RESUMEN
BACKGROUND: The aim of this study was to compare the predictive performance of three statistical models-logistic regression, classification tree, and structural equation model (SEM)-in predicting severe dengue illness. METHODS/FINDINGS: We adopted modified classification of dengue illness severity based on WHO 1997 guideline. Predictive models were constructed using demographic factors and laboratory indicators on the day of fever occurrence. We developed statistical predictive models using data from two hospital cohorts in Thailand, consisting of 257 Thai children. Different predictive models for each category of severe dengue illness were developed employing logistic regression, classification tree, and SEM. The probability of discrimination of each model for severe output of disease was analyzed with external validation data sets from 55 and 700 patients not used in model development. From external validation using predictors on the day of presentation to the hospital, the area under the receiver operating characteristic curve was between 0.65 and 0.84 for the regression model. It was between 0.73 and 0.85 for SEM models. Classification tree models showed good results of sensitivity, ranging from 0.95 to 0.99. However, they showed poor specificity ranging from 0.10 to 0.44. CONCLUSIONS: Our study showed that SEM is comparable to logistic regression or classification tree, which was widely used for more severe form of dengue prediction.
RESUMEN
Individuals infected with dengue virus (DENV) often show no symptoms, which raises the risk of DENV transfusion transmission (TT-DENV) in areas where the virus is prevalent. This study aimed to determine the evidence of DENV infection in blood donors from different geographic regions of Thailand. A cross-sectional study was conducted on blood donor samples collected from the Thai Red Cross National Blood Center and four regional blood centers between March and September 2020. Screening for DENV nonstructural protein 1 (NS1), anti-DENV immunoglobulin G (IgG), and IgM antibodies was performed on residual blood from 1053 donors using enzyme-linked immunosorbent assay kits. Positive NS1 and IgM samples indicating acute infection were verified using four different techniques, including quantitative real-time (q) RT-PCR, nested PCR, virus isolation in C6/36 cells, and mosquito amplification. DENV IgG seropositivity was identified in 89% (938/1053) of blood donors. Additionally, 0.4% (4/1053) and 2.1% (22/1053) of Thai blood donors tested positive for NS1 and IgM, respectively. The presence of asymptomatic dengue virus infection in healthy blood donors suggests a potential risk of transmission through blood transfusion, posing a concern for blood safety.
Asunto(s)
Anticuerpos Antivirales , Donantes de Sangre , Virus del Dengue , Dengue , Inmunoglobulina G , Inmunoglobulina M , Humanos , Tailandia/epidemiología , Dengue/transmisión , Dengue/epidemiología , Donantes de Sangre/estadística & datos numéricos , Estudios Transversales , Virus del Dengue/inmunología , Virus del Dengue/aislamiento & purificación , Virus del Dengue/genética , Anticuerpos Antivirales/sangre , Femenino , Masculino , Adulto , Inmunoglobulina M/sangre , Inmunoglobulina G/sangre , Adulto Joven , Persona de Mediana Edad , Adolescente , Proteínas no Estructurales Virales/genética , Proteínas no Estructurales Virales/inmunología , Donación de SangreRESUMEN
BACKGROUND: Travel to Southeast Asia increases the likelihood of acquiring mosquito-borne Flavivirus infections such as dengue (DENV), Japanese encephalitis (JEV) and Zika viruses (ZIKV). Expatriates are long-term travellers who have a higher risk of mosquito-borne illness at their destination country. The purpose of this study was to evaluate the seroprevalence of DENV, JEV and ZIKV infections and the determinants contributing to seropositivity among expatriates living in Thailand. METHODS: A cross-sectional study was performed from December 2017 to February 2020. Expatriates from non-Flavivirus endemic countries were recruited. 5 mL of blood was collected for DENV 1-4, JEV and ZIKV antibody testing by plaque reduction neutralization test (PRNT50). Individuals with vaccination histories or diagnoses for dengue, Japanese encephalitis, yellow fever and tick-borne encephalitis were excluded. RESULTS: Among 254 participants, most participants (83.1%) were male, the mean age was 65 years and the median duration of stay in Thailand was 6 years. Seroprevalence rate of any Flavivirus, non-specific DENV, DENV1-4, JEV and ZIKV were 34.3, 30.7, 20.5, 18.1, 18.9, 10.6, 4.7 and 2.8%, respectively. The presence of neutralizing antibodies against DENV1-4 positively correlates with the duration of stay in Thailand. DENV seropositivity was associated with living in urban areas (aOR 2.75, 95% CI 1.36-5.57). Expatriates were unlikely to have detectable anti-JEV antibodies regardless of time spent in a JEV-endemic area. No risk factors were identified that were significantly associated with JEV or ZIKV seropositivity. Only 48.4% received pre-travel counselling services, while only 18.9% visited a travel medicine specialist. CONCLUSIONS: A high proportion (34.3%) of long-term expatriates living in Thailand were seropositive for flavivirus, mainly from dengue (30.7%). To minimize risk, travel medicine practitioners should provide adequate pre-travel health risk information on mosquito-borne flavivirus infection and offer advice on mosquito bite prevention strategies. Dengue vaccine might be considered in high-risk travellers such as long-term expatriate.
Asunto(s)
Virus del Dengue , Dengue , Encefalitis Japonesa , Infección por el Virus Zika , Virus Zika , Animales , Masculino , Humanos , Anciano , Femenino , Encefalitis Japonesa/epidemiología , Encefalitis Japonesa/prevención & control , Infección por el Virus Zika/epidemiología , Dengue/prevención & control , Tailandia/epidemiología , Estudios Seroepidemiológicos , Estudios Transversales , Anticuerpos AntiviralesRESUMEN
We report coding-complete genome sequences of 44 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains of the alpha and delta variants identified from patients in Kamphaeng Phet, Thailand. Two nonsense mutations in open reading frame 3a (ORF3a) (G254*) and ORF8 (K68*) were found in the alpha variant sequences. Two lineages of the delta variant, B.1.617.2 and AY.30, were found.
RESUMEN
OBJECTIVE: Trichomonas vaginalis (TV) infection is common, curable, and associated with significant reproductive morbidity and risk for HIV infection. This analysis updates estimates of the prevalence of asymptomatic TV infection, and its associated risk factors, in the non-institutionalized U.S. population. METHODS: We analyzed data from 4057 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) 2013-2014 data collection cycle. Participant interviews ascertained demographic characteristics, self-reported tobacco use, and sexual history. Self-collected urine specimens from participants aged 18 to 59 years were tested for TV infection using the Gen-Probe Aptima TV assay. Cotinine was assayed from serum to provide a biomarker of recent tobacco exposure. Weighted percentages are provided to account for unequal selection probabilities among participants and adjustments for non-response. RESULTS: Our sample included 1942 men (49.2%, 95% Confidence Interval [CI] 48.0-50.5) and 2115 women (50.8%, 95%CI 49.5-52.0). The infection prevalence among men was 0.5% (n = 16; 95%CI 0.2-1.0) and 1.8% (n = 55; 95%CI 1.1-3.1) in women. After controlling for participant characteristics associated with TV infection, females had a 5.2-fold increased odds of being infected compared to men (adjusted odds ratio (aOR) 5.2, 95% CI 2.4-11.4). Non-Hispanic blacks were more likely to be infected compared to non-Hispanic whites (aOR 11.2, 95% CI 4.6-27.2). Individuals below the federal poverty level were more likely to be infected compared to those earning >3 times the federal poverty level (aOR 6.7, 95% CI 1.7-26.6), and active smokers were more likely to be infected compared to participants with no nicotine exposure (aOR 8.7, 95% CI 4.1-18.2). CONCLUSION: Trichomonas vaginalis infection continues to be relatively common, especially in women, smokers, non-Hispanic blacks, and in groups of lower socioeconomic status. Identifying the demographic characteristics of populations in the United States disproportionately affected by TV could impact screening and treatment of this infection in clinical practice. Further research on whether screening and treating for asymptomatic TV infection in high-risk populations improves risk for reproductive morbidity and HIV infection is warranted.
Asunto(s)
Tricomoniasis/diagnóstico , Trichomonas vaginalis/aislamiento & purificación , Adolescente , Adulto , Cotinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Oportunidad Relativa , Pobreza , Prevalencia , Factores de Riesgo , Conducta Sexual , Fumar , Tricomoniasis/epidemiología , Tricomoniasis/etnología , Tricomoniasis/parasitología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed.
Asunto(s)
Traumatismos por Explosión , Personal Militar , Pitiosis , Pythium , Infección de Heridas , Adulto , Bombas (Dispositivos Explosivos) , Resultado Fatal , Humanos , Masculino , Técnicas de Diagnóstico Molecular , Pythium/genética , Pythium/aislamiento & purificación , Adulto JovenRESUMEN
Epidemiologic evidence suggests a beneficial effect of HMG-CoA reductase inhibitors (statins) in sepsis, and in-vitro data exist for antimicrobial activity of statins against some bacteria and fungi. We examined whether statin exposure at physiologic concentrations enhances activity of selected antimicrobials against Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Broth microdilution was performed with and without dose-ranging concentrations of lovastatin, fluvastatin, atorvastatin, pravastatin and simvastatin. No effects on antimicrobial activity were demonstrated.