Zoonotic febrile illnesses misdiagnosed as COVID-19: a review of reported clinical cases.

COVID-19 is a zoonotic coronavirus disease caused by SARS-CoV-2. Its fast spreading by aerosol transmission has made it a highly contagious disease, causing the most recent 2020 pandemic. Although it mainly affects the respiratory system, atypical forms of the disease have been described, including developing an undifferentiated febrile illness without respiratory symptoms, that can represent a diagnostic challenge, mainly in tropical areas where several zoonotic febrile diseases are circulating. Thus, despite the broad clinical spectrum of COVID-19, in the tropics, other zoonotic etiologies should always be considered as differential diagnoses. According to our case reports review, eight different zoonotic febrile diseases misdiagnosed as COVID-19 have been reported in the available scientific literature of four databases. These were only suspected due to the epidemiological history. Thus, making a complete and detailed clinical history of a febrile patient in the tropics is essential to suspect the etiology and request the necessary confirmatory tests. Therefore, COVID-19 must be included as a differential diagnosis of undifferentiated febrile illness in the tropics, but other zoonotic infectious diseases must not be ruled out.

Mapping Eastern (EEE) and Venezuelan Equine Encephalitides (VEE) among Equines Using Geographical Information Systems, Colombia, 2008-2019.

INTRODUCTION: Eastern equine encephalitis virus (EEEV) and Venezuelan equine encephalitis virus (VEEV) viruses are zoonotic pathogens affecting humans, particularly equines. These neuroarboviruses compromise the central nervous system and can be fatal in different hosts. Both have significantly influenced Colombia; however, few studies analyse its behaviour, and none develop maps using geographic information systems to characterise it. OBJECTIVE: To describe the temporal-spatial distribution of those viruses in Colombia between 2008 and 2019. METHODS: Retrospective cross-sectional descriptive study, based on weekly reports by municipalities of the ICA, of the surveillance of both arboviruses in equines, in Colombia, from 2008 to 2019. The data were converted into databases in Microsoft Access 365®, and multiple epidemiological maps were generated with the Kosmo RC1®3.0 software coupled to shape files of all municipalities in the country. RESULTS: In the study period, 96 cases of EEE and 70 of VEE were reported, with 58% of EEE cases occurring in 2016 and 20% of EEV cases in 2013. The most affected municipalities for EEE corresponded to the department of Casanare: Yopal (20), Aguazul (16), and Tauramena (10). In total, 40 municipalities in the country reported ≥1 case of EEE. CONCLUSIONS: The maps allow a quick appreciation of groups of neighbouring municipalities in different departments (1° political division) and regions of the country affected by those viruses, which helps consider the expansion of the disease associated with mobility and transport of equines between other municipalities, also including international borders, such as is the case with Venezuela. In that country, especially for EEV, municipalities in the department of Cesar are bordering and at risk for that arboviral infection. there is a high risk of equine encephalitis outbreaks, especially for VEE. This poses a risk also, for municipalities in the department of Cesar, bordering with Venezuela.

Monkeypox Post-COVID-19: Knowledge, Worrying, and Vaccine Adoption in the Arabic General Population.

BACKGROUND: The outbreak of monkeypox was declared a global public health emergency by the World Health Organization on 23 July 2022. There have been 60,000 cases reported worldwide, most of which are in places where monkeypox has never been seen due to the travel of people who have the virus. This research aims to evaluate the general Arabic population in regard to the monkeypox disease, fears, and vaccine adoption after the WHO proclaimed a monkeypox epidemic and to compare these attitudes to those of the COVID-19 pandemic. METHODS: This cross-sectional study was performed in some Arabic countries (Syria, Egypt, Qatar, Yemen, Jordan, Sudan, Algeria, and Iraq) between 18 August and 7 September 2022. The inclusion criteria were the general public residing in Arabic nations and being older than 18. This questionnaire has 32 questions separated into three sections: sociodemographic variables, prior COVID-19 exposure, and COVID-19 vaccination history. The second portion assesses the knowledge and anxieties about monkeypox, while the third section includes the generalized anxiety disorder (GAD7) scale. Logistic regression analyses were performed to compute the adjusted odds ratios (aOR) and their confidence intervals (95%CI) using STATA (version 17.0). RESULTS: A total of 3665 respondents from 17 Arabic countries were involved in this study. Almost two-thirds (n = 2427, 66.2%) of the participants expressed more worry about COVID-19 than monkeypox diseases. Regarding the major cause for concern about monkeypox, 39.5% of participants attributed their anxiety to the fear that they or a member of their family may contract the illness, while 38.4% were concerned about monkeypox becoming another worldwide pandemic. According to the GAD 7 score, 71.7% of the respondents showed very low anxiety toward monkeypox and 43.8% of the participants scored poor levels of knowledge about monkeypox disease. Participants with previous COVID-19 infection showed a 1.206 times greater acceptance to receive the monkeypox vaccine than those with no previous infection. A 3.097 times higher concern for monkeypox than COVID-19 was shown by the participants who perceived monkeypox as dangerous and virulent than those who did not. Participants who have a chronic disease (aOR: 1.32; 95%CI: 1.09-1.60); participants worried about monkeypox (aOR: 1.21; 95%CI: 1.04-1.40), and perceived monkeypox as a dangerous and virulent disease (aOR: 2.25; 95%CI: 1.92-2.65); and excellent knowledge level (aOR: 2.28; 95%CI: 1.79-2.90) have emerged as significant predictors. CONCLUSIONS: Our study reported that three-fourths of the participants were more concerned about COVID-19 than monkeypox disease. In addition, most of the participants have inadequate levels of knowledge regarding monkeypox disease. Hence, immediate action should be taken to address this problem. Consequently, learning about monkeypox and spreading information about its prevention is crucial.

Cardiac Implications of COVID-19 in Deceased and Recovered Patients: A Systematic Review.

Background: Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods: PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results: All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarkers such as highly sensitive troponin I, creatinine, and creatinine kinase-MB on admission are good prognostic markers. Conclusions: Cardiac complications such as heart failure, myocardial injury, and arrhythmias are common among patients infected with COVID-19. Elevated cardiac markers and patients with cardiac complications require utmost care and continuous cardiac monitoring.

Expert review of global real-world data on COVID-19 vaccine booster effectiveness and safety during the omicron-dominant phase of the pandemic.

INTRODUCTION: COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. However, the emergence of the Omicron variant and subvariants as the globally dominant strains have raised doubts about the effectiveness of currently available vaccines and prompted debate about potential future vaccination strategies. AREAS COVERED: Using the publicly available IVAC VIEW-hub platform, we reviewed 52 studies on vaccine effectiveness (VE) after booster vaccinations. VE were reported for SARS-CoV-2 symptomatic infection, severe disease and death and stratified by vaccine schedule and age. In addition, a non-systematic literature review of safety was performed to identify single or multi-country studies investigating adverse event rates for at least two of the currently available COVID-19 vaccines. EXPERT OPINION: Booster shots of the current COVID-19 vaccines provide consistently high protection against Omicron-related severe disease and death. Additionally, this protection appears to be conserved for at least 3 months, with a small but significant waning after that. The positive risk-benefit ratio of these vaccines is well established, giving us confidence to administer additional doses as required. Future vaccination strategies will likely include a combination of schedules based on risk profile, as overly frequent boosting may be neither beneficial nor sustainable for the general population.

The emergence of SARS-CoV-2 Omicron subvariants: current situation and future trends.

The SARS-CoV-2 Omicron variant (B.1.1.529) has been the most recent variant of concern (VOC) established by the World Health Organization (WHO). Because of its greater infectivity and immune evasion, this variant quickly became the dominant type of circulating SARS-CoV-2 worldwide. Our literature review thoroughly explains the current state of Omicron emergence, particularly by comparing different omicron subvariants, including BA.2, BA.1, and BA.3. Such elaboration would be based on structural variations, mutations, clinical manifestation, transmissibility, pathogenicity, and vaccination effectiveness. The most notable difference between the three subvariants is the insufficiency of deletion (Δ69-70) in the spike protein, which results in a lower detection rate of the spike (S) gene target known as (S) gene target failure (SGTF). Furthermore, BA.2 had a stronger affinity to the human Angiotensin-converting Enzyme (hACE2) receptor than other Omicron sub-lineages. Regarding the number of mutations, BA.1.1 has the most (40), followed by BA.1, BA.3, and BA.3 with 39, 34, and 31 mutations, respectively. In addition, BA.2 and BA.3 have greater transmissibility than other sub-lineages (BA.1 and BA.1.1). These characteristics are primarily responsible for Omicron's vast geographical spread and high contagiousness rates, particularly BA.2 sub-lineages.

Clinical-epidemiological characteristics and maternal-foetal outcomes in pregnant women hospitalised with COVID-19 in Venezuela: a retrospective study.

BACKGROUND: In low- and middle-income countries, pregnant women and newborns are more vulnerable to adverse outcomes from coronavirus disease 2019 (COVID-19). However, in Venezuela, there are no integrated data in a national surveillance system to identify the clinical-epidemiological characteristics and maternal-foetal outcomes of pregnant women hospitalised with COVID-19. METHODS: A retrospective study was conducted among Venezuelan pregnant women hospitalised with COVID-19 seen at the "Ruiz y Páez" University Hospital Complex and the San Cristobal Central Hospital between June 2020 and September 2021. Information was obtained from physical and digitised clinical records using a purpose-designed proforma to collect epidemiological, clinical, paraclinical, treatment, obstetric and perinatal complications, and maternal-foetal outcomes data. RESULTS: A total of 80 pregnant women with confirmed severe acute respiratory syndrome coronavirus 2 infection were seen within the study period, 59 (73.8%) survived and 21 (26.2%) died. The median (interquartile range) age was 29 (23-33) years, the majority being in the third trimester of pregnancy (81.2%; n = 65). Interestingly, four (5%) pregnant women were co-infected with malaria by Plasmodium vivax and three (3.8%) with syphilis. The most frequent symptoms were fever (75%; n = 60), dry cough (68.8%; n = 55), dyspnoea (55%; n = 44), and headache (53.8%; n = 43). The most frequent maternal complications were anaemia (51.5%; n = 66) and hypertensive disorders of pregnancy (17.5%; n = 14). The most frequent perinatal complications were preterm delivery (39.2%; n = 20/51) and oligohydramnios (31.3%; n = 25). A total of 29 (36.3%) adverse foetal outcomes were documented, 21 stillbirth and eight abortions. CONCLUSION: This is the first study to describe the clinical-epidemiological behaviour of COVID-19 in hospitalised Venezuelan pregnant women. Anaemia, hypertensive disorders of pregnancy, oligohydramnios, and low birth weight were the most frequent maternal-foetal complications in this population of pregnant women.

Characteristics and Outcomes of Patients with COVID-19 in Intensive Care in the First Year of the Pandemic: A Colombian Observational Study

Background: The COVID-19 pandemic has had a devastating impact on the world, mainly during the first year of the pandemic, where strategies such as vaccination were not available. Information on the outcomes of patients admitted to the intensive care unit (ICU) in Colombia is scarce. Our main objective was to characterize critically ill patients with COVID-19 in our region. Methods: We conducted a single-centre retrospective observational study in which we included patients with COVID-19 confirmed by RT-PCR who were admitted to the adult ICU between March 18, 2020 and March 18, 2021, in Quindío, Colombia. We identify the clinical and laboratory characteristics at admission, the support used, and their relationship with mortality during ICU hospitalization. Results: Three hundred and fifty-nine patients with a confirmed diagnosis of COVID-19 were admitted, 64% men, mean age was 62.7 years (SD±12.3), body mass index 27.9Kg/m2 (±5.8), SOFA score was 7.6 (±3.12), Pa/FiO2 96.2 (±62.3), and lung compliance 30.5 ml/cmH2O (±18.4). Mortality was 60%. The variables with the highest mortality association were obesity OR: 2.38 (95% CI:1.39 – 4.09, p: <.001), Glasgow coma scale at admission <12 : 17.5, (5.21 – 58.8, p: <.001), PaFiO2 <100: 5.63, (3.38 – 9.39, p: <.001), static lung compliance less than 50 ml / cmH2O: 3.54, (3.38 – 9.39, p: <.001), SOFA score >5: 3.75 (2.19– 6.42, p: <0.001), ferritin > 1000: 2.58, (1.66 – 4.02, p: <.001), C-reactive protein > 5: 2.52 (1.42 – 4.26, p: <.001), and LDH > 280: 2.71 (1.55 – 4.74, p: <.001). Patients who required PEEP > 10cmH2O: 2.34 (1.48 – 3.70, p: <.001), FiO2 > 60%: 4.01, (2.46 – 6.53, p: <.001), and ventilation in the prone position. Conclusion: Mortality in the first year of the pandemic in our region was high, mainly associated with obesity, inflammation, altered mental status upon admission, and increased lung elastance. Resumen Contexto: La pandemia de COVID-19 ha tenido un impacto devastador en el mundo, principalmente durante el primer año de la pandemia, donde no se disponía de estrategias como la vacunación. La información sobre los resultados de los pacientes ingresados ​​en la unidad de cuidados intensivos (UCI) en Colombia es escasa. Nuestro principal objetivo fue caracterizar a los pacientes críticos con COVID-19 en nuestra región. Métodos: Realizamos un estudio observacional retrospectivo unicéntrico donde incluimos pacientes confirmados con RT-PCR para COVID-19 que ingresaron a la UCI de adultos entre el 18 de marzo de 2020 y el 18 de marzo de 2021, en Quindío, Colombia. Identificamos las características clínicas y de laboratorio al ingreso, los soportes utilizados y su relación con la mortalidad durante la hospitalización en UCI. Resultados: Ingresaron 359 pacientes con diagnóstico confirmado de COVID-19, 64% hombres, edad 62,7 años (DE±12,3), índice de masa corporal 27,9Kg/m2 (±5,8), SOFA score 7,6 (±3,12), Pa /FiO2 96,2 (±62,3) y distensibilidad pulmonar 30,5 ml/cmH2O (±18,4). La mortalidad fue del 60%. Las variables con mayor asociación a mortalidad fueron la obesidad OR: 2,38 (IC 95%: 1,39 – 4,09, P: <0,001), escala de coma de Glasgow al ingreso <12: 17,5, (5,21 – 58,8, P: <0,001), PaFiO2 <100 : 5,63, (3,38 – 9,39, P: <0,001), distensibilidad pulmonar estática inferior a 50 ml/cmH2O: 3,54, (3,38 – 9,39, P: <0,001), puntuación SOFA >5: 3,75 (2,19– 6,42, P: <0,001), ferritina > 1000: 2,58, (1,66 – 4,02, P: <0,001), proteína C reactiva > 5: 2,52 (1,42 – 4,26, P: <0,001) y LDH > 280: 2,71 (1,55 – 4,74), P: <0,001). Pacientes que requirieron PEEP > 10cmH2O: 2,34 (1,48 – 3,70, P: <0,001), FiO2 > 60%: 4,01, (2,46 – 6,53, P: <0,001) y ventilación en decúbito prono. Conclusión: La mortalidad en el primer año de la pandemia en nuestra región fue alta, asociada principalmente a obesidad, inflamación, alteración del estado mental al ingreso y aumento de la elastancia pulmonar.

Antiviral Treatment against Monkeypox: A Scoping Review.

During the COVID-19 pandemic, the increase in reports of human monkeypox virus infection cases spreading in many countries outside Africa is a major cause for concern. Therefore, this study aimed to explore the evidence of antiviral pharmacotherapy available for the treatment of adult patients with monkeypox. A scoping review of the literature was conducted using PubMed, Scopus, Web of Science, Embase, and CENTRAL databases until 12 September 2022. The key search terms used were "monkeypox" and "treatment". A total of 1927 articles were retrieved using the search strategy. After removing duplicates (n = 1007) and examining by title, abstract, and full text, 11 studies reporting case reports of monkeypox with antiviral treatment were included, detailing the number of monkeypox cases, clinical manifestations, number of participants with antiviral treatment, history of sexually transmitted diseases, method of diagnosis, location of skin lesions, drugs used in antiviral treatment, route of administration, and outcome. A total of 1281 confirmed cases of monkeypox have been reported, of which 65 monkeypox cases had antiviral treatment distributed most frequently in the United States (n = 30), the United Kingdom (n = 6), and Spain (n = 6). Of the total cases, 1269 (99.1%) were male with an age range of 18 to 76 years, and 1226 (95.7%) had a sexual behavior of being men who have sex with men. All confirmed cases of monkeypox were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were skin lesions, fever, lymphadenopathy, headache, fatigue, and myalgia. The most frequent locations of the lesions were perianal, genital, facial, and upper and lower extremities. The most commonly used drugs for antiviral treatment of monkeypox were: tecovirimat, cidofovir, and brincidofovir. All patients had a complete recovery. According to current evidence, the efficacy and safety of antiviral drugs against monkeypox is of low quality and scarce.

Frequency of Correct Mask Use Among Pedestrians in High-Flow Indoor Public Spaces: A Multicenter Analysis in the First and Second Waves of the COVID-19 Pandemic in Peru.

BACKGROUND: Our study aimed to describe the variation in the frequency of correct mask use among pedestrians in the first and second waves of the COVID-19 pandemic in high-flow indoor public spaces from different geographic and social settings in Peru. METHODS: We carried out a cross-sectional exploratory study among pedestrians in Lima (the capital city) and other coastal and highland cities in Peru. Pedestrians were directly observed by trained medical students in 2 high-flow indoor areas at different times in November 2020 (first wave) and October 2021 (second wave). Primary outcomes included the frequencies of mask use and correct use. We applied multinomial logistic models and estimated crude and adjusted relative prevalence ratios for sex, age, obesity, and location. Additionally, we used binomial generalized linear models to estimate prevalence ratios in crude and adjusted models. RESULTS: We included 1996 participants. The frequency of mask use was similar in both years: 96.9% in 2020 and 95.5% in 2021. However, the frequency of correct mask use significantly decreased from 81.9% (95% CI, 79.4-84.3) in 2020 to 60.3% (95% CI, 57.2-67.3) in 2021. In 2020, we observed an increase in the probability of misuse in the cities of Lima (aRP: 1.42; P = .021) and Chiclayo (aPR: 1.62, P = .001), whereas, in 2021, we noted an increase in the probability of misuse in the cities of Lima (aRP: 1.72; P < .001) and Piura (aPR: 1.44; P < .001). CONCLUSIONS: The correct mask use decreased during the second wave, although no significant overall variations were observed in mask use in pedestrians between both periods. Also, we found regional differences in correct mask use in both periods.

COVID-19 and dengue coinfection in Latin America: A systematic review.

Introduction: Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread globally, becoming a long-lasting pandemic. Dengue is the most common arboviral disease in tropical and subtropical regions worldwide. COVID-19 and dengue coinfections have been reported, associated with worse outcomes with significant morbidity and mortality. Therefore, this study aims to determine the epidemiological situation of COVID-19 and dengue coinfection in Latin America. Methods: A systematic literature review was performed using PubMed, Scopus, Embase, Web of Science, LILACS, and BVS databases from January 1, 2020, to September 4, 2021. The key search terms used were "dengue" and "COVID-19". Results: Nineteen published articles were included. The studies were case reports with a detailed description of the coinfection's clinical, laboratory, diagnostic, and treatment features. Conclusion: Coinfection with SARS-CoV-2 and dengue virus is associated with worse outcomes with significant morbidity and mortality. The similar clinical and laboratory features of each infection are a challenge in accurately diagnosing and treating cases. Establishing an early diagnosis could be the answer to reducing the estimated significant burden of these conditions.

Mass Media Use to Learn About COVID-19 and the Non-intention to Be Vaccinated Against COVID-19 in Latin America and Caribbean Countries.

Background: The Latin American and Caribbean (LAC) region has been one of the regions most affected by the COVID-19 pandemic, with countries presenting some of the highest numbers of cases and deaths from this disease in the world. Despite this, vaccination intention is not homogeneous in the region, and no study has evaluated the influence of the mass media on vaccination intention. The objective of this study was to evaluate the association between the use of mass media to learn about COVID-19 and the non-intention of vaccination against COVID-19 in LAC countries. Methods: An analysis of secondary data from a Massachusetts Institute of Technology (MIT) survey was conducted in collaboration with Facebook on people's beliefs, behaviors, and norms regarding COVID-19. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI) were calculated to evaluate the association between the use of mass media and non-vaccination intention using generalized linear models of the Poisson family with logarithmic link. Results: A total of 350,322 Facebook users over the age of 18 from LAC countries were included. 50.0% were men, 28.4% were between 18 and 30 years old, 41.4% had a high school education level, 86.1% lived in the city and 34.4% reported good health condition. The prevalence of using the mass media to learn about COVID-19 was mostly through mixed media (65.8%). The non-intention of vaccination was 10.8%. A higher prevalence of not intending to be vaccinated against COVID-19 was found in those who used traditional media (aPR = 1.36; 95%CI: 1.29-1.44; p < 0.001) and digital media (aPR = 1.70; 95%CI: 1.24-2.33; p = 0.003) compared to those using mixed media. Conclusion: We found an association between the type of mass media used to learn about COVID-19 and the non-intention of vaccination. The use of only traditional or digital information sources were associated with a higher probability of non-intention to vaccinate compared to the use of both sources.