Severity of acute Zika virus infection: A prospective emergency room surveillance study during the 2015­2016 outbreak in Suriname

Acute Zika virus (ZIKV) infection is usually mild and self-limiting. Earlier, we reported three cases of fatal acute ZIKV infection in patients without typical signs of ZIKV, but rather with criteria of systemic inflammation response syndrome (SIRS). To follow up these observations, we prospectively included patients at the emergency room with temperature instability and suspected to have acute ZIKV infection, SIRS, or both. A total of 102 patients were included of whom N =21 (21%) were suspected of acute ZIKV infection, N =56 (55%) of acute ZIKV infection with SIRS criteria, and N =25 (24%) of SIRS alone. ZIKV-PCR was positive in N =21 (20%) patients. Eight (38%) ZIKV-positive patients needed admission to the hospital of whom four (50%) presented with SIRS alone. One ZIKV-positive patient had vascular co-morbidity and died following shock and severe coagulopathy. We confirm the hypothesis that acute ZIKV infection can present atypical and severely with systemic inflammation and have lethal course particularly amongst patients with significant prior disease...(AU)

Clinical, molecular and serological outcomes of the Chikungunya outbreak in Grenada

OBJECTIVE: This study evaluated the clinical utility of Chikungunya (CHIKV) test results and clinical symptoms in patients with suspected CHIKV infection. DESIGN AND METHODS: Patients with CHIKV symptoms who presented at a health facility in Grenada during the recent outbreak had a CHIKV diagnostic test form completed by a health professional and a blood sample was drawn. The serum sample was stored at -80oC, shipped to the Naval Infectious Diseases Diagnostic Lab (NIDDL) on dry ice and tested for CHIKV and Dengue (DENV) using PCR real-time assay for viral RNA, and IgM detection by ELISA. RESULTS: Sera from more than 600 patients collected from mid September till mid October, 2014 were drawn and had a CHIKV diagnostic form completed. At the time of writing 112 patients sera have been tested at the NIDDL. 90% of patients had a positive test. PCR only was positive in 8% of patients. IgM only was positive in 83%, and both PCR and IgM were positive in 9% of patients. The major symptoms presented by patients were joint pain (84%), fever (81%), body pain (74%), headache (62%), chills (54%) and rash (49%). CONCLUSION: IgM testing detected 92% of test positive patients while PCR alone detected 17%. The IgM assay was clinically most useful. In an outbreak where dengue is ruled out and CHIKV is the cause, patients with the constellation of symptoms above could be considered positive for CHIKV infection with a 98% accuracy without confirmatory testing.

Control externo de la calidad del diagnostico serologico del dengue en laboratorios de paises de las Americas, 1996-2001 / Quality control of the serological diagnosis of dengue in laboratories throughout the Americas, 1996-2001

Objective. To report the results from participating laboratories for four external quality control proficiency tests of dengue serological diagnosis that were carried out in the Region of the Americas in the period of 1996-2001. Methods. External quality control proficiency tests of dengue serological diagnosis were carried out in 1996-1997, 1998-1999, 2000-2001. Panels made up of 20 serum samples (12 of them positive for dengue IgM antibodies) were sent to participating laboratories in the Region. The sera were negative for HIV antibodies, hepatitis C virus antibodies, and hepatitis B surface antigen. The sera were stored at -20 degrees C until they were sent in refrigerated shipments to the participating laboratories. THe presence of IgM antibodies was determined through IgM-capture enzyme-linked immunosorbent assay (ELISA), while the IgG antibody titer was determined by hemagglutination inhibition or by IgG ELISA. The results of the IgM antibody testing that differed from those of the reference center were considered discordant. The IgG antibody titer was considered discordant when the results differed by two dilutions or more with respect to the reference center's results. Results. A total of 27 laboratories received a total of 59 serum panels over the 1996-2001 period, and the results from testing 54 of those panels (91.5 percent) were sent back in. Of the total of 1, 080 sera samples from those 54 panels, the results from 95.6 percent of the IgM antibody tests were concordant with the results from the reference center. With 47 of the 54 panels (87.0 percent) the participating laboratories' agreement with the reference center's results for the IgM antibody testing was 90.0 percent or higher. The laboratories sent back results from a total of 27 IgG antibody titer tests, and 22 of them (81.5 percent) coincided with those from the reference center. Considering the IgM antibody testing results from the four periods, the findings from 22 of the participating laboratories coincided with those from the reference center for at least 90 percent of the samples, and 13 of the laboratories were in complete concordance with the reference center. Conclusions. The majority of the participating laboratories showed an excellent level of performance in detecting dengue IgG and IgM antibodies. However, the deficiencies found in some instances confirm the need for continuing to improve laboratory diagnosis of dengue in the Region of the Americas (AU)

Epidemiology of acute hepatitis in the Stann Creek District of Belize, Central America

Hepaptits is common in the Stann Creek District of Southern Belize to determine the etiologies, incidence and potential risk factors for acute jaundice, we conducted active surveillance for cases. Cases of jaundice diagnosed by a physician within the previous 6 weeks were enrolled. Evaluation included a questionnaire and laboratory tests for Hepatitis A, B. C, D, and E, a blood film for malaria, and a serologic test for syphilis. Etiologies of jaundice among 62 evaluable patients included acute hepatitis A, 6 (9.7 percent), acute hepatitis B, 49 (79.0 percent) hepatitis non-A-E, 2 (3.2 percent), and malaria, 5 (8.1 percent). There were no cases of acute hepatitis E. One patient each with antibody to hepatitis C and D were detected. The annualized incidence of hepatitis A was 0.26 per 1000. All cases of hepatitis A were in children 4-16 years of age. The annualized incidence of hepatitis B, 2.17 per 1000, was highest in adults aged 15-44 years (4.4 per 1000) and was higher in men (36 cases; 3.09 per 1000) than women (13 cases; 1.19 per 1000). Four (31 percent) of the women with hepatitis B were pregnant. The annualized incidence was significantly higher in Mestizo (6.18 per 10000 and Maya (6.79 per 1000) than Garifuna (0.38 per 1000) or Creole (0.36 per 1000). Persons with Hepatitis B were significantly more likely to be born outside of Belize (82 percent), had been in Belize < 5 years (73 percent), and lived and worked in rural areas (96 percent) than was the general population. Of those o 14 years of age with Hepatitis B, only 36 percent were married. Few persons admitted to transfusions, tattoos, IV drug use, multiple sexual partners, visiting prostitutes, or sexually transmitted diseases. Only 1 of 49 had a reactive test for syphilis. Six patients were hospitalized (including 3 with acute hepatitis B and one with Hepatitis A), and none to our knowledge died. Acute hepatitis B is the most common cause of viral hepatitis in the Stann Creek District, but the modes of transmission remain obscure. Infants, women attending prenatal clinics, and new workers are potential targets for immunization with Hepatitis B vaccine. (AU)

Leptospirosis occurring in two children after fresh water immersion

Leptospirosis is relatively uncommon in children. Two cases of severe leptospirosis occurred in teenaged boys who shared a common exposure via immersion in fresh water. While both patients had laboratory-confirmed leptospirosis, their symptoms differed in many respects.(Au)

Evaluation of two methods for rapid serological diagnosis of acute leptospirosis

OBJECTIVE: To evaluate two rapid assays for serological diagnosis of acute leptospirosis in diagnostic laboratories. DESIGN AND METHODS: 209 specimens were examined from 104 patients admitted to hospital for investigation in a leptospirosis diagnostic protocol. Specimens for serology were taken on days 1 and 4 of the hospital admission. Antibodies were detected using IgM-ELISA, microscopic agglutination (MAT), an IgM-dipstick assay and indirect haemagglutination assay. RESULTS: 51 patients were found to have leptospirosis. The sensitivity of the IgM-dipstick was 98 percent, specificity was 90.6 percent, positive predictive value was 90.9 percent and the negative predictive value was 98 percent. The sensitivity of IHA was 92. percent, specificity was 94.4 percent, positive predictive value was 95.9 percent and negative predictive value was 92.7 percent. The IgM-dipstick assay was positive in 71 percent of the cases in the first sample tested. CONCLUSIONS: Both assays are highly sensitive and specific. Neither requires specialized equipment, and both are suitable for use in diagnostic laboratories.(Au)

Serological survey of leptospirosis in livestock animals in the Lesser Antilles

A serological survey was performed of 1788 cattle, goats and sheep on 13 islands in the Lesser Antilles. Sera were tested by microscopic agglutination (MAT) using a panel of 22 live antigens. Evidence of past exposure, at a titer of > or = 100, was found in 101 animals (5.6 percent). Antibodies were more common in cattle and goats (7.2 percent in each) than in sheep (1.7 percent). Seroprevalence was highest in cattle in Martinique (20 percent) and in goats in St. Vincent (23 percent). The predominant serogroups were Sejroe (largely confined to cattle in Martinique), Autumnalis, Icterohaemorrhagiae, Grippotyphosa, and Cynopteri. Eleven cattle from Martinique and 2 sheep with titers of > or = 800 showed evidence of recent infection. (AU)

Seroprevalences of brucellosis, Q-fever and toxoplasmosis in slaughter livestock in Trinidad

Serum samples obtained from livestock (cattle, chicken, pigs, sheep, goats and water buffaloes) slaughtered at various slaughter houses in Trinidad

Risk factors and cofactors for human T-cell lymphotropic virus type 1 (HTLV-1) - associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Jamaica

Human T-cell lymphotrophic virus type 1 (HTLV-1) has been etiologically associated with a neurologic syndrome called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) as well as with adult T-cell leukemia/lymphoma. The authors sought to quantify the risk in Jamaica of HAM/TSP associated with HTLV-1 infection and cofactors associated with this disease among infected individuals. Between 1988 and 1989, prevalent and incident HAM/TSP patients and controls with other neurologic diseases were enrolled in a retrospective study. A second control group was composed of HTLV-1-seropositive, asymptomatic carriers in Jamaica, ascertained in a separate study conducted in 1988. Although HTLV-1 seropositivity was not a component of the case definition for HAM/TSP, all 43 HAM/TSP patients were HTLV-1 seropsitive compared with two (4.0 percent) of the controls with other neurologic diseases. Given HTLV-1 seropositivity, one cofactor associated with the risk of HAM/TSP was young age at initial heterosexual intercourse (odds ratio = 4.00, 95 percent confidence interval 1.29-12.46 for individuals aged ó15; odds ratio = 4.26, 95 percent confidence interval 1.41-12.90 for individuals aged 16-17 years at initial intercourse). Among individuals who reported this early age at initial sexual intercourse, an increased risk of HAM/TSP was associated with having reported more than five lifetime sexual partners (odds ratio = 2.88, 95 percent confidence interval 0.90-8.70). Neither an early age at initial sexual intercourse nor the number of lifetime sexual partners was a risk factor for adult T-cell leukemia/lymphoma. These data support the hypothesis that HAM/TSP is associated with sexually acquired HTLV-1 infection, whereas adult T-cell leukemia/lymphoma is not. (AU)

SLE or HIV? Dilemma for the Caribbean clinician! - abstract

Systemic lupus erythematosus (SLE) is not an uncommon disease in the Caribbean. The clinical presentation though often characteristic can include a variety of non-specific symptoms. HIV infection, an increasing problem in the region, can mimic rheumatological diseases like SLE. This paper highlights the clinical and serological overlap of these two conditions. A 24-year old female presenting with fever, cough, weight loss, polyarthralgia and alopecia was treated for SLE. The possibility of AIDS was entertained. HIV antibody was positive by ELISA testing. Western Blot analysis was indeterminate with non-viral bands indicating a false positive ELISA test. The eventual outcome supported a final diagnosis of SLE. Four months after presentation, HIV antibody was negative by both ELISA and Western Blot analysis. This case prompted a retrospective analysis of medical records and a further three cases of SLE with false positive HIV tests by ELISA were identified. In a fourth patient with nephritis, the finding of a positive HIV by ELISA pre-empted therapeutic intervention. This patient succumbed. Ante-mortem blood samples were strongly positive for antinuclear factor and double-stranded DNA but negative for HIV by Western Blot. Caribbean clinicians should therefore be made aware of the possibility that HIV can mimic rheumatological disease and that rheumatological disease can result in false positive tests for HIV. The specific immunoblot techniques would be the investigation of choice in suspicious cases (AU)

Ovine trypanosomosis: a seroepidemiological survey in coastal Guyana

The objective of this study was to determine the seroprevalence rates of Trypanosoma vivax and Trypanosoma evansi in sheep in coastal Guyana. Blood samples were taken from a systematic random sample of one hundred and ninety-three (193) sheep on twenty-two (22) farms in Region 5, Mahaica/Berbice, a coastal area of Guyana. Age, breed, sex, and farm of origin were recorded for all sampled sheep. One hundred and seventy-six (176) serum samples were submitted for Indirect Fluorescent Antibody (IFA) testing for T. vivax and T. evansi. Fluorescence was graded as 0 (negative), 1+(very weak), 2+(weak), 3+(strong) or 4+(very strong), as measured at 1:160 dilution of serum. Samples were considered to be sero-positive if any fluorescence was observed. Indirect Fluorescent Antibody results were received for one hundred and sixty-one (161) samples. One hundred and three (64 percent) sera were sero-positive for Trypanosoma sp. Of these, 38 (23.6 percent) sera were positive to T. evansi only, 11(6.8 percent) were positive to T. vivax only and 54 (33.5 percent) were positive for both. As cross reactions occur between T. vivax and T. evansi, it was difficult to determine the true species of exposure for the sera which tested positive to both species. The overall sero-prevalence rate of 64 percent suggests that trypanosomosis is endemic in sheep in coastal Guyana. This was the first serological evidence of T. evansi in Guyana. Although T. vivax is believed to be pathogenic in sheep, the clinical siginficance of T. evansi remains unknown. The vector of both species of trypansomes in sheep on the north of South America also is not known (AU)

Seroprevalence of cytomegalovirus infection in a selected population in Jamaica

The prevalence of antibodies to cytomegalovirus (CMV) was determined by the indirect enzyme-linked immunosorbent assay in a selected population of 2655 in Jamaica. The overall prevalence rate was 95 percent, increasing from 56.2 percent in children 1-4 years of age to 90 percent in the 15-19 years age group and by 25 years of age 97 percent of subjects had been exposed to CMV. The prevalence rate in children (58.4 percent) was significantly lower than that in blood donors (84 percent), sexually transmitted disease clinic attendants (95 percent) and antenatal women (97 percent) (P< 0.001). The prevalence rate in STD clinic attendants and pregnant women was also significantly higher than in blood donors (P< 0.05). The prevalence of CMV infection in the selected population, the clinical implications, routes of transmission and socioenvironmental factors are discussed (AU)

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus herpes simplex virus (TORCH) and syphilis in Jamaican pregnant women

Seroprevalence of toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus infections (TORCH) and syphilis were determined in order to assess the immune/susceptibility status in Jamaican pregnant women in 1986. The positive rates were 57 percent (T. gondii), 69 percent (rubella), 97percent (CMV), 91 percent (HSV), and 4.9 percent (syphilis), respectively. The rate of reactivity for rubella was over 50 percent in all parishes, the highest being 85 percent in St. Thomas. The seroprevalence of T. gondii was lowest in Trelawny (37.5 percent). There were no significant differences in seropositivity of CMV and HSV infections between women from various parishes. The importance of seroprevalence of the TORCH group of agents and syphilis on perinatal morbidity and mortality in Jamaican women is discussed, and appropriate recommendations for prevention and control of congenital infections in Jamaica are suggested. (AU)

Autoimmune disease and HTLV-1 infection: case report

We describe two patients who presented with mixed connective disease. Both had antinuclear antibodies and antibodies to the extractable nuclear antigen U1RNP, and both were found to be seropositive for HTLV-1 infection. We found no evidence of HTLV-1 infection in 20 other patients known to have antibodies to U1RNP or in 36 British and West German patients with idiopathic adult polmyositis. In addition the serum from 20 anti-HTLV-1 positive patients did not contain antinuclear antibodies or antibodies to UR1NP. We conclude that the rheumatological disease is associated with HTLV-1 through geographical rather than aetiological means.(AU)

Sexual transmission of human T-lymphotropic virus type I (HTLV-I)

Human T-lymphotropic virus type I (HTLV-I), the prototype human retrovirus, has been linked epidemilogically to adult T-cell leukemia-lymphoma and to tropical spastic paraparesis. Modes of infection include mother-to-child transmission, most likely by ingestion of breast milk; parenteral transmission by blood transfusion and intravenous drug abuse; and male-to-female sexual transmission. Female-to-male transmission of HTLV-I is thought to occur only rarely, if at all. We document risk factors for male-to-female and female-to-male transmission of HTLV-I among persons in Jamaica attending clinics for sexually transmitted disease.(AU)

Seroepidemiological study of the transmission of mumps virus in St. Lucia, West Indies

A seroepidemiological study of the prevalence of mumps virus specific antibodies reveals a pattern of endemic persistence on the island of St. Lucia in the West Indies. In the unvaccinated population the proportion seropositive rose rapidly in the child age classes to attain a stable plateau close to unity in value in the teenage and adult age groups. The average age at infection was estimated to be between 3 and 4 years of age and the average duration of detactable levels of maternally derived antibodies was approximately 3 months. Analyses based on mathematical models of the transmission dynamics of the virus suggest that in excess of 75 percent of each cohort of 1-to 2-year-old children must be effectively immunized to eliminate mumps virus transmission. A mumps radial haemolysis test, developed for quantitive measurements of antibody, is discussed. (AU)

Transmission of HTLV-I and HIV among homosexual men in Trinidad

Risk for human T-cell lymphotropic virus type (HTLV-I) and human immunodeficiency virus (HIV) infection was evaluated in 100 homosexual or bisexual men from Trinidad. High seropositivity for HTLV-I (15 percent vs 2.4 percent in the general population) was linked to duration of homosexuality and numbers of partners, suggesting that HTLV-I, like HIV, can be transmitted by homosexual sex. Forty percent of homosexuals compared with 0.19 percent of the general population were seropositive for HIV, and sexual contact with US homosexual men and prior history of gonorrhea were major risk factors. The seroprevalence of HIV was three times higher than for HTLV-I, suggesting that HIV is more efficiently transmitted, especially since HIV appears to have been recently introduced into Trinidad. Altered immune status was prominent in individuals infected with HIV and coinfected with HIV and HTLV-I. Whether HIV/HTLV-I coinfection amplifies clinical effects is a hypothesis that will require further evaluation.(AU)