ABSTRACT
We report two cases of respiratory toxigenic Corynebacterium diphtheriae infection in fully vaccinated UK born adults following travel to Tunisia in October 2019. Both patients were successfully treated with antibiotics and neither received diphtheria antitoxin. Contact tracing was performed following a risk assessment but no additional cases were identified. This report highlights the importance of maintaining a high index of suspicion for re-emerging infections in patients with a history of travel to high-risk areas outside Europe.
Subject(s)
Diphtheria/diagnosis , Diphtheria/epidemiology , Anti-Bacterial Agents/therapeutic use , Contact Tracing , Diphtheria/drug therapy , Diphtheria/pathology , Female , Humans , Male , Middle Aged , Scotland/epidemiology , Travel-Related Illness , TunisiaABSTRACT
We detected 2 hepatitis E virus (HEV) strains in an acutely infected immunocompetent patient. Two populations of genotype 3 virus were observed in the hypervariable regions and open reading frames 2 and 3, indicating multiple infection with hepatitis E virus. Persons with mixed infections may provide the opportunity for virus recombination.
Subject(s)
Coinfection/diagnosis , Hepatitis E virus/genetics , Hepatitis E/diagnosis , Coinfection/immunology , Coinfection/virology , Genes, Viral , Genotype , Hepatitis E/immunology , Hepatitis E/virology , Hepatitis E virus/immunology , Humans , Immunocompetence , Male , Middle Aged , Molecular Typing , Phylogeny , Sequence Analysis, DNASubject(s)
Arthralgia/virology , Exanthema/virology , Hepatitis E/complications , Hepatitis E/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , ScotlandABSTRACT
BACKGROUND: Hepatitis E virus is well recognized cause of acute hepatitis. Traditionally hepatitis E virus (HEV) infections were generally associated with travel to Asia and Africa. Autochthonous hepatitis E is recognized as a major cause acute hepatitis in England and Wales. However, autochthonous hepatitis E has never been documented in Scotland. OBJECTIVES: We attempted to determine if autochthonous HEV occurred in Scotland. STUDY DESIGN: Samples from 377 individuals in the South-East of Scotland presenting with acute hepatitis were tested over six years. Acute hepatitis E was confirmed by detecting viraemia or documenting seroconversion and ORF-2 region sequenced. Structured interviews were carried out to identify risk factors for infection. RESULTS: Sixteen individuals (4.2%) had evidence of past HEV infection. Twelve (3.2%) had acute HEV infection, 10 of whom had viraemia (genotype 1=3; genotype 3=7). Of these seven with genotype 3 infection, three had not travelled outside Scotland within the incubation period, while four had travelled to Spain (n=3) or Turkey (n=1). All three individuals with genotype 1 infection had travelled to the Indian subcontinent. CONCLUSIONS: A significant proportion of HEV genotype 3 infections was autochthonous (43%). HEV screening should hence be an integral part of acute hepatitis screening in Scotland, irrespective of the travel history.