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BACKGROUND: People living with HIV are disproportionately represented among people with severe mpox. Mild and self-limiting conjunctival involvement has been well-documented, and severe ocular complications, including keratitis, corneal scarring, and the associated loss of vision, are increasingly recognized. Tecovirimat is the first-line antiviral therapy for severe mpox, but data around the efficacy of systemic antiviral agents for mpox are limited, particularly in cases of ocular mpox. CASE REPORT: Here, we describe a case of sight-threatening necrotic blepharokeratoconjunctivitis in a person with advanced HIV, requiring an extended course of tecovirimat due to persistent mpox viral shedding for nearly 5 months.
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The management of coronavirus disease 2019 has become more complex due to the expansion of available therapies. The presence of severe acute respiratory syndrome coronavirus 2 variants and mutations further complicates treatment due to their differing susceptibilities to therapies. Here we outline the use of real-time whole genome sequencing to detect persistent infection, evaluate for mutations confering resistance to treatments, and guide treatment decisions.
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COVID-19 , Humanos , SARS-CoV-2/genética , Secuenciación Completa del Genoma , MutaciónRESUMEN
BACKGROUND: The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the United Kingdom (n = 2), Israel (n = 1), and Singapore (n = 1) became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the United Kingdom became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS: Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS: Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS: Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation, suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool.
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Monkeypox virus , Mpox , Brotes de Enfermedades , Humanos , Mpox/epidemiología , Monkeypox virus/genética , Nigeria/epidemiología , Reino UnidoRESUMEN
We describe a case of hemorrhagic fever with renal syndrome caused by Seoul virus in a woman in Scotland, UK. Whole-genome sequencing showed the virus belonged to a lineage characterized by recent international expansion, probably driven by trade in pet rats.
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Fiebre Hemorrágica con Síndrome Renal , Virus Seoul , Animales , Fiebre Hemorrágica con Síndrome Renal/diagnóstico , Humanos , Riñón , Ratas , Escocia/epidemiología , Virus Seoul/genética , Reino UnidoRESUMEN
In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.
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Monkeypox virus , Mpox , Personal de Salud , Humanos , Mpox/epidemiología , Monkeypox virus/genética , Reino Unido/epidemiología , VacunaciónRESUMEN
West Nile virus (WNV) is an arthropod-transmitted flavivirus that causes West Nile fever and may infrequently cause neuroinvasive disease in humans. We present 2 cases of confirmed WNV infection, 1 of severe encephalitis and 1 of mild febrile illness, in a couple returning to the United Kingdom from South Africa.
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Enfermedad Relacionada con los Viajes , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental , Humanos , Sudáfrica/epidemiología , Viaje , Reino Unido/epidemiología , Fiebre del Nilo Occidental/transmisión , Virus del Nilo Occidental/clasificación , Virus del Nilo Occidental/genéticaRESUMEN
Zika virus RNA has been detected in semen samples collected <370 days after symptom onset. We report unusual persistence of Zika virus RNA in semen, confirmed by sequencing at 515 days after symptom onset and detectable for >900 days, in a patient with immunosuppression.
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Huésped Inmunocomprometido , Semen/virología , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virología , Virus Zika/clasificación , Virus Zika/genética , Antirreumáticos/efectos adversos , Antirreumáticos/uso terapéutico , Biopsia , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/epidemiología , Enfermedades Transmisibles Importadas/transmisión , Enfermedades Transmisibles Importadas/virología , Femenino , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , ARN Viral , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedad Relacionada con los Viajes , Carga Viral , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/transmisiónRESUMEN
We report a case of a previously healthy man returning to the United Kingdom from Lithuania who developed rhombencephalitis and myeloradiculitis due to tick-borne encephalitis. These findings add to sparse data on tick-borne encephalitis virus phylogeny and associated neurologic syndromes and underscore the importance of vaccinating people traveling to endemic regions.
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Virus de la Encefalitis Transmitidos por Garrapatas , Encefalitis Transmitida por Garrapatas/diagnóstico , Encefalitis Transmitida por Garrapatas/virología , Adulto , Anticuerpos Antivirales/inmunología , Biomarcadores , Virus de la Encefalitis Transmitidos por Garrapatas/clasificación , Virus de la Encefalitis Transmitidos por Garrapatas/genética , Genoma Viral , Humanos , Imagen por Resonancia Magnética , Masculino , Filogenia , Evaluación de Síntomas , Reino UnidoRESUMEN
BackgroundThe recent global emergence and re-emergence of arboviruses has caused significant human disease. Common vectors, symptoms and geographical distribution make differential diagnosis both important and challenging. AimTo investigate the feasibility of metagenomic sequencing for recovering whole genome sequences of chikungunya and dengue viruses from clinical samples.MethodsWe performed metagenomic sequencing using both the Illumina MiSeq and the portable Oxford Nanopore MinION on clinical samples which were real-time reverse transcription-PCR (qRT-PCR) positive for chikungunya (CHIKV) or dengue virus (DENV), two of the most important arboviruses. A total of 26 samples with a range of representative clinical Ct values were included in the study.ResultsDirect metagenomic sequencing of nucleic acid extracts from serum or plasma without viral enrichment allowed for virus identification, subtype determination and elucidated complete or near-complete genomes adequate for phylogenetic analysis. One PCR-positive CHIKV sample was also found to be coinfected with DENV. ConclusionsThis work demonstrates that metagenomic whole genome sequencing is feasible for the majority of CHIKV and DENV PCR-positive patient serum or plasma samples. Additionally, it explores the use of Nanopore metagenomic sequencing for DENV and CHIKV, which can likely be applied to other RNA viruses, highlighting the applicability of this approach to front-line public health and potential portable applications using the MinION.
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Virus Chikungunya/genética , Virus del Dengue/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Secuenciación Completa del Genoma , Anticuerpos Antivirales/sangre , Antígenos Virales/sangre , Fiebre Chikungunya/sangre , Fiebre Chikungunya/diagnóstico , Virus Chikungunya/aislamiento & purificación , Dengue/sangre , Dengue/diagnóstico , Virus del Dengue/aislamiento & purificación , Humanos , Metagenómica , Nanoporos , SerogrupoRESUMEN
In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.
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Enfermedades Transmisibles Emergentes/virología , Monkeypox virus/aislamiento & purificación , Mpox/diagnóstico , Viaje , Animales , Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/transmisión , Trazado de Contacto , Humanos , Mpox/virología , Nigeria/epidemiología , Infecciones por Poxviridae/microbiología , Infecciones por Poxviridae/transmisión , Salud Pública , Medición de Riesgo , Reino UnidoRESUMEN
Zika virus RNA has been detected in semen collected several months after onset of symptoms of infection. Given the potential for sexual transmission of Zika virus and for serious fetal abnormalities resulting from infection during pregnancy, information regarding the persistence of Zika virus in semen is critical for advancing our understanding of potential risks. We tested serial semen samples from symptomatic male patients in the United Kingdom who had a diagnosis of imported Zika virus infection. Among the initial semen samples from 23 patients, Zika virus RNA was detected at high levels in 13 (56.5%) and was not detected in 9 (39.1%); detection was indeterminate in 1 sample (4.4%). After symptomatic infection, a substantial proportion of men have detectable Zika virus RNA at high copy numbers in semen during early convalescence, suggesting high risk for sexual transmission. Viral RNA clearance times are not consistent and can be prolonged.
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ARN Viral/aislamiento & purificación , Semen/virología , Infección por el Virus Zika/transmisión , Virus Zika/aislamiento & purificación , Adulto , Humanos , Masculino , Reino Unido/epidemiología , Infección por el Virus Zika/virologíaRESUMEN
INTRODUCTION/BACKGROUND: Since 2015, an epidemic of Zika virus spread across the Americas. This coincided with an increased incidence of microcephaly reported at birth in Brazil, with subsequent evidence of a causal association. SOURCES OF DATA: Systemic reviews, observational studies, public health organizations. AREAS OF AGREEMENT: Zika virus causes microcephaly and brain abnormalities in infants born to mothers infected during or shortly before pregnancy. Zika virus is a trigger for Guillain Barre Syndrome. Whilst mosquito bite is the main route of transmission, sexual transmission is another confirmed route. AREAS OF CONTROVERSY: Uncertainty remains regarding the proportion of Zika-infected pregnancies that will give rise to a significantly affected infant. GROWING POINTS: The development of a vaccine remains a priority whilst public health efforts continue to educate at risk populations on reducing transmission. AREAS TIMELY FOR DEVELOPING RESEARCH: Follow-up studies of affected infants are vital to inform on prognosis and guide screening programmes of the future.
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Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/prevención & control , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/prevención & control , Vigilancia en Salud Pública , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/prevención & control , Virus Zika , Enfermedades Transmisibles Emergentes/transmisión , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Recién Nacido , Microcefalia/prevención & control , Microcefalia/virología , Estudios Observacionales como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Factores de Riesgo , Virus Zika/aislamiento & purificación , Virus Zika/patogenicidad , Infección por el Virus Zika/transmisiónRESUMEN
Rapid Ebola virus (EBOV) detection is crucial for appropriate patient management and care. The performance of the FilmArray BioThreat-E test (v2.5) using whole-blood samples was evaluated in Sierra Leone and the United Kingdom and was compared with results generated by a real-time Ebola Zaire PCR reference method. Samples were tested in diagnostic laboratories upon availability, included successive samples from individual patients, and were heat treated to facilitate EBOV inactivation prior to PCR. The BioThreat-E test had a sensitivity of 84% (confidence interval [CI], 64% to 95%) and a specificity of 89% (CI, 73% to 97%) in Sierra Leone (n = 60; 44 patients) and a sensitivity of 75% (CI, 19% to 99%) and a specificity of 100% (CI, 97% to 100%) in the United Kingdom (n = 108; 70 patients) compared to the reference real-time PCR. Statistical analysis (Fisher's exact test) indicated there was no significant difference between the methods at the 99% confidence level in either country. In 9 discrepant results (5 real-time PCR positives and BioThreat-E test negatives and 4 real-time PCR negatives and BioThreat-E test positives), the majority (n = 8) were obtained from samples with an observed or probable low viral load. The FilmArray BioThreat-E test (v2.5) therefore provides an attractive option for laboratories (either in austere field settings or in countries with an advanced technological infrastructure) which do not routinely offer an EBOV diagnostic capability.
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Sangre/virología , Ebolavirus/aislamiento & purificación , Fiebre Hemorrágica Ebola/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Manejo de Especímenes/métodos , Ebolavirus/genética , Fiebre Hemorrágica Ebola/virología , Calor , Humanos , Sensibilidad y Especificidad , Sierra Leona , Factores de Tiempo , Reino UnidoRESUMEN
The optimum treatment for persistent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not known. Our case series, across 5 hospitals in 3 countries, describes 11 cases where persistent SARS-CoV-2 infection was successfully treated with prolonged courses (median, 10 days [range, 10-18 days]) of nirmatrelvir/ritonavir (Paxlovid). Most cases (9/11) had hematological malignancy and 10 (10/11) had received CD20-depleting therapy. The median duration of infection was 103 days (interquartile range, 85-138 days). The majority (10/11) were hospitalized, and 7 (7/11) had severe/critical disease. All survived and 9 of 11 demonstrated viral clearance, almost half (4/9) of whom received nirmatrelvir/ritonavir as monotherapy. This case series suggests that prolonged nirmatrelvir/ritonavir has a role in treating persistent infection.
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OBJECTIVE: To characterise the clinical features of monkeypox infection in humans. DESIGN: Descriptive case series. SETTING: A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022. PARTICIPANTS: 197 patients with polymerase chain reaction confirmed monkeypox infection. RESULTS: The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling. CONCLUSIONS: These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.
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Infecciones por VIH , Mpox , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Adulto , Brotes de Enfermedades , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Londres/epidemiología , Masculino , Mpox/complicaciones , Dolor/complicaciones , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
BACKGROUND: In 2016, Zika virus (ZIKV) spread rapidly throughout the Americas and Caribbean in an explosive outbreak. In the UK, testing for ZIKV infection is performed at Public Health England's Rare and Imported Pathogens Laboratory. Here we present the UK's experience of imported ZIKV during the epidemic. METHOD: A retrospective review was performed on the laboratory computer system searching by orders for ZIKV PCR and/or ELISA serology tests between 1st January 2016 and 31st December 2017. Each individual request form and result was reviewed. RESULTS: Of 6333 symptomatic patients tested for ZIKV, 374 (6%) had molecular or serological evidence consistent with recent infection; most of these had travelled to the Caribbean in 2016. On follow-up of PCR-confirmed cases, ZIKV IgM disappeared within 6 weeks and often didn't appear in patients with previous dengue infection. Rash was the commonest symptom in PCR-confirmed infection (93%). There were only single cases of presumed sexual transmission and of in-utero transmission. CONCLUSIONS: The rise and fall in numbers of imported ZIKV cases largely reflected the temporal course of the outbreak in the Caribbean. ZIKV serology is difficult to interpret but the absence of antibodies to ZIKV 14 days after symptom onset makes infection very unlikely.
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Enfermedad Relacionada con los Viajes , Infección por el Virus Zika/diagnóstico , Américas/epidemiología , Dengue/inmunología , Brotes de Enfermedades , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Embarazo , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Reino Unido/etnología , Virus Zika , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/inmunologíaRESUMEN
Bio-electrospraying, a non-contact jet-based direct cell engineering approach, was recently pioneered and demonstrated for handling a wide range of primary living cells. In those studies, post-treated cells were biologically assessed in comparison to several controls by way of flow cytometry. Although flow cytometry accurately assesses those viable populations of cells, subtle effects at a sub-cellular level could have been missed. Therefore, in the present study we demonstrate metaphase chromosome breakage studies carried out on single-needle bio-electrosprayed human T-lymphocytes, which are compared with several controls. The results indicate that post-treated T-lymphocytes do not demonstrate any increase in chromosome damage in comparison to control cells. These studies further validate bio-electrospraying as a technique with potential for clinical utility.