Chikungunya in the Caribbean: An Epidemic in the Making.

Chikungunya is a mosquito-borne virus that has shown increased prevalence in the Caribbean since October 2013. There have been several outbreaks throughout Asian and African countries over the past few decades with global travel and tourism having a major impact on the further spread of this disease. Improved policies and practices for preventative measures and epidemiological surveillance must be implemented to prevent the continued transmission of chikungunya.

Leptospirosis and malaria as causes of febrile illness during a dengue epidemic in Jamaica.

BACKGROUND: Epidemics of febrile illnesses are often associated with rainy seasons in the tropics. During 2007-2008 an epidemic of dengue was identified in Jamaica based on serological testing of sera. METHODS: A subset of 3165 of 5400 sera submitted for dengue analysis was tested for Leptospira IgM and malaria IgG using ELISA to determine their role in causing epidemic fever. FINDINGS: Seropositivity for dengue, leptospirosis, and malaria were 38·4 and 6·0 and 6·5%, respectively, indicative of three concurrent epidemics. Mixed exposure to all three diseases was rare (0·1%), as were mixed dengue/malaria (2·4%); dengue/leptospirosis (1·6%), and leptospirosis/malaria (0·03%) exposure. Exposure to dengue and malaria appeared to occur most frequently among children while leptospirosis was more common among adults. CONCLUSION: While serological diagnosis definitively established that dengue was the main cause of the epidemic febrile illness, the data suggested that there may be other causes of fever, which may occur simultaneously. Consequently, leptospirosis and malaria should be considered as causes of fever during epidemics of dengue in endemic areas.

The effectiveness of the Gram stain of high vaginal swabs in the diagnosis of bacterial vaginosis at the University Hospital of the West Indies [abstract]

OBJECTIVE: To correlate the gram-stain of high vaginal swabs (HVS) with the diagnosis of bacterial vaginosis (BV) and to compare this with bacterial culture reports to determine whether any useful additional information is gained by culture. METHODS: HVS submitted to the microbiology laboratory (UWI) from patients diagnosed clinically with vaginal infection were used in this study. Specimens were submitted from the Family Planning, Gynaecology and Antenatal clinics at the University Hospital of the West Indies. Swabs were placed in Stuart's Transport Medium and taken to the microbiology laboratory within 24 hours. The specimens were subjected to standard bacteriological procedures of culture on blood and MacConkey agar and microscopic procedures of wet prepartion and gram stain. The gramstain was recorded on a specially designed data sheet for each patient with a standardized scoring method for the evaluation of gram-stained smears based on the recognition of both presence and amount of significant morphotypes. This result was then compared with the bacterial culture, available a few days later, to see the degree of correlation and to determine whether any relevant additional information was gained. Almost 60 percent of the specimens collected yielded no pathogens on culture. However, one-third of this 60 percent was diagnosed as BV by standardized scoring method. One-third of all specimens submitted yielded yeast (Candida albicans and yeast not-Candida albicans) on culture and by gram stain. Streptococcus group B was isolated in < 4 percent of all specimens and a miscellaneous group of organisms including Klebsiella sp, Pseudomonas sp and anaerobic Streptoccus made up the rest of bacterial isolates. CONCLUSIONS: The standardized scoring method of evaluating the HVS gram stains yielded a more accurate and rapid diagnosis of BV than the traditional culture method. This is worthy of further study, as implementation of this method would result in considerable cost and time saving. (AU)

Investigations of central nervous system viral infection at UHWI, 1998-1999

Preliminary results are presented for viral infections of the CNS at UHWI between July 1998 and June 1999. A total of 168 cases were referred from the following hospitals and distributed as follows: UHWI 119 (70 percent); Bustamante Children's 31 (18 percent); Spanish Town 10 (6 percent); Kingston Public 7 (4 percent); Other 2 (1 percent). Specimens received were acute and convalescent sera, throat swabs, rectal swabs and CSF. Laboratory investigations included viral culture and serology; confirmatory methods included neutralization tests, immunofluorescence (IFA) and polymerase chain reaction (PCR). The clinical diagnoses in the 168 cases included for viral CNS investigations were submitted from only 47/168 (30 percent) of cases. Viral agents were identified in 31/47 (66 percent) of the appropriate specimens received. These viruses included enteroviruses 12/31 (38 percent), human immunodeficiency virus (HIV) 9/31 (29 percent), 3/31 (9 percent) of the HIV positive patients were also positive for toxoplasmosis), dengue 6/31 (19 percent), herpes simplex virus 1/31 (3 percent), rotavirus 1/31 (3 percent), cytomegalovirus 1/31 (3 percent) and influenza 1/31 (3 percent). Enteroviruses, HIV and dengue were the viruses most frequently associated with CNS infections among the 31 cases identified. This however is not a complete representation of CNS associated with viral agents, as appropriate specimens were received from only 30 percent of the cases. This study also demonstrated a definite need for an increased understanding of appropriate specimen collection and submission necessary for the diagnosis of viral CNS infections.(AU)