes aegypti and A.albopictus. Although there have been no case reports in Turkey due to DF, there is seroepidemiological evidence indicating the presence of Dengue virus (DENV) in Turkey. In this case report we presented an imported dengue fever case. The patient was 40 years old, previously healthy male, Switzerland citizen. He had immigrated from Dubai to India two weeks ago and after one week from immigration he attended to a hospital in India because of high fever. The NS1 antigen test (Bio-Rad Laboratories, USA) was found positive and the patient was followed-up with diagnosis of dengue fever in India. During his visit to Turkey, he attended to the hospital for a routine control and his analysis revealed thrombocytopenia (PLT: 48.000/�l), leukopenia (white blood cell: 2800/�L) and elevated liver enzymes (AST: 76 U/L, ALT: 83 U/L). Fever was not detected in follow-up. The patient had petechial rash on his lower extremities. white blood cell and PLT count increased to 4100/�l and 93.000/�l, respectively. Liver function tests revealed a decrease in AST (63 U/L) and ALT (78 U/L) on the third day. The PLT count increased to 150.000/ml. Since the patient had no fever and had normal physical and laboratory findings, he was discharged from the hospital. For the confirmation of dengue fever diagnosis the serum sample was sent to National Public Health Center, Virology Reference and Research Laboratory where IgM and IgG antibodies against DENV types 1-4 were investigated by indirect immunofluorescence method (Euroimmun, Germany). The serum sample yielded positive result at the dilutions of 1/1000 for IgM and 1/10.000 for IgG. The last dilution of type 3 DENV IgM and IgG were determined high density of fluorescein, thus the serotype was identified as "DENV type 3". Travel-related diseases become important with increasing travel opportunities, globalization and transportation, recently. As a result, this imported case with foreign nationality was the first dengue fever case confirmed by clinical and laboratory tests in Turkey. PMID:23390916
Uyar, Yavuz; Akta?, Eray; Ya?c? �a?lay?k, Dilek; Erg�n�l, Onder; Y�ce, Ay?e
[Cat scratch disease with deradenoncus and high fever: report of one case].
Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae. It is mainly characterized by self-limiting lymphadenopathy in the draining site after cat scratch or bite. This paper reported a case of cat scratch disease with deradenoncus and high fever, and discussed the etiology, pathogenesis, epidemiology, pathology, clinical characteristics, diagnosis and treatment methods of CSD. PMID:23552796
Wang, Xing; Meng, Jian
Nosocomial infection of Crimean-Congo haemorrhagic fever in eastern Iran: case report.
An outbreak of Crimean-Congo haemorrhagic fever occurred in the county of Birjand in eastern Iran in November 2011. Four cases were involved in this outbreak. Two patients died after admission to hospital, one of whom was a nurse who acquired the infection nosocomially, and the others were treated successfully. PMID:23266037
Chinikar, Sadegh; Shayesteh, Majid; Khakifirouz, Sahar; Jalali, Tahmineh; Rasi Varaie, Fereshteh Sadat; Rafigh, Mahboubeh; Mostafavi, Ehsan; Shah-Hosseini, Nariman
A Rare Case of Retinal Artery Occlusion in the Context of Mediterranean Spotted Fever
Background Mediterranean spotted fever is a zoonosis endemic in the Mediterranean region. The microorganism Rickettsia conorii is responsible for the disease due to its angiotropism for endothelial cells. It produces host cell necrosis, thrombosis, and organ dysfunction. Ophthalmologic manifestations are rare. Findings The authors describe the case of a 55-year-old female with Mediterranean spotted fever who developed localized retinal vasculitis with associated macular edema. Treatment with intravitreal triamcinolone allowed a significant recovery of visual acuity. Conclusion Ophthalmological symptoms in these patients should be emphasized because there can be severe ocular complications with a potentially irreversible loss of visual acuity.
Beselga, Diana; Campos, Antonio; Castro, Miguel; Mendes, Silvia; Campos, Joana; Neves, Arminda; Violante, Luis; Castro Sousa, Joao Paulo
Double filtration plasmapheresis for a case of Crimean-Congo hemorrhagic fever.
Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through a tick bite or exposure to blood or tissues of viremic hosts. The clinical presentation is characterized by sudden onset high fever, headache, myalgia, abdominal pain and nausea-vomiting followed by gastrointestinal, urinary, respiratory tract and brain hemorrhage. Laboratory findings include leucopenia, thrombocytopenia, elevated liver enzymes, prolonged prothrombin time and activated partial thromboplastin time. We report a case of CCHF who was treated with a combination of DFPP and ribavirin therapy. As a result of this multimodal treatment, patient's clinical symptoms and laboratory findings improved gradually. PMID:23619328
Me�o, Ba?ak C; Memiko?lu, Osman; Ilhan, Osman; Ayy?ld?z, Erol; Gunt, Ceren; Unal, Necmettin; Oral, Mehmet; Tulunay, Melek
A Case of Crimean-Congo Hemorrhagic Fever with Pleural Effusion
SUMMARY: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis with the potential of human-to-human transmission that affects wide areas in Asia, Southeastern Europe, and Africa. Hemorrhagic manifestations constitute a prominent symptom of late stage disease with case fatality rates from 3 to 50%. We present a case of CCHF complicated by hemorrhagic pleural effusion and resulting in resolution without
Gonul Tanir; Nilden Tuygun; Ismail Balaban; �nder Doks�z
Dengue fever triggering systemic lupus erythematosus and lupus nephritis: a case report
We report a rare case of dengue fever triggering systemic lupus erythematosus and lupus nephritis. The patient presented herself during a large outbreak of dengue fever in December 2012 in Maharashtra, India. The diagnosis of dengue fever was confirmed by the presence of NS-1 antigen during the first few days of febrile illness. Eight weeks later, kidney tissue biopsy studies revealed evidence of lupus nephritis on microscopic examination and immunofluorescence. The report interpreted it as focal proliferative glomerulonephritis and segmental sclerosis (Stage IIIC). The case was also found positive for perinuclear antineutrophil cytoplasmic antibodies by indirect immunofluorescence assay. An active and effective management of a case essentially calls for clear perception of differentiating dengue-induced lupus flare, antineutrophil cytoplasmic antibody-related nephropathy, and/or dengue-induced de-novo lupus disease. Dengue viremia may be the trigger for immune complex formation in patients who are predisposed to developing autoimmune diseases. The present case explains the importance of considering the diagnosis of dengue-related lupus nephritis as an atypical occurrence in appropriate situations, as in this case. It would not be improper to regard this escalating disease as an expanded feature of dengue.
Talib, SH; Bhattu, SR; Bhattu, R; Deshpande, SG; Dahiphale, DB
Impact of road networks on the distribution of dengue fever cases in Trinidad, West Indies.
This study examined the impact of road networks on the distribution of dengue fever cases in Trinidad, West Indies. All confirmed cases of dengue hemorrhagic fever (DHF) observed during 1998 were georeferenced and spatially located on a road map of Trinidad using Geographic Information Systems software. A new digital geographic layer representing these cases was created and the distances from these cases to the nearest classified road category (5 classifications based on a functional utility system) were examined. The distance from each spatially located DHF case to the nearest road in each of the 5 road subsets was determined and then subjected to an ANOVA and t-test to determine levels of association between minor road networks (especially 3rd and 4th class roads) and DHF cases and found DHF cases were located away from forests, especially 5th class roads). The frequency of DHF cases to different road classes was: 0% (1st class roads), 7% (2nd class roads), 32% (3rd class roads), 57% (4th class roads) and 4% (5th class road). The data clearly demonstrated that both class 3 and class 4 roads account for 89% of nearby dengue cases. These results represent the first evidence of dengue cases being found restricted between forested areas and major highways and would be useful when planning and implementing control strategies for dengue and Aedes aegypti mosquitoes. PMID:22609547
Mahabir, R S; Severson, D W; Chadee, D D
Pathology Case Study: Fevers and Mental Status Changes
NSDL National Science Digital Library
This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman underwent an allogenic bone marrow transplant but did not respond well. Visitors are given the autopsy information and patient history, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in autopsy pathology.
Martinez, A. Julio (Augusto Julio); Nichols, Larry; Torbenson, Michael
Fever of Unknown Origin Attributable to Haematocolpos Infected with Salmonella enterica Serotype Typhi Resistant to Nalidixic Acid: A Case Report
The prevalence of nalidixic acid-resistant Salmonella Typhi (NARST) infection is increasing worldwide. We are reporting an unusual case of infected haematocolpos presenting as urinary obstruction in a patient with fever of unknown origin (FUO). This case report highlights the importance of quinolone-resistant typhoid fever in the differential diagnosis of any acute febrile illness in countries, like India, where Salmonella infection is endemic.
Dwivedi, Mayank; Batra, Priyam; Dutta, Renu
Non-choroidal yellow melanoma showing positive staining with Sudan Black consistent with the presence of lipofuscin: a case report
A case of a predominantly yellow primary superficial spreading melanoma arising on the back of a 44-year-old woman is presented. Possible causes of the clinical and dermatoscopic yellow color are discussed. Staining with the histochemical stain, Sudan Black, revealed a differential uptake compared to a closely matched control melanoma. We speculate that the clinical and dermatoscopic yellow color could be due to the presence of increased amounts of the pigment lipofuscin, which is known to produce subtle orange color in some choroidal melanomas.
Penouil, Marie Helene Jegou; Gourhant, Jean-Yves; Segretin, Catherine; Weedon, David; Rosendahl, Cliff
Postpolypectomy Fever, a Rare Adverse Event of Polypectomy: Nested Case-Control Study
Background/Aims Although postpolypectomy fever (PPF) without colon perforation or hemorrhage is rare, its incidence and risk factors have not been investigated. The objective of this study was to analyze the incidence and risk factors for PPF among inpatients. Methods Seven patients with PPF were matched with 70 patients without PPF from a total of 3,444 patients who underwent colonoscopic polypectomy. The PPF incidence during index hospitalization after colonoscopy was calculated, and univariate and multivariate analyses were performed to calculate the adjusted odds ratios (ORs) for risk factors. Results PPF without bleeding or perforation in the colon occurred in seven patients (0.2%). The median age was 58 years for cases and 61 years for controls. The median interval from polypectomy to occurrence of fever was 7 hours, and the median duration of fever was 9 hours. Polyp size >2 cm (adjusted OR, 1.08; 95% confidence interval [CI], 1.01 to 1.15; p=0.02) and hypertension (adjusted OR, 14.40; 95% CI, 1.23 to 180.87; p=0.03) were associated with a significantly increased risk of PPF. PPF increased the length of hospitalization. Conclusions Although the crude incidence of PPF is low, PPF may prolong hospitalization. Risk factors for PPF include hypertension and large polyps.
Lee, Seung-Hoon; Yang, Dong-Hoon; Jeong, Kee Wook; Ye, Byong Duk; Byeon, Jeong-Sik; Myung, Seung-Jae; Yang, Suk-Kyun; Kim, Jin-Ho
Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: case report.
Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas. PMID:21689444
Grove, Jessica N; Branco, Luis M; Boisen, Matt L; Muncy, Ivana J; Henderson, Lee A; Schieffellin, John S; Robinson, James E; Bangura, James J; Fonnie, Mbalu; Schoepp, Randal J; Hensley, Lisa E; Seisay, Alhassan; Fair, Joseph N; Garry, Robert F
Dengue Hemorrhagic Fever in Trinidad and Tobago: A Case for a Conservative Approach to Platelet Transfusion
Dengue fever is endemic to Trinidad and Tobago. A retrospective analysis of all adult admissions at a tertiary hospital in Trinidad treated for dengue during January 1�December 31, 2008 was performed. A total of 186 patients were treated during this period: 98.9% (184) of the patients were thrombocytopenic; 45.2% were severely thrombocytopenic; 13 patients showed development of minor hemorrhage and only one case of major hemorrhage; platelet transfusion was given for 7% (13) of the cases; and 6 cases for which platelet transfusion was given did not show evidence of plasma leakage (12 of these cases did not show evidence of hemorrhage). There was a strong association between the lowest platelet value and hemoconcentration (?2 = 13.16, P < 0.025). No association was found between giving a platelet transfusion and hemoconcentration or hemorrhage. Thrombocytopenia seen in dengue resolves spontaneously and independent of any transfusion used.
Sharma, Anu; Charles, Kenneth; Chadee, Dave; Teelucksingh, Surujpaul
Dengue hemorrhagic fever in Trinidad and Tobago: a case for a conservative approach to platelet transfusion.
Dengue fever is endemic to Trinidad and Tobago. A retrospective analysis of all adult admissions at a tertiary hospital in Trinidad treated for dengue during January 1-December 31, 2008 was performed. A total of 186 patients were treated during this period: 98.9% (184) of the patients were thrombocytopenic; 45.2% were severely thrombocytopenic; 13 patients showed development of minor hemorrhage and only one case of major hemorrhage; platelet transfusion was given for 7% (13) of the cases; and 6 cases for which platelet transfusion was given did not show evidence of plasma leakage (12 of these cases did not show evidence of hemorrhage). There was a strong association between the lowest platelet value and hemoconcentration (?(2) = 13.16, P < 0.025). No association was found between giving a platelet transfusion and hemoconcentration or hemorrhage. Thrombocytopenia seen in dengue resolves spontaneously and independent of any transfusion used. PMID:22403331
Sharma, Anu; Charles, Kenneth; Chadee, Dave; Teelucksingh, Surujpaul
Fever of unknown origin: a case of cardiac myxoma infected with Staphylococcus lugdunensis.
Infected cardiac myxoma is a rare entity. It poses a diagnostic challenge as clinical presentation may reflect an underlying infectious, immune, or a neoplastic disease process. To the best of our knowledge, the first case of a cardiac myxoma infected with Staphylococcus lugdunensis is reported in a 54-year-old man with fever of unknown origin for 4 months. Successful excision of the tumor was performed and was followed by an uneventful recovery. Clinical presentation, diagnosis, and management of infected cardiac myxomas are discussed. PMID:20531054
Bhanot, Nitin; Sahud, Andrew G; Bhat, Sunil; Lane, Stacy; Manyam, Harish; Chan-Tompkins, Noreen H
Pathology Case Study: Intermittent Confusion, Fever of Unknown Origin, and Lower Extremity Weakness
NSDL National Science Digital Library
This is a hematopathology case study presented by the University of Pittsburgh Department of Pathology in which a 67-year-old male has intermittent confusion, fever of unknown origin, and lower extremity weakness. Visitors are given microscopic descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using laboratory results to diagnose. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.
Chung, Wen-Wei; Contis, Lydia C.; Gollin, Susanne M.; Martinez, A. Julio (Augusto Julio); Shekhter-Levin, Sofia
Pathologic highlights of dengue hemorrhagic fever in 13 autopsy cases from Myanmar.
Vascular permeability, thrombocytopenia, liver pathology, complement activation, and altered hemostasis accompanying a febrile disease are the hallmarks of the dengue hemorrhagic fever/dengue shock syndrome, a major arthropod-borne viral disease that causes significant morbidity and mortality throughout tropical countries. We studied tissues from 13 children who died of acute dengue hemorrhagic fever/dengue shock syndrome at the Childrens' Hospital, Yangon, Myanmar. Dengue viral RNA from each of the 4 dengue viruses (DENVs) was detected by reverse transcriptase polymerase chain reaction in 11 cases, and dengue viral proteins (envelope, NS1, or NS3) were detected in 1 or more tissues from all 13 cases. Formalin-fixed and frozen tissues were studied for evidence of virus infection using monoclonal antibodies against DENV structural and nonstructural antigens (E, NS1, and nonsecreting NS3). In the liver, DENV infection occurred in hepatocytes and Kupffer cells but not in endothelial cells. Liver damage was associated with deposition on hepatocytes of complement components of both classical and alternative pathways. Evidence of dengue viral replication was observed in macrophage-like cells in spleens and lymph nodes. No dengue antigens were detected in endothelial cells in any organ. Germinal centers of the spleen and lymph nodes showed a marked reduction in the number of lymphocytes that were replaced by eosinophilic deposits, which contained dengue antigens as well as immunoglobulins, and complement components (C3, C1q, and C9). The latter findings had previously been reported but overlooked as a diagnostic feature. PMID:24767772
Aye, Khin Saw; Charngkaew, Komgrid; Win, Ne; Wai, Kyaw Zin; Moe, Kyaw; Punyadee, Nuntaya; Thiemmeca, Somchai; Suttitheptumrong, Aroonroong; Sukpanichnant, Sanya; Prida, Malasit; Halstead, Scott B
El Ni�o Southern Oscillation and vegetation dynamics as predictors of dengue fever cases in Costa Rica
NASA Astrophysics Data System (ADS)
Dengue fever (DF) and dengue hemorrhagic fever (DHF) are growing health concerns throughout Latin America and the Caribbean. This study focuses on Costa Rica, which experienced over 100 000 cases of DF/DHF from 2003 to 2007. We utilized data on sea-surface temperature anomalies related to the El Ni�o Southern Oscillation (ENSO) and two vegetation indices derived from the Moderate Resolution Imaging Spectrometer (MODIS) from the Terra satellite to model the influence of climate and vegetation dynamics on DF/DHF cases in Costa Rica. Cross-correlations were calculated to evaluate both positive and negative lag effects on the relationships between independent variables and DF/DHF cases. The model, which utilizes a sinusoid and non-linear least squares to fit case data, was able to explain 83% of the variance in weekly DF/DHF cases when independent variables were shifted backwards in time. When the independent variables were shifted forward in time, consistently with a forecasting approach, the model explained 64% of the variance. Importantly, when five ENSO and two vegetation indices were included, the model reproduced a major DF/DHF epidemic of 2005. The unexplained variance in the model may be due to herd immunity and vector control measures, although information regarding these aspects of the disease system are generally lacking. Our analysis suggests that the model may be used to predict DF/DHF outbreaks as early as 40 weeks in advance and may also provide valuable information on the magnitude of future epidemics. In its current form it may be used to inform national vector control programs and policies regarding control measures; it is the first climate-based dengue model developed for this country and is potentially scalable to the broader region of Latin America and the Caribbean where dramatic increases in DF/DHF incidence and spread have been observed.
Fuller, D. O.; Troyo, A.; Beier, J. C.
Viridans streptococci bacteraemia in children with fever and neutropenia: a case�control study of predisposing factors
Viridans streptococci (VS) are an increasing cause of bacteraemia in neutropenic patients with cancer. Case�control studies of predisposing factors for acquisition of this infection in children are not published. Between January 1989 and December 1999, 168 episodes of bacteraemia in 161 children with fever and neutropenia of haemato-oncology origin were analysed. 15 cases (9%) in 15 patients were caused by
H. Paganini; V Staffolani; P. Zubizarreta; L. Casimir; H. Lopardo; V. Luppino
Optimizing typhoid fever case definitions by combining serological tests in a large population study in Hechi City, China.
Blood culture-based diagnosis can only detect a fraction of the total burden of Salmonella enterica subsp. enterica serovar Typhi. The objective of the study was to detect additional typhoid fever cases through serological tests. A total of 1732 prolonged fever episodes were evaluated using three serological tests, Widal, Tubex and Typhidot-M in a typhoid fever endemic area of southern China. A case definition which included a positive Widal test (TO>or=80 & TH>A), a positive Tubex test (>or=4) and a positive Typhidot-M test, increased the detection of cases by more than twofold from 13 to 28 cases. The case definition has a specificity of 100% and a sensitivity of 39%. Case definitions based on combinations of serological tests can detect additional typhoid fever cases with higher specificity than a single serological test. Improved case detection is essential to understand the true disease burden and can help to boost the power of intervention trials. PMID:17217551
Dong, B; Galindo, C M; Shin, E; Acosta, C J; Page, A L; Wang, M; Kim, D; Ochiai, R L; Park, J; Ali, M; Seidlein, L V; Xu, Z; Yang, J; Clemens, J D
A Rare Case of Toxic Epidermal Necrolysis with Unexpected Fever Resulting from Dengue Virus
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a life-threatening disease with common development of large wounds. Thus, affected patients are usually treated in specialized centers. Herein, we present a case of TEN in a patient infected with human immunodeficiency virus with the additional, unexpected diagnosis of dengue fever. In this context, we discuss cause, diagnosis, pathology, and treatment of TEN and highlight the role of rare and unexpected findings, as in this case an additional tropical virus infection. We underpin the importance of an interdisciplinary approach involving dermatologists, ophthalmologists, intensive care physicians, burn specialists and various other departments and emphasize the challenge of TEN treatment, especially if rare pathological findings occur.
Grieb, Gerrit; Alazemi, Mastoura; Das, Rituparna; Dunda, Sebastian E.; Fuchs, Paul C.; Pallua, Norbert
Risk factors for typhoid fever in children in squatter settlements of Karachi: a nested case-control study.
Typhoid fever remains a major public health problem in developing countries such as Pakistan. A great majority of cases occur in children living in poor sanitary conditions in squatter settlements in large cities. We conducted a case-control study to identify risk factor for typhoid fever in children under the age of 16 years residing in squatter settlements of Karachi. We enrolled 88 typhoid fever patients, diagnosed by positive blood culture or Typhidot test, between June 1999 and December 2001. Simultaneously, we enrolled 165 age-matched neighborhood controls. Multivariate analysis done through conditional binary logistic regression analysis technique showed that increasing number of persons in the household (odds ratio [OR]=1.9; 95% confidence interval [CI] 1.2-3.1), non-availability of soap near hand washing facility (OR=2.6; 95% CI 1.1-6.3), non-use of medicated soap (OR=11.2; 95% CI 1.3-97.6) and lack of awareness about contact with a known case of typhoid fever (OR=3.7; 95% CI 1.6-8.4) were independent risk factors of the disease. Health education with emphasis on hand washing may help decrease the burden of typhoid fever in developing countries. PMID:20701852
Siddiqui, Fahad Javaid; Haider, Syed Rizwan; Bhutta, Zulfiqar Ahmed
Combined hepatocellular-cholangiocarcinoma with fever of unknown origin: a case report and review of literature.
Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is a rare form of primary liver cancer (PLC). It is difficult to make a correct preoperative diagnosis of cHCC-CC because of the lack of special features of the disease. We here present a case of a 68-year-old man who presented with fluctuant fever, chills, and sweating and was eventually diagnosed as cHCC-CC after surgery. The tumor was 6.0 cm in diameter with distinct borders and no satellite lesions or lymph nodes were observed during macroscopic examination of the resection specimen. The fever resolved in the postoperative period till the 28th day after surgery, when the patient developed extensive abdominal metastases and died shortly after. More attention should be paid to the patient with PLC showing abnormal features such as FUO, normal range of tumor markers, atypical imaging, and less cirrhosis. Hepatic resection is the treatment of choice although with short-term outcomes. PMID:24068520
E, Changyong; Xie, Yingjun; Yang, Yongsheng; Ji, Degang; Li, Wei; Zhang, Xuewen
Acute and probable chronic Q fever during anti-TNF? and anti B-cell immunotherapy: a case report
Background Q fever is caused by the intracellular bacterium Coxiella burnetii. Initial infection can present as acute Q fever, while a minority of infected individuals develops chronic Q fever endocarditis or vascular infection months to years after initial infection. Serology is an important diagnostic tool for both acute and chronic Q fever. However, since immunosuppressive drugs may hamper the humoral immune response, diagnosis of Q fever might be blurred when these drugs are used. Case presentation A 71-year-old Caucasian male was diagnosed with symptomatic acute Q fever (based on positive C. burnetii PCR followed by seroconversion) while using anti-tumor necrosis factor-? (anti-TNF?) drugs for rheumatoid arthritis (RA). He was treated for two weeks with moxifloxacin. After 24�months of follow-up, the diagnosis of probable chronic Q fever was established based on increasing anti-C. burnetii phase I IgG antibody titres in a immunocompromised patient combined with clinical suspicion of endocarditis. At the time of chronic Q fever diagnosis, he had been treated with anti B-cell therapy for 16�months. Antibiotic therapy consisting of 1.5�years doxycycline and hydroxychloroquine was started and successfully completed and no signs of relapse were seen after more than one year of follow-up. Conclusion The use of anti-TNF? agents for RA in the acute phase of Q fever did not hamper the C. burnetii-specific serological response as measured by immunofluorescence assay. However, in the presented case, an intact humoral response did not prevent progression to probable chronic C. burnetii infection, most likely because essential cellular immune responses were suppressed during the acute phase of the infection. Despite the start of anti-B-cell therapy with rituximab after the acute Q fever episode, an increase in anti-C. burnetii phase I IgG antibodies was observed, supporting the notion that C. burnetii specific CD20-negative memory B-cells are responsible for this rise in antibody titres.
Eating seeds from the 'be still' tree, yet having lucky nut poisoning: a case of acute yellow oleander poisoning.
A 25-year-old woman was evaluated and treated for ingestion of Thevetia peruviana seeds and flower petals-a natural digoxin cross reacting cardinolide-with intent to cause self-harm. The following case report provides the clinical presentation, treatment and management of acute yellow oleander poisoning. PMID:24898992
Fentanes, Emilio
Influenza or not influenza: Analysis of a case of high fever that happened 2000 years ago in Biblical time
The Bible describes the case of a woman with high fever cured by our Lord Jesus Christ. Based on the information provided by the gospels of Mark, Matthew and Luke, the diagnosis and the possible etiology of the febrile illness is discussed. Infectious diseases continue to be a threat to humanity, and influenza has been with us since the dawn of human history. If the postulation is indeed correct, the woman with fever in the Bible is among one of the very early description of human influenza disease. Infectious diseases continue to be a threat to humanity, and influenza has been with us since the dawn of human history. We analysed a case of high fever that happened 2000 years ago in Biblical time and discussed possible etiologies.
Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: Case Report
Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations.\\u000a To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular\\u000a aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and\\u000a Israel. Our report
Jessica N Grove; Luis M Branco; Matt L Boisen; Ivana J Muncy; Lee A Henderson; John S Schieffellin; James E Robinson; James J Bangura; Mbalu Fonnie; Randal J Schoepp; Lisa E Hensley; Alhassan Seisay; Joseph N Fair; Robert F Garry
Cases of travel-acquired dengue fever in Denmark 2001-2009.
Dengue fever (DF) remains one of the most important emerging infectious diseases. Whereas DF is well recognized in endemic countries, there are indications that the disease is underdiagnosed among travellers to endemic regions. Here, we present the first descriptive survey on cases of travel-acquired DF imported to Denmark diagnosed at the national reference laboratory for dengue virus diagnostics during a 9-year period. In our study, 16 - 46 travel-acquired dengue virus infections were diagnosed per year. DF is mainly imported by adults, mostly men, returning from Southeast Asian countries. The minimum incidence of dengue virus infection among Danish travellers is estimated to be 4.9 per 100,000 travellers. Our results confirm and expand studies from other European countries, and underline the importance of surveillance based on relevant diagnostic analyses. PMID:21745259
Vinner, L; Domingo, C; Ostby, A-C B; Rosenberg, K; Fomsgaard, A
Lie integrable cases of the simplified multistrain/two-stream model for tuberculosis and dengue fever
NASA Astrophysics Data System (ADS)
We apply the techniques of Lie's symmetry analysis to a caricature of the simplified multistrain model of Castillo-Chavez and Feng [C. Castillo-Chavez, Z. Feng, To treat or not to treat: The case of tuberculosis, J. Math. Biol. 35 (1997) 629-656] for the transmission of tuberculosis and the coupled two-stream vector-based model of Feng and Velasco-Hernandez [Z. Feng, J.X. Velasco-Hernandez, Competitive exclusion in a vector-host model for the dengue fever, J. Math. Biol. 35 (1997) 523-544] to identify the combinations of parameters which lead to the existence of nontrivial symmetries. In particular we identify those combinations which lead to the possibility of the linearization of the system and provide the corresponding solutions. Many instances of additional symmetry are analyzed.
Nucci, M. C.; Leach, P. G. L.
Was it a case of acute disseminated encephalomyelitis? A rare association following dengue fever
Dengue infection, caused by a flavivirus is endemic in more than hundred countries, mostly in the developing world. Recent observations indicate that the clinical profile of dengue is changing, and that atypical manifestations are being reported more frequently. The exact incidence of various neurological complications is variable. Acute disseminated encephalomyelitis (ADEM) is a neurological manifestation rarely described in association with dengue. We present a patient, 32-year-old female who was diagnosed as a case of dengue fever initially after an acute febrile illness and two weeks later admitted in emergency with seizures and altered sensorium. Although MRI did not show typical lesions suggestive of ADEM, the lag period between initial dengue infection and neurological manifestations and complete recovery with methyl prednisolone point towards immune mediated demyelinating illness.
Karoli, Ritu; Siddiqi, Zeba; Fatima, Jalees; Maini, Sumit
Spatial Clustering by Disease Severity among Reported Rocky Mountain Spotted Fever Cases in the United States, 2001-2005
Rocky Mountain spotted fever (RMSF) occurs throughout much of the United States, ranging in clini- cal severity from moderate to fatal infection. Yet, little is known about possible differences among severity levels across geographic locations. To identify significant spatial clusters of severe and non-severe disease, RMSF cases reported to Centers for Disease Control and Prevention (CDC) were geocoded by county
Jennifer Zipser Adjemian; John Krebs; Eric Mandel; Jennifer McQuiston
Influenza or not influenza: Analysis of a case of high fever that happened 2000 years ago in Biblical time
The Bible describes the case of a woman with high fever cured by our Lord Jesus Christ. Based on the information provided by the gospels of Mark, Matthew and Luke, the diagnosis and the possible etiology of the febrile illness is discussed. Infectious diseases continue to be a threat to humanity, and influenza has been with us since the dawn
Kam LE Hon; Pak C Ng; Ting F Leung
A Single Amino Acid Substitution in the Envelope Protein of Chimeric Yellow Fever-Dengue 1 Vaccine Virus Reduces Neurovirulence for Suckling Mice and Viremia/Viscerotropism for Monkeys
A chimeric yellow fever-dengue 1 (ChimeriVax-DEN1) virus was produced by the transfection of Vero cells with chimeric in vitro RNA transcripts. The cell culture supernatant was subjected to plaque purification for the identification of a vaccine candidate without mutations. Of 10 plaque-purified clones, 1 containing no mutation (clone J) was selected for production of the vaccine virus. During subsequent cell culture passaging of this clone for vaccine production, a single amino acid substitution (K to R) occurred in the envelope (E) protein at residue 204 (E204) (F. Guirakhoo, K. Pugachev, Z. Zhang, G. Myers, I. Levenbook, K. Draper, J. Lang, S. Ocran, F. Mitchell, M. Parsons, N. Brown, S. Brandler, C. Fournier, B. Barrere, F. Rizvi, A. Travassos, R. Nichols, D. Trent, and T. Monath, J. Virol. 78:4761-4775, 2004). The same mutation was observed in another clone (clone E). This mutation attenuated the virus in 4-day-old suckling mice inoculated by the intracerebral (i.c.) route and led to reduced viremia in monkeys inoculated by the subcutaneous or i.c. route. The histopathology scores of lesions in the brain tissue of monkeys inoculated with either the E204K or E204R virus were reduced compared to those for monkeys inoculated with the reference virus, a commercial yellow fever 17D vaccine (YF-VAX). Both viruses grew to significantly lower titers than YF-VAX in HepG2, a human hepatoma cell line. After intrathoracic inoculation into mosquitoes, both viruses grew to a similar level as YF-VAX, which was significantly lower than that of their wild-type DEN1 parent virus. A comparison of the E-protein structures of nonmutant and mutant viruses suggested the appearance of new intramolecular bonds between residues 204R, 261H, and 257E in the mutant virus. These changes may be responsible for virus attenuation through a change in the pH threshold for virus envelope fusion with the host cell membrane.
Guirakhoo, F.; Zhang, Z.; Myers, G.; Johnson, B. W.; Pugachev, K.; Nichols, R.; Brown, N.; Levenbook, I.; Draper, K.; Cyrek, S.; Lang, J.; Fournier, C.; Barrere, B.; Delagrave, S.; Monath, T. P.
[A case of acroparesthesias, asthenia and fever. A new mutation in Fabry's disease].
Fabry disease is an X-linked hereditary metabolic storage disorder, due to the deficiency in lysosomal alpha-galactosidase A, with the consequent glycosphingolipids accumulation, primarily globotriaosylceramide, at cellular level. Multiorganic involvement occurs progressively, leading to severe manifestations and even premature mortality. We describe a case of a 20 year-old man who was sent to Rheumatology because of inespecific symptoms that lasted for years, namely acroparesthesias and diffuse hand pain and autolimited flares of high fever and general muscular weakness. Despite denying cutaneous findings, a remarkable purplish-red rash of slightly raised angiectases in the lower trunk was present. This rash was diagnosed as angiokeratomas, and blood measurement of alpha-galactosidase A confirmed the suspicion of Fabry disease. He was referred to a rare disease consultation, where the evaluation revealed the presence of other characteristic findings, such as cornea verticilata and cerebral lacunar infarction sequelae. The authors want to remark the importance of physical examination in these cases of inespecific long-lasting symptoms, with no diagnosis and with functional impairment, and the importance of multidisciplinary evaluation and collaboration. We also highlight that this mutation was not as yet described. PMID:22472932
Cruz, Margarida; Ara�jo, Francisco; Nogueira, David; Neves, Fernanda
A climate-based spatiotemporal prediction for dengue fever epidemics: a case study in southern Taiwan
NASA Astrophysics Data System (ADS)
Dengue Fever (DF) has been identified by the World Health organization (WHO) as one of the most serious vector-borne infectious diseases in tropical and sub-tropical areas. DF has been one of the most important epidemics in Taiwan which occur annually especially in southern Taiwan during summer and autumn. Most DF studies have focused mainly on temporal DF patterns and its close association with climatic covariates, whereas few studies have investigated the spatial DF patterns (spatial dependence and clustering) and composite space-time effects of the DF epidemics. The present study proposes a spatio-temporal DF prediction approach based on stochastic Bayesian Maximum Entropy (BME) analysis. Core and site-specific knowledge bases are considered, including climate and health datasets under conditions of uncertainty, space-time dependence functions, and a Poisson regression model of climatic variables contributing to DF occurrences in southern Taiwan during 2007, when the highest number of DF cases was recorded in the history of Taiwan epidemics (over 2000). The obtained results show that the DF outbreaks in the study area are highly influenced by climatic conditions. Furthermore, the analysis can provide the required "one-week-ahead" outbreak warnings based on spatio-temporal predictions of DF distributions. Therefore, the proposed analysis can provide the Taiwan Disease Control Agency with a valuable tool to timely identify, control, and even efficiently prevent DF spreading across space-time.
Yu, H.-L.; Yang, S.-J.; Lin, Y.-C.
A case report of crimean congo hemorrhagic Fever in ostriches in iran.
Crimean Congo hemorrhagic fever (CCHF) is a viral zoonosis, which is usually transmitted via tick bites or close contact with infected blood or tissue. This disease can cause a case fatality rate of up to 25%-30% in humans. CCHF Infection in birds is less documented. An ostrich can reproduce viruses and can also play the role of a mechanical vector, by transporting infected ticks without becoming ill. In March 2007, three butchers and one worker in an ostrich farm were infected with CCHF in central part of Iran. Considering the role ostriches play in transmitting the disease, serum samples from five ostriches of that farm were taken and sent to the laboratory for CCHF ELISA tests. The result of the IgG test was positive for one (20%) of the ostriches. At the same time, serum samples of eight sheep from the same farm were sent for IgG testing, two (25%) of which were positive. This was the first report of CCHF infection of an ostrich in Iran and tracing CCHF IgG against this ostrich and the afore-mentioned sheep may have revealed that the disease in the worker was the cause of transmission of this disease from these animals or their ticks. PMID:24015162
Mostafavi, Ehsan; Chinikar, Sadegh; Moradi, Maryam; Bayat, Neda; Meshkat, Mohsen; Fard, Mohammad Khalili; Ghiasi, Seyyed Mojtaba
Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.
Repizo, Liliany P.; Malheiros, Denise M.; Yu, Luis; Barros, Rui T.; Burdmann, Emmanuel A.
Biopsy proven acute tubular necrosis due to rhabdomyolysis in a dengue fever patient: a case report and review of literature.
Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures. PMID:24553615
Repizo, Liliany P; Malheiros, Denise M; Yu, Luis; Barros, Rui T; Burdmann, Emmanuel A
Clinical considerations, management and treatment of fever of unknown origin caused by urachal cyst: a case report
Introduction Urachal cysts are rare congenital anomalies that often prompt referral to the paediatric general surgeon because of their associated complications such as infection, abdominal pain and the young age at presentation. In this report we describe a rare case of fever of unknown origin caused by an urachal cyst which was successfully treated with incision and drainage only. Since the first description of urachal anomalies by Cabriolus in 1550, few cases have been reported and, until now, only one case of infected urachal cyst presenting as fever of unknown origin has been described in the literature. Moreover, the spontaneous resolution of an urachal cyst without excision is extremely rare. Case presentation We report our experience in the management and treatment of an infected urachal cyst that occurred in a 12-year-old Caucasian girl who presented to our Department of Paediatric Surgery with a 30-day history of evening fever. The urachal cyst was treated only with incision and drainage through a minimally invasive laparoscopic approach. Conclusions The incision and drainage of an infected urachal cyst is a simple and safe procedure. It assures a complete recovery and avoids potential surgical complications related to the total excision of the urachal cyst. This report may provide important clues regarding the management of this rare anomaly and we emphasise the importance for paediatricians, who should consider the possibility that a fever of unknown origin can be caused by an urachal cyst, and for surgeons and urologists, because it suggests that conservative treatment of this rare anomaly should be considered when possible.
Serological characterization of dengue virus infections observed among dengue hemorrhagic fever/dengue shock syndrome cases in upper Myanmar.
In Myanmar, dengue fever (DF)/dengue hemorrhagic fever (DHF) is one of the leading causes of morbidity and mortality among children. From Pyinmana Hospital in 2004 and Mandalay Children Hospital in 2006, 160 patients diagnosed clinically to have DHF/dengue shock syndrome (DSS) were examined for immunoglobulin M (IgM) and IgG levels. A focus reduction neutralization test was also used to determine primary or secondary dengue virus (DENV) infection. By using IgM-capture ELISA, 139 cases were confirmed as DENV infections. Of these IgM-positives, 94 samples were collected 7-24 days from the onset of illness, to which 13 (14%) and 81 (86%) were determined to be primary and secondary DENV infections, respectively. The 13 primary DENV infection cases were spread among the various severity groups (DHF grade I-IV and DSS) and represented age groups ranging from <1 year of age to 9 years of age. The patients in these primary infection cases showed a remarkably high IgM with a low IgG titer response compared with the secondary infection cases. No significant differences were observed in IgG titers with clinical severity. The data obtained in this study suggest that primary DENV infection cases exist certainly among DHF/DSS cases in Myanmar, and that additional mechanism(s) aside from the antibody-dependent enhancement mechanism could have influenced the clinical severity in DHF/DSS cases. PMID:23595687
Ngwe Tun, Mya Myat; Thant, Kyaw Zin; Inoue, Shingo; Kurosawa, Yae; Lwin, Yee Yee; Lin, Sanda; Aye, Kay Thi; Thet Khin, Pe; Myint, Tin; Htwe, Khin; Mapua, Cynthia A; Natividad, Filipinas F; Hirayama, Kenji; Morita, Kouichi
Familial Mediterranean fever and central nervous system involvement: a case series.
We conducted this study to determine familial Mediterranean fever (FMF)-associated central nervous system involvement including demyelinating lesions, stroke, and posterior reversible leukoencephalopathy syndrome (PRES). Patients with MEFV mutations were systematically reviewed through the Medical Biology Unit database. All samples sent for mutation analysis were screened for 10 common MEFV mutations. Patients with FMF and neurologic disorders according to the clinical records were invited for reevaluation. Lumbar puncture, electroencephalography, and evoked potentials were used to determine the type of neurologic involvement in selected cases. Electrocardiography, transthoracic and/or transesophageal echocardiography, and magnetic resonance imaging and/or angiography were performed to clarify the etiology of cerebrovascular disease. Of 8864 patients in the genetic testing database, 18 with neurologic signs were assessed. The mean age of patients was 31.0 +/- 11.8 years, mean age at first FMF symptom was 12.6 +/- 5.6 years, and mean age at neurologic involvement was 25.8 +/- 12.2 years. Fifty-five percent of patients were women. A homozygote MEFV mutation was detected in 16 of 18 patients (88.8%), and a homozygote M694V mutation was found in 72.2% of patients. We found 7 FMF patients with demyelinating lesions, 7 with cerebrovascular disease, and 4 with PRES. The mean interval between first FMF sign and neurologic involvement was 13.7 +/- 8.9 years in the demyelinating group, and 23.4 +/- 10.3 years in the group with cerebrovascular disease. Mean stroke age was 28.5 +/- 16.4 years. All patients in the PRES group had hypertension. Three different neurologic conditions in FMF patients were noticeable. Demyelinating lesions and cerebrovascular disease were the most common clinical presentations. Approximately 70% of patients had the homozygote M694V mutation. Neurologic involvement is rare but serious in FMF. PMID:20517179
Kalyoncu, Umut; Eker, Amber; Oguz, Kader K; Kurne, Asli; Kalan, Isilay; Topcuoglu, Akif M; Anlar, Banu; Bilginer, Yelda; Arici, Mustafa; Yilmaz, Engin; Kiraz, Sedat; Calguneri, Meral; Karabudak, Rana
Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009
Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9�59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT?=?75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.
Hemophagocytosis in a case with Crimean-Congo hemorrhagic fever and an overview of possible pathogenesis with current evidence.
Hemophagocytic lymphohistiocytosis (HLH) is a clinicopathologic condition characterized by high fever, hepatosplenomegaly, cytopenia, hyperferritinemia, and increased hemophagocytic macrophage proliferation and activation in the reticuloendothelial system. Primary HLH is familial and is a fatal disease that begins during early childhood. Secondary HLH may be acquired after intense activation of the immune system due to infection. Clinical and biologic symptoms result from cytokines secreted by T-lymphocytes and macrophages. Subtypes of primary HLH are caused by genetic defects in several cell types, including perforin-dependent cytotoxic T-lymphocytes and natural killer (NK) cells. Secondary HLH is often associated with intracellular pathogen infections. Crimean-Congo hemorrhagic fever (CCHF) is caused by a tick-borne virus, Nairovirus, from the Bunyaviridae family. It is characterized by a poor prognosis and has a high mortality. We report the case of a 14-year-old boy living in a CCHF-endemic area with no history of tick exposure. He presented with fever, and laboratory tests showed bicytopenia and hemophagocytosis in the bone marrow aspiration. Blood samples were polymerase chain reaction (PCR)-negative for CCFH but immunoglobulin (Ig)M-positive. In conclusion, patients with hemophagocytosis should be assessed for CCHF during the evaluation of cytopenia. PMID:24217086
B?�ak�?, Zafer; Tavil, Bet�l; Tezer, Hasan; Olcay, Lale
A retrospective analysis of dengue fever case management and frequency of co-morbidities associated with deaths
Background Dengue epidemic in Lahore (2011) resulted in hundreds of deaths and affected thousands. As most of the studies were focused on its diagnosis and treatment, scanty data is available on associated diseases/co-morbidities in these patients that could have contributed to a higher mortality. There were no local guidelines available on recording, reporting and management of these co-morbidities. The objective of this study was to analyze the initial presentations of dengue cases and to estimate the frequency of co-morbidities in dengue patients. Methods Data of 556 dengue cases was retrieved from 2 major public sector tertiary-care hospitals for patients who were admitted during 2011 epidemic and a case record analysis was done. Data was retrieved from patient�s information reports which included demography, signs and symptoms and the laboratory investigations. In addition verbal autopsy of deceased cases was also done from their relatives using standardized WHO verbal autopsy form after making modifications as per needed. Results Of 556 cases studied, 390 (70%) were males. The mean age was 36�years and 30% of the cases were between 20-29�years. Average duration of the hospital stay was 6�days. Out of the total, 435 (78%) were dengue fever (DF) cases followed by dengue hemorrhagic fever (DHF) in 95 (17%) and dengue shock syndrome (DSS) in 26 (4%) cases. A total of 40 cases died and among them 17 were diagnosed with DSS, 13 DF and 10 DHF. Further the verbal autopsy from relatives of deceased cases showed 29 (60%) deceased had co-morbid diseases which included hypertension, diabetes etc. DSS was common in patients who had hypertension (27) either alone or associated with other illnesses. Conclusions Co-morbidities with dengue infection were seen in 60% deceased cases indicating the reasons for high dengue related complications and death.
[A male case of acute sarcoidosis with fever, polyarthralgia, erythema nodosum, and bilateral hilar lymphadenopathy: L�fgren's syndrome].
A 27-year-old man initially had low back pain and ankle arthralgia. He was admitted because fever, cough, and polyarthralgia developed and continued for three months. Chest X-ray and CT revealed bilateral hilar and mediastinal lymphadenopathy with pulmonary lesions. Furthermore, elevated serum-ACE level and noncaseating epitheloid cell granuloma obtained by TBLB confirmed the diagnosis of sarcoidosis. After hospitalization, erythema nodosum appeared and ocular involvement was demonstrated. As a result, this case fulfilled the criteria of L�fgren's syndrome (arthritis, erythema nodosum, and BHL). L�fgren's syndrome is not uncommon in European countries, but is extremely rare in Japan. So far, only six cases with L�fgren's syndrome were reported in Japan, and all were female cases. This is the first male case in Japan. L�fgren's syndrome is usually a self-limiting disease. We used steroids for this case and remission has been maintained after the beginning of the treatment for the past one year. PMID:16457340
Izumo, Mayu; Sekiya, Kiyoshi; Sakai, Toshihiko; Tojima, Hirokazu
Fever, Haematuria, and Acute Graft Dysfunction in Renal Transplant Recipients Secondary to Adenovirus Infection: Two Case Reports
We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR.
Ramirez, J.; Bostock, I. C.; Martin-Onraet, A.; Calleja, S.; Sanchez-Cedillo, A.; Navarro-Vargas, L. A.; Noriega-Salas, A. L.; Martinez-Mijangos, O.; Uribe-Uribe, N. O.; Vilatoba, M.; Gabilondo, B.; Morales-Buenrostro, L. E.; Alberu, J.
[Case of polymer fume fever with interstitial pneumonia caused by inhalation of polytetrafluoroethylene (Teflon)].
A 30-year old man was admitted to our hospital with cough, slight fever, and dyspnea that he had developed several hours after inhaling the fumes produced from a Teflon-coated pan, after evaporation of the water in the pan. Chest radiography revealed diffuse infiltrations, and a computed tomography (CT) scan revealed patchy interstitial shadows in both lungs. In pulmonary function tests, the diffusing capacity of the lungs showed a moderate decrease. Leukocytosis and slight hypoxemia were observed. The patient recovered clinically in a few days without any specific treatment. We speculated that the pulmonary problems in this patient may have been induced by the products of thermal degradation of Teflon that were present in the fumes. When Teflon is heated, the fumes generated cause an influenza like syndrome (polymer fume fever) or cause severe toxic effects such as pulmonary edema, pneumonitis, and death in the exposed individual. PMID:16922460
Son, Masami; Maruyama, Eiichi; Shindo, Yuichiro; Suganuma, Nobukazu; Sato, Shinji; Ogawa, Masahiro
[An imported Chikungunya fever case from New Delhi, India to Ankara, Turkey: the first imported case of Turkey and review of the literature].
Chikungunya virus (CHIKV) is an arthropod-borne alphavirus that causes an acute febrile illness, chikungunya fever. CHIKV virus is geographically distributed in Africa, India, and South-East Asia. Chikungunya fever outbreaks have been reported from India since 2006. The incubation period is 3-7 days, and the disease is characterized by sudden onset of high fever and severe arthralgia. Other symptoms can be rash, headache, fatigue, nausea-vomiting, and myalgias. Here, we report the first Chikungunya case imported from India, New-Delhi to Ankara, Turkey. In December 2010, a 55-year-old female Turkish government employee living in urban area of New Delhi for the last 3 years had sudden onset fever up to 38.4�C for 2 days. Itching rash and arthralgia also developed. Symptomatic treatment was given to patient in New Delhi. She returned to Turkey and was admitted to Hacettepe University Medical Faculty, Department of Internal Medicine, Infectious Diseases Unit, since arthralgia has continued on the 26th day of her complaints. Hepatomegaly and tenosynovitis were detected in her physical examination. Serum sample sent to Refik Saydam National Public Health Agency, Virology Reference and Research Laboratory, yielded negative results for specific IgM and IgG antibodies against Hantavirus and Dengue virus types 1-4; however, the results were positive for CHIKV specific IgM and IgG antibodies by commercial immunofluorescence method (Euroimmun, Germany). CHIKV RNA which was searched by in-house real-time RT-PCR was negative. The second serum sample obtained three weeks later also found positive for CHIKV specific IgM and IgG antibodies. This was the first laboratory confirmed imported Chikungunya case in Turkey. There are predictions regarding the presence of Aedes species mosquitos that can transmit this virus in Turkey. This case report will be an alarming signal for the clinicians in our country to consider Chikungunya fever in the differential diagnosis of patients presenting with fever, arthralgia and rash. PMID:22399181
Ya?c? �a?lay?k, Dilek; Uyar, Yavuz; Korukluo?lu, G�lay; Ertek, Mustafa; Unal, Serhat
[Isolated case of haemorrhagic fever observed in Gabon during the 2002 outbreak of Ebola but distant from epidemic zones].
During the last outbreak of Ebola virus haemorrhagic fever that occurred concurrently in Gabon and Congo, several primary foci were identified in the Ogooue Ivindo province (Northeast Gabon), where previous outbreaks had occurred. A 48-year-old woman living in Franceville located 580 Km from the epicentre presented fever with haemorrhagic signs. She was evacuated to Libreville where Ebola infection was suspected. Diagnosis was confirmed at the Centre International de Recherches M�dicales of Franceville on the basis of detection of specific antibodies. Symptoms had already subsided by the time diagnosis was documented. An epidemiological investigation was undertaken to identify the source of contamination and detect secondary cases. No human or nonhuman primate source of contamination could be formally identified. Direct contact with the virus reservoir could not be ruled out. No secondary cases were detected. The favourable outcome, absence of secondary, and failure to identify a source of contamination suggest that epidemiologically undefined cases may go unnoticed during and outside of outbreaks. PMID:16548488
Nkoghe, D; Nnegue, S; Mve, M Toung; Formenty, P; Thompson, G; Iba Ba, J; Okome Nkoumou, M; Leroy, E
Clinical manifestations of Q fever infection are fever, productive cough, decrease in exercise tolerance and chills. Cardiovascular involvement is well recognized and usually presents as endocarditis and infection of an aneurysm or vascular graft. Myocarditis has only rarely been described as a manifestation of acute Q fever infection. In this report we describe a case of a young adult who presented with angina-like symptoms and ECG and biochemical markers indicative of acute coronary syndrome. The diagnosis of myocarditis was ultimately made based on the results of a normal coronary angiography and increased anti-Coxiella burnetii antibody titer. The patient has not developed dilated cardiomyopathy after two years of follow up.
Vogiatzis, I; Dimoglou, G; Sachpekidis, V
Study on the Prevalence of Leptospirosis among Fever Cases Reported from Private Clinics in the Urban areas of Villupuram District, Tamil Nadu, India
Objectives To know the prevalence of leptospirosis cases reported in private clinics among fever cases in Villupuram District, Tamil Nadu, India to know its real magnitude of the problem and to diagnose Leptospirosis among fever cases from differential diagnosis. Methods 1502 Blood serum samples collected from three urban towns namely Kallakurichi (Latitude: 11� 73? N; Longitude: 78� 97? E), Villupuram (Latitude: 11� 75? N; Longitude: 79� 92? E) and Thindivanam (Latitude: 12� 25? N; Longitude: 79� 65? E) in fifteen clinics based on case definition of leptospirosis delineated by the National Vector Borne Disease Control Programme (NVBDCP), Government of India. Samples were tested in the laboratory of the Zonal Entomological Team (ZET), Cuddalore with Macroscopic Slide Agglutination Test (MSAT) and Ig-M ELISA. Result There were 65 positive cases detected from 1502 blood serum samples in both MSAT and Ig-M ELISA. It could be known that there was 4% cases contributed from private clinics among fever cases. From this study, further it was known that all age groups of people affected irrespective of sexes based on their living condition associated with the environment prevailed of the disease. Conclusion From this study, it was quantified that 4% of cases reported in private clinics among fever cases and its findings ascertained both the importance of differential diagnosis as well as reports that should be included to the Government for knowing its real magnitude for planning.
Basker, Parasuraman; Kannan, Pichai; Kolandaswamy, Karumana Gounder
Dengue hemorrhagic fever and severe thrombocytopenia in a patient on mandatory anticoagulation; balancing two life threatening conditions; a case report
Background Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. This is the first case report in published literature describing this therapeutic dilemma. Case presentation A fifty one year old Sri Lankan woman was diagnosed with dengue haemorrhagic fever with bleeding manifestations. During the critical phase of her illness, the platelet count dropped to 5,000/?l. She was also on warfarin 7 mg daily following a prosthetic mitral valve insertion. In managing the patient, the risk of bleeding had to be balanced against the risk of valve thrombosis without anticoagulation. Warfarin was withheld when the platelet count dropped to 100,000/?l and restarted when it recovered above 50,000/?l. The patient was off anticoagulation for 10 days. Conclusions We managed this patient with close observation and continuous risk benefit assessments of management decisions. However, experience with one patient cannot be generalized to others. Therefore, it is essential that clinicians share their experiences in managing such difficult patients.
Case management of childhood fever by traditional healers in southwest Nigeria: identification of training and collaborative needs.
Traditional healers play an important role in the provision of healthcare in many communities in Africa. This study aimed to improve home management of malaria in children by assessing the healer's knowledge and practice. A semi-structured questionnaire interview of 127 traditional healers selected by proportionate sampling technique from two rural and two urban local government areas (LGAs) of southwestern Nigeria was followed by a training program. Malaria ranked first (87%) among the illnesses managed by the healers. Diagnosis of fever was often (72%) based on client history, physical examination (24.4%), consulting oracles (18.9%), and interpretation of dreams (3.1%). Treatment of malaria was with boiled herbs ("agbo"; 72%), ground herbs ("agunmu"; 14%), and incisions and scarifications (3%). Forty-one (32.5%) healers had referred febrile children to a health facility. Younger healers and those who had at least a secondary education were more likely to refer patients (p < 0.05 in both cases). Thirty-six healers (28.4%) had previous formal training on management of fevers, most of whom were the younger (p < 0.05), educated healers (p > 0.05), with fewer years of practice (p > 0.05). Research into traditional herbs (48%), better acknowledgment by government (23.6%), and collaboration with other health sectors were suggestions to improve practice. Traditional healers, especially the older, less-educated, and long-practicing healers, urgently require formal training and collaboration with other healthcare providers to improve knowledge and promote early referral of children with fever. PMID:19193526
Fawole, Olufunmilayo I; Akinboye, Dora O; Falade, Catherine O; Arulogun, Oyedunni S; Adeniyi, Joshua D
Fever is a common symptom in childhood, and is often a sign of innocuous infection. Although most children with serious infections are diagnosed at clinical examination, there are important exceptions that should be borne in mind by all physicians. The article provides advice as to when parents ought to consult a physician in cases of childhood fever, and on the use of antipyretics. PMID:1734423
Guthonason, T H; L�thovigsson, P
Diarrhea, negative t-waves, fever and skin rash, rare manifestation of carbamazepine hypersensitivity: a case report
Introduction Antiepileptic drug induced hypersensitivity syndrome is a rare side effect of some of the first line anticonvulsive drugs such as carbamazepine and other aromatic agents. We are the first to mention a rare case of gastrointestinal, skin and cardiac findings related to carbamazepine administration, which is very uncommon and needs to be reported. Case presentation We report on a 62-year-old Caucasian woman with carbamazepine associated hypersensitivity syndrome, who developed diarrhea, fever, skin lesions, pericardial effusion and pathology on electrocardiogram with terminal negative T waves in I, II, aVL, V5 and V6,. After withdrawal of carbamazepine and administration of methylprednisolone, all initial symptoms improved, white blood cell count normalized, pericardial effusion resolved and pathologic electrocardiogram findings resolved. Conclusion Anticonvulsive drug hypersensitivity syndromes can present with a wide spectrum of unspecific symptoms, which the prescribing clinician should be aware of.
Aigner, Felix; Aigner, Wolfgang; Hoppichler, Friedrich; Luef, Gerhard; Bonatti, Hugo
Lofgren's syndrome presenting as a case of fever of unknown origin.
A 29-year-old black male had multiple hospital admissions for fever (101 degrees F-104 degrees F) of unknown origin. Over six months, the patient had a constellation of symptoms, including pleuritic chest pain, dry cough, arthralgias of hand joints and marked constitutional symptoms including weigh loss. Patient had erythema nodosum, generalized lymphadenopathy, multiple subcutaneous nodules over the epigastric region and a nodule in his left eye. The patient had bilateral hilar lymphadenopathy, mildly enlarged mediastinal lymph nodes, right upper and lower lobes infiltrate and right side pleural effusion. Patient also had cardiomyopathy with EF 35 percent. Workup for HIV, TB, atypical mycobacterium, infectious mononucleosis, CMV, toxoplasmosis, syphilis and fungal etiologies were negative. Initial rheumatological workup was also negative. Despite a broad spectrum of empiric antibiotics, the patient was having a daily spike of temperature. A left supraclavicular lymph node biopsy showed small non-caseating granuloma typical for sarcoidosis. This patient had fever of unknown origin secondary to a sub acute form of sarcoidosis, with marked constitutional symptoms, bilateral hilar and mediastinal lymphadenopathy, erythema nodosum, and arthralgias--a setof findings sometimes referred to as Lofgren's syndrome. PMID:17682699
Patel, Kaushal N; Patel, Falguniben; Hudgins, Larry
Phenotype 2 familial mediterranean fever: evaluation of 22 case series and review of the literature on phenotype 2 FMF.
Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disorder characterized by recurrent bouts of fever and serosal inflammation. FMF may be complicated by AA-type amyloidosis, worsening the prognosis, with associated renal failure in some patients. Complication rate varies with race, being as high as 60% in Turks and as low as 2% in Armenians. In a few cases of patients with FMF (phenotype 2), amyloid nephropathy may be the presenting manifestation. This study included 420 patients who were admitted to the Nephrology and Rheumatology Departments of Atat�rk Education and Research Hospital with unexplained proteinuria/nephrotic syndrome. The initial screening test for amyloidosis was the presence of significant proteinuria (300�mg/24�h). All MEFV gene exons were screened for causative mutations by direct DNA sequencing to check for any mutations. There were 22 phenotype 2 FMF patients with 27 allelic variants. The most prevalent allelic variants were M694V (10/27, 37%) and E148Q (7/27, 26%). Phenotype 2 FMF is not as rare as it was thought before; this should be kept in mind for all patients with unexplained proteinuria and/or acute phase response in high-risk ethnic groups for FMF. PMID:23228227
Altuno?lu, Alpaslan; Erten, ?�kran; Canoz, Mujdat Batur; Yuksel, Aydan; Ceylan, Gulay Gulec; Balci, Serdar; Dogan, Hayriye Tatli
Cutaneous findings in a case of Mediterranean spotless fever due to Rickettsia conorii, with gangrene of multiple toes.
Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii conorii. Some rare cases present without a rash, and they are known as "spotless." This fact is important; although the mortality rates for MSF are low and generally range from 0% to 3%, the absence of a rash usually leads to a delay in the diagnosis and, therefore, an increase in the rates of morbidity and mortality. Necrosis of the digits is one of the complications of MSF that has occasionally been reported in the literature. However, very few reports have studied the morphological changes seen in the cutaneous necrotic lesions. In this report, we describe the morphological changes found through examining a biopsy taken from a necrotic cutaneous lesion in a 69-year-old man who had been diagnosed with Mediterranean spotless fever due to R. conorii. The main morphological changes included areas of collagen degeneration in the papillary dermis, necrotic eccrine glands, and hypodermal collagen with a smudged homogeneous appearance. PMID:23719481
Fernandez-Flores, Angel; De Cabo-Lopez, Erik; Diaz-Galvez, Francisco-Javier
Sensitivity and uncertainty in crop water footprint accounting: a case study for the Yellow River basin
NASA Astrophysics Data System (ADS)
Water Footprint Assessment is a fast-growing field of research, but as yet little attention has been paid to the uncertainties involved. This study investigates the sensitivity of and uncertainty in crop water footprint (in m3 t-1) estimates related to uncertainties in important input variables. The study focuses on the green (from rainfall) and blue (from irrigation) water footprint of producing maize, soybean, rice, and wheat at the scale of the Yellow River basin in the period 1996-2005. A grid-based daily water balance model at a 5 by 5 arcmin resolution was applied to compute green and blue water footprints of the four crops in the Yellow River basin in the period considered. The one-at-a-time method was carried out to analyse the sensitivity of the crop water footprint to fractional changes of seven individual input variables and parameters: precipitation (PR), reference evapotranspiration (ET0), crop coefficient (Kc), crop calendar (planting date with constant growing degree days), soil water content at field capacity (Smax), yield response factor (Ky) and maximum yield (Ym). Uncertainties in crop water footprint estimates related to uncertainties in four key input variables: PR, ET0, Kc, and crop calendar were quantified through Monte Carlo simulations. The results show that the sensitivities and uncertainties differ across crop types. In general, the water footprint of crops is most sensitive to ET0 and Kc, followed by the crop calendar. Blue water footprints were more sensitive to input variability than green water footprints. The smaller the annual blue water footprint is, the higher its sensitivity to changes in PR, ET0, and Kc. The uncertainties in the total water footprint of a crop due to combined uncertainties in climatic inputs (PR and ET0) were about �20% (at 95% confidence interval). The effect of uncertainties in ET0was dominant compared to that of PR. The uncertainties in the total water footprint of a crop as a result of combined key input uncertainties were on average �30% (at 95% confidence level).
Zhuo, L.; Mekonnen, M. M.; Hoekstra, A. Y.
Dengue fever is a notifiable infectious disease in England because of its geographic expansion and the increase in the number of epidemics. The article highlighted the importance of informing overseas travellers of the risk of acquiring dengue fever and advising them on personal protective measures. PMID:24003820
Skinner, Anita
Essential facts Scarlet fever is an infectious disease that is most common in children aged 3-15 years. It is characterised by a red rash, and is usually accompanied by a sore throat and fever. Rarely life-threatening nowadays, in the past outbreaks of the disease led to many deaths. PMID:24823566
Quantitative plant resistance in cultivar mixtures: wheat yellow rust as a modeling case study.
Unlike qualitative plant resistance, which confers immunity to disease, quantitative resistance confers only a reduction in disease severity and this can be nonspecific. Consequently, the outcome of its deployment in cultivar mixtures is not easy to predict, as on the one hand it may reduce the heterogeneity of the mixture, but on the other it may induce competition between nonspecialized strains of the pathogen. To clarify the principles for the successful use of quantitative plant resistance in disease management, we built a parsimonious model describing the dynamics of competing pathogen strains spreading through a mixture of cultivars carrying nonspecific quantitative resistance. Using the parameterized model for a wheat-yellow rust system, we demonstrate that a more effective use of quantitative resistance in mixtures involves reinforcing the effect of the highly resistant cultivars rather than replacing them. We highlight the fact that the judicious deployment of the quantitative resistance in two- or three-component mixtures makes it possible to reduce disease severity using only small proportions of the highly resistant cultivar. Our results provide insights into the effects on pathogen dynamics of deploying quantitative plant resistance, and can provide guidance for choosing appropriate associations of cultivars and optimizing diversification strategies. PMID:23875842
Sapoukhina, Natalia; Paillard, Sophie; Dedryver, Fran�oise; de Vallavieille-Pope, Claude
Lassa hemorrhagic fever in a late term pregnancy from northern Sierra Leone with a positive maternal outcome: case report.
Lassa fever (LF) is a devastating viral disease prevalent in West Africa. Efforts to take on this public health crisis have been hindered by lack of infrastructure and rapid field deployable diagnosis in areas where the disease is prevalent. Recent capacity building at the Kenema Government Hospital Lassa Fever Ward (KGH LFW) in Sierra Leone has lead to a major turning point in the diagnosis, treatment and study of LF. Herein we present the first comprehensive rapid diagnosis and real time characterization of an acute hemorrhagic LF case at KGH LFW. This case report focuses on a third trimester pregnant Sierra Leonean woman from the historically non-endemic Northern district of Tonkolili who survived the illness despite fetal demise. Employed in this study were newly developed recombinant LASV Antigen Rapid Test cassettes and dipstick lateral flow immunoassays (LFI) that enabled the diagnosis of LF within twenty minutes of sample collection. Deregulation of overall homeostasis, significant hepatic and renal system involvement, and immunity profiles were extensively characterized during the course of hospitalization. Rapid diagnosis, prompt treatment with a full course of intravenous (IV) ribavirin, IV fluids management, and real time monitoring of clinical parameters resulted in a positive maternal outcome despite admission to the LFW seven days post onset of symptoms, fetal demise, and a natural still birth delivery. These studies solidify the growing rapid diagnostic, treatment, and surveillance capabilities at the KGH LF Laboratory, and the potential to significantly improve the current high mortality rate caused by LF. As a result of the growing capacity, we were also able to isolate Lassa virus (LASV) RNA from the patient and perform Sanger sequencing where we found significant genetic divergence from commonly circulating Sierra Leonean strains, showing potential for the discovery of a newly emerged LASV strain with expanded geographic distribution. Furthermore, recent emergence of LF cases in Northern Sierra Leone highlights the need for superior diagnostics to aid in the monitoring of LASV strain divergence with potentially increased geographic expansion. PMID:21843352
Branco, Luis M; Boisen, Matt L; Andersen, Kristian G; Grove, Jessica N; Moses, Lina M; Muncy, Ivana J; Henderson, Lee A; Schieffellin, John S; Robinson, James E; Bangura, James J; Grant, Donald S; Raabe, Vanessa N; Fonnie, Mbalu; Zaitsev, Eleina M; Sabeti, Pardis C; Garry, Robert F
Lassa hemorrhagic fever in a late term pregnancy from northern sierra leone with a positive maternal outcome: case report
Lassa fever (LF) is a devastating viral disease prevalent in West Africa. Efforts to take on this public health crisis have been hindered by lack of infrastructure and rapid field deployable diagnosis in areas where the disease is prevalent. Recent capacity building at the Kenema Government Hospital Lassa Fever Ward (KGH LFW) in Sierra Leone has lead to a major turning point in the diagnosis, treatment and study of LF. Herein we present the first comprehensive rapid diagnosis and real time characterization of an acute hemorrhagic LF case at KGH LFW. This case report focuses on a third trimester pregnant Sierra Leonean woman from the historically non-endemic Northern district of Tonkolili who survived the illness despite fetal demise. Employed in this study were newly developed recombinant LASV Antigen Rapid Test cassettes and dipstick lateral flow immunoassays (LFI) that enabled the diagnosis of LF within twenty minutes of sample collection. Deregulation of overall homeostasis, significant hepatic and renal system involvement, and immunity profiles were extensively characterized during the course of hospitalization. Rapid diagnosis, prompt treatment with a full course of intravenous (IV) ribavirin, IV fluids management, and real time monitoring of clinical parameters resulted in a positive maternal outcome despite admission to the LFW seven days post onset of symptoms, fetal demise, and a natural still birth delivery. These studies solidify the growing rapid diagnostic, treatment, and surveillance capabilities at the KGH LF Laboratory, and the potential to significantly improve the current high mortality rate caused by LF. As a result of the growing capacity, we were also able to isolate Lassa virus (LASV) RNA from the patient and perform Sanger sequencing where we found significant genetic divergence from commonly circulating Sierra Leonean strains, showing potential for the discovery of a newly emerged LASV strain with expanded geographic distribution. Furthermore, recent emergence of LF cases in Northern Sierra Leone highlights the need for superior diagnostics to aid in the monitoring of LASV strain divergence with potentially increased geographic expansion.
Isolated case of Ebola hemorrhagic fever with mucormycosis complications, Kinshasa, Democratic Republic of the Congo.
A patient with undiagnosed Ebola (EBO) hemorrhagic fever (EHF) was transferred from Kikwit to a private clinic in Kinshasa, Democratic Republic of the Congo. A diagnosis of EHF was suspected on clinical grounds and was confirmed by detection of EBO virus-specific IgM and IgG in serum of the patient. During the course of the disease, although she had no known predisposing factors, the patient developed a periorbital mucormycosis abscess on eyelid tissue that was biopsied during surgical drainage; the abscess was histologically confirmed. Presence of EBO antigen was also detected by specific immunohistochemistry on the biopsied tissue. The patient survived the EBO infection but had severe sequelae associated with the mucormycosis. Standard barrier-nursing precautions were taken upon admission and upgraded when EHF was suspected; there was no secondary transmission of the disease. PMID:9988159
Kalongi, Y; Mwanza, K; Tshisuaka, M; Lusiama, N; Ntando, E; Kanzake, L; Shieh, W J; Zaki, S R; Lloyd, E S; Ksiazek, T G; Rollin, P E
Education Fever and the East Asian Fertility Puzzle: A case study of low fertility in South Korea
Fertility throughout East Asia has fallen rapidly over the last five decades and is now below the replacement rate of 2.1 in every country in the region. Using South Korea as a case study, we argue that East Asia's ultra-low fertility rates can be partially explained by the steadfast parental drive to have competitive and successful children. Parents throughout the region invest large amounts of time and money to ensure that their children are able to enter prestigious universities and obtain top jobs. Accordingly, childrearing has become so expensive that the average couple cannot afford to have more than just one or two children. The trend of high parental investment in child education, also known as �education fever�, exemplifies the notion of �quality over quantity� and is an important contributing factor to understanding low-fertility in East Asia.
Anderson, Thomas; Kohler, Hans-Peter
Current trends in typhoid fever
Typhoid fever, a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality. Endemic cases in the United States are unusual, with most\\u000a following foreign travel to the Indian subcontinent, Africa, Asia, or Latin America. The classic findings of typhoid fever\\u000a include rose spots, relative bradycardia, and stepwise fevers, but unfortunately these signs
Nancy F. Crum
Bolivian Hemorrhagic Fever: A Pathologic Description.
National Technical Information Service (NTIS)
In 1963, an epidemic of viral hemorrhagic fever affected several hundred natives in San Joaquin, Bolivia. The mortality was 18%. This report describes the pathologic changes of Bolivian hemorrhagic fever based upon observations on eight cases that were au...
P. L. Child R. B. MacKenzie L. R. Valverde K. M. Johsnon
Use of retailer fidelity card schemes in the assessment of food additive intake: Sunset Yellow a case study
The feasibility of using a retailer fidelity card scheme to estimate food additive intake was investigated using the Swiss retailer MIGROS's Cumulus Card and the example of the food colour Sunset Yellow (E 110). Information held within the card scheme was used to identify a sample of households purchasing foods containing Sunset Yellow over a 15 day period. A sample
M. Sardi; Y. Haldemann; H. Nordmann; B. Bottex; B. Safford; B. Smith; D. Tennant; J. Howlett; P. R. Jasti
Rift Valley fever outbreak--Kenya, November 2006-January 2007.
In mid-December 2006, several unexplained fatalities associated with fever and generalized bleeding were reported to the Kenya Ministry of Health (KMOH) from Garissa District in North Eastern Province (NEP). By December 20, a total of 11 deaths had been reported. Of serum samples collected from the first 19 patients, Rift Valley fever (RVF) virus RNA or immunoglobulin M (IgM) antibodies against RVF virus were found in samples from 10 patients; all serum specimens were negative for yellow fever, Ebola, Crimean-Congo hemorrhagic fever, and dengue viruses. The outbreak was confirmed by isolation of RVF virus from six of the specimens. Humans can be infected with RVF virus from bites of mosquitoes or other arthropod vectors that have fed on animals infected with RVF virus, or through contact with viremic animals, particularly livestock. Reports of livestock deaths and unexplained animal abortions in NEP provided further evidence of an RVF outbreak. On December 20, an investigation was launched by KMOH, the Kenya Field Epidemiology and Laboratory Training Program (FELTP), the Kenya Medical Research Institute (KEMRI), the Walter Reed Project of the U.S. Army Medical Research Unit, CDC-Kenya's Global Disease Detection Center, and other partners, including the World Health Organization (WHO) and M�decins Sans Fronti�res (MSF). This report describes the findings from that initial investigation and the control measures taken in response to the RVF outbreak, which spread to multiple additional provinces and districts, resulting in 404 cases with 118 deaths as of January 25, 2007. PMID:17268404
Genome Sequence of Ex-Afghanistan Crimean-Congo Hemorrhagic Fever Virus SCT Strain, from an Imported United Kingdom Case in October 2012
Crimean-Congo hemorrhagic fever (CCHF) virus is a serious human pathogen causing severe hemorrhagic disease with a fatality rate of up to approximately 30%. We have determined the viral genomic sequence from an isolate that caused a fatal case of imported CCHF in the United Kingdom in October 2012.
Chamberlain, John; Atkinson, Barry; Logue, Christopher H.; Latham, Jennie; Newman, Edmund N. C.
Climate impacts on environmental risks evaluated from space: a contribution to social benefits within the GEOSS Health Area: The case of Rift Valley Fever in Senegal
Climate and environment vary on many spatio-temporal scales, including climate change, with impacts on ecosystems, vector-borne diseases and public health worldwide. This study is to enable societal benefits from a conceptual approach by mapping climatic and environmental conditions from space and understanding the mechanisms within the Health Social Benefit GEOSS area. The case study is for Rift Valley Fever (RVF)
Y. M. Tourre
Genome Sequence of Ex-Afghanistan Crimean-Congo Hemorrhagic Fever Virus SCT Strain, from an Imported United Kingdom Case in October 2012.
Crimean-Congo hemorrhagic fever (CCHF) virus is a serious human pathogen causing severe hemorrhagic disease with a fatality rate of up to approximately 30%. We have determined the viral genomic sequence from an isolate that caused a fatal case of imported CCHF in the United Kingdom in October 2012. PMID:23682136
Chamberlain, John; Atkinson, Barry; Logue, Christopher H; Latham, Jennie; Newman, Edmund N C; Hewson, Roger
Insights from the Genome Sequence of a Salmonella enterica Serovar Typhi Strain Associated with a Sporadic Case of Typhoid Fever in Malaysia
Salmonella enterica serovar Typhi is the causative agent of typhoid fever, which causes nearly 21.7 million illnesses and 217,000 deaths globally. Herein, we describe the whole-genome sequence of the Salmonella Typhi strain ST0208, isolated from a sporadic case of typhoid fever in Kuala Lumpur, Malaysia. The whole-genome sequence and comparative genomics allow an in-depth understanding of the genetic diversity, and its link to pathogenicity and evolutionary dynamics, of this highly clonal pathogen that is endemic to Malaysia.
Yap, Kien-Pong; Teh, Cindy Shuan Ju; Baddam, Ramani; Chai, Lay-Ching; Kumar, Narender; Avasthi, Tiruvayipati Suma; Ahmed, Niyaz
Paracetamol and fever management.
Paracetamol is one of the most commonly used legal drugs in the western world. Its availability is good, cost is low, and its uses include 'over-the-counter' (OTC) distribution, primary care prescribed therapy, secondary care 'post-operative' application and emergency treatment. Stated benefits of paracetamol include: the drug's analgesic effects, preference to aspirin in avoidance of Reye's syndrome, good patient tolerance, and iatrogenic complications are infrequent and minor. Stated cautions include hepatotoxic effect following minor doses and short duration use and users may incur compromised immune integrity. This paper is concerned with paracetamol's role in fever management. Public concern regarding, in particular, childhood fever and febrile convulsions is largely unwarranted. Despite paracetamol's reputation as a popular fever-reducing agent the drug is poorly effective in the control of febrility and febrile convulsions showing no important advantage compared with placebo. Paracetamol is probably grossly over-prescribed for fever management and its value more perceived than real. Greater efforts are needed to inform patients of the natural benefits of the biological strategy of fever and of the highly limited and in some cases contraindicated use of paracetamol in fever management. PMID:19058473
Warwick, C
... a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States, it is estimated ... to protect yourself. How is typhoid fever spread? Salmonella Typhi lives only in humans. Persons with typhoid ...
... and throat. This can trigger a type of allergy called hay fever. Symptoms can include Sneezing, often ... to use distilled or sterilized water with saline. Allergy shots can help make you less sensitive to ...
National Technical Information Service (NTIS)
Between one and five percent of travelers from industrialized countries to the developing world seek medical attention during or immediately after their travel. International travelers who present to the emergency department (ED) with fever pose a unique ...
J. M. Schofer
... is an acute viral illness that occurs in west Africa. The illness was discovered in 1969 when two ... borne. Lassa fever is endemic in parts of west Africa including Sierra Leone, Liberia, Guinea and Nigeria; however, ...
Slight, moderate but also high rises in temperature, excluding other causes of fever, can be considered symptoms of periodic syndrome originating by hypothalamic centers as soon as headache, recurrent abdominal pains, growing pains, dizziness, kinetosis. These rises aren't uncommon, but often aren't considered important and this few statistics are available. The Authors present 16 case reports of fever as periodic symptom and discuss how common factors exist in the mechanism of hyperthermia and other clinical signs of periodic syndrome (ex. migraine) but they are generally modulated differently so that disturbance of temperature regulation predominates in the first case, pain in the second. PMID:1461778
Castelli, S; Domenici, R; Meossi, C; Stefani, G
Use of retailer fidelity card schemes in the assessment of food additive intake: Sunset Yellow a case study.
The feasibility of using a retailer fidelity card scheme to estimate food additive intake was investigated using the Swiss retailer MIGROS's Cumulus Card and the example of the food colour Sunset Yellow (E 110). Information held within the card scheme was used to identify a sample of households purchasing foods containing Sunset Yellow over a 15 day period. A sample of 1204 households was selected for interview, of which 830 households were retained in the study following interview. Interviews were conducted to establish household structure, patterns of consumption by different individuals within the household, and the proportion of foods containing Sunset Yellow habitually purchased at the retailer and/or consumed outside the home. Information provided by the retailer on levels of Sunset Yellow in the foods was combined with the information obtained at interview to calculate the per-capita intake of Sunset Yellow by members of participating households. More than 99% of consumers (n = 1902) of foods containing Sunset Yellow were estimated to consume less than 1 mg Sunset Yellow kg(-1) body weight day(-1). The method proved to be a simple and resource-efficient approach to estimate food additive intake on the basis of actual consumer behaviour and thus reports results more closely related to the actual consumption of foods by individuals. PMID:20672203
Sardi, M; Haldemann, Y; Nordmann, H; Bottex, B; Safford, B; Smith, B; Tennant, D; Howlett, J; Jasti, P R
Yellow nails are seen in the 'yellow nail syndrome' in which there is thickening and yellow to yellow-green discoloration of all nails. Lymphedema, especially of the ankles, and compromised respiration ...
Ophthalmic manifestations in familial Mediterranean fever: a case series of 6 patients.
Purpose: To describe the ocular involvement of patients with familial Mediterranean fever (FMF) followed in a tertiary referral center.Methods: The data of 6 patients with FMF were retrospectively reviewed. Detailed ophthalmologic examinations, type of inflammation, course of the disease, number of recurrences, treatment regimens, complications, and comorbid ocular or systemic diseases were noted.Results: The mean age � SD at diagnosis was 29.3 � 19.3 (4-53) years. A total of 66.7% of the patients were male and 66.7% of the patients had bilateral disease. The anatomical distribution of the ophthalmic involvement was as follows: posterior uveitis in 2 (33.3%), anterior uveitis in 2 (33.3%), posterior scleritis in 1 (16.7%), and intermediate uveitis in 1 (16.7%) patient. The course was recurrent in 50% of the patients. Final visual acuities were favorable except in the patients with chronic course uveitis. Cystoid macula edema, epiretinal membrane, retinal ischemia, cataract, glaucoma, and band keratopathy were complications noted in the follow-up period. Both cataract and glaucoma patients (50%) needed a surgical intervention. In 33.3% of patients, Beh�et disease was present as a concurrent disease. In patients with posterior uveitis and the patient with intermediate uveitis (50%), systemic immunosuppression was required.Conclusions: There was a male and bilateral involvement predominance. The course of the inflammation was recurrent in half of the patients. Since ocular involvement in FMF is very rare, it should be considered as diagnosis of exclusion. PMID:24338581
Yazici, Alper; Ozdal, Pinar; Yuksekkaya, Pinar; Elgin, Ufuk; Teke, Mehmet Yasin; Sari, Esin
Remote Sensing in a Changing Climate and Environment: the Rift Valley Fever Case
NASA Astrophysics Data System (ADS)
Climate and environment are changing rapidly whilst global population already reached 7 billions people. New public health challenges are posed by new and re-emerging diseases. Innovation is a must i.e., 1) using high resolution remote sensing, 2) re-invent health politics and trans-disciplinary management. The above are part of the 'TransCube Approach' i.e., Transition, Translation, and Transformation. The new concept of Tele-epidemiology includes such approach. A conceptual approach (CA) associated with Rift Valley Fever (RVF) epidemics in Senegal is presented. Ponds are detected using high-resolution SPOT-5 satellite images and radar data from space. Data on rainfall events obtained from the Tropical Rainfall Measuring Mission (NASA/JAXA) are combined with in-situ data. Localization of vulnerable and parked hosts (obtained from QuickBird satellite) is also used. The dynamic spatio-temporal distribution and aggressiveness of RVF mosquitoes, are based on total rainfall amounts, ponds' dynamics and entomological observations. Detailed risks maps (hazards + vulnerability) in real-time are expressed in percentages of parks where animals are potentially at risks. This CA which simply relies upon rainfall distribution from space, is meant to contribute to the implementation of the RVF early warning system (RVFews). It is meant to be applied to other diseases and elsewhere. This is particularly true in new places where new vectors have been rapidly adapting (such as Aedes albopictus) whilst viruses (such as West Nile and Chikungunya,) circulate from constantly moving reservoirs and increasing population.
Tourre, Y. M.; Lacaux, J.-P.; Vignolles, C.; Lafaye, M.
[Assessment of the management of cases of fever and malaria by general practitioners in the central Highlands of Madagascar, 2009-2010].
The aim of this study was to determine the frequency of confirmed malaria among patients with fever in the central Highlands of Madagascar, the clinical utility of treating this fever, and the involvement of community general practitioners in improving malaria management. This descriptive, prospective study took place from July 1, 2009, through June 30, 2010. Patients consulting for fever were classified into 2 groups: the first (G1) included all children younger than 5 years and the second group (G2) children 5 years or older and adults. In G1, 1383 cases of fever included 145 (10.5%) confirmed cases of malaria. The corresponding numbers in G2 were 1172 and 276 (23.5%). The prevalence of malaria was highest between December and May. In G1, the main clinical signs associated with a positive rapid diagnostic test (RDT) were pallor, jaundice, seizures, and failure to eat. In G2, a positive RDT was associated with pallor, coma, and jaundice. Treatment of patients with positive RDTs was based on quinine (51%) or artemisinin-based combination therapy (49%). Malaria remains endemic in the central Highlands of Madagascar. Efforts should be undertaken to improve prescription of antimalarial drugs. PMID:23174525
Rakotoarivelo, R A; Razakarison, C; Gottot, S; Ravony Harintsoa, L; Randrianiriana, G; Andriamanjato, D; Harilalarisoa, H; Ramaniraka, I; Rakotondramanga, J; Rafaliarivony, N; Ranaivoson, F; Rakotonirina, J F; Desplats, D
Childhood fever is a common symptom, reflective of multiple causes. As the child is often unable to express himself, the physician must rely on parents' observations and the physical examination. The majority of febrile children have non-bacterial upper respiratory tract infection and indiscriminate use of antibiotics is inappropriate, ineffective and leads to drug-resistance such as the emergence of Penicillin-resistant Streptococcus pneumoniae. In this article, we attempt to identify the possible causes of fever by a simple approach using the presence or absence of associated or localising symptoms. Infants less than 3 months constitute a unique group as the fever may be related to perinatal events and as serious bacterial infections can still occur despite unremarkable physical findings. Management of fever needs to take into account the toxicity, immune status and age of the patients as well as the source of the infection. Zealous overprescription of antipyretics needs to be avoided with attention directed to the cause of the fever, the child's capacity to cope with the illness and parental education. PMID:8783923
Chong, C Y; Allen, D M
A timely reminder--rheumatic fever.
Rheumatic fever is a disease diagnosed using the Jones criteria. The Jones criteria were designed using data from areas with a low prevalence of rheumatic fever. In New Zealand there is a high prevalence of rheumatic fever amongst Maori and Pacific peoples. A case is presented where a child of Samoan ethnicity is diagnosed and treated for rheumatic fever without fulfilling the Jones criteria. Evidence supporting the broadening of the diagnostic criteria in high prevalence areas is highlighted. PMID:23797082
Lilic, Nikola; Kumar, Priyanka
Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature
Background Acquired complete heart block, in pediatric age is mainly the results of direct injury to conduction tissue during cardiac surgery or cardiac catheterisation. It can also be observed in different clinical settings as infectious diseases, neoplasia, and inflammatory diseases. It has a wide range of presentation and in some settings it can appear a dramatic event. Although a rare finding during acute rheumatic fever, with a transient course, it may need a specific and intensive treatment. Case presentation We report the case of an Adams-Stokes attack in an adolescent with acute rheumatic carditis and complete atrio-ventricular block. The attack was the first symptom of carditis. We reviewed the literature and could find 25 cases of complete atrio-ventricular block due to rheumatic fever. Ten of the 25 patients experienced an Adams-Stokes attack. Nineteen of the 25 patients were certainly in the pediatric age group. Seven of the 19 pediatric cases experienced an Adams-Stokes attack. In 16/25 cases, the duration of the atrio-ventricular block was reported: it lasted from a few minutes to ten days. Pacemaker implantation was necessary in 7 cases. Conclusion Rheumatic fever must be kept in mind in the diagnostic work-up of patients with acquired complete atrio-ventricular block, particularly when it occurs in pediatric patients. The insertion of a temporary pacemaker should be considered when complete atrio-ventricular block determines Adams-Stokes attacks. Complete heart block during acute rheumatic fever is rare and is usually transient. Along with endocarditis, myocarditis and pericarditis, complete atrio-ventricular block has been recognized, rarely, during the course of acute rheumatic carditis.
The Unfortunate Nurse A Case Study of Dengue Fever and Social Policy
NSDL National Science Digital Library
Based on an actual incident in which dengue virus was transmitted by an accidental needlestick, this case study introduces students to "emerging pathogens" and other concepts in parasitology, immunology, epidemiology, and public policy. Students also read a primary paper and learn about two modern techniques widely used in medical and research settings (i.e., EIA and Taqman RT-PCR). The case is suitable for general education biology, cell biology, microbiology, immunology, and science and public policy courses.
Aguirre, Karen M.
Dengue fever, or West Nile fever, is a mild viral illness transmitted by mosquitoes which causes fever, ... second exposure to the virus can result in Dengue hemorrhagic fever, a life-threatening illness.
Clinical manifestations of Q fever infection are fever, productive cough, decrease in exercise tolerance and chills. Cardiovascular involvement is well recognized and usually presents as endocarditis and infection of an aneurysm or vascular graft. Myocarditis has only rarely been described as a manifestation of acute Q fever infection. In this report we describe a case of a young adult who presented with angina-like symptoms and ECG and biochemical markers indicative of acute coronary syndrome. The diagnosis of myocarditis was ultimately made based on the results of a normal coronary angiography and increased anti-Coxiella burnetii antibody titer. The patient has not developed dilated cardiomyopathy after two years of follow up. PMID:18923753
Vogiatzis, I; Dimoglou, G; Sachpekidis, V
Sandfly fever among Swedish tourists.
All clinical and serologically confirmed cases of sandfly fever among Swedish tourists during 1986-1989 were investigated. A total of 37 cases of Sicilian virus sandfly fever and 1 case of Naples virus sandfly fever were recorded from Cyprus. One case of Toscana virus infection was documented from Spain. The clinical and laboratory findings did not differ from those in previous reports, except for elevated aminotransferase levels. A questionnaire, that offered a possibility to estimate the number of cases that had not been reported, was sent to 713 tourists who had visited different hotels in Cyprus and Mallorca in September 1987. Serum samples from 95 of these tourists were tested for sandfly fever virus antibodies. These tests indicated that only some 20% of the real number of sandfly fever infections had been diagnosed. Both clinical cases and cases found by the questionnaire showed a focal distribution with an overrepresentation of certain hotels in Cyprus. The results were reported to the local health officers and possibly due to the measures undertaken hereafter the number of sandfly fever cases diagnosed have decreased. PMID:1659738
Eitrem, R; Niklasson, B; Weiland, O
A Historical Look at the First Reported Cases of Lassa Fever: IgG Antibodies 40 Years After Acute Infection.
Lassa fever is an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. One important question regarding Lassa fever is the duration of immunoglobulin G (IgG) antibody after infection. We were able to locate three persons who worked in Nigeria dating back to the 1940s, two of whom were integrally involved in the early outbreaks and investigations of Lassa fever in the late 1960s, including the person from whom Lassa virus was first isolated. Two persons had high titers of Lassa virus-specific IgG antibody over 40 years after infection, indicating the potential for long-term duration of these antibodies. One person was likely infected in 1952, 17 years before the first recognized outbreak. We briefly recount the fascinating stories of these three pioneers and their important contribution to our understanding of Lassa fever. PMID:23277481
Bond, Nell; Schieffelin, John S; Moses, Lina M; Bennett, Andrew J; Bausch, Daniel G
A historical look at the first reported cases of Lassa fever: IgG antibodies 40 years after acute infection.
Lassa fever is an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. One important question regarding Lassa fever is the duration of immunoglobulin G (IgG) antibody after infection. We were able to locate three persons who worked in Nigeria dating back to the 1940s, two of whom were integrally involved in the early outbreaks and investigations of Lassa fever in the late 1960s, including the person from whom Lassa virus was first isolated. Two persons had high titers of Lassa virus-specific IgG antibody over 40 years after infection, indicating the potential for long-term duration of these antibodies. One person was likely infected in 1952, 17 years before the first recognized outbreak. We briefly recount the fascinating stories of these three pioneers and their important contribution to our understanding of Lassa fever. PMID:23390223
Bond, Nell; Schieffelin, John S; Moses, Lina M; Bennett, Andrew J; Bausch, Daniel G
Aminotransferase changes and acute hepatitis in patients with dengue fever: analysis of 1,585 cases
Introduction: Type 3 dengue virus caused an extensive epidemic in the state of Rio de Janeiro in summer 2002. In some of the patients, it was found in an atypical form with increased aminotransferase levels and acute hepatitis. Material and Methods: An analysis was made of 1,585 serologically confirmed dengue cases at the Dengue Reference Center in Campos dos Goytacazes,
Luiz Jos� de Souza; Jos� Galv�o Alves; Rita Maria Ribeiro Nogueira; Carlos Gicovate Neto; Diogo Assed Bastos; Edno Wallace da Silva Siqueira; Jo�o Tadeu Damian Souto Filho; Thiago de Abreu Cez�rio; Carlos Eduardo Soares; Rodrigo da Costa Carneiro
Hantavirus infection�Hemorrhagic fever with renal syndrome: the first case series reported in Romania and review of the literature
Hemorrhagic fever with renal syndrome (HFRS) is a zoonotic infectious disease caused by Hantaviruses, a group of RNA viruses\\u000a belonging to the Bunyaviridae family. Humans may get the disease by contamination with excreta of carrier rodents. The disease typically manifests with\\u000a the triad fever�thrombocytopenia�acute kidney injury (AKI). Although its global prevalence seems to be increasing, Hantavirus\\u000a infection is still commonly
Irinel-Doina Maftei; Liviu Segall; Raluca Panculescu-Gatej; Cornelia Ceianu; Adrian Covic
Rapid Diagnosis of Primary Dengue Fever by the Immunochromatographic Test and by Electron Microscopy � A Case Report
Summary��\\u000a A 21-year-old women presented with an acute febrile illness after a two-week holiday in Jamaica. Her symptoms started two\\u000a days after return, with sudden onset of continuous higher fever (> 39 ?C), dizziness and nausea. Three days later she developed\\u000a a generalized macular rash, which led to the tentative diagnosis �acute dengue fever�. Laboratory confirmation was achieved\\u000a by demonstrating
Regina Allwinn; C. Schieferstein; S. Glauke; H. W. Doerr
ERIC Educational Resources Information Center
Exotic, captivating, and seductive, orchids have long fascinated plant lovers. They first attracted the attention of Westerners in the 17th century, when explorers brought back samples from South America and Asia. By the mid-1800s, orchid collecting had reached a fever pitch, not unlike that of the Dutch tulip craze of the 1630s, with rich (and�
Oliver, Phillip
Q Fever: Statistics and Epidemiology
... 55% 2009 71% 2010 61% Top of Page Geography Cases of Q fever are most frequently reported ... Indiana, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Oklahoma, Rhode Island, South Carolina, Utah and West Virginia. Incidence ranged ...
Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series
Background Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases. Methods Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998�2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125�1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed. Results Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125�0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015�0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9�10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization. Conclusions Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility.
Slinger, Robert; Desjardins, Marc; McCarthy, Anne E; Ramotar, Karam; Jessamine, Peter; Guibord, Christiane; Toye, Baldwin
[Splenic abscess in typhoid fever].
We report the case of a young patient with typhoid fever who complained of pain in his left hypochondrium and shoulder and recrudescence of fever after 21 days of treatment with tiamphenicol and ampicilline. Ultrasonography lead to the diagnosis of splenic abscess; the patient was splenectomized and S. typhi was cultured from the pus. Splenic abscess was frequently observed before 1940; since then only 6 more cases are reported in literature. PMID:1831093
Calleri, G; Gaiottino, F; Sommo, M; Grillone, W
Review of Dengue Hemorrhagic Fever Fatal Cases Seen Among Adults: A Retrospective Study
Background Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it is becoming more of an adult disease. Malaysia experienced a large dengue outbreak in 2006 to 2007, involving mostly adults, with a high number of deaths. Methodology/Principal Findings We undertook a retrospective study to examine dengue death cases in our hospital from June 2006 to October 2007 with a view to determine if there have been changes in the presentation of severe to fatal dengue. Nine of ten fatal cases involved adult females with a median age of 32 years. All had secondary dengue infection. The mean duration of illness prior to hospitalization was 4.7 days and deaths occurred at an average of 2.4 days post-admission. Gastrointestinal pain, vomiting, diarrhea, intravascular leakages and bleeding occurred in the majority of cases. DSS complicated with severe bleeding, multi-organ failure and coagulopathy were the primary causes of deaths. Seven patients presented with thrombocytopenia and hypoalbuminemia, five of which had hemoconcentration and increased ALT and AST indicative of liver damage. Co-morbidities particularly diabetes mellitus was common in our cohort. Prominent unusual presentations included acute renal failure, acute respiratory distress syndrome, myocarditis with pericarditis, and hemorrhages over the brain and heart. Conclusions In our cohort, dengue fatalities are seen primarily in adult females with secondary dengue infection. The majority of the patients presented with common clinical and laboratory warning signs of severe dengue. Underlying co-morbidities may contribute to the rapid clinical deterioration in severe dengue. The uncommon presentations of dengue are likely a reflection of the changing demographics where adults are now more likely to contract dengue in dengue endemic regions.
Sam, Sing-Sin; Omar, Sharifah Faridah Syed; Teoh, Boon-Teong; Abd-Jamil, Juraina; AbuBakar, Sazaly
Step-filling and development of a three-layer magma chamber: the Neapolitan Yellow Tuff case history
The Neapolitan Yellow Tuff, the product of the largest known trachytic phreatoplinian eruption, gives a good opportunity to investigate the filling mechanisms and internal dynamics of a trachytic magma chamber. A detailed study of the geochemical, mineralogical and isotopical features of the deposit was carried out to investigate the behaviour of the magma chamber before the eruption. The collected data
G. Orsi; L. Civetta; M. D'Antonio; P. Di Girolamo; M. Piochi
Frozen soil change and adaptation of animal husbandry: a case of the source regions of Yangtze and Yellow Rivers
This paper discusses the spatial and temporal change of different frozen soil types from 1980s to 2000s, and the impacts of frozen soil change on rangeland productivity and sustainable livelihood in the source regions of Yangtze and Yellow Rivers employed numerical model and GIS technology. Authors use the analytical framework of adaptation of animal husbandry according to national, regional, community
Yiping Fang; Dahe Qin; Yongjian Ding
Raman identification of yellow synthetic organic pigments in modern and contemporary paintings: Reference spectra and case studies
NASA Astrophysics Data System (ADS)
The characterization of the binding media and pigments in modern and contemporary paintings is important for designing safe conservation treatments, as well as for determining suitable environmental conditions for display, storage and transport. Raman spectroscopy is a suitable technique for the in situ non-destructive identification of synthetic organic pigments in the presence of the complex binding media characteristic of synthetic resin paints or colour lithographic inks. The precise identification of a pigment by comparing its spectrum to that of a reference is necessary when conservation treatments with aqueous solutions or organic solvents are being considered for a work of art, since solubility properties can sometimes vary within the same pigment group. The Raman spectra of 21 yellow synthetic organic pigments, belonging to the monoazo, monoazo lakes, diarylide, disazo condensation, benzimidazolone, bisacetoacetarylide, azo-methine metal complex, isoindolinone and isoindoline groups are presented. Since modern artists frequently mixed paint developed for other applications, in addition to colorants developed as artists' paints, other synthetic organic pigments were included in the spectral database. Two monoazo pigments, Pigment Yellow 1 and Pigment Yellow 3, a benzimidazolone, Pigment Yellow 154 and a phthalocynanine, Pigment Green 7, were identified in sample cross-sections from four modern and contemporary paintings in the collection of The Museum of Modern Art in Ljubljana, Slovenia.
Ropret, Polonca; Centeno, Silvia A.; Bukovec, Peter
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
Between the end of June and the middle of July 2011, an outbreak of Crimean-Congo Hemorrhagic Fever occurred in southern part of Tehran, Iran. This study reports clinical, laboratory findings and outcome of six cases, who were all consanguine. Index case who was livestock-worker died with hemorrhagic manifestations; thereafter his pregnant wife, three brothers, mother-in-law and his pregnant sister-in-law were admitted and except for the latter, ribavirin was administered. The brother with close contact with body fluids and blood of index case, died with hemorrhage. Low platelet, high aminotransferases and elevated PT, PTT were detected in this case. Skin manifestations were present in five cases. Only in one case RT-PCR and IgM serology were reported as positive for CCHF virus by reference laboratory. In endemic areas, high index of suspicion should be kept in mind in successfully finding and treating cases in early phase of the disease.
Mardani, Masoud; Namazee, Najmeh
Close contact precautions could prevent an outbreak of crimean-congo hemorrhagic Fever: a case series report from southern part of tehran.
Between the end of June and the middle of July 2011, an outbreak of Crimean-Congo Hemorrhagic Fever occurred in southern part of Tehran, Iran. This study reports clinical, laboratory findings and outcome of six cases, who were all consanguine. Index case who was livestock-worker died with hemorrhagic manifestations; thereafter his pregnant wife, three brothers, mother-in-law and his pregnant sister-in-law were admitted and except for the latter, ribavirin was administered. The brother with close contact with body fluids and blood of index case, died with hemorrhage. Low platelet, high aminotransferases and elevated PT, PTT were detected in this case. Skin manifestations were present in five cases. Only in one case RT-PCR and IgM serology were reported as positive for CCHF virus by reference laboratory. In endemic areas, high index of suspicion should be kept in mind in successfully finding and treating cases in early phase of the disease. PMID:23930191
Mardani, Masoud; Namazee, Najmeh
Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and ...
Q Fever Presenting As Recurrent, Culture-negative Endocarditis with Aortic Prosthetic Valve Failure: A Case Report and Review of the Literature.
The present report describes a case of recurrent, culture-negative endocarditis presenting with aortic prosthetic valve dysfunction in a 62-year-old man who required four valve replacement surgeries. On each occasion, he presented with valve failure. Fever was only documented during his first presentation. Furthermore, no vegetations were detectable on his aortic valve at transesophageal echocardiography. On the occasion of his most recent presentation, a detailed history of animal exposure - including hunting and skinning deer, moose and other large animals with his bare hands - was the only clue to his diagnosis. Serum antibodies against Coxiella burnetii were strongly positive, and C burnetii DNA was detected by polymerase chain reaction from his resected aortic valve tissue. Q fever is a worldwide zoonotic infection with diverse reservoirs. This diagnosis should be considered when evaluating unexplained prosthetic valve dysfunction, particularly in the setting of animal exposure. PMID:18382649
Alshukairi, Abeer N; Morshed, Muhammad G; Reiner, Neil E
Localizing chronic Q fever: a challenging query
Background Chronic Q fever usually presents as endocarditis or endovascular infection. We investigated whether 18F-FDG PET/CT and echocardiography were able to detect the localization of infection. Also, the utility of the modified Duke criteria was assessed. Methods Fifty-two patients, who had an IgG titre of???1024 against C. burnetii phase I???3 months after primary infection or a positive PCR???1 month after primary infection, were retrospectively included. Data on serology, the results of all imaging studies, possible risk factors for developing proven chronic Q fever and clinical outcome were recorded. Results According to the Dutch consensus on Q fever diagnostics, 18 patients had proven chronic Q fever, 14 probable chronic Q fever, and 20 possible chronic Q fever. Of the patients with proven chronic Q fever, 22% were diagnosed with endocarditis, 17% with an infected vascular prosthesis, and 39% with a mycotic aneurysm. 56% of patients with proven chronic Q fever did not recall an episode of acute Q fever. Ten out of 13 18F-FDG PET/CT-scans in patients with proven chronic Q fever localized the infection. TTE and TEE were helpful in only 6% and 50% of patients, respectively. Conclusions If chronic Q fever is diagnosed, 18F-FDG PET/CT is a helpful imaging technique for localization of vascular infections due to chronic Q fever. Patients with proven chronic Q fever were diagnosed significantly more often with mycotic aneurysms than in previous case series. Definite endocarditis due to chronic Q fever was less frequently diagnosed in the current study. Chronic Q fever often occurs in patients without a known episode of acute Q fever, so clinical suspicion should remain high, especially in endemic regions.
Fever occurs when pyrogenic stimulation activates thermal control centres. Fever is common during the perioperative period, but rare during anaesthesia. Although only a limited number of studies are available to explain how anaesthesia affects fever, general anaesthesia seems to inhibit fever by decreasing the thermoregulatory-response thresholds to cold. Opioids also inhibit fever; however, the effect is slightly less than that
Rainer Lenhardt
Atypical manifestations of dengue Fever.
We reviewed case records of 40 in-patients (22 boys) with serologically confirmed dengue fever between 1st October and 30th November, 2013. Severe dengue was seen in 30, out of which 12 (30%) had compensated shock. Splenomegaly (6,15%) and encephalopathy (4,10%) were the commonest atypical features. Atypical manifestations of dengue fever were more common than that reported in the past. PMID:24986292
Pawaria, Arti; Mishra, Devendra; Juneja, Monica; Meena, Jagdish
Q fever in Bulgaria and Slovakia.
As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed.
Serbezov, V. S.; Kazar, J.; Novkirishki, V.; Gatcheva, N.; Kovacova, E.; Voynova, V.
... of this website will be limited. Search Help? Dengue Fever Testing Share this page: Was this page ... fever, can I get it again? 1. Can dengue fever be prevented? Currently, there is no immunization ...
Valley Fever (Coccidioidomycosis) Statistics
... valley fever may be under-recognized. 2 , 3 Public health surveillance for valley fever Valley fever is reportable ... MMWR ) . Check with your local, state, or territorial public health department for more information about disease reporting requirements ...
... Library > Allergy Library > Hay Fever Medications Share | Hay Fever Medications This article has been reviewed by Thanai ... MD, FAAAAI Seasonal allergic rhinitis known as hay fever symptoms range from being mildly annoying to seriously ...
The liver in boutonneuse fever
Hepatic lesions were studied for the first time in 13 cases of boutonneuse fever (Mediterranean exanthematous fever). The glutamic-oxalacetic transaminases were raised in eight patients, the glutamic-pyruvic transaminases showed an increase in 10 patients, alkaline phosphatases in seven of the 10 patients investigated, and conjugate bilirubin showed moderate increases in three patients. Five patients were studied histologically; this study showed lesions of a granulomatous type, similar to those described in Q fever, in three patients, fatty degeneration with marked alcoholism in another patient, and a normal liver in the last patient. Two of the three patients with granulomatous lesions showed a moderate increase in alkaline phosphatases. After this report boutonneuse fever must be included among the infectious conditions that can produce granulomas within the liver. ImagesFig 1Fig 2Fig 3
Guardia, J.; Martinez-Vazquez, J. M.; Moragas, A.; Rey, C.; Vilaseca, J.; Tornos, J.; Beltran, M.; Bacardi, R.
Dietary treatment of chylous ascites in yellow nail syndrome
Chylous ascites has rarely been reported in yellow nail syndrome. A case of chylous ascites in yellow nail syndrome is described which was treated successfully with dietary restriction of fat and supplements of medium chained triglycerides.
W C Tan
Rift Valley Fever (RVF) is a zoonotic arbovirosis. Among animals, it mainly affects ruminants, causing abortions in gravid females and mortality among young animals. In humans, RVF virus infection is usually asymptomatic or characterized by a moderate fever. However, in 1 to 3% of cases, more severe forms of the disease (hepatitis, encephalitis, retinitis, hemorrhagic fever) can lead to the death of infected individuals or to major sequels. The RVF virus (Bunyaviridae, genus Phlebovirus) was identified for the first time in the 1930s in Kenya. It then spread over almost all African countries, sometimes causing major epizootics/epidemics. In 2000, the virus was carried out of Africa, in the Middle East Arabian Peninsula. In 2007-2008, Eastern-African countries, including Madagascar, reported significant episodes of RVF virus, this was also the case for the Comoros archipelago and the French island of Mayotte. This ability to spread associated with many vectors, including in Europe, and high viral loads in infected animals led the health authorities worldwide to warn about the potential emergence of RVF virus in areas with a temperate climate. The awareness has increased in recent years with climate changes, which may possibly modify the vector distribution and competence, and prompted many RVF virus-free countries to better prepare for a potential implantation of RVF. PMID:21295425
P�pin, M
Cumulative sediment trapping by reservoirs in large river basins: A case study of the Yellow River basin
NASA Astrophysics Data System (ADS)
Reservoir sedimentation has been a serious problem for reservoir operation and watershed management worldwide, which highlights the importance of accurate estimate of the deposited sediment amount. With reservoir information derived from remote sensing dataset and observed hydrological records of water and sediment, this paper is concerned with the cumulative reservoir sediment trapping in the Yellow River basin. The river basin was divided into 12 sub-basins, upon which the reservoirs' sediment trapping efficiency (TE) and their interception effects on inflowing sediment were estimated with sediment records extracted from 179 field sampling stations. The results show that, with the sediment TE greater than 80% for all the sub-basins, theoretically the basin-wide reservoirs are able to trap most sediment. For the whole river basin, the sediment TE averages 95.2%, which indicates that the reservoirs can collectively make a significant anthropogenic signature on basin-wide sediment delivery. A basin-wide sediment yield map was generated to estimate the reservoir sedimentation amount. During 1950-1970, annually about 2.483 Gt of sediment was transported into channels from sloping lands. Taking into account the actual water storage changes and the reservoir construction history, the actual reservoir sedimentation rate was estimated at 0.59 Gt/yr after corrections, which represents 47.6% of the river basin's total sediment load reduction. Globally, reservoir sedimentation in the Yellow River basin represents about 12-15% of the global mean rate. Up to 2010, approximately 19.32 Gt of sediment has been trapped by Yellow River reservoirs, and totally about 40.32 Gt of sediment has been artificially fixed if silt check dams are also considered. With huge amounts of sediment deposited, these reservoirs have been losing their storage capacity to sedimentation at a rate of 0.6% per year. The magnitude is expected to enhance in future following new reservoir completions. Thus, more efforts are strongly needed to explore the associated responses.
Ran, Lishan; Lu, X. X.; Xin, Zhongbao; Yang, Xiankun
Clinical Profile of Concurrent Dengue Fever and Plasmodium vivax Malaria in the Brazilian Amazon: Case Series of 11 Hospitalized Patients
Malaria and dengue fever are the most prevalent vector-borne diseases worldwide. This study aims to describe the clinical profile of patients with molecular diagnosis of concurrent malaria and dengue fever in a tropical-endemic area. Eleven patients with concurrent dengue virus (DENV) and Plasmodium vivax infection are reported. Similar frequencies of DENV-2, DENV-3, and DENV-4 were found, including DENV-3/DENV-4 co-infection. In eight patients, the World Health Organization (WHO) criteria for severe malaria could be fulfilled (jaundice being the most common). Only one patient met severe dengue criteria, but warning signs were present in 10. Syndromic surveillance systems must be ready to identify this condition to avoid misinterpretation of severity attributed to a single disease.
Magalhaes, Belisa M. L.; Alexandre, Marcia A. A.; Siqueira, Andre M.; Melo, Gisely C.; Gimaque, Joao B. L.; Bastos, Michele S.; Figueiredo, Regina M. P.; Carvalho, Ricardo C.; Tavares, Michel A.; Naveca, Felipe G.; Alonso, Pedro; Bassat, Quique; Lacerda, Marcus V. G.; Mourao, Maria P. G.
The host restricts dissemination of invasive enteric pathogens, such as non-typhoidal Salmonella serovars, by mounting acute inflammatory responses characterized by the recruitment of neutrophils. However, some enteric pathogens, such as Salmonella enterica serovar Typhi (S. typhi), can bypass these defenses and cause an invasive bloodstream infection known as typhoid fever. Recent studies on virulence mechanisms of S. typhi suggest that tight regulation of virulence gene expression during the transition from the intestinal lumen into the intestinal mucosa enables this pathogen to evade detection by the innate immune system, thereby penetrating defenses that prevent bacterial dissemination. This example illustrates how the outcome of host pathogen interaction at the intestinal mucosal interface can alter the clinical presentation and dictate the disease outcome.
Wangdi, Tamding; Winter, Sebastian E.; Baumler, Andreas J.
Rheumatic Fever in the Adult: A Forgotten Diagnosis
The authors of this article present a case of acute rheumatic fever in an adult and review the diagnostic criteria for this illness. They emphasize the prevention of acute rheumatic fever by the adequate treatment of streptococcal pharyngitis with penicillin.
Berger, Brian; Swanson, Richard; Smith, Stanley
Tickborne Relapsing Fever in Israel
We evaluated the epidemiology of relapsing fever from 1971 to 2003 in Israel. In civilians, incidence declined from 0.35 to 0.11 cases per 100,000 persons annually; in military personnel it averaged 6.4 cases per 100,000 persons annually. These data imply that the pathogen and vector continue to exist in Israel.
Sidi, Gil; Davidovitch, Nadav; Balicer, Ran D.; Anis, Emilia; Grotto, Itamar
Dengue Fever/Dengue Haemorrhagic Fever in Filipino Children: Clinical Experience During the 1983-1984 Epidemic.
National Technical Information Service (NTIS)
Although more than thirty years have lapsed since the first cases of dengue haemorrhagic fever, then known as Philippine haemorrhagic fever, were reported, studies on the various aspects of this disease were handicapped by the lack of valuable laboratory ...
R. S. Songco C. G. Hayes C. D. Leus C. O. Manaloto
Azathioprine-induced fever in autoimmune hepatitis
Underdiagnosis of drug-induced fever leads to extensive investigation and prolongation of hospitalization, and may lead to multiple unnecessary invasive procedures and a wrong diagnosis. Azathioprine is a widely used immunosuppressive drug. We report a case of a 53-year-old female patient diagnosed with autoimmune hepatitis treated with azathioprine, who presented to the emergency room with a 6-wk history of fever and chills without other associated symptoms. Since the patient�s fever was of unknown origin, she was hospitalized. All treatment was stopped and an extensive workup to explore the source of fever and chills was performed. Results of chest X-ray, viral, urine, and blood cultures, autoimmune serology, transthoracic and transesophageal echocardiography, and abdominal ultrasound revealed no source of infection. A rechallenge test of azathioprine was performed and the fever and chills returned within a few hours. Azathioprine was established as the definite cause following rechallenge. Fever as an adverse drug reaction is often unrecognized. Azathioprine has been reported to cause drug-induced fever in patients with inflammatory bowel disease, rheumatoid arthritis, and sarcoidosis. To the best of our knowledge there have been no previous reports documenting azathioprine-induced fever in patients with autoimmune hepatitis. The occurrence of fever following the readministration of azathioprine suggests the diagnosis of drug-induced fever, particularly after the exclusion of other causes. A careful rechallenge is recommended to confirm the diagnosis.
Khoury, Tawfik; Ollech, Jacob E; Chen, Shmuel; Mizrahi, Meir; Shalit, Meir
Louse-Borne Relapsing Fever; A Clinical and Laboratory Study of 62 Cases in Ethiopia and a Reconsideration of the Literature.
National Technical Information Service (NTIS)
Sixty-two patients with louse-borne relapsing fever in Addis Ababa, Ethiopia, from 1966 to 1968 were studied. The clinical presentation varied. Fever, headache, skeletal and abdominal pain, and the usual symptoms of acute infection were common. Tachypnoea...
A. D. M. Bryceson E. H. O. Parry P. L. Perine D. A. Warrell D. Vukotich
[Laboratory diagnosis of acute Q fever].
In the Netherlands an increasing number of laboratories are involved in diagnosing acute Q-fever. More uniformity in diagnostics and interpretation is desirable. To enable this, a working group on diagnostics of acute Q-fever was created on the initiative of the National Institute for Public Health and the Environment (RIVM) and the Dutch Association for Medical Microbiology (NVMM). The diagnostics of acute Q-fever includes a diagnostic flow chart (algorithm) consisting of tests for DNA and for antibodies against the antigens that appear in the successive stages of the disease. Reporting of both confirmed and suspected cases of acute Q-fever is obligatory. PMID:20858325
Wegdam-Blans, Marjolijn C A; Nabuurs-Franssen, Marrigje N; Horrevorts, Alphons M; Peeters, Marcel F; Schneeberger, Peter M; Bijlmer, Henk A
Step-filling and development of a three-layer magma chamber: the Neapolitan Yellow Tuff case history
NASA Astrophysics Data System (ADS)
The Neapolitan Yellow Tuff, the product of the largest known trachytic phreatoplinian eruption, gives a good opportunity to investigate the filling mechanisms and internal dynamics of a trachytic magma chamber. A detailed study of the geochemical, mineralogical and isotopical features of the deposit was carried out to investigate the behaviour of the magma chamber before the eruption. The collected data show three distinct compositional groups separated by gaps. Single depositional units contain glass shards formed contemporaneously. Although each of these shards is homogeneous they display the same compositional variations and gaps detected in pumice clasts. This feature is taken as an evidence for interpreting the detected compositional gaps as real gaps in the chamber. Therefore the chamber was filled by three distinct magma bodies separated by compositional gaps. The uppermost magma was alkali-trachyte and highly homogeneous, likely a consequence of vigorous convection. The intermediate magma was trachyte with a slight and continuous compositional variation, likely resulting from less intense convection. The lowermost magma was compositionally zoned from alkali-trachyte to latite downward. This compositional zonation was most likely acquired during uprise from a deeper reservoir. The three magmas entered the chamber sequentially from the uppermost to the lowermost. The latter entered the chamber short before the beginning of the eruption. Its input was interpreted as a possible triggering factor for the eruption. The results of this study strongly support a step-filling mechanism for the Neapolitan Yellow Tuff magma chamber and allow definition of the temporal succession of input of magma batches. Furthermore they also suggest that the magma bodies did not mix although, at least the uppermost two, coexisted inside the chamber for a time long enough to allow internal homogeneization by convection.
Orsi, G.; Civetta, L.; D'Antonio, M.; Di Girolamo, P.; Piochi, M.
Rift Valley fever outbreak, southern Mauritania, 2012.
After a period of heavy rainfall, an outbreak of Rift Valley fever occurred in southern Mauritania during September-November 2012. A total of 41 human cases were confirmed, including 13 deaths, and 12 Rift Valley fever virus strains were isolated. Moudjeria and Temchecket Departments were the most affected areas. PMID:24447334
Sow, Abdourahmane; Faye, Ousmane; Ba, Yamar; Ba, Hampath�; Diallo, Diawo; Faye, Oumar; Loucoubar, Cheikh; Boushab, Mohamed; Barry, Yahya; Diallo, Mawlouth; Sall, Amadou Alpha
NSDL National Science Digital Library
You, the reader, are helping Terry sail a yacht from South America to New Zealand. You are asked to investigate an outbreak of disease on board a second yacht. You interview the crew members, consult a medical reference, and observe other clues to determine what diseases the ill crew members have. The solution involves medical science, sports science, human health, biology, microbiology, infectious diseases, epidemiology, and hygiene. The mystery tests literacy, problem solving skills and deductive reasoning. The mystery has three parts. In the first part, you meet the characters and enter the story. In the second part, you interview the characters, investigate the facts, and attempt to solve the case. When you solve the case, you enter the third part, which concludes the story, and summarizes the scientific analysis needed to solve the case. The narrative is fictional, but the scenario is based on actual events and contemporary science research and discoveries.
Ken Eklund (WriterGuy REV)
Integrated Community Case Management of Fever in Children under Five Using Rapid Diagnostic Tests and Respiratory Rate Counting: A Multi-Country Cluster Randomized Trial
Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009�2010. Compliance with the malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9% (17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17). The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.
Mukanga, David; Tiono, Alfred B.; Anyorigiya, Thomas; Kallander, Karin; Konate, Amadou T.; Oduro, Abraham R.; Tibenderana, James K.; Amenga-Etego, Lucas; Sirima, Sodiomon B.; Cousens, Simon; Barnish, Guy; Pagnoni, Franco
Fever, fever patterns and diseases called 'fever'--a review.
Fever is a prominent feature of disease since antiquity. The febrile response is orchestrated by the central nervous system through endocrine, neurological, immunological and behavioural mechanisms. Other than a regulated rise in body temperature, fever is often accompanied by various sickness behaviours, changes in metabolic and physiological characteristics of body systems and alterations in immune responses. Fever and the febrile response, therefore, remain significant contributors to the pathogenesis, clinical presentation and outcome of many illnesses and diseases. This review highlights the pathophysiology of the febrile response and describes the fever types and patterns, including their clinical significance. The various medical illnesses called "fever" are also listed and the origins of their appellations discussed. PMID:21843857
Ogoina, Dimie
Complete genome characterization of Rocio virus (Flavivirus: Flaviviridae), a Brazilian flavivirus isolated from a fatal case of encephalitis during an epidemic in Sao Paulo state
The flaviviruses of major medical importance in South American countries are yellow fever, dengue, Saint Louis encephalitis, West Nile and Rocio viruses. Rocio virus (ROCV) has been responsible for epidemics of severe encephalitis in Brazil with a case-fatality rate of 10% and development of sequelae in 20% of the survivors. We have sequenced and characterized the entire genome of ROCV
Daniele B. A. Medeiros; Marcio R. T. Nunes; Pedro F. C. Vasconcelos; Gwong-Jen J. Chang; Goro Kuno
The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey
Background Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV. Methods A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected. Results Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01�1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15�5.63, p = 0.020) for CCHFV infection. Conclusion This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.
Favorable Outcomes for both Mother and Baby Are Possible in Pregnant Women with Crimean-Congo Hemorrhagic Fever Disease: A Case Series and Literature Review.
To assess the impact of Crimean-Congo hemorrhagic fever (CCHF) infection during pregnancy on maternal and fetal outcomes, we present the clinical and laboratory findings and outcomes of 5 pregnant women with CCHF infection as well as fetal outcomes. We also reviewed previously reported cases with CCHF infection in pregnant women. All pregnant women with CCHF infection who had been hospitalized between August 2007 and September 2011 were included. The gestational ages at the time of CCHF infection were 8, 18, 20, 21 and 32 weeks. CCHF infection was acquired during the 1st trimester in only 1 case and resulted in spontaneous abortion. The other 4 pregnant women completely recovered, all reached a healthy full-term gestation and 4 term babies were born. All infants had normal birth weight and were found to be healthy on their first examination and follow-up. In the literature concerning CCHF infection in pregnancy, 8 published articles including case reports or case series and 1 poster presentation including 1 case could be accessed. In conclusion, there is a risk of vertical transmission of CCHF infection, and infections acquired early in gestation had a poor prognosis for the fetus. � 2014 S. Karger AG, Basel. PMID:24732981
Gozel, Mustafa Gokhan; Elaldi, Nazif; Engin, Aynur; Akkar, Ozlem Bozoklu; Bolat, Fatih; Celik, Cem
Unusual Presentation of Anaplastic Large Cell Lymphoma with Clinical Course Mimicking Fever of Unknown Origin and Sepsis: Autopsy Study of Five Cases
Aim To describe a subset of cases with the unusual clinical and histomorphological presentation of anaplastic large cell lymphoma (ALCL) mimicking fever of unknown origin (FUO) and sepsis. Methods A pathology database was searched using full term Systematized Nomenclature of Medicine codes for ALCL to identify 23ALCL cases from the period 1999-2006. Of those, five cases that did not have a correct premortem diagnosis were further analyzed to elucidate the reasons for delayed and incorrect pre-mortem diagnosis. The analyzed data included clinical presentation, duration of symptoms, duration of hospital stay, premortem presumed cause of death, white blood cell count, platelet count, anion gap and blood pH, liver enzymes (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase), lactate, coagulation tests (prothrombin time, partial thromboplastin time, fibrinogen, D-dimers), microbiology cultures, and radiology and surgical pathology reports. Autopsy reports were reviewed for description of major gross findings, initial clinical diagnosis, and cause of death. Results Five fatal and pre-mortem unrecognized ALCL cases were characterized by rapid decline, with histologic findings showing predominantly extranodal involvement, intravascular lymphomatosis, and hemophagocytosis. The cases were also characterized by unusual clinical manifestations including a FUO, sepsis, and disseminated intravascular coagulation-like picture, lactic acidosis, hepatosplenomegaly, and absence of significant peripheral adenopathy. Conclusions There is a distinct group of ALCLs with unique and specific clinical, gross autopsy, and histopathologic findings. Recognition of this clinical variant may facilitate early detection and potentially timely diagnosis and therapy.
Mosunjac, Marina B.; Sundstrom, J. Bruce; Mosunjac, Mario I.
Current trends in typhoid Fever.
Typhoid fever, a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality. Endemic cases in the United States are unusual, with most following foreign travel to the Indian subcontinent, Africa, Asia, or Latin America. The classic findings of typhoid fever include rose spots, relative bradycardia, and stepwise fevers, but unfortunately these signs are frequently absent. Gastrointestinal manifestations may include diffuse abdominal pain, bleeding, perforation, cholecystitis, and cholangitis. The diagnosis should be suspected after collection of the appropriate clinical and travel history with confirmation by blood or bone marrow culture. Novel methods are in development to establish the diagnosis when cultures are negative or unavailable. Multidrug resistance has increased worldwide, and decisions on antimicrobial therapy must take such resistance into account. The empiric treatment of choice is a fluoroquinolone drug; ceftriaxone and azithromycin are alternatives. Preventive strategies include good sanitation and food handling practices along with vaccination of selected groups. PMID:12864957
Crum, Nancy F
... JavaScript on. Read more information on enabling JavaScript. Dengue Fever Skip Content Marketing Share this: Main Content ... Treatment There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. ...
... Risk factors are recent outdoor activity and recent tick bite . Colorado tick fever is seen most often in ... start 3 to 6 days after getting the tick bite. A sudden fever continues for 3 days, goes ...
... by the bacteria Coxiella burnetii , which lives in domestic animals such as cattle, sheep, goats, birds, and cats. ... destroys the bacteria that cause early Q fever. Domestic animals should be inspected for signs of Q fever ...
Groundwater flow and geochemistry in the lower reaches of the Yellow River: a case study in Shandang Province, China
NASA Astrophysics Data System (ADS)
Water samples were collected from the Yellow River and from wells for chemical and isotopic measurement in the counties of Yucheng and Qihe, to which 6-9�108 m3 of water is diverted annually from the Yellow River. A zone of high electrical conductivity (EC) in groundwater corresponds well on the regional scale with a ridge in groundwater level, which is the main flow path through the region, but has a low gradient. The zone of highest EC along this ridge occurs at a position with the lowest ground altitude in the study area. The unique characteristic of the groundwater is the linear relationship among the principal anions as the result of mixing. The mixing effect is confirmed by its isotopic signature, which was then used to calculate the contributions from three sources: rainfall, old water, and diverted water with an average mixing rate of 18, 17, and 65%, respectively. As an indicator of water movement, Cl- content varies across a wide range in the profile from 30-10 m with a maximum concentration at about 1.2 m depth. Concentrations are relatively stable at about 2 m, which is the average boundary of the saturated and unsaturated zone. The water from the Yellow River has proved to be dominant in mixing in the aquifer in terms of groundwater flow and geochemistry. R�sum�. En vue d'analyses chimiques et isotopiques, des �chantillons d'eau ont �t� pr�lev�s sur le Fleuve Jaune et dans des puits des comt�s de Yucheng et Qihe, o� l'on pr�l�ve sur le fleuve 6-9�108 m3. Une zone de forte conductivit� �lectrique dans la nappe correspond bien, � l'�chelle r�gionale, avec une cr�te pi�zom�trique li�e au principal canal traversant la r�gion, mais avec une faible pente. La zone de plus fortes conductivit�s le long de cette cr�te se situe l� o� l'altitude est la plus basse dans la r�gion. La caract�ristique remarquable de la nappe est la relation lin�aire entre les principaux anions, r�sultant d'un m�lange. L'effet de m�lange est confirm� par la signature isotopique, qui a alors �t� utilis�e pour calculer les contributions des trois sources: la pluie, l'eau ancienne et l'eau pr�lev�e dans le fleuve, avec un taux moyen de m�lange respectivement de 18, 17 et 65%. Comme indicateur de l'�coulement de l'eau, la concentration en Cl- varie dans une large gamme, dans un profil de 30 cm � 10 m en profondeur, avec une concentration maximale � une profondeur d'environ 1,2 m. Les concentrations sont relativement stables � partir de 2 m, profondeur de la limite entre les zones non satur�e et satur�e. On a ainsi montr� que l'eau du Fleuve Jaune est pr�dominante dans le m�lange, au sein de l'aquif�re en termes d'�coulement de la nappe et de composition chimique. Resumen. Se ha recogido muestras de agua del R�o Amarillo y de pozos para obtener medidas qu�micas e isot�picas en los condados de Yucheng y Qihe, que se abastecen con 6-9�108 m3 anuales de aguas de dicho r�o. Hay una zona de conductividad el�ctrica (CE) elevada en las aguas subterr�neas, la cual se corresponde bien a escala regional con una divisoria en el nivel piezom�trico que representa la v�a principal de flujo a trav�s de la regi�n, pero con un gradiente bajo. La zona de mayor CE a lo largo de la divisoria est� localizada en el punto con la menor cota topogr�fica en el �mbito de estudio. La caracter�stica principal de las aguas subterr�neas es la relaci�n lineal que existe entre los aniones principales como resultado de un proceso de mezcla. Este efecto se confirma mediante la huella isot�pica, que se utiliz� para calcular las contribuciones de tres or�genes distintos: precipitaci�n, aguas antiguas y aguas derivadas del r�o, obteni�ndose porcentajes respectivos del 18, 17, y 65%. Como trazador del agua, la concentraci�n de cloruro var�a ampliamente en el perfil del suelo de 0,3-10 m, con un m�ximo a una profundidad aproximada de 1,2 m. Las concentraciones son relativamente estables hacia 2 m de profundidad, que es la cota promedio del nivel fre�tico. El agua del R�o Amarillo domina en la mezcla de aguas
Chen, J. Y.; Tang, C. Y.; Sakura, Y.; Kondoh, A.; Shen, Y. J.
An electronic literature search through August 2010 was performed to obtain articles describing fever incidence, impact, and\\u000a treatment in patients with subarachnoid hemorrhage. A total of 24 original research studies evaluating fever in SAH were identified,\\u000a with studies evaluating fever and outcome, temperature control strategies, and shivering. Fever during acute hospitalization\\u000a for subarachnoid hemorrhage was consistently linked with worsened outcome
V. Scaravilli; G. Tinchero; G. Citerio
... doctors will deliver intravenous (IV) fluids and electrolytes (salts) to replace the fluids lost through vomiting or diarrhea . This is usually enough to effectively treat the disease, as long as fluid replacement therapy begins early. In more advanced cases, doctors ...
Dengue hemorrhagic fever presenting with hemorrhagic pancreatitis and an intramural hematoma of the duodenal wall: a case report and review of the literature.
Dengue fever may present with atypical manifestations. Here we report a 47 year-old male presenting with fever and sore throat for 2 days, followed by epigastric pain and tarry stool for 4 days. The esophagogastroduodenoscopy revealed multiple ulcers with a nodular margin in the duodenal bulb and second portion of the duodenum. A MRI of the abdomen revealed hemorrhagic pancreatitis, with a large intramural hematoma in the second portion of duodenum. The final diagnosis was dengue hemorrhagic fever, grade II, complicated with hemorrhagic pancreatitis and an intramural hematoma of the duodenal wall. Physicians should be aware of the atypical abdominal presentations of dengue fever. PMID:24050071
Lee, Chun-Yuan; Tsai, Hung-Chin; Lee, Susan Shin-jung; Lin, Chun-Ku; Huang, Jer-Shyung; Chen, Yao-Shen
Spontaneous splenic rupture in typhoid fever.
Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.
Ali, G.; Kamili, M. A.; Rashid, S.; Mansoor, A.; Lone, B. A.; Allaqaband, G. Q.
Climate impacts on environmental risks evaluated from space: a conceptual approach to the case of Rift Valley Fever in Senegal
Background Climate and environment vary across many spatio-temporal scales, including the concept of climate change, which impact on ecosystems, vector-borne diseases and public health worldwide. Objectives To develop a conceptual approach by mapping climatic and environmental conditions from space and studying their linkages with Rift Valley Fever (RVF) epidemics in Senegal. Design Ponds in which mosquitoes could thrive were identified from remote sensing using high-resolution SPOT-5 satellite images. Additional data on pond dynamics and rainfall events (obtained from the Tropical Rainfall Measuring Mission) were combined with hydrological in-situ data. Localisation of vulnerable hosts such as penned cattle (from QuickBird satellite) were also used. Results Dynamic spatio-temporal distribution of Aedes vexans density (one of the main RVF vectors) is based on the total rainfall amount and ponds� dynamics. While Zones Potentially Occupied by Mosquitoes are mapped, detailed risk areas, i.e. zones where hazards and vulnerability occur, are expressed in percentages of areas where cattle are potentially exposed to mosquitoes� bites. Conclusions This new conceptual approach, using precise remote-sensing techniques, simply relies upon rainfall distribution also evaluated from space. It is meant to contribute to the implementation of operational early warning systems for RVF based on both natural and anthropogenic climatic and environmental changes. In a climate change context, this approach could also be applied to other vector-borne diseases and places worldwide.
Tourre, Yves M.; Lacaux, Jean-Pierre; Vignolles, Cecile; Lafaye, Murielle
[Immunocompromised HIV patient with lymphadenopathy and fever].
The case of a immunocompromised HIV patient with fever and lymphadenopathy discussed in an anatomo-pathological round. This complex clinical case was used as an opportunity to discuss the broad differential diagnosis of fever in an immunocompromized individual with multiples lymphadenopathies. Clinical reasoning leading to the probable diagnosis based on clinical, biological and radiological informations is not only a difficult task for the speaker but also a rich source of learning opportunities for our medical community. PMID:21140959
Giardelli, Greta; Cometta, Alain; Rausch, Thierry; Bize, Pierre; Waeber, G�rard
Pulmonary histoplasmosis presenting as chronic productive cough, fever, and massive unilateral consolidation in a 15-year-old immune-competent boy: a case report
Introduction Severe histoplasmosis is known to be among the AIDS-defining opportunistic infections affecting patients with very low CD4 cell counts in histoplasmosis-endemic areas. Histoplasma capsulatum var. duboisii is common in West and Central Africa, where it occurs in both HIV/AIDS and non-HIV patients. Few cases of life-threatening histoplasmosis in immune-competent individuals have been reported worldwide. Case report We describe a case of pulmonary histoplasmosis diagnosed on the basis of autopsy and histological investigations. A 15-year old East African immune-competent boy with a history of smear-positive tuberculosis and a two-year history of rock cutting presented to our hospital with chronic productive cough, fever, and massive unilateral consolidation. At the time of presentation to our hospital, this patient was empirically treated for recurrent tuberculosis without success, and he died on the seventh day after admission. The autopsy revealed a huge granulomatous lesion with caseation, but no acid-fast bacilli were detected on several Ziehl-Neelsen stains. However, periodic acid-Schiff staining was positive, and the histological examination revealed features suggestive of Histoplasma yeast cells. Conclusion Severe pulmonary histoplasmosis should be considered in evaluating immune-competent patients with risk factors for the disease who present with pulmonary symptoms mimicking tuberculosis.
Persistent fever, neck swelling, and small vessel vasculitis following tonsillectomy in a patient with Beh?et's disease: a case report
Introduction Beh�et�s disease commonly presents with recurrent oral and genital mucocutaneous ulcerations, uveitis and various skin manifestations. Other clinical symptoms include gastrointestinal ulcerations, arthritis, venous thrombosis, arterial aneurysms and central nervous system affection. Vasculitis underlies most clinical symptoms of Beh�et�s disease. Case presentation We report the case of a 62-year-old European Caucasian woman with Beh�et�s disease who presented with persistent fever and neck soft-tissue swelling, despite broad antibiotic treatment, two weeks after acute tonsillitis and a tonsillectomy. Diffuse epi- and mesopharyngeal swelling shown on a computed tomography scan of her neck and persistently elevated serum markers of inflammation initially prompted suspicion of an infectious etiology. Magnet resonance imaging of her neck and a neck tissue biopsy finally confirmed small vessel vasculitis involving skin, subcutaneous tissue and muscle. Considering the clinical presentation, past medical history and histological findings, we interpreted our patient�s symptoms as a flare of Beh�et�s disease. Immunosuppressive treatment led to rapid clinical improvement. Conclusion A patient with Beh�et�s disease developed small vessel vasculitis of the soft tissue of her neck after tonsillitis and a tonsillectomy. Infection and surgery probably triggered a flare of Beh�et�s disease.
Lamotrigine Hypersensitivity Syndrome and Spiking Fever
We report a case of a 26 year old woman with rash, lymphadenopathy, liver enzyme abnormalities and spiking fever. She was diagnosed with drug-induced hypersensitivity syndrome (DHS) to lamotrigine. Spiking fever in relation to drug-induced hypersensitivity syndrome has not earlier been described in adults. Spiking fever is an important symptom of the wide spectrum of disease presentation. The syndrome is commonly referred to as either Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) or DHS. In accord with previous authors we see both syndromes as two ends of a spectrum, with a wide range of symptoms and presentations. Therefore we plea for unity in nomenclature.
Bakker, Christiaan V; Hegt, Vincent Noordhoek; Praag, Marinus C G Van
Botryoid Wilms tumor: case report and review of literature
A rare case of botryoid Wilms tumor is presented. The main clinical manifestations were persistent low-grade fever, malaise,\\u000a and proteinuria associated with microhematuria. Ultrasonography revealed an echogenic mass in the right kidney, and a contrast-enhanced\\u000a mass was found in the dilated collecting system by contrast-enhanced computed tomography. The surgically resected tumor was\\u000a a polypoid, light-yellow, glistening mass that occupied a
A. Honda; M. Shima; S. Onoe; M. Hanada; T. Nagai; S. Nakajima; S. Okada
Tweeting Fever: Are Tweet Extracts a Valid Surrogate Data Source for Dengue Fever?
Objective To determine whether Twitter data contains information on dengue-like illness and whether the temporal trend of such data correlates with the incidence dengue or dengue-like illness as identified by city and national health authorities. Introduction Dengue fever is a major cause of morbidity and mortality in the Republic of the Philippines (RP) and across the world. Early identification of geographic outbreaks can help target intervention campaigns and mitigate the severity of outbreaks. Electronic disease surveillance can improve early identification but, in most dengue endemic areas data pre-existing digital data are not available for such systems. Data must be collected and digitized specifically for electronic disease surveillance. Twitter, however, is heavily used in these areas; for example, the RP is among the top 20 producers of tweets in the world. If social media could be used as a surrogate data source for electronic disease surveillance, it would provide an inexpensive pre-digitized data source for resource-limited countries. This study investigates whether Twitter extracts can be used effectively as a surrogate data source to monitor changes in the temporal trend of dengue fever in Cebu City and the National Capitol Region surrounding Manila (NCR) in the RP. Methods We obtained two sources of ground truth incidence for dengue. The first was daily dengue fever incidence for Cebu City and the NCR taken from the Philippines Integrated Disease Surveillance and Response System (PIDSR). The second ground truth source was fever incidence from Cebu City for 2011. The Cebu City Health Office (CCHO) has monitored fever incidence as a surrogate for dengue fever since the 1980s. Tweets from Cebu City, and the NCR were collected prospectively thru Twitter�s public application program interface. The Cebu City fever ground truth data set was smoothed with a seven day moving average to facilitate comparison to the PIDSR and Twitter data. A vocabulary of words and phrases describing fever and dengue fever in the tweets collected were identified and used to mark relevant tweets. A subset of these �fever� tweets that mentioned fever related to a medical situation were identified. The incidence and the temporal pattern of these medically-relevant tweets were compared with the incidence and pattern of fever and dengue fever in the two ground truth data sets. Pearson correlation coefficient was used to compare the correlation among the different data sets. Noted lag periods were adjusted by moving the data in time and re-computing the correlation coefficient. Results 26,023,103 tweets were collected from the two geographic regions: 10,303,366 from Cebu City and 15,719,767 tweets from the NCR. 8,814 (0.02%) Tweets contained the word fever and 4099 (0.01% of total) mentioned fever in a medically-relevant context, for example. ��I have a fever�� vs. ��football fever�.� The medically-relevant tweets were compared with both ground truth data sets. The correlation between the Tweets and each of the incidence data sets is shown below. Conclusions Tweets containing medically-relevant fever references were correlated (p<0.0001) with both fever and dengue fever incidence in the ground truth data sets. The signal indicating fever in the medically-related tweets led the incidence data significantly: by 6 days for the Cebu City fever incidence; and by 12 days for the PIDSR dengue fever incidence. Temporal adjustment to account for observed lag periods increased the correlation coefficient by about one-third in both cases. This was a limited pilot study, but it suggests that Twitter extracts may provide a valid and timely surrogate data source to monitor dengue fever in this population. Further study of the correlation of Twitter and dengue in other areas, and of Twitter with other illnesses is warranted.
Coberly, Jacqueline S.; Fink, Clayton R.; Elbert, Eugene; Yoon, In-Kyu; Velasco, John M.; Tomayo, Agnes; Roque, V.; Ygano, S.; Macasoco, Durinda; Lewis, Sheri
Bacteria Stimulate Hatching of Yellow Fever Mosquito Eggs
Background Aedes aegypti Linnaeus is a peridomestic mosquito that lays desiccation-resistant eggs in water-filled human-made containers. Previous investigations connected egg hatching with declining dissolved oxygen (DO) that is associated with bacterial growth. However, past studies failed to uncouple DO from other potential stimulatory factors and they contained little quantitative information about the microbial community; consequently, a direct role for bacteria or compounds associated with bacteria in stimulating egg hatching cannot be dismissed. Methodology/Principal Findings Environmental factors stimulating hatch of Ae. aegypti eggs were investigated using non-sterile and sterile white oak leaf (WOL) infusions and a bacterial culture composed of a mix of 14 species originally isolated from bamboo leaf infusion. In WOL infusion with active microbes, 92.4% of eggs hatched in 2-h at an average DO concentration of 2.4 ppm. A 24-h old bacterial culture with a DO concentration of 0.73 ppm also stimulated 95.2% of eggs hatch within 1-h. In contrast, only 4.0% of eggs hatched in sterile infusion, whose DO averaged 7.4 ppm. Effects of bacteria were uncoupled from DO by exposing eggs to bacterial cells suspended in NaCl solution. Over a 4-h exposure period, 93.8% of eggs hatched while DO concentration changed minimally from 7.62 to 7.50 ppm. Removal of bacteria by ultra-filtration and cell-free filtrate resulted in only 52.0% of eggs hatching after 4-h at an average DO concentration of 5.5 ppm. Conclusions/Significance Collectively, the results provide compelling evidence that bacteria or water-soluble compounds secreted by bacteria, not just low DO concentration, stimulate hatching of Ae. aegypti eggs. However, the specific cues involved remain to be identified. These research findings contribute new insight into an important aspect of the oviposition biology of Ae. aegypti, a virus vector of global importance, providing the basis for a new paradigm of environmental factors involved in egg hatching.
Ponnusamy, Loganathan; Boroczky, Katalin; Wesson, Dawn M.; Schal, Coby; Apperson, Charles S.
A comparative study of the typhidot (Dot-EIA) and Widal tests in blood culture positive cases of typhoid fever.
Seventy-six blood culture positive typhoid cases and forty-eight controls were studied. The typhidot test was positive in 74 (97.36%) cases, with a sensitivity, specificity and positive predictive value of 96%, 89.5%, and 95%, respectively, compared to the Widal test which was positive in 56 (73.68%) cases with a sensitivity, specificity, and positive predictive value of 72%, 87%, and 87%, respectively (P = 0.001). In the control group, seven (14.5%) cases tested positive for the Widal test and two (4.16%) for the typhidot (P = 0.001), yielding the sensitivity and specificity for the Widal test and the typhidot test of 63% and 83%, and 85% and 97%, respectively. We conclude that the Dot-EIA (enzyme immunoassay; typhidot) is a more sensitive and specific test which is easy to perform and more reliable compared to the Widal test and that it is useful in early therapy. PMID:21576347
Khoharo, Haji Khan
Fever of unknown origin as a presentation of colonic inflammatory myofibroblastic tumor in a 36-year-old female: A case report
Inflammatory myofibroblastic tumor is a rare type of lesion that mimics malignancy and has various clinical manifestations. The current study presents a 36-year-old female with a colonic mass, which closely resembled a stromal tumor during imaging. The patient experienced intermittent fever and slight abdominal pain for one month. The fever remained at ?38.5�C until the day of surgery. The patient underwent a right hemicolectomy and the preoperative fever disappeared and did not recur until the patient was discharged.
[Fever in returning travelers].
Travel-related illness is most often due to gastrointestinal, febrile, and dermatologic diseases. Fever in a returned traveler demands prompt attention because it may be a manifestation of an infection that could be rapidly progressive and lethal. The approach to the febrile patient should be stepwise and consider travel and exposure history. Malaria is the most common cause of fever in patients returning from Sub-Saharan Africa, whereas dengue is more frequent in travelers from other tropical and subtropical areas. Other serious diseases are typhoid and paratyphoid fever, amebic liver abscess, visceral leishmaniasis, leptospirosis and-rarely-viral hemorrhagic fevers. PMID:24557143
Burchard, G
Fever in immunocompromised hosts.
Fever is one of the most common reasons for the emergency department presentation of immunocompromised patients. Their differential diagnosis can be broad and includes rare or unexpected pathogens. Certain infectious causes of fever portend true emergencies; if they are not managed appropriately, rapid progression and death may ensue. This article reviews the diagnosis and management of fevers in patients immunocompromised by human immunodeficiency virus/AIDS, solid-organ and hematopoietic transplants, chemotherapy-induced neutropenia, and tumor necrosis factor-? inhibitors. Prompt recognition of the type of immunosuppression and delineation of possible causes of fever are critical for management of these complex patients. PMID:24176479
Patel, Devang M; Riedel, David J
The academic study of body temperature began in 1868. Since then, a variety of thermometers have been developed for clinical use. A working knowledge of these different thermometers, the various sites for taking temperature, and the normal range of body temperatures, is essential. As the pathogenesis of fever is being elucidated, and the cytokines involved identified, the risks and benefits of fever to the organism are becoming better understood. The importance of recognising diagnostic fever patterns should be stressed. Acetaminophen (paracetamol) and ibuprofen are accepted as the standard medical treatments for fever. PMID:11861992
Ng, D K K; Lam, J C Y; Chow, K W
Development and evaluation of loop-mediated isothermal amplification assay for detection of Crimean Congo hemorrhagic fever virus in Sudan.
Crimean-Congo hemorrhagic fever (CCHF) virus (CCHFV) activity has been detected in Kordufan region of the Sudan in 2008 with high case-fatality rates in villages and rural hospitals in the region. Therefore, in the present study, a reverse transcription (RT) loop-mediated isothermal amplification (RT-LAMP) assay was developed and compared to nested RT-PCR for rapid detection of CCHFV targeting the small (S) RNA segment. A set of RT-LAMP primers, designed from a highly conserved region of the S segment of the viral genome, was employed to identify all the Sudanese CCHFV strains. The sensitivity studies indicated that the RT-LAMP detected 10fg of CCHFV RNA as determined by naked eye turbidity read out, which is more likely the way it would be read in a resource-poor setting. This level of sensitivity is good enough to detect most acute cases. Using agarose gel electrophoresis, the RT-LAMP assay detected as little as 0.1fg of viral RNA (equivalent to 50 viral particle). There was 100% agreement between results of the RT-LAMP and the nested PCR when testing 10-fold serial dilution of CCHFV RNA. The specificity studies indicated that there was no cross-reactivity with other related hemorrhagic fever viruses circulating in Sudan including, Rift Valley fever virus (RVFV), Dengue fever virus, and yellow fever virus. The RT-LAMP was performed under isothermal conditions at 63�C and no special apparatus was needed, which rendered the assay more economical and practical than real-time PCR in such developing countries, like Sudan. In addition, the RT-LAMP provides a valuable tool for rapid detection and differentiation of CCHFV during an outbreak of the disease in remote areas and in rural hospitals with resource-poor settings. PMID:23542058
Osman, Hana A M; Eltom, Kamal H; Musa, Nasreen O; Bilal, Nasreldin M; Elbashir, Mustafa I; Aradaib, Imadeldin E
Shoulder Fever be Treated in Sepsis?
The febrile response is a critical host defense mechanism that favors the host and is only detrimental to the infecting pathogen.\\u000a The height of the fever elevation, the fever pattern, and pulse-temperature relationships have important diagnostic implications\\u000a which are eliminated if antipyretics are employed. Similarly, in many cases, the only way to assess the efficacy of antimicrobial\\u000a therapy in a
Burke A. Cunha
Climate impacts on environmental risks evaluated from space: a contribution to social benefits within the GEOSS Health Area: The case of Rift Valley Fever in Senegal
NASA Astrophysics Data System (ADS)
Climate and environment vary on many spatio-temporal scales, including climate change, with impacts on ecosystems, vector-borne diseases and public health worldwide. This study is to enable societal benefits from a conceptual approach by mapping climatic and environmental conditions from space and understanding the mechanisms within the Health Social Benefit GEOSS area. The case study is for Rift Valley Fever (RVF) epidemics in Senegal is presented. Ponds contributing to mosquitoes� thriving, were identified from remote sensing using high-resolution SPOT-5 satellite images. Additional data on ponds� dynamics and rainfall events (obtained from the Tropical Rainfall Measuring Mission) were combined with hydrological in-situ data. Localization of vulnerable hosts such as parked cattle (from QuickBird satellite) are also used. Dynamic spatio-temporal distribution of Aedes vexans density (one of the main RVF vectors) is based on the total rainfall amount and ponds� dynamics. While Zones Potentially Occupied by Mosquitoes (ZPOM) are mapped, detailed risks areas, i.e. zones where hazards and vulnerability occur, are expressed in percentages of parks where cattle is potentially exposed to mosquitoes� bites. This new conceptual approach, using remote-sensing techniques belonging to GEOSS, simply relies upon rainfall distribution also evaluated from space. It is meant to contribute to the implementation of integrated operational early warning system within the health application communities since climatic and environmental conditions (both natural and anthropogenic) are changing rapidly.
Tourre, Y. M.
An Epidemiologic and Immunologic Study of Boutonneuse Fever in Israel.
National Technical Information Service (NTIS)
Sera from suspected cases of rickettsioses were tested by fluorescent antibody and complement fixation. The former method revealed more cases of past and present infection than the latter. Follow-up bleedings from cases of murine typhus and spotted fever ...
M. A. Klingberg R. A. Goldwasser T. A. Swartz W. Klingberg Y. Steiman
Diabetes with Hypertension as Risk Factors for Adult Dengue Hemorrhagic Fever in a Predominantly Dengue Serotype 2 Epidemic: A Case Control Study
Background Dengue hemorrhagic fever (DHF) is a severe form of dengue, characterized by bleeding and plasma leakage. A number of DHF risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF. This study explored demographic and comorbidity risk factors for DHF in adult dengue epidemics in Singapore in year 2006 (predominantly serotype 1) and in year 2007�2008 (predominantly serotype 2). Methods A retrospective case-control study was conducted with 149 DHF and 326 dengue fever (DF) patients from year 2006, and 669 DHF and 1,141 DF patients from year 2007�2008. Demographic and reported comorbidity data were collected from patients previously. We performed multivariate logistic regression to assess the association between DHF and demographic and co-morbidities for year 2006 and year 2007�2008, respectively. Results Only Chinese (adjusted odds ratio [AOR]?=?1.90; 95% confidence interval [CI]: 1.01�3.56) was independently associated with DHF in year 2006. In contrast, age groups of 30�39 years (AOR?=?1.41; 95% CI:1.09�1.81), 40�49 years (AOR?=?1.34; 95% CI:1.09�1.81), female (AOR?=?1.57; 95% CI:1.28�1.94), Chinese (AOR?=?1.67; 95% CI:1.24�2.24), diabetes (AOR?=?1.78; 95% CI:1.06�2.97), and diabetes with hypertension (AOR?=?2.16; 95%CI:1.18�3.96) were independently associated with DHF in year 2007�2008. Hypertension was proposed to have effect modification on the risk of DHF outcome in dengue patients with diabetes. Chinese who had diabetes with hypertension had 2.1 (95% CI:1.07�4.12) times higher risk of DHF compared with Chinese who had no diabetes and no hypertension. Conclusions Adult dengue patients in Singapore who were 30�49 years, Chinese, female, had diabetes or diabetes with hypertension were at greater risk of developing DHF during epidemic of predominantly serotype 2. These risk factors can be used to guide triaging of patients who require closer clinical monitoring and early hospitalization in Singapore, when confirmed in more studies.
Pang, Junxiong; Salim, Agus; Lee, Vernon J.; Hibberd, Martin L.; Chia, Kee Seng; Leo, Yee Sin; Lye, David C.
Spotted fever in Brazil: a seroepidemiological study and description of clinical cases in an endemic area in the state of S�o Paulo.
During 1985-1995, illnesses clinically and epidemiologically compatible with Brazilian spotted fever were identified in 17 patients in the county of Pedreira, in the state of S�o Paulo, Brazil. Spotted-fever group rickettsial infection was confirmed by serology and/or immunostaining of tissues in 10 of these patients. Immunostaining confirmed infection in a 37-year-old pregnant patient, although rickettsial antigens were not demonstrable in the tissues of the fetus. A serosurvey was conducted in four localities in the county to determine the prevalence of subclinical or asymptomatic infections with spotted fever group rickettsiae. Five hundred and twenty-five blood samples were tested by an indirect immunofluorescence assay for antibodies reactive with Rickettsia rickettsii. Twenty-two (4.2%) of these samples demonstrated titers > or = 1:64. The results indicate that Brazilian spotted fever is endemic within this region of Brazil. PMID:11693878
de Lemos, E R; Alvarenga, F B; Cintra, M L; Ramos, M C; Paddock, C D; Ferebee, T L; Zaki, S R; Ferreira, F C; Ravagnani, R C; Machado, R D; Guimar�es, M A; Coura, J R
Male-female differences in the number of reported incident dengue fever cases in six Asian countries
Introduction Demographic factors, such as age and sex, are associated with the likelihood of exposure to Aedes aegypti, the vector for dengue. However, dengue data disaggregated by both sex and age are not routinely reported or analysed by national surveillance systems. This study analysed the reported number of incident dengue cases by age and sex for six countries in Asia. Methods Data for the Lao People's Democratic Republic, the Philippines, Singapore and Sri Lanka were obtained from DengueNet; the number of male and female dengue cases was available for four age groups (<�1, 1�4, 5�14 and ? 15 years) over a cumulative period of six to 10 years. Data for Cambodia (2010) and Malaysia (1997�2008) were obtained from their respective ministries of health. Results An excess of males was found among reported dengue cases ? 15 years of age. This pattern was observed consistently over several years across six culturally and economically diverse countries. Discussion These data indicated the importance of reporting data stratified by both sex and age since collapsing the data over all ages would have masked some of the male�female differences. To target preventive measures appropriately, assessment of gender by age is important for dengue because biological or gender-related factors can change over the human lifespan and gender-related factors may differ across countries.
Anker, Martha
Seir Model for Transmission of Dengue Fever in Selangor Malaysia
NASA Astrophysics Data System (ADS)
In this paper, we study a system of differential equations that models the population dynamics of SEIR vector transmission of dengue fever. The model studied breeding value based on the number of reported cases of dengue fever in Selangor because the state had the highest case in Malaysia. The model explains that maximum level of human infection rate of dengue fever achieved in a very short period. It is also revealed that there existed suitability result between theoretical and empirical calculation using the model. The result of SEIR model will hopefully provide an insight into the spread of dengue fever in Selangor Malaysia and basic form for modeling this area.
Syafruddin, S.; Noorani, M. S. M.
Severe Thrombotic Events Associated with Dengue Fever, Brazil
Dengue fever has been a major problem in hospital settings in Brazil for the past 15 years. The main concern has been the severe forms, i.e., dengue hemorrhagic fever and dengue shock syndrome. Hemorrhagic events of different degrees have also been a major concern. We report five cases of large vein thrombotic events associated with the acute phase of dengue fever, including a previously non-reported case of mesenteric vein thrombosis. Complications such as these could have been overlooked in the diagnosis of dengue fever, given that the major concern is the hemorrhagic event.
da Costa, Paulo Sergio Goncalves; Ribeiro, Geyza Machado; Junior, Cleber Soares; da Costa Campos, Lenilton
Travelers' Health: Yellow Book
... Home CDC 24/7: Saving Lives. Protecting People.� Travelers' Health All CDC Topics Search The CDC Note: Javascript ... message, please visit this page: About CDC.gov . Travelers' Health: Travel Safe, Travel Smart Share Compartir Yellow Book ...
HE OBSERYA'fIOX of yellow discoloration in cerebrospinal fluid (CSF) dates back to the earliest of lumbar punctures. In 1902 Milian and Chiray, 1 in their description of the supernatant fluid in subarachnoid hemorrhage, proposed the term \\
Donald G. Rosenberg; John T. Galambos
Delirium and High Fever Are Associated with Subacute Motor Deterioration in Parkinson Disease: A Nested Case-Control Study
Background In Parkinson disease (PD), systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients. Purpose To identify factors associated with subacute motor deterioration in PD patients with systemic inflammation. Methods The association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H�Y) stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H�Y stage, dementia, and psychosis history) and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium), the odds ratios for these factors were estimated as relative risks. Results Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up). Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P?=?0.001 for delirium and P?=?0.026 for body temperature), the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23�78.14) and 2.78 (95% CI: 1.13�6.83), respectively. Conclusions In patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration can persist for over 6 months.
Umemura, Atsushi; Oeda, Tomoko; Tomita, Satoshi; Hayashi, Ryutaro; Kohsaka, Masayuki; Park, Kwiyoung; Sugiyama, Hiroshi; Sawada, Hideyuki
Airborne Dust Models in Valley Fever Research
NASA Astrophysics Data System (ADS)
Dust storms (haboobs) struck Phoenix, Arizona, in 2011 on July 5th and again on July 18th. One potential consequence: an estimated 3,600 new cases of Valley Fever in Maricopa County from the first storm alone. The fungi, Coccidioides immitis, the cause of the respiratory infection, Valley Fever, lives in the dry desert soils of the American southwest and southward through Mexico, Central America and South America. The fungi become part of the dust storm and, a few weeks after inhalation, symptoms of Valley Fever may appear, including pneumonia-like illness, rashes, and severe fatigue. Some fatalities occur. Our airborne dust forecast system predicted the timing and extent of the storm, as it has done with other, often different, dust events. Atmosphere/land surface models can be part of public health services to reduce risk of Valley Fever and exacerbation of other respiratory and cardiovascular illness.
Sprigg, W. A.; Galgiani, J. N.; Vujadinovic, M.; Pejanovic, G.; Vukovic, A. J.; Prasad, A. K.; Djurdjevic, V.; Nickovic, S.
The exanthem of dengue fever: Clinical features of two US tourists traveling abroad
Background Dengue fever is the most common identifiable cause of acute febrile illness among travelers returning from South America, South Central Asia, Southeast Asia, and the Caribbean. Although the characteristic exanthem of dengue fever occurs in up to 50% of patients, few descriptions of it are found in the dermatology literature, and discussions of how to distinguish the dengue exanthem from other infectious disease entities are rare. Chikungunya fever is an emerging infectious disease now seen in returning US tourists and should be considered in the differential diagnosis of dengue fever in the appropriate patient. Objective The purpose of our study was to report two cases of dengue fever among returning US tourists, provide a review of dengue fever, offer an extensive differential diagnosis of dengue fever, and raise awareness among dermatologists of chikungunya fever. Methods This study includes clinical findings of two returning travelers, one who traveled to Mexico and the other to Thailand, complemented by a discussion of both dengue fever and its differential diagnosis. Limitations Limited to 2 case reports. Conclusion Dengue fever should be considered in the differential diagnosis of fever and rash in the returning traveler. Dermatologists should be aware of the distinctive exanthem of dengue fever. Recognition of the dengue fever rash permits a rapid and early diagnosis, which is critical, as dengue fever can progress to life-threatening dengue hemorrhagic fever or dengue shock syndrome.
Pincus, Laura B.; Grossman, Marc E.; Fox, Lindy P.
Hemophagocytic Syndrome in Classic Dengue Fever
A 24-year-old previously healthy girl presented with persistent fever, headache, and jaundice. Rapid-test anti-dengue virus IgM antibody was positive but anti-dengue IgG was nonreactive, which is suggestive of primary dengue infection. There was clinical deterioration during empiric antibiotic and symptomatic therapy. Bone marrow examination demonstrated the presence of hemophagocytosis. Diagnosis of dengue fever with virus-associated hemophagocytic syndrome was made according to the diagnostic criteria of the HLH 2004 protocol of the Histiocyte Society. The patient recovered with corticosteroid therapy. A review of literature revealed only a handful of case reports that showed the evidence that this syndrome is caused by dengue virus. Our patient is an interesting case of hemophagocytic syndrome associated with classic dengue fever and contributes an additional case to the existing literature on this topic. This case highlights the need for increased awareness even in infections not typically associated with hemophagocytic syndrome.
Ray, Sayantan; Kundu, Supratip; Saha, Manjari; Chakrabarti, Prantar
Tropical fevers: Management guidelines.
Tropical fevers were defined as infections that are prevalent in, or are unique to tropical and subtropical regions. Some of these occur throughout the year and some especially in rainy and post-rainy season. Concerned about high prevalence and morbidity and mortality caused by these infections, and overlapping clinical presentations, difficulties in arriving at specific diagnoses and need for early empiric treatment, Indian Society of Critical Care Medicine (ISCCM) constituted an expert committee to develop a consensus statement and guidelines for management of these diseases in the emergency and critical care. The committee decided to focus on most common infections on the basis of available epidemiologic data from India and overall experience of the group. These included dengue hemorrhagic fever, rickettsial infections/scrub typhus, malaria (usually falciparum), typhoid, and leptospira bacterial sepsis and common viral infections like influenza. The committee recommends a 'syndromic approach' to diagnosis and treatment of critical tropical infections and has identified five major clinical syndromes: undifferentiated fever, fever with rash / thrombocytopenia, fever with acute respiratory distress syndrome (ARDS), fever with encephalopathy and fever with multi organ dysfunction syndrome. Evidence based algorithms are presented to guide critical care specialists to choose reliable rapid diagnostic modalities and early empiric therapy based on clinical syndromes. PMID:24678147
Singhi, Sunit; Chaudhary, Dhruva; Varghese, George M; Bhalla, Ashish; Karthi, N; Kalantri, S; Peter, J V; Mishra, Rajesh; Bhagchandani, Rajesh; Munjal, M; Chugh, T D; Rungta, Narendra
[Spatiotemporal variation of eco-environmental frangibility based on remote sensing and catastrophe theory: a case study of Kenli County in Yellow River Delta, China].
Based on remote sensing and the nonlinear theories of entropy and catastrophe, the spatiotemporal variation of eco-environmental frangibility in Kenli County of Yellow River Delta was analyzed through the installation of sampling plots. The methods of analyzing and estimating eco-environmental frangibility were also established. The results indicated that in 1987-2005, the environment of Kenli County tended to deteriorating, and two catastrophes of environmental frangibility occurred, one in 1997, and the other in 2004. The former catastrophe was mainly caused by storm tide and the water shortage from Yellow River, with the main appearance characteristics being habitat change and dominant species substitution, while the latter one was mainly from the water shortage from Yellow River, increase of evaporation-precipitation ratio, a great deal construction of reservoir, and increases of traffic road and population density, with the main appearances of the changes in vegetation type and coverage ratio. The analysis on the spatial variations of the environmental frangibility along the directions of different distances to the Yellow River and to the ocean testified the spatial gradual change pattern of the frangibility. This research was a new attempt, and provided an effective way for the quantitative measurement of environmental frangibility. PMID:18975758
Wang, Rui-yan; Zhao, Geng-xing; Jiang, Shu-qian; Wang, Ai-ling; Wang, Jing
Using Thematic Mapper data for change detection and sustainable use of cultivated land: a case study in the Yellow River delta, China
Preservation of cultivated land is one of China's four basic strategic policies. Timely land use monitoring is a prerequisite of cultivated land management and sustainable utilization. Using digital satellite remote sensing techniques, the intention is to develop a workable procedure for cultivated land change detection in the Yellow River delta region. Four detection methods were assessed. The assessment, in general,
G. X. Zhao; G. Lin; T. Warner
[Metal fume fever, an almost forgotten disease].
Metal fume fever is an ancient and almost forgotten occupational disease found among welders. Diagnosis is made difficult by the frequency and the non-specific flue-like symptomatology. We present the cases of three patients admitted for developing the symptoms after being exposed to welding fumes. Treatment was symptom based. Severe cases have been described after exposure to military fumes. PMID:20378299
Yordanov, Y; Cantin, D; Le Guerrou�, G; Pourriat, J-L
... ticks. The bacteria spread to humans through a tick bite. In the western United States, the bacteria are ... develop about 2 to 14 days after the tick bite. They may include: Chills Confusion Fever Headache Muscle ...
Valley Fever (Coccidioidomycosis)
... 2-3 months, but some people will need antifungal medication. Certain groups of people are at higher ... Testing How is valley fever diagnosed? Treatment & Outcomes Antifungal treatment, resolution of symptoms Health Professionals Technical information ...
National Technical Information Service (NTIS)
Prevention of Lassa Fever requires elucidation of its epidemiology, and will likely require the preparation and use of a vaccine. However, investigations in to Lassa Virus infection carry a definite risk, and measures should be available to protect invest...
J. D. Frame
A 29-year-old Japanese man presented with fever, dyspnoea and non-productive cough after massive inhalation of evaporant from a polytetrafluoroethylene-coated cooking pan. Chest CT scan showed diffuse interstitial infiltration in both lungs. Based on the patient history, images and the pan he brought to the hospital, polymer fume fever was strongly suspected. His symptoms dramatically improved over the following 2 days after admission. PMID:23230259
Shimizu, Taro; Hamada, Osamu; Sasaki, Akinori; Ikeda, Mari
Fever is an excellent example of neuroimmunomodulation in that mediators of immunity initiate a pathway to raise the thermoregulatory set-point, resulting in behavioral and physiological responses that increase body temperature. This rise in temperature is thought to be adaptive, facilitating host defenses. Many cytokines are endogenous mediators of fever (i.e. endogenous pyrogens), including interleukin (IL)-1?, IL-6 and others. Tumor necrosis
Matthew J. Kluger; Wieslaw Kozak; Lisa R. Leon; Dariusz Soszynski; Carole A. Conn
Spring and summer can bring misery to millions who suffer from allergic reactions to pollen. Hay fever can cause runny noses, streaming eyes and sore throats. Sadly, many treatments for this distressing condition are not recommended during pregnancy because of fears surrounding the effect on the unborn child. This article presents the causes and treatments of hay fever and explores the alternatives for use during pregnancy which may be able to relieve or minimise the unpleasant symptoms without harming the baby. PMID:24873116
Wiseberg, Max
Hyperendemic Focus of Q Fever Related to Sheep and Wind
Q fever is a worldwide zoonosis which is caused by Coxiella burnetii and presents as both acute or chronic cases. The disease can be transmitted from animal reservoirs to humans by the inhalation of infected aerosols. The authors investigated the epidemiology of Q fever in the Bouches-du-Rhone district of southern France. The study area was centered around the small town
Herve Tissot-Dupont; Sylvie Torres; Meyer Nezri; Didier Raoult
An overview of Crimean Congo Hemorrhagic Fever in Iran
Crimean- Congo Hemorrhagic Fever (CCHF) is a viral zoonotic tick-born disease with a mortality rate of up to 50% in humans. After a short incubation period, the disease is characterized by sudden fever, chills, severe headache, dizziness, back, and abdominal pain. Additional symptoms can include nausea, vomiting, diarrhea, neuropsychiatric, and cardiovascular changes. In severe cases, hemorrhagic manifestations, ranging from petechiae
Chinikar S; Goya MM; Zeinali M; Haeri A
An Insular Outbreak of Dengue Hemorrhagic Fever. I. Epidemiologic Observations.
National Technical Information Service (NTIS)
Between 10 July and 23 October 1966 an epidemic of dengue hemorrhagic fever occurred on an island in the Gulf of Thailand. Fourteen cases of dengue-shock syndrome (with one death) and 20 of hemorrhagic-fever syndrome due to dengue occurred. An additional ...
P. E. Winter T. M. Yuill S. Udomaskdi D. Gould S. Nantapanich
Climate change or variability? The case of Yellow river as indicated by extreme maximum and minimum air temperature during 1960�2004
Summary��The spatial and temporal variability of winter extreme low-temperature events and summer extreme high-temperature events was\\u000a investigated using daily air temperature series (1960�2004) from 66 sites in the Yellow River basin, China, with the help\\u000a of Mann�Kendall trend test method. In this study an extreme temperature event is defined by exceeding or falling below various\\u000a threshold values of daily maximum
Q. Zhang; C.-Y. Xu; Z. Zhang; G. Ren; Y. D. Chen
Characterisation of inflammatory response, coagulation, and radiological findings in Katayama fever: a report of three cases at the Medical University of Vienna, Austria
Background Katayama fever is an acute clinical condition characterised by high fever, dry cough and general malaise occurring during early Schistosoma spp. infection. It is predominantly reported in travellers from non-endemic regions. Whereas the immunological response to Schistosoma infection is well characterised, alterations in inflammatory markers and coagulation in response to acute infection are poorly understood. Methods Here we report the clinical, laboratory and radiological characteristics of three returning travellers with Katayama fever. Inflammatory markers and coagulation status were assessed repeatedly during follow-up to characterise the host response to infection. Radiographic findings were correlated with clinical and laboratory markers. Results Clinical symptoms were suggestive of a significant inflammatory response in all patients including high fever (>39�C), cough, and general malaise. Classical inflammatory markers including blood sedimentation rate, C-reactive protein, and serum amyloid A were only moderately elevated. Marked eosinophilia (33�42% of white blood cells) was observed and persisted despite anti-inflammatory and anthelminthic treatment for up to 32�weeks. Analysis of blood coagulation markers indicated increased coagulability reflected by elevated D-dimer values (0.57�1.17�?g/ml) and high thrombin generating potentials (peak thrombin activity: 311�384 nM). One patient showed particularly high levels of microparticle-associated tissue factor activity at initial presentation (1.64�pg/ml). Multiple pulmonary and hepatic opacities demonstrated by computed tomography (CT) scanning were associated with raised inflammatory markers in one patient. Conclusions The characterisation of the inflammatory response, blood coagulation parameters and radiological findings in three patients adds to our current understanding of Katayama fever and serves as a starting point for further systematic investigations of the pathophysiology of this acute helminthic infection.
The body temperature is influenced among other things by time of day or age and exhibits a Gaussian inter-individual distribution. If measured orally, normal values vary between 35.6 degrees C and 38.2 degrees C. Temperature exceeding the 99th percentile (> 37.7 degrees C) can therefore be interpreted as fever. Nevertheless, an universally accepted definition of fever does not exist. Viral infection is the most frequent cause of acute fever in infants, even in the absence of a source. Bacterial infections are by far a rarer reason. Nevertheless, below the age of 3 years, acute fever is a ticklish issue because of the higher risk for rapidly evolving life-threatening invasive bacterial infections. Following introduction of vaccination against Haemophilus influenzae type b (Hib), Streptococcus pneumoniae has advanced to the most frequent cause of invasive bacterial infections in infants. Fever is rarely seen in newborns (age 1-28 days), but when present, it is more frequently serious. Around 12% of these newborns show an invasive bacterial infection. Therefore, a full workup for sepsis is strongly indicated. This includes cultures of blood,urine and cerebrospinal fluid plus a chest radiography. In addition, immediate start of an empirical intravenous antibiotic therapy and monitoring in a hospital setting are necessary. Apart from this exception, primary antibiotic therapy is rarely necessary in fever without a detectable focus and source. Also, routine prescription of antipyretics is not indicated. Though paracetamol may improve well-being and drinking behavior of infants, it does neither shorten the duration of fever duration, nor prevent febrile seizures. PMID:17048185
Kahlert, Ch; Nadal, D
Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a cross-sectional study
Background Use of diagnostics in integrated community case management (iCCM) of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs) trained and provided with malaria rapid diagnostic tests (RDTs) and respiratory rate timers (RRTs) to practice iCCM. Methods A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10. Results Most (86%, 365/423) households resided within a kilometre of a CHW�s home, compared to 26% (111/423) residing within 1 km of a health facility (p?0.001). The median walking time by caregivers to a CHW was 10 minutes (IQR 5�20). The first option for care for febrile children in the month preceding the survey was CHWs (40%, 242/601), followed by drug shops (33%, 196/601). Fifty-seven percent (243/423) of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1�3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11�2.68) more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1�3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10�0.36) less likely to utilize CHW services compared to those households residing within 1 km of a CHW. A majority (79%, 336/423) of respondents thought CHWs services were better with RDTs, and 89% (375/423) approved CHWs� continued use of RDTs. Eighty-six percent (209/243) of respondents who visited a CHW thought RRTs were useful. Conclusion ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three-month period. However, one-third of caregivers used drug shops in spite of the presence of CHWs.
National Technical Information Service (NTIS)
There exists a need in the oceanography community to be able to produce climatologies of remote or poorly sampled shallow water areas through remote sensing techniques. Our goal was to construct a three-dimensional thermal structure of the Yellow Sea base...
C. R. Fralick
Ebola Hemorrhagic Fever Outbreaks in Gabon, 1994�1997: Epidemiologic and Health Control Issues
From the end of 1994 to the beginning of 1995, 49 patients with hemorrhagic symptoms were hospitalized in the Makokou General Hospital in northeastern Gabon. Yellow fever (YF) virus was first diagnosed in serum by use of polymerase chain reaction followed by blotting, and a vaccination campaign was immediately instituted. The epidemic, known as the fall 1994 epidemic, ended 6
Sylvain Baize
Study of Child-Invented Health Educational Games on Dengue Fever
The study's goal was to demonstrate the ability of an eight-year-old child to create educational games on the topic of dengue fever control. A naturalistic descriptive case study method was employed. The child had two dengue fever educational game creation activities. The study demonstrated that a child could develop functional games related to dengue fever control. The study, however, revealed
Jeffrey L Lennon; David W Coombs
Clinicopathologic Features of Q Fever Patients with Acute Hepatitis
Background Q fever caused by Coxiella burnetii presents with diverse clinical and pathological features including subclinical or cholestatic hepatitis. However, the pathological features of liver biopsies from patients with Q fever have not been well described. Methods Clinical features and pathological findings of liver biopsies were reviewed in seven cases of Q fever that were confirmed by serological, microbiological, or molecular tests. Results All cases presented with fever. Liver enzymes were mildly elevated except one case with marked hyperbilirubinemia. Characteristic fibrin ring granulomas were present in three cases, epithelioid granulomas with eosinophilic infiltration in two cases, extensive extravasated fibrins without ring configuration mimicking necrotizing granuloma in one case, and acute cholangitis without granuloma in one case. All cases were treated with antibiotics for 20 days. Six cases were completely cured, but one suffered from multiorgan failure. Conclusions C. burnetii infection is uncommon, but should always be considered in patients with acute hepatitis and fever. Because variable-sized circumferential or radiating fibrin deposition was a consistent feature of the present cases, Q fever can be strongly suggested by pathological features and confirmed by serological and/or molecular tests.
Lee, Miji; Jang, Jae Jeong; Kim, Yang Soo; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Sung-Han
Fatal dengue hemorrhagic fever in Cuba, 1997
Objectives: After more than 15 years without dengue activity, a dengue II epidemic was reported in Cuba in 1997. Three thousand and twelve serologically confirmed cases were reported, with 205 dengue hemorrhagic fever\\/dengue shock syndrome (DHF\\/DSS) cases and 12 fatalities. This report presents the clinical, serologic, and virologic findings in the 12 fatal DHF\\/DSS cases.Methods: Serum and necropsy samples were
Maria G. Guzm�n; Mayling Alvarez; Rosmari Rodriguez; Delfina Rosario; Susana V�zquez; Luis Vald�s; Maria V. Cabrera; Gustavo Kouri
Reemergence of Rift Valley Fever, Mauritania, 2010
A Rift Valley fever (RVF) outbreak in humans and animals occurred in Mauritania in 2010. Thirty cases of RVF in humans and 3 deaths were identified. RVFV isolates were recovered from humans, camels, sheep, goats, and Culex antennatus mosquitoes. Phylogenetic analysis of isolates indicated a virus origin from western Africa.
Faye, Ousmane; Ba, Hampathe; Ba, Yamar; Freire, Caio C.M.; Faye, Oumar; Ndiaye, Oumar; Elgady, Isselmou O.; Zanotto, Paolo M.A.; Diallo, Mawlouth
Reemergence of Rift Valley fever, Mauritania, 2010.
A Rift Valley fever (RVF) outbreak in humans and animals occurred in Mauritania in 2010. Thirty cases of RVF in humans and 3 deaths were identified. RVFV isolates were recovered from humans, camels, sheep, goats, and Culex antennatus mosquitoes. Phylogenetic analysis of isolates indicated a virus origin from western Africa. PMID:24447381
Faye, Ousmane; Ba, Hampath�; Ba, Yamar; Freire, Caio C M; Faye, Oumar; Ndiaye, Oumar; Elgady, Isselmou O; Zanotto, Paolo M A; Diallo, Mawlouth; Sall, Amadou A
Crimean-Congo Hemorrhagic Fever Virus, Greece
Seroprevalence of Crimean-Congo hemorrhagic fever virus (CCHFV) is high in some regions of Greece, but only 1 case of disease has been reported. We used 4 methods to test 118 serum samples that were positive for CCHFV IgG by commercial ELISA and confirmed the positive results. A nonpathogenic or low-pathogenicity strain may be circulating.
Sidira, Persefoni; Larichev, Victor; Gavrilova, Ludmila; Kuzmina, Ksenia; Mousavi-Jazi, Mehrdad; Mirazimi, Ali; Stroher, Ute; Nichol, Stuart
Lassa virus, an Old World arenavirus (family Arenaviridae), is the etiological agent of Lassa fever, a severe human disease that is reported in more than 100,000 patients annually in the endemic regions of West Africa with mortality rates for hospitalized patients varying between 5-10%. Currently, there are no approved vaccines against Lassa fever for use in humans. Here, we review the published literature on the life cycle of Lassa virus with the specific focus put on Lassa fever pathogenesis in humans and relevant animal models. Advancing knowledge significantly improves our understanding of Lassa virus biology, as well as of the mechanisms that allow the virus to evade the host�s immune system. However, further investigations are required in order to design improved diagnostic tools, an effective vaccine, and therapeutic agents.
Yun, Nadezhda E.; Walker, David H.
The success of colchicine therapy in the management of familial Mediterranean fever has provided new direction to investigations into the pathogenesis of this disease. Examination of HLA antigen frequencies in 53 patients with familial Mediterranean fever and appropriate controls, as well as various immunologic studies have yielded no significant differences. However, B lymphocyte typing and assays for immune complexes, lymphokines and prostaglandins may be of potential interest. Preliminary studies indicate that leukocytes of patients with familial Mediterranean fever release increased amounts of lysozyme (P<0.01), when subjected to high temperatures, and of both lysozyme and myeloperoxidase at low osmotic concentrations. The known and potential effects of colchicine on leukocyte and cellular metabolism, and the current status of colchicine prophylaxis are reviewed. In patients receiving an optimum colchicine dose of 1.5 to 1.8 mg per day, side effects have been minimal and the frequency of attacks has been decreased significantly.
Schwabe, Arthur D.; Terasaki, Paul I.; Barnett, Eugene V.; Territo, Mary C.; Klinenberg, James R.; Peters, Robert S.
Lassa virus, an Old World arenavirus (family Arenaviridae), is the etiological agent of Lassa fever, a severe human disease that is reported in more than 100,000 patients annually in the endemic regions of West Africa with mortality rates for hospitalized patients varying between 5-10%. Currently, there are no approved vaccines against Lassa fever for use in humans. Here, we review the published literature on the life cycle of Lassa virus with the specific focus put on Lassa fever pathogenesis in humans and relevant animal models. Advancing knowledge significantly improves our understanding of Lassa virus biology, as well as of the mechanisms that allow the virus to evade the host's immune system. However, further investigations are required in order to design improved diagnostic tools, an effective vaccine, and therapeutic agents. PMID:23202452
Yun, Nadezhda E; Walker, David H
The Pathogenesis of Rift Valley Fever
Rift Valley fever (RVF) is an emerging zoonotic disease distributed in sub-Saharan African countries and the Arabian Peninsula. The disease is caused by the Rift Valley fever virus (RVFV) of the family Bunyaviridae and the genus Phlebovirus. The virus is transmitted by mosquitoes, and virus replication in domestic ruminant results in high rates of mortality and abortion. RVFV infection in humans usually causes a self-limiting, acute and febrile illness; however, a small number of cases progress to neurological disorders, partial or complete blindness, hemorrhagic fever, or thrombosis. This review describes the pathology of RVF in human patients and several animal models, and summarizes the role of viral virulence factors and host factors that affect RVFV pathogenesis.
Ikegami, Tetsuro; Makino, Shinji
Children are commonly brought to doctors mid emergency departments for evaluation of fewer. Fever provokes anxiety in parents and concern in physicians. This article examines some factors behind the fear of fever, emphasizing the behaviors of physicians that tend to exaggerate and misdirect parental concern. Measurement of fever is surprisingly controversial. Some reasons for this are examined. As tympanic infrared
Howard M. Corneli
Dengue fever and dengue haemorrhagic fever in adolescents and adults
Dengue fever (DF) is endemic in tropical and subtropical zones and the prevalence is increasing across South-east Asia, Africa, the Western Pacific and the Americas. In recent years, the spread of unplanned urbanisation, with associated substandard housing, overcrowding and deterioration in water, sewage and waste management systems, has created ideal conditions for increased transmission of the dengue virus in tropical urban centres. While dengue infection has traditionally been considered a paediatric disease, the age distribution of dengue has been rising and more cases have been observed in adolescents and adults. Furthermore, the development of tourism in the tropics has led to an increase in the number of tourists who become infected, most of whom are adults. Symptoms and risk factors for dengue haemorrhagic fever (DHF) and severe dengue differ between children and adults, with co-morbidities and incidence in more elderly patients associated with greater risk of mortality. Treatment options for DF and DHF in adults, as for children, centre round fluid replacement (either orally or intravenously, depending on severity) and antipyretics. Further data are needed on the optimal treatment of adult patients.
Tantawichien, Terapong
Fever is considered a key actor of innate immunity aimed to fight infection. A new investigation reports an association of the use of antipyretic drugs with poorer outcome among patients with sepsis. In contrast, high temperature in non-infectious intensive care patients is associated with higher mortality.
SOME years ago Prof. Helmholtz, in a letter to you, gave an account of a remedy he had found for ``hay fever.'' This was simply to treat the part of the nose, which seems to be the seat of the trouble, with sulphate of quinine solution by pouring it into the nose with a pipette, while lying on a sofa
J. B. Hannay
National Technical Information Service (NTIS)
122 Units of plasma were obtained in Liberia from convalescents from Lassa fever. 98 units were forwarded to the USAMRIID for its use, of these, 59 were found to have Log Neutralization titers of 00.3 or higher, indicating a protective value against Lassa...
J. D. Frame
National Technical Information Service (NTIS)
One hundred forty-one Lassa Fever Immune Plasma (LFIP)Units have been obtained by plasmapheresis in the last 12 months; 59 have been forwarded to USAMRIID and 16 more are awaiting shipment to the United States. Virological and serological testing for Lass...
J. D. Frame
Fungal Pneumonia: A Silent Epidemic Coccidioidomycosis (Valley Fever)
... cases are being detected and reported i From soil to lungs Valley fever occurs in people who ... caused by the fungus Coccidioides, which lives in soil. People can become infected by inhaling fungal spores. ...
Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever.
A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone. PMID:8183156
Leong, K W; Srinivas, P
An Epidemiologic and Immunologic Study of Boutonneuse Fever in Israel.
National Technical Information Service (NTIS)
Sera from cases of suspected rickettsioses were tested by fluorescent antibody (FA) and complement fixation (CF). FA revealed many more past and present infections than CF. Spotted fever (SF) infections were more numerous and widespread than in previous y...
M. A. Klingberg R. A. Goldwasser T. A. Swartz W. Klingberg Y. Steinman
Filgrastim as a Rescue Therapy for Persistent Neutropenia in a Case of Dengue Hemorrhagic Fever with Acute Respiratory Distress Syndrome and Myocarditis
Pathogenesis of dengue involves suppression of immune system leading to development of characteristic presentation of haematological picture of thrombocytopenia and leucopenia. Sometimes, this suppression in immune response is responsible for deterioration in clinical status of the patient in spite of all specific and supportive therapy. Certain drugs like steroids are used for rescue therapy in conditions like sepsis. We present a novel use of filgrastim as a rescue therapy in a patient with dengue hemorrhagic fever (DHF) with acute respiratory distress syndrome (ARDS), myocarditis, and febrile neutropenia and not responding to standard management.
Deepak, Desh; Garg, Rakesh; Pawar, Mridula; Banerjee, Neerja; Solanki, Rakesh; Maurya, Indubala
Background Dengue is a disease which is now endemic in more than 100 countries of Africa, America, Asia and the Western Pacific. It is transmitted to the man by mosquitoes (Aedes) and exists in two forms: Dengue Fever and Dengue Haemorrhagic Fever. The disease can be contracted by one of the four different viruses. Moreover, immunity is acquired only to the serotype contracted and a contact with a second serotype becomes more dangerous. Methods The present paper deals with a succession of two epidemics caused by two different viruses. The dynamics of the disease is studied by a compartmental model involving ordinary differential equations for the human and the mosquito populations. Results Stability of the equilibrium points is given and a simulation is carried out with different values of the parameters. The epidemic dynamics is discussed and illustration is given by figures for different values of the parameters. Conclusion The proposed model allows for better understanding of the disease dynamics. Environment and vaccination strategies are discussed especially in the case of the succession of two epidemics with two different viruses.
Derouich, M; Boutayeb, A; Twizell, EH
Treatment of Crimean-Congo hemorrhagic fever
Crimean-Congo hemorrhagic fever (CCHF) has the most extensive geographic range of the medically significant tick-borne viruses, occurring from western China across southern Asia to eastern Europe and South Africa. The causative agent is a negative-sense, single-stranded RNA virus in the genus Nairovirus, family Bunyaviridae. In published reports, the case fatality rate has generally ranged from 10% to 50%. Sporadic cases
Onder Ergonul
Vaccine Platforms to Control Arenaviral Hemorrhagic Fevers.
Arenaviruses are rodent-borne emerging human pathogens. Diseases caused by these viruses, e.g., Lassa fever (LF) in West Africa and South American hemorrhagic fevers (HFs), are serious public health problems in endemic areas. We have employed replication-competent and replication-deficient strategies to design vaccine candidates potentially targeting different groups "at risk". Our leader LF vaccine candidate, the live reassortant vaccine ML29, is safe and efficacious in all tested animal models including non-human primates. In this study we showed that treatment of fatally infected animals with ML29 two days after Lassa virus (LASV) challenge protected 80% of the treated animals. In endemic areas, where most of the target population is poor and many live far from health care facilities, a single-dose vaccination with ML29 would be ideal solution. Once there is an outbreak, a fast-acting vaccine or post-exposure prophylaxis would be best. The 2(nd) vaccine technology is based on Yellow Fever (YF) 17D vaccine. We designed YF17D-based recombinant viruses expressing LASV glycoproteins (GP) and showed protective efficacy of these recombinants. In the current study we developed a novel technology to clone LASV nucleocapsid within YF17D C gene. Low immunogenicity and stability of foreign inserts must be addressed to design successful LASV/YFV bivalent vaccines to control LF and YF in overlapping endemic areas of West Africa. The 3(rd) platform is based on the new generation of alphavirus replicon virus-like-particle vectors (VLPV). Using this technology we designed VLPV expressing LASV GP with enhanced immunogenicity and bivalent VLPV expressing cross-reactive GP of Junin virus (JUNV) and Machupo virus (MACV), causative agents of Argentinian and Bolivian HF, respectively. A prime-boost regimen required for VLPV immunization might be practical for medical providers, military, lab personnel, and visitors in endemic areas. PMID:23420494
Carrion, Ricardo; Bredenbeek, Peter; Jiang, Xiaohong; Tretyakova, Irina; Pushko, Peter; Lukashevich, Igor S