ABSTRACT
OBJECTIVE: To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. METHODS: An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C) and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay. RESULTS: Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%), and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100%) had strong-positive IgG responses to scrub typhus. All but one control (10%) had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. DISCUSSION: This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.
ABSTRACT
Microalbuminuria is a known marker of kidney disease. It is used to monitor chronic kidney disease in diabetes mellitus and hypertension. Its association with early cardiovascular disease is well established. Microalbuminuria is hallmark of endothelial dysfunction, which is the early step in progressive atherosclerosis. Urine Albumin-to-creatinine ratio is preferred method of measurement of microalbuminuria and is performed on a spot urine sample. It is a precise index of urinary albumin excretion and is not affected by state of hydration, osmotic diuresis and concentrating defects. MA and endothelial dysfunction are interrelated and very appropriately called as "vicious twins"; they are implicated in the initiation and progression of atherosclerosis. Routine use of measurement of MA in clinical practice in patients with suspected acute coronary syndrome will help to identify those with poorer prognosis and could be used not only for risk strticfication but also as a target for treatment. Early preventions and interventions can reduce MA. It is also possible to introduce therapies which have shown efficacy in reducing UAE, such as ACE inhibitors, ARBs and statins to prevent further deterioration in renal function and CV complications. Hewever more prospective trials are needed to prove the advantage of routine measurement of MA in suspected coronary syndrome