Disease X Testing: The results of an international external quality assessment exercise

The United Nations Secretary-General Mechanism (UNSGM) for investigation of the alleged use of chemical and biological weapons is the only established international mechanism of this type under the UN. The UNGSM may launch an international investigation, relying on a roster of expert consultants, qualified experts, and analytical laboratories nominated by the member states. Under the framework of the UNSGM, we organized an external quality assurance exercise for nominated laboratories, named the Disease X Test, to improve the ability to discover and identify new pathogens that may cause possible epidemics and to determine their animal origin. The "what-if" scenario was to identify the etiological agent responsible for an outbreak that has tested negative for many known pathogens, including viruses and bacteria. Three microbes were added to the samples, Dabie bandavirus, Mammarenavirus, and Gemella spp., of which the last two have not been taxonomically named or published. The animal samples were from Rattus norvegicus, Marmota himalayana, New Zealand white rabbit, and the tick Haemaphysalis longicornis. Of the 11 international laboratories that participated in this activity, six accurately identified pathogen X as a new Mammarenavirus, and five correctly identified the animal origin as R. norvegicus. These results showed that many laboratories under the UNSGM have the capacity and ability to identify a new virus during a possible international investigation of a suspected biological event. The technical details are discussed in this report.Copyright © 2022

Infectious disease Roundup 2022

This paper describes the epidemiology, prevalence, transmission, prevention and control of some infectious diseases in companion animals, livestock, wild animals and humans in Ontario, Canada, in 2022, including SARS-CoV-2;Echinococcus multilocularis, Leishmania spp. and SARS-CoV-2;antimicrobial stewardship resources;2 cases of rabid dogs imported from Iran (July 2021 and January 2022);prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriacea, Dirofilaria immitis, Brucella canis, canine parainfluenza and adeno- and herpes viruses in dogs recently imported from Asia;Paragonimus kellicotti lung flukes and Streptococcus equi subsp. zooepidemicus in dogs;African swine fever in pet pigs, backyard pigs and wild pigs and blastomycosis in dogs and humans.

Expression of Brucella abortus Omp25 protein in Lactococcus lactis probiotic bacteria

Background and purpose: The sequence of Omp25 is conserved in all Brucella species. The high antigenicity of the product of this gene stimulates the host's immune system. Using engineered probiotic bacteria is an appropriate method for vaccine transport. The aim of this study was to express the Omp25 of the Brucella abortus pathogenic bacterium in Lactococcus lactis probiotic bacterium. Materials and methods: In this experimental study, the required vector was designed and synthesized to include the gene of interest and a signal peptide (pNZ8148-Usp45-Omp25). E. coli strain TOP10F was transformed using the pNZ8148-Usp45-Omp25 expression vector based on induction by nisin. The recombinant plasmid was extracted from the transformed bacteria using a plasmid extraction kit. The L. lactis was transformed by pNZ8148-Usp45-Omp25 vector using electroporation. Evaluation of the expression of Omp25 gene at the RNA level was assessed by reverse transcription method and confirming the presence of recombinant Omp25 protein in the engineered bacteria using SDS-PAGE method. Results: Successful expression of B. abortus Omp25 in L. lactis was verified by RT-PCR. Subsequently, the proteins were separated based on molecular weight using sodium dodecyl sulfate- polyacrylamide gel electrophoresis (SDS-PAGE). The protein expression analysis showed the expression of Omp25 as a 25 kDa extra band in transformed L. lactis compared to the L. lactis receiving the vector lacking the target gene. Conclusion: This study shows that Omp25 is expressed in L. lactis transformed via pNZ8148-Usp45-Omp25 by electroporation. Transformed L. lactis can be successfully used as a subunit oral vaccine in prevention of Brucellosis.

Possession of exotic animals and zoonotic diseases: an approach from the Mexican context

The possession of exotic animals as pets is a social practice that has become more visible in Mexico in recent years, so it is interesting to understand its environmental and social implications and those related to human health. The present study aims to identify the main species of exotic animals kept as pets and the zoonotic diseases reported in these species. We analyzed official figures of seizures of exotic fauna in Mexico and reviewed specialized literature on zoonotic diseases documented in Mexico in these species. We identified zoonoses in species of fauna that can be acquired legally and illegally in the country, reported in environments in which animals coexist with other species and are in direct contact with people, which represents an important factor in the spread and propensity of this type of disease. We conclude that the sanitary regulation of wildlife markets, the monitoring and studying microorganisms associated with wildlife are valuable strategies to prevent the emergence of zoonoses.

Brucellosis relapse seven years after first infection in a COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) emerged in China and then has spread worldwide. It has been seen in Turkey since March. Brucellosis is a zoonotic disease which is observed in Turkey endemically. Here, we report the firstcase of Brucellosis relapse in a COVID-19 patient. A 39-year-old female had cough, dispnea, fatigue and backpain and miyalgia for one week was admitted. She had leucopenia and lymphopenia in whole blood count. She had a contact history with her COVID-19 positive sister. COVID-19 polymerase chain reaction (PCR) test resulted positive. She received hydroxychloroquine treatment for five days. Her COVID-19 PCR became negative and laboratory improved. Her miyalgia, back pain and fatigue got worse. When her medical history was elaborated, she had a brucellosis history seven years ago. She was completely treated and her Brucella serology tests were negative in 2015. She stated that she didn't consume any unpasteurized milk product recently. Rose-Bengal and Coombs agglutination tests were positive (1:320 titers). She was initialized on treatment and symptoms started to resolve after 15 days of treatment. Severe COVID-19 patients show lymphopenia, particularly reduction of T-cells. Cell mediated immunity is crucial against brucellosis. During pandemic, endemic infections like brucellosis can be observed in patients due to lymphopenia. Further immunological studies are needed.Copyright © 2022, Kuwait Medical Association. All rights reserved.

A Rare Case of Neuralgic Amyotrophy Associated with Brucella Infection.

Multiple micro-organisms associated with Neuralgic Amyotrophy (NA) have been reported and Brucella species should be an important and overlooked infectious cause or trigger.We report a rare case of neuralgic amyotrophy associated with Brucella infection and is believed to be the first such case report in China. A 42-year-old male with brucellosis was confirmed serologically, who presented recurrent fever and fatigue and suddenly developed severe pain in the right shoulder within one week, followed by the inability to lift and abduct the proximal end of the right upper limb. Based on typical clinical manifestions, MRI neuroimaging of the brachial plexus and neuro-electrophysiological studies to confirm a diagnosis of NA and presented spontaneous recovery during this period, immunomodulatory treatment with corticosteroid or intravenous immunoglobulin had not been attempted, leaving a serious movement disorder in the right upper limb. Even rare, NA and other neurobrucellosis forms should be considered as complications of Brucella infection.

Present status of microfluidic PCR chip in nucleic acid detection and future perspective

Polymerase chain reaction (PCR) amplifies specific fragment of DNA molecules and has been extensively applied in fields of pathogens and gene mutation detection, food safety and clinical diagnosis which on the other hand, holds the drawbacks of large size instrument, high heat dissipation etc. It has been demonstrated that microfluidics technique coupling with PCR reaction exhibits characteristics of integration, automatization, miniaturization, and portability. Meanwhile, various designed fabrication of microchip could contribute to diverse applications. In this review, we summarized major works about a variety of microfluidic chips equipped with several kinds of PCR techniques (PCR, RT-PCR, mPCR, dPCR) and detection methods like fluorescence, electrochemistry, and electrophoresis detection. The development and application of PCR-based microfluidic chip in pathogen and gene mutation detection, diseases prevention and diagnosis, DNA hybridization and low-volume sample treatment were also discussed. Copyright © 2022 Elsevier B.V.

Bioaerosol dispersion and environmental risk simulation: Method and a case study for a biopharmaceutical plant of Gansu province, China.

Pathogenic bacteria pose a great threat to global public health from environmental and public health perspectives, especially regarding the impact of the COVID-19 pandemic worldwide. As a result, the increased risk of pathogenic bioaerosol exposure imposes a considerable health burden and raises specific concerns about the layout and location of vaccine manufacturers. This study proposed a grid computing method based on the CALPUFF modelling system and population-based environmental risks to reduce bioaerosol-related potential risks. We previously used the CALPUFF model to quantify the diffusion level, the spatial distribution of emissions, and potential environmental risks of bioaerosol leakage in Gansu province's Zhongmu Lanzhou biopharmaceutical plant from July 24, 2019, to August 20, 2019. By combining it with publicly available test data, the credibility was confirmed. Based on our previous research, the CALPUFF model application combined with the environmental population-based environmental risks in two scenarios: the layout and site selection, was explored by using the leakage accident of Zhongmu Lanzhou biopharmaceutical plant of Gansu province as a case study. Our results showed that the site selection method of scenario 2 coupled with the buffer area was more reasonable than scenario 1, and the final layout site selection point of scenario 2 was grid 157 as the optimal layout point. The simulation results demonstrated agreement with the actual survey. Our findings could assist global bioaerosol manufacturers in developing appropriate layout and site selection strategies to reduce bioaerosol-related potential environmental risks.

Septic arthritis caused by Brucella melitensis - An orthopedic chal-lenge (11194)

Introduction The zoonotic infection with Brucella melitensis can be acquired by inges-tion of unpasteurized goat's or sheep's milk. The infection is common in Eastern Mediterranean countries (EMC), but rare in western Europe (6 cases in Switzerland, 2021). When evaluating patients with symptoms of septic arthritis, brucellosis is not the foremost differential diagnosis. How-ever, with the increasing population of people from EMC in western Eu-rope, the incidence may be rising. We present a patient who was initially suspected to suffer from Long-COVID-Syndrome (LCS), which underscores the relevance of this case in a pandemic situation. Methods/Results A 58-year-old male patient was admitted to the emergency department with a painful right knee effusion after a minor trauma. Additionally, he suffered from fatigue, subfebrile temperatures, back pain and myalgias for more than two months. He was suspected to suffer from LCS after a mild COVID-19 three months earlier. The culture of the arthrocentesis (14.400 cells/mul with 61% polynuclear cells) unexpectedly turned positive for B. melitensis. The patient declared that he had been drinking three liters of unpasteurized goat's milk to cure the presumptive LCS. To ensure staff safety, arthroscopic lavage was postponed until brucella-active antibiotics had been administered for at least 24 hours. Surgery was performed under strict infection control measures to avoid generating aerosols. According to Duke, one major (continuous bacteremia over 14 days) and 2 minor criteria (fever, most probably septic embolic gonarthritis) were fulfilled. Therefore, possible endocarditis had to be assumed although transesophageal echocardiography was normal. Antibiotic treatment was escalated to a quadruple regimen (intravenous gentamicin for three weeks;as well as oral doxycycline, trimethoprim/sulfomethoxazole and rifampin for at least 3 months). The clinical recovery - still under treatment - is protracted with slowly improving knee pain and normalizing signs of inflammation. Conclusion Although B. melitensis is a rare pathogen in Switzerland, orthopedic sur-geons, rheumatologists and infectious disease specialists need to be aware of diseases with low incidence and non-specific symptoms espe-cially in times of a global pandemia. A high index of suspicion is needed in patients related to EMC. When brucellosis is confirmed, strict infection control measures to protect staff involved in aerosol generating proce-dures must be adopted.

Case report: post-Covid-19 arthritis and peri arthritis

We present the case of a 63 years old male patient known for type 2 diabetes and sleep apnoea. He was admitted as inpatient for a nontraumatic severe and disabling left hip pain. The pain started progressively one month ago. The medical history was otherwise irrelevant, with no general symptoms nor other symptoms suggestive of an inflammatory disease. To mention a history of an asymptomatic SARS-COV2 infection, diagnosed by a naso-pharyngial PCR, approximately 10 days before the onset of the pain. On physical examination, the patient was afebrile. The palpation of the inguinal region was tender on palpation with marked limitation of the hip range of motion. The spine and other peripheral joints were painless without inflammatory sign. Moreover, there was no skin lesion nor inguinal lymph nods enlargement. Due to the importance of pain with marked functional limitation, the patient is hospitalized for investigations and pain-management. On blood sample there was a mild increase of inflammatory markers (CRP 25mg/l, VS 20mm/h) with normal cell count. Standard X-rays of the pelvis and hip were normal. The MRI of the hip showed a mild coxo-femoral arthritis with marked inflammation of the surrounding musculature. An arthrocentesis was performed and 2ml of serous fluid was aspirated. There were no crystals. The cellularity could not be tested due to small amounts of fluid. The synovial culture showed a polymicrobious growth compatible with contamination. In summary, we were facing a patient with an acute and very painful hip monoarthritis. There was no history of gastrointestinal or urinary tract infection, the search for C. trachomatis and N. gonorrhoea in urines was negative. An extensive serologic testing (HIV, HBV, HCV, HBV, HCV, HIV, Lyme, Syphilis, Coxiella, Bartonella, Brucella & Quantiferon) and the search for T. whipplei were negative as well. There was no HLA-B27 and rheumatoid factor, ACPA, ANA, ANCA and specific antibodies related to polymyositis were negative. The chest-abdomen-pelvis scan showed no sign of neoplasia. To rule out a vasculitis we proceeded to a PET-CT, which showed no sign of vasculitis or myositis. Considering the timing of the onset of the symptoms and the absence of any other diagnosis, the patient was diagnosed with reactive arthritis caused by SARS-COV2. The patient was treated with Diclofenac 150 mg/day and opioids. The clinical evaluation one month after discharge showed a spontaneous significant improvement.

Brucella pleurisy: An extremely rare complication of brucellosis.

Brucella is a rare pathogen of the lung. This intracellular organism can involve pleura in the sub-acute and chronic course of the disease. Here, we introduce an infrequent case of brucella pleurisy that presented to our hospital with chest pain.

AN UNUSUAL CASE OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS ASSOCIATED WITH M.CHIMAERA OR LARGE CELL NEUROENDOCRINE CARCINOMA

CASE: 56-year-old Caucasian male presented to the hospital with worsening weakness, exertional dyspnea, dry and nonproductive cough, and a 5-pound weight loss in 2 weeks associated with loss of appetite. He has a significant medical history of mitral valve repair in July 2014, status post bioprosthetic mitral valve replacement in August 2019- culture-negative treated with ceftriaxone, vancomycin, and doxycycline for 6 weeks complicated with CVA, atrial flutter, tobacco abuse, alcohol abuse. His shortness of breath worsened quickly with O2 saturations dropping to 85% and had to be placed on BiPAP followed by high flow nasal cannula/ noninvasive ventilation and became febrile. He was then transferred to ICU for acute hypoxemic respiratory failure. Differentials could be very broad ranging from infections like visceral leishmaniasis, atypical/tuberculous mycobacteria, histoplasmosis, Ehrlichia, Bartonella, Brucella, adeno, disseminated HSV, hematological like Langerhans cell histiocytosis, multicentric Castleman disease. In this patient, differentials included hemophagocytic lymphohistiocytosis, COVID-19. Covid was negative x2. His lab abnormalities as well as diagnostic testing revealed hemophagocytic lymphohistiocytosis. He was empirically started on antibiotics and dexamethasone 20 mg to be continued for 2 weeks then taper if the patient has continued improvement. Dexamethasone was tapered over 8 weeks. On later admissions, Carious test was positive for M. chimaera, and core biopsy of the lung nodule showed large cell neuroendocrine carcinoma. IMPACT/DISCUSSION: Hemophagocytic lymphohistiocytosis (HLH) is a rare but very dangerous condition, characterized by abnormal activation of the immune system, causing hemophagocytosis, inflammation, and potentially widespread organ damage. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity, is most commonly seen in children. Secondary HLH is commonly associated with infections or malignancies. Most current information on diagnosis and treatment is based on pediatric populations. The HLH-2004 diagnostic criteria are the most commonly used diagnostic criteria and were developed for children;but used in adults as commonly as in children, although there is a gap in the knowledge. The HLH-2004 diagnosis criteria state that diagnosis of HLH can be established if either a molecular diagnosis is made consistent with HLH or diagnostic criteria for HLH is fulfilled, which includes meeting 5 of 8 criteria. These are lab and clinical findings including fever, splenomegaly, significant cytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis in bone marrow/spleen or lymph nodes, low or no NK cell activity, ferritin >500 ug/L or sCD25 >2400 U/mL. CONCLUSION: HLH is a disease that needs to be diagnosed and treated promptly, it is fatal otherwise. Treatment is mostly tailored to the patient's root cause, treat the cause, and symptomatic treatment with dexamethasone and etoposide.

FEVER OF UNKNOWN ORIGIN: ATYPICAL CLINICAL PRESENTATION OF MURINE TYPHUS

CASE: 66yo woman with a past medical history of hypertension and monoclonal gammopathy of undetermined significance was sent from clinic in winter for 4 days of worsening fevers and sinus congestion unrelieved by over-the- counter medications. COVID and flu negative. Patient has had no sick contacts or recent travel and has pet cats but no recent scratches. Initial chest x-ray showed no acute processes, but patient was continuing to have fevers up to 103 with mild dyspnea and chills so a CT chest was completed which showed ground glass opacities in the right middle lobe. Blood and sputum cultures were obtained, and patient was started on ceftriaxone and azithromycin for community acquired pneumonia. Urine strep and legionella antigens were also acquired, both negative. Over the next two days, she continued to have high fevers and chills at nights with leukocytosis, thrombocytopenia, hyponatremia, and notable worsening of mild elevation of liver enzymes on admission. Cultures were negative and patient had no other indication of an infection aside from the cyclical fevers therefore empiric doxycycline was added for coverage of atypical infections. Over the next two days, she continued to have nightly fevers up to 103 so ID was consulted for fever of unknown origin. On repeat exposure assessment, patient revealed that she lived with multiple animals including cats, dogs, parakeets, chickens, geese and a pony. Patient was continued on doxycycline while additional lab tests were sent for atypical infections including Rickettsia typhi, Coxiella brunetti (Q fever), and Brucella spp given patient's history of exposure to multiple animals at home. Patient was discharged on doxycycline after being afebrile for 48hrs with declining white count and liver enzymes. Lab results confirmed the diagnosis with high titers for Rickettsia typhi IgG and IgM. IMPACT/DISCUSSION: This case illustrates an atypical presentation of murine typhus with pneumonia in winter. There are several key teaching points in this case: 1. Ricketssia typhi infections have largely nonspecific symptoms therefore it should should be included in differential diagnoses of febrile illnesses with thrombocytopenia and elevated liver enzymes 2. Although a complete history is acquired on admission, it is important to revisit and review information again when a clinical diagnosis has not been established 3. Defeverscence after starting doxycycline can take anywhere from 4 to 66hrs so fevers during this timeframe is not an indication of failure of therapy CONCLUSION: Murine typhus presents with non-specific symptoms so it should be included in the differential diagnosis of patients with fevers of unknown origin with potential exposure to flea-bearing animals. The optimal therapy is doxycycline 100mg twice a day for seven days. Patients should also be advised to treat their animals for fleas to prevent recurrent infections.

Research status and trend of zoonosis and zoonotic microorganisms based on pubmed database retrieval

Objective: To gather information on the research status and the hot spots of zoonosis and zoonotic microorganisms worldwide, and to provide references for the prevention and control of zoonotic diseases in China. Method: COOC 12.6 and Citespace 5.8 R1 software were used to carry out frequency statistics, co-occurrence analysis, cluster analysis, timeline analysis and burst analysis on the keywords associated with zoonosis and zoonotic microorganisms in PubMed database. Result: According to the keywords frequency statistics and co-occurrence analysis results from the year of 2001 to 2021 in pubMed database, the zoonosis and zoonotic microorganisms arousing high international attentions were classified into the following three categories: the first category was commonly observed zoonotic microorganisms such as Brucella, hepatitis E virus, Streptococcus, Escherichia coli (E. coli) and Salmonella, to which continuous public attentions were still needed to be paid;the second category was the zoonotic microorganisms worldwide concerned in recent years such as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and influenza A virus, which were worthy of more in-depth research to control the spread of these diseases as soon as possible;the third category was the zoonosis that had massively prevailed in specific regions abroad such as Q fever and middle east respiratory syndrome (MERS), and these diseases were expected to be noticed in terms of imported risks to avoid their outbreaks in China. In addition to the above mentioned zoonosis and zoonotic microorganisms, some keywords associated with detection and diagnosis such as phylogeny and PCR were also of high interests. The cluster analysis generated a total of 10 clusters, in which the tick-borne infectious disease cluster suggested the role of ticks in the transmission of zoonotic diseases;the results of timeline and burst analysis demonstrated that among the zoonotic microorganisms, the attentions being paid to influenza A virus and SARS-CoV-2 were gradually increasing. At the same time, the detection technology of zoonotic microorganisms was evolving from specific sequence detection to whole genome sequencing. These fields were likely to be the research direction and trend in the future.

Brucella activates the host RIDD pathway to subvert BLOS1-directed immune defense.

The phagocytosis and destruction of pathogens in lysosomes constitute central elements of innate immune defense. Here, we show that Brucella, the causative agent of brucellosis, the most prevalent bacterial zoonosis globally, subverts this immune defense pathway by activating regulated IRE1α-dependent decay (RIDD) of Bloc1s1 mRNA encoding BLOS1, a protein that promotes endosome-lysosome fusion. RIDD-deficient cells and mice harboring a RIDD-incompetent variant of IRE1α were resistant to infection. Inactivation of the Bloc1s1 gene impaired the ability to assemble BLOC-1-related complex (BORC), resulting in differential recruitment of BORC-related lysosome trafficking components, perinuclear trafficking of Brucella-containing vacuoles (BCVs), and enhanced susceptibility to infection. The RIDD-resistant Bloc1s1 variant maintains the integrity of BORC and a higher-level association of BORC-related components that promote centrifugal lysosome trafficking, resulting in enhanced BCV peripheral trafficking and lysosomal destruction, and resistance to infection. These findings demonstrate that host RIDD activity on BLOS1 regulates Brucella intracellular parasitism by disrupting BORC-directed lysosomal trafficking. Notably, coronavirus murine hepatitis virus also subverted the RIDD-BLOS1 axis to promote intracellular replication. Our work establishes BLOS1 as a novel immune defense factor whose activity is hijacked by diverse pathogens.

Bacterial, fungal and viral zoonoses of pets

Today, pets are the source of numerous infectious diseases that can be transmitted to humans, as a result of their increasingly frequent contact. The most important viruses with zoonotic potential include rabies and influenza viruses as well as rotaviruses and noroviruses. However, the importance of individual viruses varies depending on the climate and infectious disease control systems in certain countries. Dogs, cats, and other increasingly popular types of pets can transmit bacterial zoonotic agents to humans in various ways. In addition to known pathogens such as the bacteria causing leptospirosis, salmonellosis, campylobacteriosis, or brucellosis, the bacteria Pasteurella multocida and Bartonella henselae transmitted by bites or scratches are also significant in human pathology. There has been a significant increase in the prevalence of methicillin-resistant strains of Staphylococcus aureus in isolates originating from pets and the transmission of these strains between humans and animals requires special attention. Furthermore, fungi causing diseases such as sporotrichosis or dermatophytosis are linked to long-term and persistent infections in humans. The epidemiological situation caused by SARS-CoV-2, and the assumption of an interspecies jump of this virus from animals to humans, including its documented presence in domestic cats, dogs, tigers, and martens, have raised the question of the possibility of virus transmission from pets to humans. However, the current pandemic is caused exclusively by SARS-CoV-2 transmission in the human population, and these animals are not a source of infection for humans. A significant number of zoonoses originating from pets is a threat to public health, thus requiring the "One Health" approach through close cooperation between human and veterinary medicine to develop and implement effective health measures for both humans and animals. As part of responsible ownership, pet owners must be informed by veterinarians about measures to prevent infectious diseases and certain risks that are related to keeping certain species of animals.

Quarterly report of investigations of suspected exotic diseases: July to September 2021

Exotic pest and disease investigations are managed and reported by the Ministry for Primary Industries' (MPI's) Diagnostic and Surveillance Directorate. This article presents a summary of investigations of suspect exotic and emerging pests and diseases in New Zealand during the period from July to September 2021.

Special Issue: Microbiologists making waves around the South Pacific. (Special Issue: Microbiologists making waves around the South Pacific.)

This special issue includes 11 articles focusing on development of container laboratories in response to COVID-19;COVID-19 in Fiji;Pacific Regional Infectious Disease Association (PRIDA) - capacity-building for microbiology and infectious disease across the Pacific;meningococcal surveillance in Southeast Asia and the Pacific;tropical fever in remote tropics;movement of arboviruses between Indonesia and Western Australia;Rotavirus surveillance informs diarrhoea disease burden in the WHO Western-Pacific region;surveillance for One Health and high consequence veterinary pathogens (Brucellosis, Coxiellosis and Foot and Mouth Disease) in Southeast Asia - Lao PDR and Cambodia in focus and the importance of international partnerships;Avian influenza H5N1.

Brucella Seroprevalence and Associated Risk Factors in Occupationally Exposed Humans in Selected Districts of Southern Province, Zambia.

Background: Brucellosis is a neglected debilitating zoonosis widely recognized as an occupational health hazard. The seroprevalence of human anti-Brucella antibodies in high-risk populations, as well as their risk factors, have not been well-documented in Zambia. This study aimed at estimating the Brucella seroprevalence in herdsmen and abattoir workers and assess the associated risk factors. Methods: A cross-sectional seroepidemiological study was carried out between May and December 2020 among abattoir workers and herdsmen in Namwala, Monze and Choma districts of Southern Province in Zambia. Seroprevalence was assessed by indirect enzyme-linked immunosorbent assay (i-ELISA) or competitive enzyme-linked immunosorbent assay (c-ELISA) while a questionnaire was administered to obtain epidemiological data. Results: A total of 153 individuals were recruited in the study. The overall Brucella seroprevalence was 20.3% (95% CI: 14.6-27.5). Seropositivity among herdsmen and abattoir workers was 14.4% (95% CI: 9.2-21.8) and 46.4%, (95% CI: 28.8-65.0), respectively. Comparable seropositive results among districts showed Namwala with 26.9%, which was the highest, seconded by Monze 19.0%, and the least was Choma with 11.36%, seropositivity. The multivariate logistic regression model showed that occupation, age category, and district of residence were predictors of being seropositive to Brucella spp. antibodies. The odds of abattoir workers being seropositive to Brucella antibodies were 8.6 (95% CI: 2.6-28.2) higher than that of herdsmen being the reference group. The odds of age category 17-50 years being seropositive to Brucella antibodies were 7.0 (95% CI: 0.7-72.2) higher than being <16 years as the reference group. The odds of one having attained primary level of education being seropositive to Brucella were 1.3 (95% CI: 0.1-14.7) or secondary level of education were 6.2 (95% CI: 0.5-72.6) or tertiary level of education were 5.1 (95% CI: 0.2, 113.3) higher than that of no level of education as the reference group. Furthermore, the odds of a respondent being seropositive to Brucella antibodies were 4.5 (95% CI: 1.3-15.7) for Namwala and 4.9 (95% CI: 1.1-21.7) for Monze higher than that of Choma as the reference group. Conclusion: Anti-Brucella antibodies are prevalent among herdsmen and abattoir workers in the study areas of Zambia (20.26%), a sign of exposure to Brucella pathogens. Type of profession, age and level of education seem to influence the exposure to Brucella pathogens. This zoonosis should be considered as one of the differential diagnosis in humans presenting intermittent fever, malaria-like signs and general pain in humans.

Subacute thyroiditis post COVID-9 vaccinations

Background: Subacute thyroiditis is being frequently seen after Covid infection as the cases of many other viral infections. Patients classically complain of symptoms of thyrotoxicosis mainly palpitations and sweating but with associated tenderness in neck with or without fever. Subacute thyroiditis has seldom been seen after viral vaccinations. We present a case series of subacute thyroiditis which presented after administration of the COVID-19 vaccine. Material(s) and Method(s): Case 1: A 28-year-old female without previous medical problems, presented to the clinic for sore throat, palpitations and dizziness . No recent history of any upper respiratory tract infection or pregnancy. The patient received her second dose of Pfizer/BioNTech mRNA vaccine for COVID-19 2 weeks earlier. Thyroid function testing was done and revealed TSH 0.001, fT4 3.29, fT3 6.8. Her TPO antibody, thyroglobulin antibodies and Trab were negative. Technetium-99m pertechnetate scan revealed diffuse thyroiditis. The patient was prescribed prednisone 20 mg daily. She reports rapid improvement of her symptoms and prednisone treatment was given for 3 weeks then stopped. Repeated tests showed normal TSH 10 days after stopping steroids. Case 2: A 49-year-old female with the history of V Leiden mutation and repetitive abortions presented to the clinics on May 25, 2021 for the complaint of unintentional weight loss of 6 kg in 20 days and palpitations, preceded by fever and neck pain at the end of April. The patient noted that she was vaccinated with her second dose of Sinopharm vaccine on the 6th of April 2021. Thyroid function test revealed a thyrotoxic profile TSH 0.005, fT4: 42, fT3 9,02. With negative thyroglobulin antibody, TRAb. CRP 60 , . Thyroid Ultrasound showed a diffuse heterogenous echtexture of the thyroid. A fever work up was done to rule out other infectious causes including Salmonella and Brucella, all were negative. The patient was prescribed prednisone 40 mg daily and propranolol 10 three times daily, gradually tapered over one months. Her Symptoms resolved and her follow up tests showed normal tsh and CRP Result(s): Discussion: Subacute thyroiditis is usually associated with upper respiratory tract infections including Covid -19 infection. This can be explained by T cells cross reacting between the virus and the thyroid cells. Moreover, De Quervain thyroiditis following viral vaccines has been reported influenza vaccines. Thyroiditis has not been described until now as a frequent side effect of Covid vaccine. So we presented the cases of a 28 and 49- year-old females who has presented with cases of subacute thyroiditis after receiving respectively the Pfizer mRNA vaccine and Sinopharm vaccine for COVID-19. Conclusion(s): Conclusion: Subacute thyroiditis after Covid-19 vaccine is rare but may be underreported. Further investigations are required to evaluate predisposing factors to De Quervain thyroiditis following Covid-19 vaccine.