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.

Outbreak of leptospirosis amidst COVID'19 in Tanzania: a new threat? Short communication.

As the world is still fighting to combat the coronavirus disease 2019 (COVID-19) virus, the United Republic of Tanzania has been confronting yet another bacterial infection called leptospirosis (LS). It is caused by the spirochete bacteria of genus Leptospira, and has been known to infect several people, already claiming a number of lives. It infects 1 million people annually with ~60 000 deaths having a fatality rate of 6.85% worldwide. COVID has profusely burdened the healthcare system worldwide within the past 2 years; it has sabotaged medical management and brought down resources, which has now made it difficult for any country to withstand another pandemic. LS has overburdened the medical care system of Tanzania abjectly; it is now imperative not to overlook environmental factors, like a flood, the presence of rodents, unsatisfactory socioeconomic conditions in areas where dogs reside, substandard wastewater and garbage disposal facilities, or any other factor which might lead to further spread of LS and put Tanzania in jeopardy.

Hepatotoxicity From Marijuana Gummies

Introduction: We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods: A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure) Discussion: Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).

Detection of Leptospira DNA among Post-Mortem Specimens during Covid-19 Pandemic

Intro: Leptospirosis is an emerging zoonosis with a global health concern. In Malaysia, leptospirosis incidence remains significant, since its first gazettement as a compulsorily notifiable disease in 2010. However, the prevalence of this disease among local forensic cases is unknown. Therefore, the present study aimed to determine the frequency of human leptospirosis among post-mortem specimens. Method(s): Archived forensic specimens referred to the Institute for Medical Research (IMR), Malaysia between January 2020 and December 2021 were retrieved. DNA from the specimens were extracted using an automated MagNA Pure 96 instrument and subjected to in-house qPCR targeting LipL32 gene and 16S rRNA gene of the pathogenic group of Leptospira spp. Amplification of RNaseP gene was included as internal amplification control (IAC). Finding(s): A total of 408 forensic specimens from 365 patients were received during the study period. Majority of the specimens were blood (n = 195, 47.8%), followed by tissue (n = 136, 33.3%) and liver (n = 59, 14.5%). Of the tested specimens, 2.2% (n = 9) were positive for leptospiral DNA. These positive specimens belonged to 9 different patients, of which the vast majority were male (n = 8, 88.9%), with an average age of 37.5 years. Conclusion(s): Albeit low detection of leptospiral DNA among forensic specimens in Malaysia, this study highlighted that majority of the positive patients were males of productive age.Copyright © 2023

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.

The Investigation of Significant Leptospirosis Hotspots during the Initial COVID-19 Pandemic in the City of Jakarta, Indonesia

Leptospirosis is a common bacterial infection caused by pathogenic Leptospira spp.in tropical region, including in Indonesia. During the first year of COVID-19 pandemic, Jakarta reported a significant increase in leptospirosis cases. A study was conducted to analyze the distribution of leptospirosis and to identify hotspots of the leptospirosis. Leptospirosis notifications for the period of January to December 2020 were collected from the online surveillance database provided by the Provincial Health Office of Jakarta. Global and local spatial clustering at the village level across Jakarta was examined using Moran’s I and local indicators for spatial association (LISA). In 2020, total of 207 people infected by Leptospira spp. The highest number was recorded in January (n=142), accounting for 68.5% of the total reports over the period studied. The incidence was geographically dissimilar at village-level with the highest rates was observed in the west of the city. Moran’s I analysis demonstrates that leptospirosis incidence was significantly clustered (I = 0.191, p-value = 0.001). Total of 19 high-risk clusters in 9 sub-districts were identified and approximately 891,202 people were at higher risk of leptospirosis during the year of 2020. The findings suggest needs an improved disease surveillance to support spatially targeted interventions to control leptospirosis transmission.

TULAREMIA PRESENTING AS LARGE GI ULCERATION AND HEMORRHAGE

SESSION TITLE: Critical Care Infections SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Francisella tularensis is a zoonotic disease by an aerobic, gram negative coccobacillus. It is transmitted by exposure to infected animal or vectors in individuals who landscape or camp. Common symptoms are fever, chills, anorexia, and headache. Abdominal tularemia can present with abdominal pain, emesis, diarrhea, and rarely intestinal ulceration and hemorrhage. It is treated with aminoglycosides, fluoroquinolones and tetracycline. CASE PRESENTATION: 38-year-old male presented with fever, cough, anorexia, and black stool for 5 days. Patient worked as a landscaper. He has no pets, travel history or sick contacts. He does not take any medications at home. Physical exam was significant for sinus tachycardia and rhonchi of right upper lobe. Significant labs include WBC of 9.8 with 41% bands, hemoglobin 15.5, sodium 125, procalcitonin 27.3, and lactic acid 1.8. COVID-19, MRSA, Legionella and Pneumococcal urine antigen were negative. CTA chest revealed mass-like opacity in right upper lobe with multiple bilateral pulmonary nodules. Lower respiratory culture showed Candida albicans. Patient was empirically started on ceftriaxone and azithromycin. He was transferred to intensive care for worsening respiratory status and was placed on non-invasive ventilation on hospital day 1. Antibiotics were broadened to ceftaroline and levofloxacin due to suspicion of tularemia. Amphotericin B was added. Labs for Histoplasma, Blastomyces, TB, Leptospira, and HIV were negative. Patient then suffered a cardiac arrest on hospital day 2 after having large brown secretions pouring from his mouth. Cardiopulmonary resuscitation was initiated and patient was intubated and started on vasopressors with return of spontaneous circulation. Massive blood transfusion protocol was initiated. Emergent bedside upper endoscopy showed large blood clot adherent to duodenal ulcer. Interventional radiology planned on performing gastric duodenal artery embolization. However, patient suffered two more cardiac arrest with resuscitation efforts terminated per family request. Karius Digital Culture later was positive for Francisella tularensis. Autopsy revealed diffuse alveolar hemorrhage, hilar lymphadenopathy, and perforated duodenal ulceration with large adherent clot. DISCUSSION: Gastrointestinal tularemia is rare and usually from drinking contaminated water or oral inoculation of bacteria. Intestinal tract involvement can present with mesenteric lymphadenopathy and ulcerative lesions resulting in gastrointestinal bleeding with case fatality rate of 50%. Even though this is noted in the literature, to our knowledge no case reports have been published. CONCLUSIONS: Careful history taking and early identification of risk factors are important when severe tularemia infection is suspected such as in individuals with extensive outdoor activities. Treatment should be empirically initiated in high risk patients. Reference #1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4585636/ Reference #2: https://casereports.bmj.com/content/2017/bcr-2017-22125. Reference #3: Altman GB, Wachs JE. Tularemia: A pathogen in nature and a biological weapon. Aaohn Journal. 2002 Aug;50(8):373-9. DISCLOSURES: No relevant relationships by Maria Haider Baig

Changing Trends in the Seroprevalence of Leptospirosis in Kelambakkam: A Ten-Year Retrospective Study

Introduction: Leptospirosis is a zoonotic infection affecting humans. The main sources of infection are animal reservoir hosts and man is the accidental host in the disease transmission process. The diagnosis is usually made by microscopy, culture, molecular techniques, and serological tests like ELISA, MAT (Microscopic Agglutination Test) and MSAT (Macroscopic Slide Agglutination Test). The ELISA method to detect IgM antibodies is used as a good cost-effective testing method. An increasing titre of IgM antibody is a sign of active leptospirosis. Aims and Objectives: The study aimed to evaluate the seroprevalence of Leptospirainfection over a 10-year period in a tertiary care hospital located in Kelambakkam village in Chengalpattu district. Material and Method: The samples were tested for the presence of specific Leptospira IgM antibodies in the patient’s serum using the Panbio Leptospira IgM ELISA kit. The samples were reported as positive/negative/equivocal accordingly. Results: This retrospective study included a total of 2035 patients, clinically suspected of leptospirosis, over a 10-year period from 2011 to 2021. 186 patients tested positive for specific IgM antibodies by ELISA method,giving an overall prevalence rate of 9.14%. Conclusion: The seroprevalence of leptospirosis over a time period of more than 10 years is highlighted in our study. Clinical suspicion of leptospirosis should be kept in mind at all times, especially now during the COVID-19 pandemic. The Panbio Leptospira IgM ELISA test kit used in our study proves to be a very useful method for diagnostic purposes, especially in limited-resource settings. Copyright © 2022: Author(s).

Multisystem Inflammatory Syndrome in Indian Children Associated with SARS-CoV-2 Infection: A Case Series ABS0026)

Introduction: The coronavirus disease 2019 pandemic has affected all the countries and age groups alike. However, during the initial part of a pandemic, COVID-19 affected children with a milder form of the disease and had better clinical outcomes than adults.1 Subsequently, a rising number of previously well children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) induced hyperinflammatory states resembling macrophage activation syndrome, toxic shock syndrome, and Kawasaki disease were reported.2 Here, we describe four children with COVID-19-associated MIS-C presenting to a tertiary care center between May 17 and June 17, 2021. They had distinct clinical features, but similar laboratory and radiological findings. However, none of them were positive for SARS-CoV-2 nucleic acid on real-time polymerase chain reaction but all of them had elevated immunoglobulin G titers against SARS-CoV-2. Case description: Four previously well children, aged 13-14 years, including equal number of males and females, presented to us with complaints of fever with rash, abdominal pain for 5-6 days. None of the patients had comorbidities, except patient 2, who was a known case of type 1 diabetes mellitus and was receiving huminsulin. At presentation, patients 1 and 4 had hypovolemic shock and dyspnea. There was mild global hypokinesia with mild tricuspid and mitral regurgitation in patient 3 and biventricular dysfunction (ejection fraction: 54%) with mild pericardial effusion in patient 4. Laboratory investigations revealed negative for malaria, dengue, scrub typhus, and leptospira in all the patients. Neutrophilia and lymphocytosis were observed in every patient. All, except patient 2, had thrombocytopenia. The international normalization ratio was raised in patients 1 and 2. All patients had negative RT-PCR for SARS-CoV-2. While, the levels of COVID-19 IgG antibody, C-reactive protein, D-dimer, lactate dehydrogenase, erythrocyte sedimentation rate. They were managed in the medicine intensive care unit (MICU). The shock and hypoxia was managed with fluids and inotropes and 6-8 L O2 through bag-mask-ventilation (BMV). Additionally, in all the patients, MIS-C was suspected and intravenous immunoglobulin (IVIG, 2 mg/kg), intravenous methylprednisolone, low molecular weight heparin, broad spectrum antibiotics, fluid therapy, and supportive care was initiated. One of them developed cardiorespiratory arrest. Resuscitation was done but the patient could not be revived back. While other patients responded well over the next 48-72 hours with a gradual decrease in titers of inflammatory markers. Steroids were slowly tapered off and patients were discharged. Conclusion: The findings of our series suggest that COVID-19 can trigger a hyperinflammatory state resulting in shock and pulmonary involvement, in some of the patients. The patients presented with distinct clinical features, with some mimicking atypical KD, the underlying mechanism for which still remain unclear. The physicians should be suspicious of MIS-C in children presenting with fever, rash, and gastrointestinal symptoms.

Leptospirosis: A Consideration When Acute Liver Failure Accompanies Acute Kidney Injury (AKI)

A 48 y.o. male maintenance worker in a rat-infested building with history of tobacco and marijuana smoking, atrial fibrillation on no medications was admitted in July 2021 for fever, headache and body aches for 5 days and new onset of hemoptysis. Initial labs notable for BUN 36 mg/dl, Cr 1.4 mg/dl urine protein 100 mg/dl RBCs 5-10/hpf, platelets 46,000. total bilirubin 3.8 mg/dl direct bilirubin 3.0 SARS-CoV-PCR negative and CXR revealed patchy bilateral infiltrates. He was intubated on day 2 and had ventricular fibrillation and cardiac arrest on day 3 with rapid return of purposeful movement. He had worsening anemia and thrombocytopenia, positive ANA and dsDNA, leading to use of steroids and plasmapheresis on Day 6 when peak bun/cr was 91/3.1 with urine protein/cr ratio 0.7, urine microscopy 2 rbc/hpf, urine Na 20 meq/l, urine osm 775 mosm/kg and cpk 400 U/l. These tests were negative or normal: Anti-GBM, ANCA, repeat ANA, repeat dsDNA, C3, C4, HIV, RF, hepatitis C RNA, cryoglobulins, ASO titer, ADAMTS13, Pneumocystis PCR, Sputum AFB, blood, AFB and fungal cultures, viral and fungal testing, hanta virus antibodies. Leptospira antibodies IgM by Dot Blot were positive and Leptospirosis diagnosis confirmed by NYC Department of Health (DOH) after obtaining confirmatory microscopic agglutination testing from the CDC. Urine and blood Leptospira DNA PCR not detected. He remained intubated with FiO2 requirement at 100% prior to his death on hospital day 16. Initially pulmonary renal syndrome considered but he was later found to have pre-renal azotemia. The elevated bilirubin led to testing for leptospirosis, his final diagnosis. In September 2021 the NYC DOH reported 14 cases of leptospirosis (increased from 5 cases in 2020), 13 of which had acute renal and hepatic failure, with 2 having severe lung involvement (1). This case is the only one in this group who died. The leptospirosis case fatality rate for severe diffuse alveolar hemorrhage exceeds 50%. Early appropriate antibiotic treatment prior to lab confirmation has been recommended by the CDC and may decrease severity of disease.

LEPTOSPIROSIS IN THE CITY: A CASE REPORT

CASE: A 58 year-old undomiciled man with no medical history presented with three days of anorexia, malaise, abdominal pain, and decreased urination. Exam was notable for scleral icterus. Lab-work revealed sodium 133 mEq/L, BUN 132mg/dL, creatinine 8.82 mg/dL, platelet 64 K/uL, total bilirubin 6.4 mg/dL, direct bilirubin 5 mg/dL. Lab-work two years prior was normal. HCV antibody was reactive, urinalysis revealed microscopic hematuria, and cocaine was detected on toxicology. Abdominopelvic CT, MRCP and renal sonogram were non-pathologic. On hospital day 5 his creatinine downtrended but total bilirubin continued to rise to a peak of 11.2 mg/dL and a leukocytosis without fever developed (peak 21.2 K/uL). Ceftriaxone was started empirically and a workup of blood cultures, viral serologies, ANA, alpha-1 antitrypsin, complement, cryoglobulin, ceruloplasmin level, microsomal, smooth muscle and antimitochondrial antibodies was normal. Review of his history suggested exposure to rodents as he slept close to a dumpster. Pending Leptospirosis serology, the antibiotics were adjusted to doxycycline. At discharge, the WBC and platelet counts normalized while the bilirubin and creatinine downtrended. IgM serology for leptospira later resulted positive. IMPACT/DISCUSSION: Leptospirosis is a worldwide zoonotic disease commonly associated with moist environments, poor housing and inadequate sanitation. Rodents are important reservoirs, shedding spirochetes through urine. Human infection results from exposure to animal urine, contaminated soil or water, or infected animal tissue. Portals of entry include cuts, mucous membranes or conjunctivae. Person-toperson transmission is rare. The incubation period is 5-14 days and illness severity ranges from subclinical to life-threatening. Disease manifestations include jaundice with acute kidney failure (Weil's disease), rash, conjunctival suffusion, hyponatremia, thrombocytopenia, microscopic hematuria, myocarditis, pulmonary hemorrhage, and meningitis. A biphasic illness, the acute febrile bacteremic phase can last 2-9 days followed by a period of apparent improvement. An “immune” phase then follows characterized by development of complications, as in our patient. During this phase, leptospires are absent from blood but may appear in the urine. While human cases of leptospirosis are rarely reported in the US outside of Puerto Rico and Hawaii (in the absence of travel), there was a significant rise reported to the NYC DOH in 2021. A potential explanation is an increase in housing insecurity and disruptions to waste management as a consequence of the COVID-19 pandemic. CONCLUSION: Leptospirosis is an important consideration in at-risk populations who may unknowingly be exposed due to living conditions. Our case of unexpected Weil's disease in an urban setting underscores the importance of a thorough social history as well as timely recognition of uncommon infections as possible reversible causes of multi- organ failure in the context of a changing world climate.

A review of pig and poultry diseases in the Eastern Cape province of South Africa, 2000-2020

The informal poultry and pig sector in the Eastern Cape Province (ECP) of South Africa is of significant socio-economic importance as it sustains livelihoods and ensures food security;yet little is known about the distribution and prevalence of infectious and zoonotic diseases in this region. This paper reviews data published for pig and poultry diseases in the province during the last 20 years (2000-2020). The review included relevant published papers identified by a computerised literature search from Web of Science;provincial animal health reports;the national database from the Department of Agriculture, Land Reform and Rural Development (DALRRD);animal health reports submitted by DALRRD to the World Organisation for Animal Health (OIE) via the World Animal Health Information Database (WAHID) interface and laboratory records. A publication was considered eligible if it included qualitative or quantitative information on any disease affecting pigs and poultry including zoonosis. The search retrieved 174 publications, of which 26 were relevant. The review found that Newcastle disease (ND), coccidiosis and fowl pox (FP) were the most reported avian diseases in the national database, whereas avian infectious bronchitis (AIB), ND and highly pathogenic avian influenza (HPAI) were the most reported diseases in the OIE database. Classical swine fever (CSF) was the most reported pig disease in both databases. The retrieved literature on pig and poultry diseases was scarce and no longer up to date, providing decision makers with little information. The review identified important zoonotic diseases that require further studies yet failed to find information on important neglected diseases like leptospirosis.

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.

Leptospirosis and COVID-19 Co-Infection Manifesting as an Enhanced Thrombotic Phenomenon

Clinical manifestations of coronavirus disease 2019 (COVID-19) range from mild self-limiting illness to multi-organ dysfunction and acute respiratory distress syndrome (ARDS). Also, leptospirosis manifests as mild or asymptomatic infection, and only a small number of patients progress to ARDS and develop systemic manifestation. COVID-19 and leptospira co-infection can have fatal outcomes because of augmented pathophysiological manifestations of both the disease. We here describe a case of leptospira and COVID-19 coinfection in a patient who had poor results due to multi-organ involvement

Special Issue: All subjects about laboratory sciences in emerging diseases. (Special Issue: All subjects about laboratory sciences in emerging diseases.)

This special issue contains 10 papers on the following topics: evaluating association between ABO blood groups and COVID 19;impact of COVID-19 on Libyan laboratory specialists;microscopic agglutination test for diagnosis of leptospirosis by using filter paper-dried serum samples;prevalence of haemoparasites among blood donors in Calabar, Nigeria;assessment of peripheral blood lymphocytosis in adults and determination of thresholds for differential diagnosis between clonal and reactive lymphocytosis;investigation of antibiotic resistance pattern in isolates from urine and blood samples of patients admitted to the Intensive Care Unit of Velayat Hospital in Qazvin, Iran;evaluation of rejection rates and reasons among specimens taken from different hospital units;quality tools to ensure patient safety and reduce the turnaround time of medical laboratories in tertiary care teaching hospitals;prevalence and antibiotic resistance pattern of Gram-positive isolates from burn patients in Velayat Burn Center in Rasht, North of Iran;and infective endocarditis caused by Staphylococcus aureus in a 6-year-old girl with no history of heart and dental problems.

Summary of global surveillance data of infectious diseases in January 2022

In January 2022, a total of 68 infectious diseases were reported globally, affecting 228 countries and regions. Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were corona virus disease 2019 (COVID-19, 228), dengue fever (26), measles (19), cholera (12) and leptospirosis (10). The top five infectious diseases with highest case fatality rates were Rift Valley fever (100.0%), Lassa fever (19.0%), yellow fever (15.5%), plague (7.5%) and West Nile fever (7.1%). The top five infectious diseases with greatest number of deaths were COVID-19, malaria, measles, Lassa fever and cholera. The prevalent infectious diseases in Asia were COVID-19 and dengue fever, the prevalent infectious diseases in Africa were COVID-19, cholera, yellow fever, Lassa fever, malaria and measles, the prevalent infectious diseases in America were COVID-19, dengue fever and chikungunya fever, the prevalent infectious disease in Europe was COVID-19.

Coinfection of leptospirosis and coronavirus disease 2019: A retrospective case series from a coastal region in South India.

During the monsoon season of 2020, the coastal areas of South India were endemic to both leptospirosis and coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical features and outcomes of patients infected with both infections. A retrospective review of charts of all patients with COVID-19 who were also diagnosed with leptospirosis by immunoglobulin M enzyme-linked immunosorbent assay was undertaken. The clinical features, laboratory report, treatment details, and outcomes of all the included patients were recorded. The collected data were summarized as the frequency with percentage for categorical data and the mean or median for continuous data. Twenty-four cases of coinfections were admitted between July and November 2020. Most of these patients were categorized as severe COVID-19 (n = 15, 62.5%). Acute kidney injury was seen in 79.2% (n = 19) patients, while raised bilirubin was present in 79.2% (n = 19) of the patients. All patients had raised C-reactive protein, while all but one had raised procalcitonin. Thrombocytopenia, leucocytosis, and leukocytopenia were seen in 91.7% (n = 22), 45.8% (n = 11), and 12.5% (n = 3) of the patients. The median duration of hospital stay was 11 (8.25-15) days. A total of 79.2% (n = 19) of the patients improved and were discharged, while 20.8% (n = 5) died during the hospital stay. In conclusion, patients with fever and atypical manifestations such as hepatic dysfunction, renal dysfunction, and thrombocytopenia should be evaluated for leptospirosis even if they are COVID positive.

Role of Diagnostics in Epidemiology, Management, Surveillance, and Control of Leptospirosis.

A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.

Compatibility between a rabies vaccine and two canine combined vaccines against canine distemper, adenovirosis, parvovirosis, parainfluenza virus disease and leptospirosis, with or without canine coronavirus.

In many countries, vaccination programs still require dogs to be vaccinated against rabies in addition to Canine distemper virus (CDV), adenovirus (CAV), parvovirus (CPV), parainfluenza virus (CPiV), Leptospira (L) or Canine coronavirus (CCV= Cv). Few vaccines containing all these antigens are commercially available and, unless compatibility between the vaccines was demonstrated, concurrent administration of a DAPPi-L(Cv) vaccine and a vaccine against rabies should not be recommended. This may be of concern for practitioners who wish to vaccinate dogs with all components on the same day. This study aimed at evaluating immunological compatibility between a monovalent rabies vaccine (Rabisin™) and two large combination vaccines against CDV, CAV, CPV, CPiV with 2 leptospira components +Cv (Recombitek® C6/Cv) or with 4 Leptospira components (Recombitek® C8), when injected concomitantly at two separate injection sites. Fourteen days after administration of the rabies vaccine, with or without concomitant administration of combo vaccines, all dogs had seroconverted against rabies and maintained protective titers over the duration of the study. In addition, 100% of the puppies vaccinated with one or the other combo vaccines seroconverted against CDV, CAV, CPV, CPiV (CCV) and Leptospira, whatever the vaccination group. Lack of immunological interference between Rabisin™ and all components of the Recombitek® C6/Cv or Recombitek® C8 Combo vaccines was demonstrated by non-inferiority analysis, except for CDV in the Recombitek®C8+ Rabisin™ group. Based on these results, a concomitant administration of Rabisin™ with Recombitek® C6/Cv or Recombitek® C8 can be recommended in daily practice, which can be essential for facilitating vaccination compliance.

Clinical profile, management and outcome of patients with leptospirosis during the times of COVID-19 pandemic: A prospective study from a tertiary care centre in South India.

Leptospirosis is a rodent-borne acute febrile illness, classically seen after heavy rainfall and floods. This study aimed to describe the clinical profile, management strategies and outcome of patients with leptospirosis amidst the Coronavirus disease-2019 outbreak. A prospective study of adult patients with undifferentiated fever (5-15 days) was conducted in South India between October 2020 and February 2021. The demographic, clinical details, laboratory details, treatment and outcome of leptospirosis positive (based on serology) and negative patients were compared. A chisquare test was used for qualitative variables, while an independent t-test or Mann Whitney U test was used for continuous variables. Of the 206 patients with suspected acute febrile illness, a total of 63 patients were diagnosed with leptospirosis based on serology results. The median sequential organ failure assessment score was higher in those with leptospirosis (p<0.001). Myalgia, abdominal pain, jaundice, decreased urine output, myocarditis, and dialysis requirement were more common in patients with leptospirosis. Leucocytosis and raised procalcitonin/C-reactive protein were more common in patients with leptospirosis. The duration of stay and antibiotic consumption was higher in patients with leptospirosis. Acute febrile illness such as leptospirosis should be suspected in tropical areas with significant risk factors. The presence of conjunctival suffusion, hepatic and renal dysfunction should warrant a serology test for leptospirosis.