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.

Molecular characterization of the severe falciparum malaria with typhoid co-infection A case report

Malaria and typhoid co-infections can be a serious public health issue in tropical countries leading to incorrect diagnosis due to overlapping clinical presentations of malaria and typhoid and hence, causing a delay in implementing the appropriate treatment regimen for these concurrent infections. This study reports a case of six-year-old female child co-infected with severe malaria (Plasmodium falciparum) and typhoid (Salmonella typhi) diagnosed by rapid malaria antigen test (RMAT) and blood culture respectively. Further, analysis of the chloroquine resistance gene Pfcrt for the falciparum demonstrated the presence of K76T mutant allele in pfcrt gene with high IC50 (150nM) for chloroquine (CQ) drug. The present case highlights the significance of timely identification and treatment of co-infections and also provides information about the circulating P. falciparum clinical strains.

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.

Coinfecciones en el niño con infección por el virus de inmunodeficiencia humana

El Virus de Inmunodeficiencia Humana (VIH) cursa con una alta morbimortalidad, para el año 2020 vivían 1,7 millones de personas menores de 15 años de edad con diagnóstico de VIH con diferentes coinfecciones, se plantea como objetivo identificar las principales coinfecciones que afectan a la población pediátrica con VIH. Metodología: Estudio descriptivo, retrospectivo, observacional, mediante revisión de historias clínicas, evaluándose las coinfecciones evidenciadas en los pacientes pediátricos VIH positivos en seguimiento en la consulta del Hospital Universitario de Caracas (HUC) desde el año 1998 hasta el 2019. Resultados: Se revisaron las historias clínicas de 101 pacientes de los cuales 77 presentaron coinfecciones con una media de 1,5 episodios por paciente y 24 pacientes no tuvieron ninguna coinfección. El 50,4 % correspondió al sexo femenino. Los preescolares fueron los que presentaron más episodios (29,2 %). De los 123 episodios evaluados, el 52,8 % presentaron para el momento de la coinfección cargas virales mayores a 100 000 copias/mL; 60,1 % categoría clínica C y el 53,6 % categoría inmunológica 3. Los antirretrovirales más usados fueron abacavir/ lamivudina en 57,7 % y lopinavir/ritonavir en 67,4 %; sólo el 47,9 % de los episodios referían adherencia del 100 %. Al evaluar las principales coinfecciones se evidenció que los lactantes menores y preescolares presentaron con mayor frecuencia infecciones bacteriana graves (IBG) (35,1 %), candidiasis (39,1 %) y en menor medida neumocistosis (30,8 %), la tuberculosis pulmonar (TB) fue evidenciada con mayor frecuencia en los adolescentes (53,8 %) (p en 0,0001) Conclusión: Las IBG, candidiasis, TB pulmonar y neumocistosis son las principales coinfecciones presentadas en pacientes pediátricos con diagnóstico de VIH

The Human Immunodeficiency Virus (HIV) has a high morbidity and mortality, by 2020 there were 1.7 million people under 15 years of age with a diagnosis of HIV with different coinfections the objective is to identify the main coinfections that affect the pediatric population with HIV. Methodology: Descriptive, retrospective, observational study, by reviewing medical records, evaluating the coinfections evidenced in HIV-positive pediatric patients in follow-up at the pediatric HIV consultation of the Hospital Universitario de Caracas from 1998 to 2019. Results: The clinical records of 101 patients, of which 77 had coinfections with a mean of 1.5 coinfection episodes per patient and 24 patients had no coinfection. 50.4 % corresponded to the female sex. Preschoolers were the ones with the most episodes (29.2 %). Of the 123 episodes evaluated, 52.8 % had viral loads greater than 100 000 copies / mL at the time of comorbidity; 60.1 % clinical category C and 53.6 % immunological category 3. The most used antiretroviral drugs was abacavir / lamivudine in 57.7 % and lopinavir / ritonavir in 67.4 %; only 47.9 % of the episodes referred 100 % adherence. When evaluating the main coinfections, it was evidenced that younger and preschool infants had more frequent serious bacterial infections (SBI) (35.1 %), candidiasis (39.1 %) and, to a lesser extent, pneumocystosis (30.8 %), Pulmonary tuberculosis (TB) was evidenced more frequently in adolescents (53.8 %) (p in 0.0001) Conclusion: SBI, candidiasis, pulmonary TB and pneumocystosis are the main coinfections presented in pediatric patients diagnosed with HIV

Agents of pneumonia in slaughtered pigs in southern Brazil / Agentes patogênicos de pneumonia em suínos abatidos no sul do Brasil

A high prevalence of pneumonic lesions has been reported to affect slaughtered pigs in southern Brazil. In order to identify which microorganisms have been causing those lesions, 30 pig lungs presenting pneumonic gross lesions were collected from five different slaughterhouses, totaling 150 lungs. Samples for bacterial isolation, molecular, histopathologic and immunohistochemistry (IHC) evaluation were taken from each lung. The pneumonic lesion scoring ranged from 1.53 to 2.83. The most frequent histopathological lesions found was the concomitant Influenza A virus (IAV) and Mycoplasma hyopneumoniae infection, corresponding to 55.3% (83/150), and Pasteurella multocida type A was isolated in 54.2% (45/83) of these cases. In 102 samples (68%), there was histopathologic suggestion of involvement of more than one infectious agent. M. hyopneumoniae was the most frequent agent associated with pneumonic lesions, being present in 92.1% (94/102) of the lungs with coinfections, followed by IAV in 89.2% (91/102). Besides the coinfections, IAV lesions were observed also in six samples without another pathogenic microorganism detected. A total of 46 samples with acute and subacute IAV suspected lesions in histopathological examination were assessed for IHC and real time RT-PCR for IAV. A total of 35% (16/46) of them were positive by IHC and 13% (6/46) by real time RT-PCR. Regarding M. hyopneumoniae, 79.3% (119/150) of samples were positive by qPCR and 84.9% (101/119) of them also presented M. hyopneumoniae suspected lesions in the histopathological examination. The results of this study suggest the importance of IAV in respiratory diseases in finishing pigs, even though this virus is more frequently reported in the nursery phase. In addition, our results emphasize the importance of lung coinfections in finishing pigs.(AU)

Lesões sugestivas de pneumonia são frequentemente encontradas em altas prevalências em suínos abatidos no sul do Brasil. Para identificar quais microrganismos causam essas lesões, foram coletados 30 pulmões de suínos com lesão macroscópica sugestiva de pneumonia em cinco frigoríficos diferentes, totalizando 150 pulmões. Amostras para isolamento bacteriano, avaliação molecular, histopatológica e imuno-histoquímica (IHC) foram coletadas de cada pulmão. O escore de lesão pulmonar variou entre 1,53 a 2,83. O achado histopatológico mais observado foi a lesão sugestiva de infecção concomitante pelo vírus Influenza A (IAV) e Mycoplasma (M.) hyopneumoniae, correspondendo a 55,3% (83/150), e em 54,2% (45/83) desses casos Pasteurella (P.) multocida tipo A foi isolado. Em 102 amostras (68%), houve lesão histopatológica sugestiva do envolvimento de mais de um agente infeccioso. M. hyopneumoniae foi o microrganismo mais frequente associado a lesões de pneumonia, estando presente em 92,1% (94/102) dos pulmões com coinfecções, seguido de IAV, que foi encontrado em 89,2% (91/102). Além das coinfecções, lesões de IAV foram observadas em mais seis amostras que não aparentavam envolvimento de outro agente infeccioso. Um total de 46 amostras com suspeita de lesão aguda e subaguda de IAV no exame histopatológico foram avaliadas para IHC e RT-PCR em tempo real para IAV e 35% (16/46) delas foram positivas por IHC e 13% (6/46) foram positivas por RT-PCR em tempo real. Com relação a M. hyopneumoniae, 79,3% (119/150) das amostras foram positivas por qPCR e 84,9% (101/119) delas também apresentaram lesões suspeitas de M. hyopneumoniae no exame histopatológico. Os resultados deste trabalho sugerem a importância do IAV como agente causador de pneumonias em suínos de terminação, embora esse vírus seja mais frequentemente relatado na fase de creche. Além disso, os achados deste trabalho demonstram a presença frequente de coinfecções pulmonares em suínos de terminação.(AU)

Agents of pneumonia in slaughtered pigs in southern Brazil

ABSTRACT: A high prevalence of pneumonic lesions has been reported to affect slaughtered pigs in southern Brazil. In order to identify which microorganisms have been causing those lesions, 30 pig lungs presenting pneumonic gross lesions were collected from five different slaughterhouses, totaling 150 lungs. Samples for bacterial isolation, molecular, histopathologic and immunohistochemistry (IHC) evaluation were taken from each lung. The pneumonic lesion scoring ranged from 1.53 to 2.83. The most frequent histopathological lesions found was the concomitant Influenza A virus (IAV) and Mycoplasma hyopneumoniae infection, corresponding to 55.3% (83/150), and Pasteurella multocida type A was isolated in 54.2% (45/83) of these cases. In 102 samples (68%), there was histopathologic suggestion of involvement of more than one infectious agent. M. hyopneumoniae was the most frequent agent associated with pneumonic lesions, being present in 92.1% (94/102) of the lungs with coinfections, followed by IAV in 89.2% (91/102). Besides the coinfections, IAV lesions were observed also in six samples without another pathogenic microorganism detected. A total of 46 samples with acute and subacute IAV suspected lesions in histopathological examination were assessed for IHC and real time RT-PCR for IAV. A total of 35% (16/46) of them were positive by IHC and 13% (6/46) by real time RT-PCR. Regarding M. hyopneumoniae, 79.3% (119/150) of samples were positive by qPCR and 84.9% (101/119) of them also presented M. hyopneumoniae suspected lesions in the histopathological examination. The results of this study suggest the importance of IAV in respiratory diseases in finishing pigs, even though this virus is more frequently reported in the nursery phase. In addition, our results emphasize the importance of lung coinfections in finishing pigs.

RESUMO: Lesões sugestivas de pneumonia são frequentemente encontradas em altas prevalências em suínos abatidos no sul do Brasil. Para identificar quais microrganismos causam essas lesões, foram coletados 30 pulmões de suínos com lesão macroscópica sugestiva de pneumonia em cinco frigoríficos diferentes, totalizando 150 pulmões. Amostras para isolamento bacteriano, avaliação molecular, histopatológica e imuno-histoquímica (IHC) foram coletadas de cada pulmão. O escore de lesão pulmonar variou entre 1,53 a 2,83. O achado histopatológico mais observado foi a lesão sugestiva de infecção concomitante pelo vírus Influenza A (IAV) e Mycoplasma (M.) hyopneumoniae, correspondendo a 55,3% (83/150), e em 54,2% (45/83) desses casos Pasteurella (P.) multocida tipo A foi isolado. Em 102 amostras (68%), houve lesão histopatológica sugestiva do envolvimento de mais de um agente infeccioso. M. hyopneumoniae foi o microrganismo mais frequente associado a lesões de pneumonia, estando presente em 92,1% (94/102) dos pulmões com coinfecções, seguido de IAV, que foi encontrado em 89,2% (91/102). Além das coinfecções, lesões de IAV foram observadas em mais seis amostras que não aparentavam envolvimento de outro agente infeccioso. Um total de 46 amostras com suspeita de lesão aguda e subaguda de IAV no exame histopatológico foram avaliadas para IHC e RT-PCR em tempo real para IAV e 35% (16/46) delas foram positivas por IHC e 13% (6/46) foram positivas por RT-PCR em tempo real. Com relação a M. hyopneumoniae, 79,3% (119/150) das amostras foram positivas por qPCR e 84,9% (101/119) delas também apresentaram lesões suspeitas de M. hyopneumoniae no exame histopatológico. Os resultados deste trabalho sugerem a importância do IAV como agente causador de pneumonias em suínos de terminação, embora esse vírus seja mais frequentemente relatado na fase de creche. Além disso, os achados deste trabalho demonstram a presença frequente de coinfecções pulmonares em suínos de terminação.

Analysis of HIV/Malaria Coinfections among HIV-1 Infected Individuals in Two Tertiary Hospitals in Old Cross River State, Nigeria

Aims: Human Immunodeficiency Virus (HIV) and Malaria are the two main global public health threats that dent development in low and middle-income countries. This study evaluated the immunological marker and HIV/Malaria co-infection among individuals infected with HIV-1 in old Cross River State, Nigeria. Study Design:Cross-sectional study.Place and Duration of Study:University of Calabar Teaching Hospital (UCTH) and University of Uyo Teaching Hospital (UUTH) between March 2018 and August 2019.Original Research Article Methods: A total of 417 individuals infected with HIV-1 partook in this study. The age of these individuals ranged from 4-72 years (average age = 39.1 years). Plasma samples were analyzed for HIV and Malaria using Enzyme-Linked immunosorbent Assay. The CD4 count was enumerated using the Partec CyFlow®Counter. Plasma viral loads (PVL) were determined using the Abbott Real-Time HIV-1 assay.Results: Results showed that 230(55.1%) of the participants were in the 31-45 years age range. The majority (67.4%) of the HIV-1 infected individuals were females. An overall prevalence of HIV/Malaria coinfection in Old Cross River State, Nigeria was 14.3%, of which Uyo was 6.3% and Calabar was 3.0%. A higher prevalence of HIV/Malariacoinfection was observed among age groups <25 years (17.5%), males (5.1%), singles or divorced/widow/widower (7.7%), those with primary education (7.5%), and students (10.0%). Higher HIV/Malaria coinfection was also observed amongthose with CD4 cell count <200 cells/μl and 350-499 cells/μl (5.7%) and PVL >5000 copies/mL (7.9%) compared to others with 2.0% prevalence. Of all variables evaluated only marital status (p= 0.033), educational background (p= 0.000) and occupations (p =0.000) were significantly associated.Conclusions: This study further confirmed the presence of HIV/Malaria coinfection in old Cross River State, Nigeria. This study has added to the voices on the ground to give a better view on the frequency and the pattern of distribution of HIV/Malaria coinfection since limited studies have been done on this in old Cross River State, Nigeria. This, therefore, highlights the need for a well-structured approach to the management of HIV/Malaria coinfection in Nigeria.

Respiratory infections and coinfections: geographical and population patterns / Infecciones y coinfecciones respiratorias: patrón geográfico y de circulación poblacional

Abstract Introduction: Acute respiratory infections are the second cause of mortality in children younger than five years, with 150.7 million episodes per year. Human orthopneumovirus (hOPV) and metapneumovirus (hMPV) are the first and second causes of bronchiolitis; type 2 human orthorubulavirus (hORUV) has been associated with pneumonia in immunocompromised patients. Objective: To define hOPV, hMPV and hORUV geographical distribution and circulation patterns. Method: An observational, prospective cross-sectional pilot study was carried out. Two-hundred viral strains obtained from pediatric patients were genotyped by endpoint reverse transcription polymerase chain reaction (RT-PCR). Results: One-hundred and eighty-six positive samples were typed: 84 hOPV, 43 hMPV, two hORUV and 57 co-infection specimens. Geographical distribution was plotted. hMPV, hOPV, and hORUV cumulative incidences were 0.215, 0.42, and 0.01, respectively. Cumulative incidence of hMPV-hORUV and hMPV-hOPV coinfection was 0.015 and 0.23; for hOPV-hMPV-hORUV, 0.035; and for hORUV-hOPV, 0.005. The largest number of positive cases of circulating or co-circulating viruses occurred between January and March. Conclusions: This study successfully identified circulation and geographical distribution patterns of the different viruses, as well as of viral co-infections.

Resumen Introducción: Las infecciones respiratorias agudas constituyen la segunda causa de mortalidad en los niños menores de cinco años, con 150.7 millones de episodios anuales. Entre los principales agentes etiológicos están Orthopneumovirus (hOPV) y metapneumovirus (hMPV) humanos como primera y segunda causa de bronquiolitis, respectivamente; Orthorubulavirus humano tipo 2 (hORUV) se ha asociado a neumonía en pacientes inmunocomprometidos. Objetivo: Definir patrones de distribución geográfica y de circulación de hOPV, hMPV y hORUV. Método: Se llevó a cabo un estudio piloto transversal prospectivo observacional. Se genotipificaron 200 aislamientos virales de pacientes pediátricos mediante transcripción inversa seguida de reacción en cadena de la polimerasa en punto final (RT-PCR). Resultados: Se tipificaron 186 muestras positivas: 84 de hOPV, 43 de hMPV, dos de hORUV y 57 de coinfecciones. Se trazó la distribución geográfica. Las incidencias acumuladas de hMPV, hOPV y hORUV fueron de 0.215, 0.42 y 0.01, respectivamente. Las incidencias acumuladas de la coinfección de hMPV-hORUV y hMPV-hOPV fueron de 0.015 y 0.23; de hOPV-hMPV-hORUV, de 0.035; y de hORUV-hOPV, de 0.005. El mayor número de casos positivos de virus circulantes o cocirculantes se presentó entre enero y marzo. Conclusiones: Fue posible identificar patrones de circulación y distribución geográfica de los diferentes virus, así como de las coinfecciones virales.

The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy

Abstract Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.

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.

Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State

Abstract INTRODUCTION: Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS: Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS: Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.

Prevalence and characteristics of HIV/HBV and HIV/HCV coinfections in Tuscany

Abstract Introduction Worldwide about 30% of HIV-infected patients are coinfected with HCV or HBV. The HIV/HCV coinfection is more common in individuals who have a history of drug addiction. The aims of this study were to assess the HCV and HBV prevalence in HIV-infected patients and analyze their characteristics. Methods We considered the new HIV diagnoses notified by the regional surveillance system of Tuscany from 2009 to 2013. Descriptive analyses were conducted on the socio-demographic characteristics, routes of transmission, and reason to perform the test. In coinfected patients we assessed the risk for being late presenter (LP) or the risk of having AIDS. Results In 5 years of surveillance a total of 1354 new HIV diagnoses were notified: 1188 (87.7%) were HIV alone, 106 (7.8%) HIV/HCV, 56 (4.1%) HIV/HBV, and 4 (0.33%) HIV/HCV/HBV. The main risk factor was injection drug use in 52.8% of HCV/HIV cases, while in HIV/HBV patients the main risk factor was sexual exposure. HIV/HBV coinfected patients showed worse clinical and immunological features than HIV and HIV/HCV patients: 78.6% had CD4 count less than 350 mm−3 (vs. 54.6% and 62.1%, respectively) and 39.4% had AIDS (vs 20.7% and 7.6%). The risk for being LP triples for HIV/HBV (OR 2.98; 95% IC: 1.56–5.70) than patients with HIV alone. Conclusions We have observed less advanced disease in HIV and HCV-HIV patients compared with HBV–HIV coinfected patients. Moreover, our results show a higher prevalence of HIV/HCV among drug addicts and in the age-group 35–59, corresponding to those born in years considered most at risk for addiction. This study also confirms the finding of a less advanced HIV disease in HIV/HCV coinfected patients.

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.

Dengue in pregnancy：an under-reported illness, with special reference to other existing co-infections

Objective:To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.Methods:A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient’s age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes.Results:Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.Conclusions:Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Dengue in pregnancy: an under-reported illness, with special reference to other existing co-infections

OBJECTIVE@#To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned.@*METHODS@#A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes.@*RESULTS@#Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks.@*CONCLUSIONS@#Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.

Dengue in pregnancy: An under-reported illness, with special reference to other existing co-infections

Objective: To keep the level of awareness high as far as incidence of dengue among pregnant women is concerned. Methods: A total of 300 blood samples of patients with fever in pregnancy were received in the Department of Microbiology to rule out dengue infection (January 2011 to December 2012). The samples were put up for presence of dengue IgM antibodies and NS1Ag by ELISA. The patients who turned out to be positive for dengue serology were retrospectively analysed with respect to patient's age, gestational age, clinical presentation, complications, platelet counts and maternal as well as foetal outcomes. Results: Out of 300 females tested, 22 (7.3%) were found positive for dengue infection during the said time period. Out of them 9 were positive for IgM antibodies against dengue and 10 were found to be positive for NS1Ag, while 3 were positive for both IgM antibody and NS1Ag. Five patients presented with dengue in first trimester, 9 in second trimester and 8 in third trimester. Two patients had coinfections. Patient with coinfection of dengue with malaria had intrauterine death of fetus at 37 weeks while the second one having dengue with typhoid had a preterm vaginal delivery at 35 weeks. Conclusions: Establishing diagnosis of dengue infection in pregnancy is important for effective management by the obstetricians particularly the mode of delivery due to the potential risk of hemorrhage for both the mother and the newborn. Co-infections seen in endemic areas may be more common than usually reported.