Identifying Paucisymptomatic or Asymptomatic and Unrecognized Ebola Virus Disease Among Close Contacts Based on Exposure Risk Assessments and Screening Algorithms.

BACKGROUND: There is limited evidence to evaluate screening algorithms with rapid antigen testing and exposure assessments as identification strategies for paucisymptomatic or asymptomatic Ebola virus (EBOV) infection and unrecognized EBOV disease (EVD). METHODS: We used serostatus and self-reported postexposure symptoms from a cohort study to classify contact-participants as having no infection, paucisymptomatic or asymptomatic infection, or unrecognized EVD. Exposure risk was categorized as low, intermediate, or high. We created hypothetical scenarios to evaluate the World Health Organization (WHO) case definition with or without rapid diagnostic testing (RDT) or exposure assessments. RESULTS: This analysis included 990 EVD survivors and 1909 contacts, of whom 115 (6%) had paucisymptomatic or asymptomatic EBOV infection, 107 (6%) had unrecognized EVD, and 1687 (88%) were uninfected. High-risk exposures were drivers of unrecognized EVD (adjusted odds ratio, 3.5 [95% confidence interval, 2.4-4.9]). To identify contacts with unrecognized EVD who test negative by the WHO case definition, the sensitivity was 96% with RDT (95% confidence interval, 91%-99%), 87% with high-risk exposure (82%-92%), and 97% with intermediate- to high-risk exposures (93%-99%). The proportion of false-positives was 2% with RDT and 53%-93% with intermediate- and/or high-risk exposures. CONCLUSION: We demonstrated the utility and trade-offs of sequential screening algorithms with RDT or exposure risk assessments as identification strategies for contacts with unrecognized EVD.

Investigation of the Optic Nerve Head Morphology Influence to the Optic Nerve Head Biomechanics - Population Specific Model.

Glaucoma is an eye disorder potentially leading to permanent blindness through the damage of optic nerves at the optic nerve head (ONH). As a critical region of optic nerve damage, the porous Lamina Cribrosa (LC) in the ONH plays a critical role in determining whether optic nerves passing through will experience apoptosis in response to shear stress. The primary cause of shear stress to the LC is the increase in intraocular pressure (IOP). Since morphology governs how mechanical stresses distributes, LC morphology could be an important factor in determining the risks of glaucoma development and progression. The current project aims at investigating how anterior LC surface morphology impacts its response to shear stress caused by IOP. Results of the current study show that steeper LC morphologies could be associated with increased average shear stress on the anterior LC surface. The effect of LC morphology was comparable to that of IOP. This highlights the potential significance of LC morphology on the distribution of IOP-induced shear stress and calls for further investigation in this area.

Rhinosporidium seeberi: light, phase contrast, fluorescent and scanning electron microscopic study.

Phase contrast microscopic study indicated the multilayered structure of the sporangial wall of R. seeberi while the scanning electronmicroscopic study revealed a trilaminated wall compared to a thick double walled light microscopic structure. The scanning electronmicroscopy revealed the spores of varying sizes which were found either discretely or in groups interconnected and seen attached to the inner aspect of the sporangial wall. Autofluorescence of sporangia and spores was observed under microscope. Acridine orange staining revealed the presence of DNA materials in the spore and sporangia.

Incidence and clinicopathological studies on rhinosporidiosis in Tamil Nadu.

A clinicopathological study on 83 cases of rhinosporidiosis attended at Tirunelveli Medical College Hospital during 1979 to 1984 from Tirunelveli, Tamil Nadu revealed its endemicity. The season has no apparent influence on the incidence probably due to chronicity of the disease. The incidence was mostly seen in 11-30 years age group (57/83). Males were predominantly affected (60/83). Temperature, pulse, respiration, blood pressure, bleeding and clotting times were within the normal range. Urinalysis revealed no abnormal constituents. Haematological examination revealed that the haemoglobin level was below normal ranges (males-8.58 g/dl; females-7.71 g/dl). Though the total leucocyte counts were found to be normal the differential count showed a slight monocytosis (males-8.39%, females-9.17%).

Ocular rhinosporidiosis in Tamil Nadu, India.

A high incidence of ocular rhinosporidiosis in Kanyakumari district of Tamil Nadu, India is reported. Among the four taluks (sub-division for administration), highest occurrence was found in Agastheeswaram taluk (51.2%) followed by Kalkulam (24.4%), Thovalai (22%) and Vilavancode (2.4%). The disease occurred among both sexes equally and preponderance of a particular sex was not observed. The young adolescents were found to be more susceptible. The disease was found in all socio-economic strata and among all communities and persons belonging to different religious groups. Most of the patients gave a history of bathing in muddy stagnant pools of water.

Epidemiological survey of rhinosporidiosis in Kanyakumari district of Tamil Nadu.

One hundred and twelve nasal polyps received along with full history from three different hospitals of Kanyakumari district of Tamil Nadu during the period 1983-1987 were found positive for rhinosporidiosis on histopathological examination. Among the four taluks (countries) the majority of the cases (41.1 per cent) came from Agastheeswaram, followed by Kalkulam (28.6 per cent), Thovalai (17.0 per cent) and Vilavancode (13.3 per cent). The 11-20 years age group found to be highly susceptible (60 per cent). There was no sex prepondence in contracting the disease as the cases were evenly distributed between both sexes. These findings exhibited the endemic nature of the disease in Kanyakumari district. Unreported cases to an extent of 9 to 40 per cent were encountered during the ENT disease diagnostic camps conducted in nine high incidence villages. Further 8 more cases were detected in addition to cases attended in the hospitals and ENT camps when a complete enumeration of cases was undertaken in Pallam village. Thus the actual number of cases found in the district need a stratified random sampling.

Rhinosporidiosis in bovines of Kanyakumari district, Tamil Nadu, India.

A survey on rhinosporidiosis in animals was conducted in Kanyakumari (K.K.) district of Tamil Nadu, India. Among 103 animals (40 bullocks, 45 cows, 15 heifers, 2 bulls and a buffalo), 19 (9 bullocks, 8 cows, 1 heifer and a she-buffalo) were found to be infected with Rhinosporidium seeberi. The study revealed the endemic nature of the disease in bovines of K.K. district. Agastheeswaram taluk contributed 52.6 per cent of positive cases followed by Kalkulam (26.2 per cent). The disease was also found in exotic cattle (1 Holstein Friesien (HF) cow, 1 Swiss Brown cow and 1 HF heifer). The rest 16 were indigenous non-descript cattle. There was no sex variance as the cases were evenly distributed between both sexes. One of the infected animals was a she-buffalo. A case of recurrence of growth was observed in a bullock. Another bullock had concurrent infection of both rhinosporidiosis and nasal schistosomiasis. All the animals were adults and aged except the heifer. All were nose-roped. Cows were stall fed but bathed in ponds.