Wastewater genomic surveillance to track infectious disease-causing pathogens in low-income countries: Advantages, limitations, and perspectives.

The emergence of infectious diseases, particularly those caused by respiratory pathogens like COVID-19 and influenza viruses, poses a significant threat to public health, especially in the context of climate change. Vulnerable variants and major pathogenicities are appearing, leading to a wide range of illnesses and increased morbidity. Wastewater genomic surveillance represents a cost-effective and a crucial tool for tracking infectious diseases, particularly in regions where clinical testing resources might be limited or inadequate. However, there are numerous limitations that need to be addressed in order to enhance its effectiveness for monitoring a wide range of pathogens. The current study uses this approach for the first time in Morocco to monitor the epidemiology of SARS-CoV-2 and Influenza A, B and RSV virus infections during the third wave of COVID-19 caused by the Omicron variant. The virome was concentrated from wastewater collected from two sewersheds of two cities, Agadir and Inezgane, using the the polyethylene glycol (PEG)/NaCl method. All 26 samples from both cities exhibited positive results for SARS-CoV-2, indicating varying viral loads. In the case of the Influenza A virus, four samples tested positive in Inezgane. However, no detection of Influenza B or RSV was observed in any of the samples. The estimated SARS-CoV-2 viral RNA copy numbers observed were then used to estimate the number of infected individuals using the SEIR model. The estimated number of cases correlates positively with the number of reported cases. Next Generation Sequencing showed that samples contain the following two variants: BA.1 and BA.2 that have been detected in clinical samples. In the case of Influenza A, clinical samples revealed a mild presence of the influenza virus subtype A(H3N2). This study demonstrates the effectiveness and feasibility of wastewater genomic surveillance in monitoring pathogens such as SARS-CoV-2 in Morocco. This approach can become an even more powerful tool for monitoring and predicting the spread of infectious diseases by addressing several key considerations. These include enhancing data collection methods, making environmental corrections for factors affecting RNA stability in wastewater, and refining mathematical models to improve their accuracy in predicting the number of infected cases. Incorporating statistical and machine learning models can further enhance the precision of these predictions.

Pleuropulmonary nocardiosis, an unusual radiological presentation: Case report.

Nocardiosis is caused by strict aerobic filamentous bacteria of the genus Nocardia belonging to the order Actinomycetales with Actinomyces, Streptomyces and Mycobacterium. The radio-clinical presentation in the chest is often misleading. We report a case of pulmonary nocardiosis with an unusual radiological presentation. A 54-year-old patient, chronic smoker, never treated for pulmonary tuberculosis, who presented with a chronic cough complicated by moderate hemoptysis, all evolving in a context of altered general condition and feverish sensations. The radiological aspect was in favor of a hydro-pneumothorax, the pleural puncture brought back a chocolate colored purulent liquid with the presence of numerous yellow grains and the direct examination showed numerous branched gram-positive bacilli. The bacteriological study allowed to retain the presumptive diagnosis of nocardiosis, the patient was put under antibiotic treatment with a clear clinical and radiological improvement. This observation illustrates the diagnostic difficulty of pulmonary nocardiosis and emphasizes the importance of thinking about nocardiosis in front of any dark thoracic syndrome.

Human Papillomavirus genotypes distribution and associated risk factors among women living in Southern Morocco.

Purpose: The aim of this work was to investigate potential risk factors associated with HPV infection and to determine the HPV genotype prevalence among women from the Southerns areas of Morocco. Methods: A total of n = 308 sexually active women provided their written consent to participate in this study. A detailed questionnaire was used to collect data, related to the age and life style of participants. HPV L1 gene detection was performed by a nested PCR method using consensus primers. HPV genotypes were determined using direct Sanger sequencing method. Statistical analysis of the results obtained was carried out using R software. Results: We detected HPV in 42.5 % of the total investigated samples. HPV infection was significantly associated with the following risk factors: age of the first intercourse (OR = 2.27, 95 % CI: 1.03-5.10, p = 0.044), and previous history of STIs (OR = 3.13, 95 % CI: 1.12-9.63, p = 0.034). High risk-HPV and Low risk-HPV genotypes were found in 26.6 % and 5.5 % of the participants, respectively. The most prevalent genotypes were HPV16 (22 %), HPV18 (2.6 %), HPV11 (1.6 %) and HPV83 (1.3 %). Multiple infections were found in 3.2 %. The genotypes covered by the bivalent, quadrivalent and nonavalent HPV vaccines account for 57.5 %, 62.8 % and 66.6 %, respectively. Conclusion: HPV infection prevalence reported in this study among women from the Southerns areas of Morocco is one of the highest reported in the country so far. Our finding confirm that the current HPV vaccines directed against the most prevalent HPV16 genotype, recently introduced in the country, should offer a good protection to the most vulnerable population if implemented properly. These results highlight the importance of HPV screening and vaccination programs in this region.

The prevalence of syphilis in HIV-seropositive patients: a retrospective study at the regional hospital in Agadir, Morocco.

INTRODUCTION: HIV and syphilis are major public health problems in Morocco. The region of Souss-Massa, south-west of the country, hold more than 24% of HIV seropositive cases registered in Morocco during 2009. The aim of this study is to evaluate the seroprevalence of syphilis among HIV seropositive patients in the region of Souss-Massa, south-west of Morocco. METHODS: To evaluate the seroprevalence of syphilis and neurosyphilis among HIV seropositive patients, we retrospectively investigated the medical records of HIV-infected patients attending the regional hospital located in the city of Agadir, during the period comprised between 2011 and 2016. RESULTS: The population studied involved 1381 males (49.18%) and 1427 females (50.82%) HIV seropositive patients. Among them, 481 patients were seropositive for syphilis and three cases were diagnosed with neurosyphilis. The sex ratio distribution was 243 male (52.71%) and 218 female (47.29%). The prevalence of syphilis among the studied population was estimated to 16.42% with a slight dominance in male (17.63%) compared to female (15.28%). By contrast, neurosyphilis was only detected in male patients, with a prevalence estimated to 0.11%. CONCLUSION: Even if the prevalence of HIV and syphilis is stable in the region of Souss-Massa, the prevalence of syphilis among HIV seropositive patients remained high and correlated positively with that of HIV infection. We did not find a significant difference between the genders, in relation to the prevalence of HIV and syphilis. We concluded that it was essential to continue monitoring the population, in order to improve the prevention and the access to the medical care in the south-west of Morocco.