Research progress on the role of monocytes in viral hemorrhagic fevers / 细胞与分子免疫学杂志

Monocytes are important target cells of various hemorrhagic fever viruses. In viral hemorrhagic fevers (VHFs), monocytes can be infected by viruses and produce different kinds of cytokines, which contribute to the antiviral immune response and participation in the immunopathogenesis of VHFs. During the pathogenesis of various VHFs (early stage), monocytes change in cell counting, subpopulation distribution and expression of surface molecules with an activated phenotype. Several hemorrhagic fever viruses can infect monocytes and induce immune response, which may play an important role in immunopathological injury. Monocytes and the cytokines they produce may interact with platelets and vascular endothelial cells, contributing to disease progression.

Outbreaks repored in 2016

In the year 2016, several major out-breaks from emerging and re-emerging diseases including cholera in Somalia and Yemen; MERS-CoV in Saudi Arabia; Chikungunya in Somalia, Pakistan and Crimean– Congo Haemorrhagic fever in Pakistan were reported in the Eastern Mediterranean Region [EMR]

Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique

Background. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics.Objectives. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique.Methods. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed.Results. Antibiotics were used in 97.6% of the patients, with no significant differences (p>0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole(9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47;1.54 - 7.60) were treated with antibiotics.Conclusion. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients' clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly

Connaissances et attitudes des relais communautaires sur les fièvres hémorragiques à virus Lassa et Ebola dans le département de la Donga (Nord Bénin)

Introduction: l'objectif de cette étude était d'évaluer les connaissances et attitudes des relais communautaires vis-à-vis des fièvres hémorragiques à virus Ebola et Lassa et leur implication dans la mise œuvre des activités de prévention de ces maladies.Méthodes: une enquête transversale descriptive a été menée auprès des relais communautaires recrutés par tirage au sort dans 40 villages du département de la Donga. Ces relais faisaient la prise en charge à domicile des maladies respiratoires, diarrhéiques et du paludisme chez les enfants de moins de cinq ans. Un questionnaire anonyme a été administré par interview directe. Les données ont été analysées à l'aide du logiciel Epi-info 3.5.1.Résultats: au total 58 relais communautaires (RC) ont participé à cette enquête sur les 60 attendus. L'âge moyen était de 38,7±10,6 ans avec un sex-ratio de 3,5. Il y avait majoritairement trente cinq cultivateurs (60,3%) et treize revendeuses (22,4%). Quarante huit enquêtés (82,8%) reconnaissaient les deux maladies comme étant graves, mortelles et transmissibles. Les trois principales voies de transmission citées étaient le contact ou la consommation de gibiers (87,9%), le contact direct avec les personnes infectées (74,1%) ou leurs cadavres (46,6%). Les principaux moyens préventifs énumérés étaient en lien avec les voies de transmission. La fièvre (81,0%), les vomissements (81,0%) et la diarrhée (60,3%) venaient en tête des symptômes cités. Seulement vingt-deux RC (37,9%) disposaient de gants mais les utilisaient rarement pour examiner les enfants malades. Quant à la conduite à tenir devant un cas suspect de fièvre hémorragique virale Lassa ou Ebola, quarante-et-un relais communautaires (70,7%) feraient recours aux agents de santé sans toucher au malade, neuf (15,5%) feraient appel à l'ambulance et huit (13,8%) transporteraient le cas sur leur propre moto ou sur un taxi-moto vers le centre de santé le plus proche. Conclusion: le renforcement des capacités des relais communautaires sur les fièvres hémorragiques virales contribuerait à l'amélioration de leurs connaissances sur ces épidémies mortelles et à la qualité de leurs interventions dans la population

Cutaneous Manifestations of Potential Chemical, Biological, and Radiological Agents and Their Clinical Management / 대한피부과학회지

The level of terrorist threats using chemical, biological, and radiological agents has been continuously increasing, and it is an undeniable truth that these agents are actually in use today. The fact that most chemical, biological, and radiological agents cause skin-related symptoms, and that the skin symptoms are observed at a relatively early stage of the condition, leads to the conclusion that dermatologists could be the first point of contact for potential victims of these agents. It is highly important that first responders are able to recognize symptoms caused by these agents early and react quickly. Therefore, dermatologists do have a responsibility to take on a role in dealing with chemical, biological, and radiological attacks, and pre-equip themselves with professional knowledge in this field. Among the various types of chemical agents, typical examples of agents causing skin-related symptoms are blistering agents, which lead to bullae and necrosis on the skin. Biological agents are classified from Category A to C according to their respective risk factors. The most dangerous Category A agents include anthrax, smallpox, plague, tularemia, and viral hemorrhagic fever, all of which are known to show characteristic skin-related symptoms. Upon exposure to a certain level of radiation, radiological agents can also lead to erythema on the skin. In this article, we will discuss various characteristics and up-to-date treatment methods of potential chemical, biological, and radiological agents to help dermatologists advance their knowledge in this field.

Cutaneous Manifestations of Potential Chemical, Biological, and Radiological Agents and Their Clinical Management / 대한피부과학회지

The level of terrorist threats using chemical, biological, and radiological agents has been continuously increasing, and it is an undeniable truth that these agents are actually in use today. The fact that most chemical, biological, and radiological agents cause skin-related symptoms, and that the skin symptoms are observed at a relatively early stage of the condition, leads to the conclusion that dermatologists could be the first point of contact for potential victims of these agents. It is highly important that first responders are able to recognize symptoms caused by these agents early and react quickly. Therefore, dermatologists do have a responsibility to take on a role in dealing with chemical, biological, and radiological attacks, and pre-equip themselves with professional knowledge in this field. Among the various types of chemical agents, typical examples of agents causing skin-related symptoms are blistering agents, which lead to bullae and necrosis on the skin. Biological agents are classified from Category A to C according to their respective risk factors. The most dangerous Category A agents include anthrax, smallpox, plague, tularemia, and viral hemorrhagic fever, all of which are known to show characteristic skin-related symptoms. Upon exposure to a certain level of radiation, radiological agents can also lead to erythema on the skin. In this article, we will discuss various characteristics and up-to-date treatment methods of potential chemical, biological, and radiological agents to help dermatologists advance their knowledge in this field.

Suspected VHF in Sudan: Cases decline but not contained

The suspected cases of viral haemorrhagic fever [VHF] reported from Darfur region in Sudan continue to be reported sporadically. Although, cases have declined, there is yet no sign that the outbreak has been contained

Unknown VHF in Sudan

An outbreak of Viral Haemorrhagic Fever [VHF] of unknown illness has been reported from Darfur in Sudan. Between 30 August to 27 November 2015, a total of 469 suspected cases of VHF including 120 deaths [CFR: 26%] were reported from 27 localities in Greater Darfur

Emerging Infectious Diseases on the rise in the EMR

In 2015, a number of countries in the WHO Eastern Mediterranean Region [EMR] reported emerging infectious diseases [EID]. Some countries reported explosive outbreaks from these EIDs

MERS-CoV infections in health care

The recent experience from the current epidemic of MERS-CoV infections in the Eastern Mediterranean Region [EMR] indicates that the health care associated transmissions continue to occur despite calls for strengthening appropriate infection prevention and control measures in health facilities. This remains a particular challenge for control of this epidemic

Laboratory diagnosis of viral hemorrhagic fevers / 病毒学报

Viral hemorrhagic fevers (VHFs) refer to a group of acute infections with high case fatality rates that are caused by four distinct families of RNA viruses belonging to the families Bunyaviridae, Flaviviridae, Filoviridae and Arenaviridae, the main clinical symptoms of these diseases are accompanied by fever and bleeding. For the reason that these infections have similar primary clinical symptoms, it is difficult to diagnose and distinguish them; rapid and reliable laboratory diagnostic tests are required in suspected cases for epidemiological investigation and controlling the spread of VHFs. This review addresses the laboratory diagnostics of VHFs, covering etiological classification and different diagnostic techniques, such as virus isolation, nucleic acid detection, as well as antigen and antibody assays. Prospects for novel diagnostic tools are also discussed.

Report: strategic approach to control of viral haemorrhagic fever outbreaks in the Eastern Mediterranean Region: report from a regional consultation

The viral haemorrhagic fevers [VHF] are a growing public health threat in the Eastern Mediterranean Region. Nearly all of them are of zoonotic origin. VHF often cause outbreaks with high fatalities and, except for yellow fever, currently there are no specific treatment or vaccination options available. In response to this growing threat, the Regional Office for the Eastern Mediterranean of the World Health Organization convened a technical consultation in Tehran on 27-30 November 2011 to review the current gaps in prevention and control of VHF outbreaks in the Region. The meeting recommended a number of strategic public health approaches for prevention and control of VHF outbreaks through synergizing effective collaboration between the human and animal health sectors on areas that involve better preparedness, early detection and rapid response. Implementation of these approaches would require working together with vision, commitment and a sense of purpose involving partnerships and cooperation from all relevant sectors

Fiebre manchada de las montañas rocosas: ni tan manchada ni tan montañosa como pensábamos / Rocky Mountain Spotted Fever: not as spotted

La fiebre manchada de las Montañas Rocosas es una infección producida por Rickettsia rickettsii, un cocobacilo polimorfo perteneciente a la familia Rickettsiaceae. A pesar de que ha pasado más de un siglo desde que fue descrita, continúa siendo una de las zoonosis más importantes en todo el mundo. Aunque los casos se presentan de manera focal y esporádica, en los últimos años se ha notado un incremento de su incidencia en los Estados Unidos y parece estar resurgiendo en varios países de Suramérica. En Colombia, poco se sabía de la enfermedad desde 1937, cuando fue descrita por primera vez, pero, en los últimos años se han presentado nuevos casos con alta tasa de mortalidad. Dado que los hallazgos clínicos y de laboratorio son inespecíficos, la fiebre manchada de las Montañas Rocosas debe incluirse en el diagnóstico diferencial de los síndromes febriles de causa no clara. A continuación se presenta una revisión de la literatura, señalando los aspectos más importantes del resurgimiento de la enfermedad en Colombia y se resaltan su etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento, con el objeto de mejorar el conocimiento local de esta infección, probablemente subdiagnosticada, que puede curarse fácilmente con unas cuantas dosis de antibióticos por vía oral.

Rocky Mountain Spotted Fever (RMSF) is an infection caused by Rickettsia rickettsii, a pleomorphic cocobacillae which belongs to the Rickettsiaceae family. Although it has been more than a century since its first description, this disease is still one of the most important zoonosis in the world. Usually cases occur in focal and sporadic form, but an unusual increase in the frequency of cases during the last few years has drawn the attention of surveillance systems in United States and some South American countries. Little was known about the disease in Colombia when it was first described in 1937, but in recent years new cases have been reported showing high mortality rates. Since clinical and laboratory findings have not been specific, the RMSF must be included in the differential diagnosis of febrile syndromes of unknown origin. A literature review follows herein, pointing out the most important features of the cases diagnosed in Colombia and highlighting their pathogenesis, clinical manifestations, diagnosis, and treatment, and attempting to improve local knowledge of this infection. The disease is probably under-diagnosed and could be treated with a few doses of PO antibiotics.

Febre hemorrágica de evolução fatal: possível associação com varicela maligna purpúrica / Hemorrhagic Fever fatal outcome: possible associationwith malignant purpuric chickenpox

Este artigo descreve o acompanhamento de dois pacientes com doença exantemática caracterizada pela presença simultânea de máculas, pápulas, vesículas, pústulas, crostas, púrpuras e evolução com insuficiência nefropulmonar fatal e possível associação com varicela purpúrica. Representa alerta para o cuidado com casos semelhantes.

This article describes the follow up of two patients with rash illness characterized by the simultaneous presence of maculae, papules, vesicles, pustules, crusts, purple and evolution of fatal nefropulmonar failure and possible association with varicella purpuric. It represents an alert to the care of similar cases.

Alkhurma haemorrhagic fever virus in the kingdom of Saudi Arabia

The Ministry of Health of the Kingdom of Saudi Arabia [KSA] recently reported four laboratory confirmed cases of Alkhurma Haemorrhagic Fever Virus [AHFV], detected from Jeddah. The epidemiological investigation revealed that all these four cases were exposed to infected animal [sheep] either during slaughtering or during processing of sheep meat during the last Hajj [2009]. All the cases were detected during the post hajj period [November/early December 2009] in Jeddah and were sporadic in nature The cases were successfully treated in hospitals and recovered fully. The outbreak is currently contained. The potential for further spread of the outbreak seems limited now given the fact that the reported cases were not epidemiologically linked and no more case of AHFV has been reported from the KSA since December 2009

Chikungunya infection in children.

Chikungunya fever is caused by Chikungunya virus (CHIK) and spread by Aedes aegypti and Aedes albopictus. The median incubation period is 2 to 4 days. Vertical transmission of disease from mother to child has also been documented. Clinical manifestations are very variable, from asymptomatic illness to severe debilitating disease. Children are among the group at maximum risk for severe manifestations of the disease and some clinical features in this group are distinct from those seen in adults. Common clinical features include: abrupt onset high grade fever, skin rashes, minor hemorrhagic manifestations, arthralgia/ arthritis, lymphadenopathy, conjunctival injection, swelling of eyelids and pharyngitis. Unusual clinical features include: neurological manifestations including seizures, altered level of consciousness, blindness due to retrobulbar neuritis and acute flaccid paralysis. Watery stools may be seen in infants. Treatment is symptomatic. Generally non- steroidal anti-inflammatory drugs are avoided. Paracetamol may be used for pain and fever. However, NSAIDS may be required for relief of severe arthralgia during convalescent phase.

Adverse Events Following Yellow Fever Vaccination in Korean Children / 소아감염

PURPOSE:Yellow fever, a mosquito-borne viral hemorrhagic fever, is one of the most lethal diseases. Recently there have been an increasing number of Korean children who have travelled to yellow fever endemic zones and were administered yellow fever vaccine (YFV). Therefore, we carried out this study to provide child travelers with safety information of YFV. METHODS:This study was conducted at the International Clinic of National Medical Center in Seoul between April 2007 and June 2008 for the evaluation of adverse events of YFV. One hundred twenty- five children received YFV (17-DD) and were prospectively monitored for adverse events through telephone interviews on day 3, 6, 9, 16, 23 and 30 after vaccination. RESULTS:Adverse events were observed in 31 (24.8%) of 125 child travelers who received the YFV. The mean age was 12.5+/-5.0 years. Sixty-six of the child travelers (52.8%) were males. The common adverse events were pain in 11 (8.8%), swelling in 8 (6.4%) and redness in 7 children (5.6%) at the injection site. The systemic adverse events included mild fever in 5 (4.0%), headache in 5 (4.0%), cough in 4 (3.2%), abdominal pain in 3 (2.4 %), and vomiting in 2 children (1.6%). Most of the adverse events were detected within 7 days of administration and there were no differences in adverse events by gender or age. All travelers who had complained of symptoms improved spontaneously or following symptomatic treatment. CONCLUSION:This study showed that YFV is well-tolerated and there were no reports of severe adverse events. Studies are ongoing to clarify the cause and risk factors for rare adverse events.

Meningitis following vaccination with yellow-fever vaccine / 대한내과학회지

Yellow fever is the original viral hemorrhagic fever (VHF), a pansystemic viral sepsis with viremia, fever, prostration, hepatic, renal, and myocardial injury, hemorrhage, shock, and high lethality. Yellow fever was one of the most feared lethal diseases before the development of an effective vaccine. Yellow fever (YF) can be prevented by an attenuated vaccine. The yellow-fever 17D vaccine developed in the 1930s has been regarded as one of the most successful live attenuated vaccines, with few side effects or adverse events. The adverse effects associated with yellow-fever vaccine are generally mild and include headache, myalgia, and low-grade fever. Recently, however, some cases of severe neurologic disease and multi-organ system disease have been described in individuals who received yellow-fever vaccine. We report the case of a 39-year-old female with meningitis following vaccination with 17D yellow-fever vaccine.

Fluorescent microbeads-based multiplex detection of IgM antibodies to pathogens caused viral hemorrhagic fever / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To develop and evaluate a multiplex detection of IgM antibodies to pathogens caused viral hemorrhagic fever.</p><p><b>METHODS</b>The nucleocapsid proteins (NP) of HTN, SEO, Puu MBV, Lassa, RFV and HPS viruses expressed in prokaryotic cells and purified were coupled to 7 different xMAP fluorescent microbeads. The assay was evaluated and optimized when screened against a panel of reference sera collected from HFRS patients, and compared to commonly used MacELISA Kits.</p><p><b>RESULTS</b>For detection of anti-NP antibodies, the sensitivity and specificity of the assay were comparable to a commonly used MacELISA kit, but it could detect different antigen specific antibodies in one reaction simultaneously.</p><p><b>CONCLUSION</b>A robust, rapid and multiplex assay based on NPs could be developed via Luminex xMAP platform for laboratory diagnosis of viral hemorrhagic fever and seroepidemiological investigation.</p>