Monkeypox in Pakistan-First case report.

Monkeypox (mpox) is an uncommon zoonotic contagious viral ailment, resulting from the poxvirus. Symptoms include fever, headache, muscle aches, and a characteristic rash. There is no specific treatment, and only a limited number of antiviral drugs and vaccines are available. Employing stringent contact and respiratory precautions is essential to curb disease transmission. Till April 17, 2023, no mpox cases have been reported from Pakistan. Here we present the case of a 41-year-old male with a travel history to Saudi Arabia and a week-long history of multiple nodular and pustular eruptions on various parts of the body. It is essential to emphasise that due to its infrequency, a high index of clinical suspicion is imperative in facilitating an accurate diagnosis.

The Importance of Multidisciplinary Teams in the Early Detection and Management of Disseminated Nannizziopsis Infections in Solid Organ Transplant Recipients: A Case-Based Review.

This case report presents the clinical course of a 58-year-old female renal transplant patient with a complex medical history, including type 2 diabetes mellitus, hypertension, and chronic immunosuppression, who developed a disseminated Nannizziopsis obscura infection. The patient presented with persistent left leg pain and rapidly progressed to multisystem involvement, including central nervous system abscesses. Despite aggressive antifungal therapy and multidisciplinary management, her condition deteriorated, leading to a transition to palliative care. This report highlights the challenges in diagnosing and managing rare fungal infections in immunocompromised patients, highlighting the importance of early detection, advanced imaging, and a coordinated approach to care. The case also emphasizes the ethical considerations in balancing aggressive treatment with quality of life in terminal conditions.

Malaria Severity in the Elimination Continuum: A Retrospective Cohort Study between Beitbridge and Lupane Districts in Zimbabwe, 2021-2023.

Malaria has created a resurgence crisis in Zimbabwe's elimination continuum, diverging from global commitment to malaria elimination by 2030. This retrospective cohort study aimed to determine the risk factors associated with severe malaria in the Beitbridge and Lupane districts. Multistage sampling was used to recruit 2414 individuals recorded in the District Health Information Software2 Tracker database. The study used IBM SPSS 29.0.2.0(20) for data analysis, and odds ratios (ORs) to estimate the relative risk (RR; 95% C.I; p < 0.05). The study revealed significant relative risks (p-value < 0.05) for individuals who had no Long-Lasting Insecticidal Nets (Beitbridge 47.4; Lupane 12.3), those who owned but used the LLINs (Beitbridge 24.9; Lupane 7.83), those who slept outdoors during the night (Beitbridge 84.4; Lupane 1.93), and adults (Beitbridge 0.18; Lupane 0.22) compared to the corresponding reference groups. Other factors showed varying RR: sex (Beitbridge 126.1), prompt treatment (Beitbridge 6.78), hosting visitor(s) (Lupane 6.19), and residence (Lupane 1.94) compared to the corresponding reference groups. Risk factor management needs to focus on increasing local awareness of malaria, universal LLINs coverage of indoor and outdoor sleeping spaces, community-based programs on proper and consistent LLIN usage, screening of visitors from malaria-endemic areas, comprehensive entomological activities, mixed malaria interventions in rural hotspots, and future research on local malaria transmission dynamics. While Zimbabwe has the potential to meet the global goal of malaria elimination, success depends on overcoming the risk factors to sustain the gains already made among malaria elimination districts.

Unsuspected Malaria Diagnosed on a Routine Peripheral Smear Review.

Prompt diagnosis of malaria infection is critical for effective management, yet it can be challenging due to varying incubation periods and the need for physician-initiated laboratory workups. We present a case of a 40-year-old male with fever and dark-colored urine, initially evaluated for sepsis. Plasmodium vivax was incidentally identified on a peripheral smear review after obtaining a remote travel history from a malaria-endemic area. Consultation with the Centers for Disease Control confirmed the diagnosis, emphasizing the importance of thorough travel history assessment and timely laboratory investigation in suspected cases of malaria. This case underscores the significance of early diagnosis in managing this potentially life-threatening infection.

Traveling Does More Than Widen One's Horizon: Travel History as Key to Diagnosing Blastomycosis.

This case report highlights the importance of a detailed travel history and the need to revisit the differential diagnosis when there is an unexpected clinical course. A previously healthy 15-year-old male presented to a hospital in Florida with a fever, cough, and shortness of breath. He was seen multiple times at urgent care centers and treated with steroids and antibiotics for community-acquired pneumonia (CAP). The patient's chest X-rays and CT showed necrotizing pneumonia with pleural effusion, which required a chest tube. Despite broadening coverage for possible resistant organisms, his fevers and hypoxia continued. On day 14 of hospitalization, a bronchoscopy was performed, which led to the diagnosis of blastomycosis. History was revisited, and a specific travel history was obtained. The patient had been camping with his father on the Minnesota/Canada border a few months prior to his presentation. Blastomycosis is caused by a dimorphic fungus endemic in certain parts of the United States including areas surrounding the Mississippi and Ohio River valleys, some southeastern states, and areas bordering the Great Lakes. Autochthonous blastomycosis is not seen in Florida. The infection is acquired by inhalation of the organism and is associated with outdoor occupation and recreation. As with other infections with specific endemic distribution, the diagnosis of blastomycosis can be delayed if the epidemiologic link is not established. Questions about travel history need to be very specific as this could be critical in establishing the appropriate differential diagnosis and leading the workup. The patient's lack of improvement despite appropriate antibiotic therapy for CAP led to questioning the working diagnosis, revisiting the history, and expanding the workup, which was critical in this case.

Towards malaria elimination: analysis of travel history and case forecasting using the SARIMA model in Limpopo Province.

Despite various efforts and policy implementation aimed at controlling and eliminating malaria, imported malaria remains a major factor posing challenges in places that have made progress in malaria elimination. The persistence of malaria in Limpopo Province has largely been attributed to imported cases, thus reducing the pace of achieving the malaria-free target by 2025. Data from the Limpopo Malaria Surveillance Database System (2010-2020) was analyzed, and a seasonal auto-regressive integrated moving average (SARIMA) model was developed to forecast malaria incidence based on the incidence data's temporal autocorrelation. The study found that out of 57,288 people that were tested, 51,819 (90.5%) cases were local while 5469 (9.5%) cases were imported. Mozambique (44.9%), Zimbabwe (35.7%), and Ethiopia (8.5%) were the highest contributors of imported cases. The month of January recorded the highest incidence of cases while the least was in August. Analysis of the yearly figures showed an increasing trend and seasonal variation of recorded malaria cases. The SARIMA (3,1,1) X (3,1,0) [12] model used in predicting expected malaria case incidences for three consecutive years showed a decline in malaria incidences. The study demonstrated that imported malaria accounted for 9.5% of all cases. There is a need to re-focus on health education campaigns on malaria prevention methods and strengthening of indoor residual spray programs. Bodies collaborating toward malaria elimination in the Southern Africa region need to ensure a practical delivery of the objectives.

The outbreak of the monkeypox virus in the shadow of the pandemic.

The human monkeypox virus (MPXV) was first identified in 1959. Since then, the incidence of the disease has been sporadic. The endemic regions were identified in Africa's central and western areas. However, the infection started to spread in 2017 to non-endemic regions such as North and South America, Europe, and Asia. Since May 2022, the non-endemic areas reported 62,635 till 20th September 2022. Although the monkeypox virus has a mortality of ≥ 10%, it showed only 82 mortalities worldwide in 2022. The common symptoms include chills, fever, fatigue, and skin lesions, and the complications include secondary respiratory tract infections, encephalitis, blindness, and severe diarrhea. The factors responsible for spreading the virus include improper handling and consumption of infected bushmeat, unprotected sexual intercourse, contact with an infected person, no smallpox vaccination, improper hygiene, lower diagnostic capacity, and strong travel history from the endemic regions. The therapeutic strategy is symptom-based treatment and supportive care. Antivirals and vaccines such as Tecovirimat, Brincidofovir, Cidofovir, Imvamune, and ACAM2000 have shown promising results. The primary purpose of the review is to perform an epidemiological study and investigate the pathobiology, diagnosis, prevention, treatment, and some associated complications of the monkeypox virus in 2022.

Visceral leishmaniasis in new foci areas of Nepal: Sources and extent of infection.

Background & objectives: The successful elimination program of visceral leishmaniasis (VL) in Nepal decreased the incidence to less than 1 per 10,000 population leading to the consolidation phase. However, new VL cases have been recorded from new districts, threatening the elimination goal. This study monitors the geographical spread of VL and identifies potential risk factors. Methods: VL data of 2017-2020 were obtained from the Epidemiology and Disease Control Division (EDCD) of Nepal and mapped. Telephonic interviews with 13 VL patients were conducted. Results: The incidence maps indicate that VL is spreading to new areas. The target incidence exceeded four times in hilly and twice in mountainous districts. VL cases occurred in 64 of 77 districts in all three regions (mountainous, hilly and Terai). Interviews showed a correlation between travel history (private, commercial and for studies) and the spread of VL cases to new foci. Interpretation & conclusion: One major challenge of VL elimination in the maintenance phase is the spread of infection through travelers to new foci areas, which needs to be under continuous surveillance accompanied by vector control activities. This should be confirmed by a large-scale analytical study.

Clustered Incidence of Leukocytoclastic Vasculitis and Purpura Fulminans: A Case Series of a Rare Dermatological Manifestation of Rickettsial Disease.

Rickettsiae are a group of eukaryotic obligatory intracellular parasites with ticks and mites as vectors. Rickettsia conorii is the Indian counterpart of Rocky Mountain spotted fever causing the endemic variant - Indian tick typhus. This disease can cause severe illness in adults and children and can be missed despite the availability of serological tests. Initial screening for rickettsial diseases (RD) may include blood workup and a non-specific agglutination test, Weil-Felix (WF). In WF, agglutination against Proteus antigens is analyzed and can show false-negative results within the first week of presentation. Delayed immune reaction in patients with RD in the first week could also be responsible for negative specific IgM serology. The challenge for physicians is to differentiate between the two common diagnoses for fever with rash - viral exanthematous fever and rickettsial fever. By its endothelial cell tropism, RD rarely can lead to purpura fulminans, which is characterized by widespread progressive dermal vascular necrosis and hemorrhage. This case series demonstrates dermatologic presentations of rickettsial fever in three individuals from the same neighborhood within the same week. Based on serologic IgM levels, the patients were treated with doxycycline and made a full recovery. This case series aimed to highlight the need for awareness regarding the variable presentations of rickettsial fever including leukocytoclastic vasculitis and purpura fulminans.

Monkey finger mycology? First case of otomycosis externa caused by Trichophyton simii after encounter with a monkey.

Unilateral ear pain, ear canal blockage and reduced hearing in an 18-year-old Canadian male who had travelled to India revealed, on examination of a swab, secretions bearing unusual fungal filaments visually suggestive of dermatophyte elements. Culture yielded Trichophyton simii, an unusual skin infecting species with a worldwide distribution but most often seen from India. The patient recalled swimming in the Ganges River but also had had his ear manipulated by a street monkey.

A Severe Case of Falciparum Malaria, 10 Years After Malaria Eradication: A Case Report.

Malaria is a major mosquito-borne public health problem especially in tropical countries. The authors report a malaria infection in a 31-year-old man who had returned from East Africa with developed fever and rigor. Because of his thrombocytopenia, decreased hemoglobin, elevated liver enzymes, and splenomegaly, and because of failure to question about recent travel history, he was initially referred to the hematological hospital and medical staff suspected a hematological problem, so he was investigated for bone marrow aspirate and biopsy. As he progressively deteriorated, and after retaking history, his relatives eventually came to mention their travel to Africa. Blood samples were sent to detect malarial parasites, but the results were negative. When an internist was consulted, the patient was drowsy with low oxygen saturation (SpO2), so he was intubated and put on continuous positive airway pressure (CPAP). The internist suggested empirical anti-malarial treatment, which improved the clinical and hematological conditions of the patient. However, the repeated thin blood film showed falciparum malaria ring-shaped trophozoites. The patient persisted with the same treatment for 1 week until his condition improved gradually and completely stabilized, and then he was discharged. Presentation of this case of malaria is crucial to outpatient clinics' proper referral of cases, as is encouraging the physician to think of malaria as a cause of fever and rigor even in countries with eradicated malaria and to insist on mentioning travel history. It is also imperative, in the case of sustaining fever with further deterioration of the patient after proper antibiotic use, to start empirical anti-malarial treatment immediately.

Transmission dynamics of novel Coronavirus-SARS-CoV-2 in South Sumatera, Indonesia.

SARS-CoV-2 has shaken the world by extremely raising death tolls, illnesses, and economic losses. The virus is transmitted by humans to other humans, spreading to more than 200 countries. This research aims to analyze the transmission dynamics of novel Coronavirus-SARS-CoV-2 in South Sumatera Indonesia. This is epidemiologic research, and the research population is all SARS-CoV-2 patients and those who have close contact with the patients in all districts/cities in South Sumatera. It has been widely known that those that have made contact with patients confirmed positive for SARS-CoV-2 has a risk of getting infected by SARS-CoV-2 by 3.591 higher than those who never have (OR = 3.591, 95% CI: 2.933-4.396). Also, according to the findings, those who have a contact history to patients confirmed positive for SARS-CoV-2 have a risk of getting infected by SARS-CoV-2 by 2.387 higher than those who never have (OR = 2.387, 95% CI: 1.362-4.184). Meanwhile, those who have no idea for having made contact with patients confirmed positive for SARS-CoV-2 has a risk of getting infected by SARS-CoV-2 by 1.082 higher than those who have never a contact history to the SARS-CoV-2 patients (OR = 1.082, 95% CI: 0.622-1.882). To prevent broader transmission, those who have made contact with the SARS-CoV-2 patients need to be quarantined. The findings help us give community health interventions to globally fight this transmittable disease.

Bayesian Phylogeographic Analysis Incorporating Predictors and Individual Travel Histories in BEAST.

Advances in sequencing technologies have tremendously reduced the time and costs associated with sequence generation, making genomic data an important asset for routine public health practices. Within this context, phylogenetic and phylogeographic inference has become a popular method to study disease transmission. In a Bayesian context, these approaches have the benefit of accommodating phylogenetic uncertainty, and popular implementations provide the possibility to parameterize the transition rates between locations as a function of epidemiological and ecological data to reconstruct spatial spread while simultaneously identifying the main factors impacting the spatial spread dynamics. Recent developments enable researchers to make use of travel history data of infected individuals in the reconstruction of pathogen spread, offering increased inference accuracy and mitigating sampling bias. Here, we describe a detailed workflow to reconstruct the spatial spread of a pathogen through Bayesian phylogeographic analysis in discrete space using these novel approaches, implemented in BEAST. The individual protocols focus on how to incorporate molecular data, covariates of spread, and individual travel history data into the analysis. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Creating a SARS-CoV-2 MSA using sequences from GISAID Basic Protocol 2: Setting up a discrete trait phylogeographic reconstruction in BEAUti Basic Protocol 3: Phylogeographic reconstruction incorporating travel history information Basic Protocol 4: Visualizing ancestral spatial trajectories for specific taxa.

Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation.

BACKGROUND: Patient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text. OBJECTIVE: This study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats. METHODS: Clinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy. RESULTS: Among 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events. CONCLUSIONS: Automated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases.

A case of dengue fever that should be considered as imported infectious disease with digestive symptoms.

Patients with dengue fever usually present with fever and rash, but non-specific symptoms such as headache, myalgia, arthralgia, and digestive symptoms are sometimes seen. We report a case of dengue fever with digestive symptoms in a patient who traveled to Indonesia. A 35-year-old man presented with fever, diarrhea, headache, and arthralgia. He later developed generalized rash. Dengue fever was clinically suspected from the travel history and confirmed by laboratory tests. He tested positive for anti-dengue virus antibodies, so dengue fever was diagnosed. Dengue fever should be included in the differential diagnosis of patients with digestive symptoms after returning to Japan.

Amoebic colitis: A case series of a recurring missed diagnosis.

Entamoeba histolytica, a pathogenic protozoan that causes amoebiasis, remains the second leading cause of death from parasitic infections worldwide. We present a case series of patients presenting to metropolitan tertiary gastroenterology units in Melbourne, Australia, highlighting the complexities of diagnosing amoebic colitis and the potential for misdiagnosis. These cases illustrate four key lessons in the identification of amoebic colitis: (i) obtaining a thorough travel and exposure history, (ii) having a high index of suspicion, (iii) understanding the limitations of available investigations, and (iv) being aware that amoebic colitis may masquerade as other common conditions.

Examining geographical disparities in the incubation period of the COVID-19 infected cases in Shenzhen and Hefei, China.

BACKGROUND: Current studies on the COVID-19 depicted a general incubation period distribution and did not examine whether the incubation period distribution varies across patients living in different geographical locations with varying environmental attributes. Profiling the incubation distributions geographically help to determine the appropriate quarantine duration for different regions. METHODS: This retrospective study mainly applied big data analytics and methodology, using the publicly accessible clinical report for patients (n = 543) confirmed as infected in Shenzhen and Hefei, China. Based on 217 patients on whom the incubation period could be identified by the epidemiological method. Statistical and econometric methods were employed to investigate how the incubation distributions varied between infected cases reported in Shenzhen and Hefei. RESULTS: The median incubation period of the COVID-19 for all the 217 infected patients was 8 days (95% CI 7 to 9), while median values were 9 days in Shenzhen and 4 days in Hefei. The incubation period probably has an inverse U-shaped association with the meteorological temperature. The warmer condition in the winter of Shenzhen, average environmental temperature between 10 °C to 15 °C, may decrease viral virulence and result in more extended incubation periods. CONCLUSION: Case studies of the COVID-19 outbreak in Shenzhen and Hefei indicated that the incubation period of COVID-19 had exhibited evident geographical disparities, although the pathological causality between meteorological conditions and incubation period deserves further investigation. Methodologies based on big data released by local public health authorities are applicable for identifying incubation period and relevant epidemiological research.

Epidemiological characteristics and treatment outcomes of hospitalized patients with COVID-19 in Ethiopia.

INTRODUCTION: coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness which epidemiologically linked to the seafood and wet animal wholesale market in Wuhan, Hubei Province, China. Since there is paucity of research on characteristics and treatment outcomes of COVID-19, the finding of this study will helps to provide insight for the effectiveness of measures to fight against coronavirus disease in resource-limited countries. METHODS: a retrospective review of released data about cases in daily bases and documents from Ethiopian public health institute website. In this article, we included and analyzed data of cases from 13 March to 13 May 2020 which were available at the time of the review. RESULTS: a total of 263 cases were included (median age, 34 years [range, 0.9-85 years]; 76% male). COVID-19 cases among age group 15-24 years and 25-34 years were 92(35%) and 76(28.9%) respectively. More than half (55.5%) of cases had travel history abroad and African countries are the leading 64(24.3%). About 167(63.5%) cases were identified based on symptom-based surveillance and the finding confirmed an interrupted kind of epidemiological curve. Whereas, one-third (41.1%) were recovered and the overall case fatality rate was 1.9%. Four out of five patients in ICU were deceased after 2-6days spent in critical care. CONCLUSION: an integrated action includes the provision of health education to youths, taking measures to rise up treatment outcomes, enhancing ICU care quality. Moreover, tightening prevention and restriction measures to flattening the curve and also establishment of fast detection and advanced treatment of cases were critically requires through the patriotic efforts of frontline health workers, leaders, and stakeholders.

COVID-19 in children across three Asian cosmopolitan regions.

ABSTRACT As another wave of COVID-19 outbreak has approached in July 2020, a larger scale COVID-19 pediatric Asian cohort summarizing the clinical observations is warranted. Children confirmed with COVID-19 infection from the Republic of Korea, the Hong Kong Special Administrative Region (HKSAR) and Wuhan, China, during their first waves of local outbreaks were included. Their clinical characteristics and the temporal sequences of the first waves of local paediatric outbreaks were compared. Four hundred and twenty three children with COVID-19 were analyzed. Wuhan had the earliest peak, followed by Korea and HKSAR. Compared with Korea and Wuhan, patients in HKSAR were significantly older (mean age: 12.9 vs. 10.8 vs. 6.6 years, p < 0.001, respectively) and had more imported cases (87.5% vs. 16.5% vs. 0%, p < 0.001, respectively). The imported cases were also older (13.4 vs. 7.6 years, p < 0.001). More cases in HKSAR were asymptomatic compared to Korea and Wuhan (45.5% vs. 22.0% vs. 20.9%, p < 0.001, respectively), and significantly more patients from Wuhan developed fever (40.6% vs. 29.7% vs. 21.6%, p=0.003, respectively). There were significantly less imported cases than domestic cases developing fever after adjusting for age and region of origin (p = 0.046). 5.4% to 10.8% of patients reported anosmia and ageusia. None developed pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). In general, adolescents were more likely to be asymptomatic and less likely to develop fever, but required longer hospital stays. In conclusion, majority patients in this pediatric Asian cohort had a mild disease. None developed PIMS-TS. Their clinical characteristics were influenced by travel history and age.