Mycoplasma Genitalium and Chlamydia Trachomatis Prevalence, Co-Infection and Relevant Factors in An Epidemiology Study (2016 - 2019) In Ho Chi Minh, Vietnam

Chlamydia trachomatis and Mycoplasma genitalium are two common types of sexually transmitted infections. However, currently in Vietnam, there is no report on the rate of patients infected by the two types of bacteria. In this study, there were 6194 patients visiting the STI clinic of the HCMC Hospital of Dermato-Venereology, Vietnam, from 2016 to 2019. The results show that the proportion of patients positive with CT and MG is in-dependent on time. The infection rate is mainly at the age of 21 - 30 (53.4%). The CT infection rate in female and male is equal (17.3% vs 17.4%) while the rate of MG in female is lower (5.1% vs 7, 8%). The rate of pa-tients co-infected with either CT or MG is 4.5%, 17% and 5.7% respectively, time independence. This study may give better understandings of the epidemiological characteristics of MG and CT in Vietnam.

Intestinal mucormycosis in a patient with COVID-19: A case report

The novel coronavirus disease (COVID-19) has spread to all the continents posing a serious threat to global health. It can present with myriad symptoms and complications including susceptibility to fungal co-infections. We hereby describe a case of mucormycosis in a 17 year old COVID-19 positive female with no known comorbidities presenting with abdominal pain and distention and ultimately developing intestinal perforation. Early identication of the symptoms is essential to make a correct and early diagnosis to prevent complications.

Corticosteroid therapy associated with COVID-19: an ally or a risk factor for the establishment of secondary fungal co-infections?

Corticosteroid therapy to combat inflammation caused by SARS-CoV-2 seems to be a risk factor for developing secondary fungal co-infections. PubMed and ScienceDirect databases were searched, with the following word groups: [(aspergillosis OR mucormycosis OR candidiasis) AND (coronavirus disease) AND (corticoids). The selected articles present the main risk factors related to the establishment of secondary fungal co-infections in COVID-19 patients. Corticosteroid therapy used to combat inflammation caused by SARS-CoV-2 has been shown to be strongly associated with the establishment of mucormycosis and aspergillosis. Mucormycosis has been the main fungal co-infection related to corticosteroid therapy, causing a high number of deaths in COVID-19 patients. Diabetes mellitus was the most prevalent comorbidity, especially for the establishment of mucormycosis. Dexamethasone use seems to be associated with mucormycosis emergence and death. However, aspergillosis showed a greater relationship with patient recovery. Thus, risk factors such as diabetes mellitus, combined with corticosteroid use, have shown a relationship to the establishment of mucormycosis. The corticosteroids used in COVID-19 patients should be individually analyzed, considering the patient's medical history and the risk/benefit ratio of the use of these drugs.

Association Of Typhoid Fever With Hepatitis A And Hepatitis E Viral Infections: A South Indian Perspective

Introduction: Endemic, enteric infectious agents continue to wreak havoc on the health of communities in our country. The present study was undertaken with the aim of elucidating the association of typhoid fever with Hepatitis A(HAV) and Hepatitis E (HEV) viral infections as there is a paucity of data regarding the prevalence of concurrent infections with these pathogens from our region. Materials and Methods: Of the serum specimens received during February – March 2018, 100 samples were routinely tested by Widal tube agglutination method. The same specimens were analysed for the presence of HAVand HEV IgM antibodies by ELISA. Results: The prevalence of typhoid, HAV and HEV in the study population was 3 %, 1% and 3% respectively while co-infection with typhoid and HEVwas found in 1% of cases. Conclusions: There is a need to conduct similar studies but on a larger scale to correctly estimate the burden of co-infections with common enteric pathogens.

Seroprevalence Of Syphilis And Co-Infections With Hepatitis B Virus, Hepatitis C Virus And Hiv In A Tertiary Care Hospital In Mumbai

Syphilis does not only affect the individual but is also a public health problem. It also increases risk of HIV infection and can cause lifelong morbidity among children born to infected mothers. High risk behaviour like multiple sex partners and unsafe injection practices not only increases chances of acquiring HIV but increase the risk for HBV and HCV transmission. This study was undertaken to study the seroprevalence of Syphilis and co-infection with HIV, HBVand HCVin a tertiary care hospital of Mumbai. Material and Methods: A total of 4160 blood samples received in the Regional STI Training, Research and Reference Laboratory, Department of Microbiology, Mumbai from patients attending the Suraksha clinic, referrals from high risk cases from peripheral hospitals, various STI clinics and ART patients were received from January to December 2016. Syphilis testing was performed using VDRL antigen from Institute of Serology, Kolkata. All the sera reactive in qualitative and quantitative VDRL test were confirmed for antitreponemal antibodies by TPHA test. Biological false positives (BFP) estimated Testing for HIV was done as per National guidelines. Hepatitis B surface Antigen and Hepatitis C virus antibody testing were done using ELISAmethods. Results: The seroprevalence of Syphilis in our study was 3% with BFP of 0.7 %. HIV, HBV and HCV seropositivity in the study was 6.63%, 3.36% and 1.73% respectively. The co-infection rate of HIV, HBV and HCV with Syphilis in the study was 0.21%, 0.16% and 0.07% respectively. Coinfection of HBVand HCVwith HIVwas 0.28% and 0.26% respectively. HBVand HCVco-infection was 0.04%. Conclusion: Public health interventions should be carried out to promote awareness of syphilis among physicians and populations at risk in India. The increased risk of acquiring HBV, HCVand HIVin STI clinic attendees warrants screening the high-risk population for these viral infections.

Sexually transmitted pathogens, coinfections and risk factors in patients attending obstetrics and gynecology clinics in Jalisco, Mexico / Patógenos de transmisión sexual, coinfecciones y factores de riesgo en pacientes que asisten a clínicas de obstetricia y ginecología en Jalisco, México

Abstract: Objective: To determine the frequency of nine sexually transmitted pathogens, coinfections and risk factors in patients attending obstetrics and gynecology clinics in Jalisco, Mexico. Materials and methods: Samples from 662 patients attending obstetrics and gynecology clinics were analyzed. Treponema pallidum, HIV, and HCV were detected by serology. HPV was detected by Polimerase Chain Reaction (PCR), and its genotype was determined by Restriction Fragment Length Polymorphism (RFLP). Trichomonas vaginalis, HSV-1, HSV-2, Mycoplasma genitalium, Neisseria gonorrhoeae and T. pallidum were detected by multiplex PCR. Results: By serology, HIV frequency was 6.8%, T. pallidum was 2.26%, and HCV was 0.15%. By PCR, HPV frequency was 13.9%, (more frequent genotype was 16, 33.7%), followed by T. vaginalis (14.2%), HSV-1 (8.5%), M. genitalium (2,41%), N. gonorrhoeae (2.11%), HSV-2 (1.8%), and T. pallidum (1.05%). Patients infected with T. vaginalis were more likely to have multiple coinfections (p = 0.01). Conclusion: The frequency of HPV, HVS-1, HSV-2, M. genitalium and T. vaginalis was lower than that reported. However, a high frequency of HIV, T. pallidum, and N. gonorrhoeae was detected.

Resumen: Objetivo: Determinar la frecuencia de nueve patógenos de transmisión sexual, coinfecciones y factores de riesgo en pacientes que acudieron a una consulta de ginecología y obstetricia en Jalisco, México. Material y métodos: Se analizaron muestras de 662 pacientes que asistieron a la consulta de ginecología y obstetricia. Se detectaron Treponema pallidum, VIH y VHC mediante serología. Se detectó VPH por Reacción de Cadena de Polimerasa (PCR) y sus genotipos se detectaron por Polimorfismos de Longitud de Fragmentos de Restricción (RFLP). Se detectaron Trichomonas vaginalis, VHS-1,VHS-2, Mycoplasma genitalium, Neisseria gonorrhoeae y T. pallidum por PCR múltiple. Resultados: Por serología, la frecuencia deVIH fue 6.8%, de T. pallidum fue 2.26% y deVHC fue 0.15%. Por PCR, la frecuencia más alta fue deVPH (13.9%, el genotipo más frecuente fue el 16, 33.7%), seguida deT. vaginalis (14.2%), VHS-1 (8.5%), M. genitalium (2.41%), N. gonorrhoeae (2.11%), VHS-2 (1.8%) y T. pallidum (1.05%). Los pacientes infectados con T. vaginalis presentaron más probabilidades de tener múltiples coinfecciones (p = 0.01). Conclusiones: La frecuencia de infección por VPH, VHS-1,VHS-2, M.genitalium y T. vaginalis fue menor a lo reportado. Sin embargo, se detectó una alta frecuencia de VIH, T. pallidum, y N. gonorrhoeae.

Tuberculosis in an HIV-infected Child in a Developing Country: A Case Report of Diagnosis Challenges.

Aims: To highlight the challenges and the diagnostic dilemmas in resource restricted settings to diagnose and treat Tuberculosis (TB), especially when it co-exists with Human immunodeficiency virus (HIV) infection. Presentation of Case: A 7-year-old HIV-infected male child admitted to our hospital with clinical features suggestive of Tuberculosis - non-productive cough of 6 months, associated excessive sweating and weight loss despite a good appetite. He did not receive Bacillus Calmette-Guerin (BCG) vaccine and no history of contact with Tuberculosis patient. He was wasted, small for age and, dyspnoeic, with features of consolidation in both lungs. All investigations initially carried out, including chest x-ray examination failed to confirm the diagnosis of TB. However, twenty-three (23) weeks after admission and commencement of antiretroviral drugs, was a radiologic diagnosis of TB made from a repeat chest x-ray examination. He subsequently commenced on anti-TB drugs with remarkable improvement, gaining 4Kg within two months. Discussion: Diagnosing Tuberculosis in developing countries can be very challenging, especially when there is a co-infection with HIV. The use of appropriate radiological, immunological and bacteriological tests and a good clinical acumen often defy the ability to make a timely diagnosis and institute appropriate treatment. These delays may eventually lead to increase morbidity and mortality. In this reported case of co-infections, it took twenty-three (23) weeks to establish a diagnosis of TB in the HIV-infected child. Provision of inexpensive, sensitive, specific, rapid point-of-care diagnostic tests for tuberculosis will reduce diagnosis delay and facilitate prompt and accurate treatment. Conclusion: Delay diagnosis and treatment of TB still occur in resource-poor countries, especially when it coexists with HIV infection. With the advent of new tests, such as GeneXpert MTB/RIF assay, the diagnosis of TB in HIV patients would be rapid and precise. Although this premise on its availability and maintenance in various clinics or hospitals where TB cases are managed.

Current scenario of Opportunistic and co-infections in HIV-infected individuals at a tertiary care hospital in Mumbai, India.

Purpose: An update on opportunistic infections/co-infections (OIs/CIs) is essential to understand the success of highly active antiretroviral therapy offered by the government agencies in reducing AIDS-related OIs/CIs. Hence, the present study aimed to evaluate the frequency of OIs/CIs in HIV-positive individuals at a tertiary care hospital in Mumbai. Its’ association with CD4 counts, anti-retroviral treatment and on HIV transmission was also determined. Materials and Methods: An observational study was designed to evaluate different OIs/CIs in individuals, who tested positive for HIV infection at the ICTC/Shakti Clinic of Seth G.S. Medical College and KEM Hospital, Mumbai. Data analysis was done with the use of SPSS software (version 19.0, SPSS, Chicago, IL, USA). P value was considered signifi cant if it is < 0.05. Results: Heterosexual contact was the major route of transmission among the enrolled 185 individuals. Ninety (48.06%) HIV-infected individuals were with OIs/CIs. Tuberculosis (TB) was the most common OI (68.8%). Other CIs noted were Herpes zoster, syphilis, hepatitis C and B, malaria, typhoid and dengue. The median CD4 count in HIV-positive individuals with TB was 337 ± 248 cells/μl, and 67.7% of individuals with OIs/CIs had low CD4 counts (<400 cells/μl). Individuals in 31-40 years of age group had signifi cantly (P = 0.01) more OIs/CIs. More (53.7%) spouse/children of HIV-positive individuals without OIs/CIs were HIV-1 positive. Low proportions of individuals with or without OIs/CIs were on ART. Conclusion: Nearly half of HIV-infected individuals were with OIs/ CIs. Initiation of free ART programme since 2004 possibly associated with the type and rate of OIs/CIs. Tuberculosis and multiple OIs/CIs were associated with low CD4 counts. Infection was high in 31-40 years age group. Most of the spouses of individuals without OIs/CIs were HIV positive, indirectly indicates lack of condom use or lack of awareness of condom use.

Medley of infections-a diagnostic challenge

We present a rare case of multiple infections coexisting together. This is one of the rarest cases of four infections which coexisted together in our patient. It is an alarming for the physicians to be aware of such infections as early prompt diagnosis can be lifesaving.

Co-infections associated with human immunodeficiency virus type 1 in pregnant women from southern Brazil: high rate of intraepithelial cervical lesions

Human immunodeficiency virus type 1 (HIV-positive) pregnant women require specific prophylactic and therapeutic approaches. The efficacy of established approaches is further challenged by co-infection with other sexually transmitted diseases (STDs). The objective of this study was to determine the prevalence of co-infections in pregnant women infected with different HIV-1 subtypes and to relate these findings, together with additional demographic and clinical parameters, to maternal and infant outcomes. Blood samples from pregnant women were collected and tested for syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). Human papillomavirus (HPV) diagnosis was evaluated by the presence of alterations in the cervical epithelium detected through a cytopathological exam. Medical charts provided patient data for the mothers and children. Statistical analyses were conducted with STATA 9.0. We found a prevalence of 10.8 percent for HCV, 2.3 percent for chronic HBV, 3.1 percent for syphilis and 40.8 percent for HPV. Of those co-infected with HPV, 52.9 percent presented high-grade intraepithelial lesions or in situ carcinoma. Prematurity, birth weight, Apgar 1' and 5' and Capurro scores were similar between co-infected and non-co-infected women. The presence of other STDs did not impact maternal and concept outcomes. More than half of the patients presenting cervical cytology abnormalities suggestive of HPV had high-grade squamous intraepithelial lesions or cervical cancer, evidencing an alarming rate of these lesions.

Multiple filarial species microfilaraemia: a comparative study of areas with endemic and sporadic onchocerciasis.

Background & objectives: The study was aimed at determining the pattern of co-occurrence of species of microfilaraemia between onchocerciasis endemic and sporadic populations. Methods: From every consenting person of one year and above, 50 μl of day and night blood samples were collected and processed respectively with Haemotoxylin and Giemsa as vital stains. Two skin snips (one each from the waist and the shoulder) were also taken from these individuals and processed. Results: Results showed single species microfilaraemia (86.4 and 82.3%), double species microfilaraemia (12.2 and 16.9%) and triple species microfilaraemia (1.4 and 0.7%) for endemic and sporadic populations respectively. All the species had single species microfilaraemia mostly, but Mansonella perstans and Loa loa showed greatest tendency towards double and triple species microfilaraemia. The prevalence of Wuchereria bancrofti microfilaraemia among those positive for Onchocerca volvulus was significantly lower than the overall prevalence of Wuchereria bancrofti. Wuchereria bancrofti microfilaraemia was most common among those who had L. loa microfilaraemia. Wuchereria bancrofti microfilarial intensity was higher among those with M. perstans microfilaraemia than among those positive for any of the other filarial species. Similarly, the intensity of M. perstans microfilaraemia among those positive for W. bancrofti exceeded the overall intensity of M. perstans. Conclusion: It is concluded that there was no definite pattern in mf densities discernible from co-occurrence infections either in the onchocerciasis endemic or sporadic population. There could be varied outcomes of onchocerciasis infection attributable to positive or negative regulatory effects of other pathogens harbored by the victims.

Sero-prevalence of viral Co-infections in HIV infected children of northern India.

Objective. To assess the prevalence of viral co-infections in HIV infected children. Methods. Children born to HIV seropositive parents and those children who were suspected to be HIV infected based on clinical presentation by the pediatrician were screened for HIV –1 and 2 antibodies as per National Aids Control Organization (NACO) guidelines. Those found to be seropositive for HIV infection were further tested for Hepatitis B&C, Herpes simplex virus and Human cytomegalovirus infection. Results. Among 803 children screened, 101 were found positive for HIVantibodies. Among the five viral markers tested, HCMV IgG was positive in 88 children (87.1%). HCMV IgM was positive in 35 cases (34.6%). HBsAg tested positive in 30 children, while anti-HCV IgM was reactive in 27 cases. IgM anti- HSV antibodies were observed positive in 59 (58.4%) cases. Both hepatitis virus coinfection (HBsAg and anti- HCV IgM antibodies) was observed in 10 HIV positive children, while both Herpesviridae family viruses (HCMV -IgM antibodies and HSV -IgM antibodies) were positive in 30 cases (29.7%). Conclusion. Viral co-infections are significantly higher in HIV positive children, which adds to significant mortality and morbidity and should therefore be screened in all HIV positive children for timely treatment in order to improve the quality of life and better survival of HIV infected children.

Typhus Fever: An Overlooked Diagnosis.

A case of typhus fever is presented. On admission, the clinical diagnosis was typhoid fever. Forty-eight hours after admission, the presence of subconjunctival haemorrhage, malena, and jaundice raised the possibility of a different aetiology, the two most likely differentials being dengue and typhus. Finally, a co-infection of typhoid and typhus was discovered. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission being treated as a case of typhoid fever.

Intestinal lesions in pigs affected with postweaning multisystemic wasting syndrome / Lesões entéricas em suínos afetados por síndrome multissistêmica do definhamento dos suínos

Samples of mesenteric lymph nodes and intestines from 79 unthrifty 3- to 5-month-old postweaning pigs, confirmed as naturally affected with postweaning multisystemic wasting syndrome (PMWS), were studied. Pigs originated from 12 farms in southern Brazil and were selected on the basis of clinical signs and/or gross lesions suggestive of enteric disorder. Lymphohistiocytic infiltrates of varying intensity were associated with anti-porcine circovirus type 2 (anti-PCV2) immunostaining (IS) in samples of intestines and mesenteric lymph nodes from all pigs. Although most findings were similar to those described in PCV2-associated enteritis, anti-PCV2 IS in association with depletion of the goblet cell mucin stores (24 pigs), diffuse ileal villous atrophy and fusion (18 pigs), and dilatation of the lymphatic vessels (11 pigs) combined or not with lymphangitis were also observed. PCV2 antigen was immunohistochemically demonstrated in the cytoplasm and nuclei from intralesional epithelial cells, histiocytes, and endothelial-like cells in intestinal tissues. Together these findings imply an association with PCV2. The presence of co-infections by Lawsonia intracellularis, Brachyspira spp., Mycobacterium spp., Salmonella spp., rotavirus, parvovirus, coronavirus and enteric calicivirus with PCV2 in the intestinal lesions was investigated.

Amostras de linfonodos mesentéricos e intestinos de 79 leitões desmamados refugos, entre 3 e 5 meses de idade e confirmados como naturalmente afetados pela síndrome multissistêmica do definhamento foram estudadas. Os suínos eram oriundos de 12 criações no sul do país e foram selecionados em função dos sinais clínicos e/ou lesões macroscópicas sugestivos de doença entérica. Infiltrados linfoistiocíticos de intensidades variáveis foram associados com marcação positiva anti-circovirus suíno tipo 2 (anti-PCV2) em amostras de intestinos e linfonodos mesentéricos de todos os 79 animais. Embora a maioria dos achados fossem semelhantes aos descritos em enterite associada com PCV2, marcação imuno-histoquímica anti-PCV2 foi associada com depleção de células caliciformes (24 suínos), atrofia e fusão de vilosidades do íleo (18 suínos) e dilatação de vasos linfáticos (11 suínos) combinada ou não com linfangite. Antígenos de PCV2 foram demonstrados por imuno-histoquímica no citoplasma e núcleo de células epiteliais intralesionais, histiócitos e células tipo endotelial em tecidos intestinais. Em conjunto, esses resultados sugerem que as lesões estavam associadas com PCV2. A presença de co-infecções por Lawsonia intracellularis, Brachyspira spp., Mycobacterium spp., Salmonella spp., rotavírus, parvovírus, coronavírus e calicivírus entérico com PCV2 nas lesões intestinais foi investigada.