Nosocomial malaria transmissions resolved by genomic analyses - a retrospective case report study in France (2007-2021).

BACKGROUND: Exposure of blood to malaria parasites can lead to infection even in the absence of the anopheles mosquito vector. During a stay in a healthcare facility, accidental inoculation of the skin with blood from a malaria patient might occur, referred to as nosocomial malaria transmission. METHODS: Between 2007 and 2021, we identified six autochthonous malaria cases that occurred in six different French hospitals, originating from nosocomial transmission and imported malaria patients being the infection source. Four cases were observed during the COVID-19 pandemic. The genetic relatedness between source and nosocomial infections was evaluated by genome-wide short tandem repeats (STRs) and single-nucleotide polymorphisms (SNPs). RESULTS: None of the patients with autochthonous malaria had travel history to an endemic area nor had been transfused. For each case, both the source and recipient patients stayed a few hours in the same ward. After diagnosis, autochthonous cases were treated with antimalarials and all recovered except one. Genetically, each pair of matched source/nosocomial parasite infections showed less than 1% of different genome-wide STRs, and less than 6.9% (<1.5% for monoclonal infections) of different SNPs. Similar levels of genetic differences were obtained for parasite DNA samples that were independently sequenced twice as references of identical infections. Parasite phylogenomic results were consistent with travel information reported by the source patients. CONCLUSIONS: Our study demonstrates that genomics analyses may resolve nosocomial malaria transmissions, despite the uncertainty regarding the modes of contamination. Nosocomial transmission of potentially life-threatening parasites should be taken into consideration in settings or occasions where compliance with universal precautions is not rigorous.

High genetic diversity of Babesia canis (Piana & Galli-Valerio, 1895) in a recent local outbreak in Berlin/ Brandenburg, Germany.

Canine babesiosis caused by Babesia canis (Piana & Galli-Valerio, 1895) is emerging in new regions in Europe since its vector Dermacentor reticulatus (Fabricius, 1794) is expanding its geographic range. In the Berlin/Brandenburg area in northeast Germany, D. reticulatus is highly abundant but in the past only one autochthonous B. canis infection was reported. Since 2015, autochthonous cases were occasionally diagnosed but numbers increased since autumn 2019. The aim of the study was to genotype autochthonous canine Babesia spp. infections from Berlin/Brandenburg. Between 04/2015 and 01/2022, 46 dogs with acute babesiosis were presented to the small animal clinic (one dog was infected twice resulting in 47 samples). There were 32 dogs that had never left Berlin/Brandenburg and 14 others that had not left the region in the 6 weeks prior to disease onset. PCRs targeting the 18S rRNA and the Bc28.1 merozoite surface antigen were positive in 47 and 42 samples, respectively. Sequencing of cloned PCR products identified all samples as B. canis with 17 18S rRNA and 12 Bc28.1 haplotypes. Based on network analysis for 18S rRNA sequences and a previously described polymorphic dinucleotide, samples were assigned to two distinct clusters. One contained 31 and the other 16 samples. Using network analysis, the Bc28.1 haplotypes could also be separated into two clusters differing by at least five polymorphisms. Analyses of sequences from multiple clones indicated the presence of up to five 18S rRNA and eight Bc28.1 haplotypes and thus high parasite variability in an individual host. The genetic diversity could suggest that the parasites in the region have multiple origins, but diversity in individual dogs and dog populations from endemic regions is unknown. The suitability of both markers for genotyping is questionable due to potential intragenomic diversity for the rRNA and high intergenomic variability for the Bc28.1 marker.

Direct Transmission of SARS-CoV-2 Among Contacts in Santiago de Cuba

Introduction: SARS-CoV-2 spreads, mainly, through close contact among people, hence the importance of detecting contacts of confirmed cases and identifying the mode of transmission between them. Objective: To identify the main modes of direct transmission among contacts of imported and autochthonous cases. Methods: A cross-sectional descriptive study was conducted in two populations: the confirmed cases of COVID-19 in Santiago de Cuba in the last quarter of 2020, and their declared direct contacts. In the search of the best representativeness, a two-stage stratified sampling method was used. The interview was used to collect the primary data;numbers and percentage, to summarize the information;the one-sample proportion hypothesis test and the compare proportions test using Minitab v.19, to identify possible differences across groups;and Microsoft Excel 2016, to produce the graphics. Results: The average number of contacts was higher among the autochthonous cases, prevailing the co-workers, neighbors and children. The contact-case relationship in imported cases was friend, driver, and mother or father-in-law;while in the autochthonous cases, it was son or daughter. Preventive actions were less used, and extra-domiciliary contacts of imported cases predominated. Contacts of imported cases were hospitalized more often, and had a higher proportion of asymptomatic than the autochthonous cases, but there was no significant differences. Conclusions: A differentiated pattern of transmission was not obtained;except that, transmission among autochthonous cases was between parent and child;while in imported cases, it was between friends. © 2022, Editorial Ciencias Medicas. All rights reserved.

First autochthonous dengue outbreak in Italy, August 2020.

In August 2020, during the coronavirus disease (COVID-19) pandemic, five locally acquired cases of dengue virus type 1 were detected in a family cluster in Vicenza Province, North-East Italy where Aedes albopictus mosquitoes are endemic. The primary case was an importation from West Sumatra, Indonesia. This is the first outbreak of autochthonous dengue reported in Italy. During the COVID-19 pandemic, screening of febrile travelers from endemic countries is crucial in areas where competent vectors are present.