Progressive Severe Hemophagocytic Syndrome due to disseminated Histoplasmosis in a Patient with HIV-1 Infection.

Histoplasmosis is caused by Histoplasma capsulatum and is prevalent in areas of the world where H. capsulatum is endemic. We herein report a patient diagnosed with HIV-1 who developed histoplasmosis from a non-H. capsulatum endemic area who experienced severe hemophagocytic syndrome due to a delayed diagnosis. The patient's symptoms emerged four years after residing in regions with a high histoplasmosis prevalence. The unrestricted administration of antifungal medication for oral candidiasis delayed the diagnosis because it improved the patient's condition. This case underscores the importance of prudent antifungal drug use in undiagnosed disseminated conditions and evaluating the travel history going back several years to facilitate a diagnosis.

Interactive effects of trust in government information and perceived value on Chinese consumers' actual purchasing behavior toward contaminated seafood.

Previous studies have separately examined the roles of trust in government information and perceived value in consumer food choices; however, the interactive effects of trust in government information and perceived value remain unknown. Therefore, this study explores the joint effects of trust in government information and perceived value on shaping consumers' actual food purchase behavior after food contamination. A logit model was used to estimate the interactive effects. The results from a sample of 710 Chinese consumers indicated that a lack of trust continues to make consumers concerned about the safety of seafood, which, together with the spread of internet rumors, leads to the fact that trust in government information does not directly affect consumers' actual purchase behavior. However, it can also indirectly influence purchase behavior through perceived risks and benefits. Specifically, trust in government information reduces risk perception among low-income consumers and enhances benefit perception among low-risk city consumers, thus enhancing purchasing behavior. Moreover, we find city heterogeneity in its impact on consumer purchasing behavior. Specifically, in low-risk cities, it significantly promotes consumer purchasing behavior, however, in high-risk cities, it does not directly affect consumer purchasing behavior. Overall, trust in government information does not directly affect consumer purchasing behavior. Perceived value is a key factor affecting consumer purchasing behavior. An interactive effect exists between trust in government information and perceived value on consumer purchasing behaviors. These results highlight the role of perceived value in amplifying the effects of trust in government information. These findings have significant implications for seafood producers and policymakers. Effective strategies should encompass both the provision of perceived value and the cultivation of trust in government information to promote consumer choices of contaminated food.

[Epidemiological characteristics and diagnosis of imported Plasmodium malariae and Plasmodium ovale malaria cases in five provinces of China from 2014 to 2021].

OBJECTIVE: To investigate the epidemiological characteristics and diagnosis of imported Plasmodium malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Guangxi Zhuang Autonomous Region and Henan Province from 2014 to 2021, so as to provide insights into malaria control in these five provinces. METHODS: All data pertaining to malaria cases reported in five provinces of China were captured from Chinese Disease Control and Prevention Information System from 2014 to 2021, and the epidemiological characteristics of imported P. malariae and P. ovale malaria cases were analysed using a descriptive epidemiological method. The duration from onset of malaria to initial diagnosis, duration from initial diagnosis to definitive diagnosis, institutions of initial and definitive diagnoses, and proportion of correct malaria diagnosis at initial diagnosis were statistically analyzed. RESULTS: A total of 1 223 imported P. malariae and P. ovale malaria cases were reported in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021, there were 158 P. malariae malaria cases (12.92%) and 1 065 P. ovale malaria cases (87.08%). Totally 98.53% (1 205/1 223) of the imported malaria cases were from Africa, with Angola (18.99%, 30/158), Nigeria (11.39%,18/158), Cameroon (10.76%, 17/158), Ghana (10.13%, 16/158) and the Democratic Republic of the Congo (10.13%,16/158) as predominant countries where P. malariae malaria cases were from, and Ghana (23.19%, 247/1 065), Cameroon (14.74%, 157/1 065), Nigeria (9.39%, 100/1 065) and Angola (6.95%, 74/1 065) as predominant countries where P. ovale malaria cases were from. There were significant differences in the duration from onset of malaria to initial diagnosis (χ2 = 27.673, P = 0.000) and duration from initial diagnosis to definitive diagnosis of P. malariae and P. ovale malaria cases (χ2 = 29.808, P = 0.000), and the proportions of correct initial diagnosis of P. malariae and P. ovale malaria cases were 38.61% (61/158) and 56.53% (602/1 065). There were 74.69% (118/158) of P. malariae malaria cases with definitive diagnosis in county-, city-, and province-level medical institutions, and 79.25% (844/1 065) of P. ovale malaria cases with definitive diagnosis in county- and city-level medical institutions and county-level centers for disease control and prevention. CONCLUSIONS: The imported P. malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021 were mainly returned from Africa and the proportion of correct diagnosis of P. malariae and P. ovale malaria was low at initial diagnosis. Persistent improvements in the diagnostic capability of malaria are required in medical institutions.

[Overseas imported cystic echinococcosis misdiagnosed as pulmonary and hepatic cysts: a case report].

Cystic echinococcosis, a zoonotic disease that poses a significant threat to human health and animal husbandry development, is prevalent across the world and predominantly occurs in agricultural and pastoral regions. However, cystic echinococcosis cases are rare in non-endemic areas, which is likely to cause misdiagnosis or missing diagnosis, resulting in delay in treatment. This report presents an overseas imported cystic echinococcosis case misdiagnosed as pulmonary and hepatic cysts, so as to provide insights into diagnosis and treatment of cystic echinococcosis in non-endemic areas.

Oropouche Virus (OROV) in Pregnancy: An Emerging Cause of Placental and Fetal Infection Associated with Stillbirth and Microcephaly following Vertical Transmission.

Oropouche virus (OROV) is an emerging arbovirus endemic in Latin America and the Caribbean that causes Oropouche fever, a febrile illness that clinically resembles some other arboviral infections. It is currently spreading through Brazil and surrounding countries, where, from 1 January to 1 August 2024, more than 8000 cases have been identified in Bolivia, Brazil, Columbia, and Peru and for the first time in Cuba. Travelers with Oropouche fever have been identified in the United States and Europe. A significant occurrence during this epidemic has been the report of pregnant women infected with OROV who have had miscarriages and stillborn fetuses with placental, umbilical blood and fetal somatic organ samples that were RT-PCR positive for OROV and negative for other arboviruses. In addition, there have been four cases of newborn infants having microcephaly, in which the cerebrospinal fluid tested positive for IgM antibodies to OROV and negative for other arboviruses. This communication examines the biology, epidemiology, and clinical features of OROV, summarizes the 2023-2024 Oropouche virus epidemic, and describes the reported cases of vertical transmission and congenital infection, fetal death, and microcephaly in pregnant women with Oropouche fever, addresses experimental animal infections and potential placental pathology findings of OROV, and reviews other bunyavirus agents that can cause vertical transmission. Recommendations are made for pregnant women travelling to the regions affected by the epidemic.

Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray.

In the United States in 2021, an outbreak of 4 cases of Burkholderia pseudomallei, the etiologic agent of melioidosis and a Tier One Select Agent (potential for deliberate misuse and subsequent harm), resulted in 2 deaths. The causative strain, B. pseudomallei ATS2021, was unintentionally imported into the United States in an aromatherapy spray manufactured in India. We established that ATS2021 represents a virulent strain of B. pseudomallei capable of robust formation of biofilm at physiologic temperatures that may contribute to virulence. By using mouse melioidosis models, we determined median lethal dose estimates and analyzed the bacteriologic and histopathologic characteristics of the organism, particularly the potential neurologic pathogenesis that is probably associated with the bimABm allele identified in B. pseudomallei strain ATS2021. Our data, combined with previous case reports and the identification of endemic B. pseudomallei strains in Mississippi, support the concept that melioidosis is emerging in the United States.

Solenopsis richteri (Hymenoptera: Formicidae) alates infected with deformed wing virus display wing deformity with altered mobility.

Deformed wing virus (DWV) has long been identified as a critical pathogen affecting honeybees, contributing to colony losses through wing deformities, neurological impairments, and reduced lifespan. Since DWV also affects other pollinators, it poses a significant threat to global pollination networks. While honeybees have been the focal point of DWV studies, emerging research indicates that this RNA virus is not host-specific but rather a generalist pathogen capable of infecting a wide range of insect species, including other bee species such as bumblebees and solitary bees, as well as wasps and ants. This expands the potential impact of DWV beyond honeybees to broader ecological communities. The black imported fire ant, Solenopsis richteri, is an economically important invasive ant species. In this study, we describe deformed wing (DW) symptoms in S. richteri. DW alates were found in three of nine (33%) laboratory colonies. The symptoms ranged from severely twisted wings to a single crumpled wing tip. Additionally, numerous symptomatic alates also displayed altered mobility, ranging from an ataxic gait to an inability to walk. Viral replication of DWV was confirmed using a modified strand-specific RT-PCR. Our results suggest that S. richteri can be an alternative host for DWV, expanding our understanding of DWV as a generalist pathogen in insects. However, additional research is required to determine whether DWV is the etiological agent responsible for DW syndrome in S. richteri.

An Outbreak Investigation of Salmonella Weltevreden Illnesses in the United States Linked to Frozen Precooked Shrimp Imported from India - 2021.

In 2021, the U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and state partners investigated a multistate sample-initiated retrospective outbreak investigation (SIROI) consisting of a cluster of nine Salmonella Weltevreden illnesses associated with frozen, precooked shrimp imported from India. Import surveillance testing identified Salmonella Weltevreden recovered from a cooked shrimp sample from Supplier B. In total, nine patients with clinical isolates highly related via whole genome sequencing were reported in four states with illness onset dates between February 26 and July 17, 2021. Epidemiologic data were gathered by state partners for seven patients, who all reported exposure to shrimp. Five patients reported consuming shrimp cocktail from the same retailer. A traceback investigation for five of the six patients converged on Supplier B. This evidence demonstrated that the outbreak of Salmonella Weltevreden illnesses was caused by the consumption of cooked, ready-to-eat shrimp manufactured by Supplier B. At the time of the investigation, outbreak and recall information was shared with Indian competent authorities. In March 2022, a follow-up inspection of Supplier B's facility in India was conducted, and insanitary conditions and practices were observed. This outbreak investigation highlighted the importance of multidisciplinary national and international public health partnerships. The lessons learned from this investigation should continue to inform investigational activities and food safety guidance for the industry.

Schistosomiasis in the Military-A Narrative Review.

Schistosomiasis is a parasitosis caused by trematodes of the genus Schistosoma. Humans are infected when coming into contact with freshwater containing the parasites' infective stages, which are amplified through freshwater-dwelling snails acting as intermediate hosts. Schistosomiasis has posed significant problems for troops exposed to freshwater in endemic regions ever since the Napoleonic wars. Schistosomiasis has substantial differences in clinical presentation, depending on the type of parasite, intensity of infection and reinfection, clinical form, and disease stage. It can remain undiagnosed for long periods of time, with well-known long-term morbidity and mortality risks. The diagnosis of schistosomiasis depends on its stage and relays on several tests, all with limitations in sensitivity and specificity. The diagnostic gold standard is the detection of eggs in urine, feces, or tissue biopsies, but this can raise problems in patients such as military personnel, in which the worm burden is usually low. Praziquantel is the drug of choice for schistosomiasis. Currently, there is no available commercial vaccine against any Schistosoma parasite. Avoiding freshwater exposure is the best prevention. Herein, we review the clinical presentation, diagnosis, treatment, and prevention of schistosomiasis in the military. This information may decrease the impact of schistosomiasis on this particular professional group.

Profile and Determinants for Complications of Imported Malaria in 5 Chinese Provinces From 2014 to 2021: Retrospective Analysis.

Background: In 2021, the World Health Organization officially declared the People's Republic of China as malaria-free. However, despite this milestone achievement, the continued occurrence of severe and fatal cases of imported malaria in China, due to globalization and increased international communication, remains a significant public health concern. Objective: The aim of this study was to elucidate the epidemiological characteristics of imported malaria in 5 Chinese provinces from 2014 to 2021 and to identify the factors that influence complications in imported malaria cases. The findings will provide a basis for enhancing prevention and control measures, thereby consolidating China's achievements in malaria elimination. Methods: A case-based retrospective study was performed, using surveillance data collected from the representative provinces of China from 2014 to 2021. Epidemiological characteristics were analyzed using descriptive statistics. Logistic regression was used to identify the factors influencing the occurrence of complications. Results: A total of 5559 malaria cases were included during the study period. The predominant species was Plasmodium falciparum (3940/5559, 70.9%), followed by Plasmodium ovale (1054/5559, 19%), Plasmodium vivax (407/5559, 7.3%), Plasmodium malariae (157/5559, 2.8%), and 1 case of Plasmodium knowlesi. Most of the cases were male (5343/5559, 96.1%). The complication rates for P falciparum and P ovale were 11.4% and 3.3%, respectively. Multivariate logistic regression analysis of the relevant factors of malaria complications revealed potential protective factors, including a previous infection by Plasmodium (P<.001; odds ratio [OR] 0.512, 95% CI 0.422-0.621), and risk factors, including increased age (P=.004; OR 1.014, 95% CI 1.004-1.024), misdiagnosis at the first clinical visit (P<.001; OR 3.553, 95% CI 2.886-4.375), and the time interval from onset to treatment (P=.001; OR 1.026, 95% CI 1.011-1.042). Subgroup analyses identified risk factors associated with P falciparum, which include advanced age (P=.004; OR 1.015, 95% CI 1.005-1.026), initial misdiagnosis during the first clinical visit (P<.001; OR 3.549, 95% CI 2.827-4.455), the time interval from onset to treatment (P<.001; OR 1.043, 95% CI 1.022-1.063), and a delay of more than 3 days from the first treatment to diagnosis (P<.001; OR 2.403, 95% CI 1.823-3.164). Additionally, the risk factors pertaining to P ovale involve misdiagnosis at the initial clinical visit (P=.01; OR 2.901, 95% CI 1.336-6.298), the time interval from onset to treatment (P=.002; OR 1.095, 95% CI 1.033-1.160), and the duration from the initial treatment to diagnosis (P=.43; OR 1.032, 95% CI 0.953-1.118). Previous infections can prevent the progression of both P falciparum and P ovale. Conclusions: This study showed that the increasing proportion of P ovale in recent years should not be ignored. Furthermore, there is a need to improve diagnostic awareness, enhance the capacity of medical institutions, and provide health education for high-risk groups.

New guidelines reduce the risk of hospitalization for adult patients with uncomplicated Plasmodium falciparum malaria: An observational, multicenter, retrospective French study.

OBJECTIVES: We aimed to evaluate the impact of malaria declaration year (before or after 2017) on the frequency of hospitalization in metropolitan France of patients with uncomplicated non-vomiting P.falciparum malaria. PATIENTS AND METHODS: An observational, multicenter, retrospective study was carried out, using the database from the French National Reference Centre for Malaria. Descriptive analysis and multivariate analysis by logistic regression were performed using the multiple imputation by chained equation method to handle missing data. RESULTS: More than 2000 (2184) uncomplicated non-vomiting P.falciparum malaria cases were recorded. Our multivariate analysis showed an association between the year 2018 and reduced risk of hospitalization (OR: 0.89; 95% CI: 0.81-0.97). CONCLUSION: Compared to 2016, during 2018 we observed a trend toward ambulatory care for patients presenting with uncomplicated non-vomiting P.falciparum malaria.

Detection of Dengue Virus 1 and Mammalian Orthoreovirus 3, with Novel Reassortments, in a South African Family Returning from Thailand, 2017.

In July 2017, a family of three members, a 46-year-old male, a 45-year-old female and their 8-year-old daughter, returned to South Africa from Thailand. They presented symptoms consistent with mosquito-borne diseases, including fever, headache, severe body aches and nausea. Mosquito bites in all family members suggested recent exposure to arthropod-borne viruses. Dengue virus 1 (Genus Orthoflavivirus) was isolated (isolate no. SA397) from the serum of the 45-year-old female via intracerebral injection in neonatal mice and subsequent passage in VeroE6 cells. Phylogenetic analysis of this strain indicated close genetic identity with cosmopolitan genotype 1 DENV1 strains from Southeast Asia, assigned to major lineage K, minor lineage 1 (DENV1I_K.1), such as GZ8H (99.92%) collected in November 2018 from China, and DV1I-TM19-74 isolate (99.72%) identified in Bangkok, Thailand, in 2019. Serum samples from the 46-year-old male yielded a virus isolate that could not be confirmed as DENV1, prompting unbiased metagenomic sequencing for virus identification and characterization. Illumina sequencing identified multiple segments of a mammalian orthoreovirus (MRV), designated as Human/SA395/SA/2017. Genomic and phylogenetic analyses classified Human/SA395/SA/2017 as MRV-3 and assigned a tentative genotype, MRV-3d, based on the S1 segment. Genomic analyses suggested that Human/SA395/SA/2017 may have originated from reassortments of segments among swine, bat, and human MRVs. The closest identity of the viral attachment protein σ1 (S1) was related to a human isolate identified from Tahiti, French Polynesia, in 1960. This indicates ongoing circulation and co-circulation of Southeast Asian and Polynesian strains, but detailed knowledge is hampered by the limited availability of genomic surveillance. This case represents the rare concurrent detection of two distinct viruses with different transmission routes in the same family with similar clinical presentations. It highlights the complexity of diagnosing diseases with similar sequelae in travelers returning from tropical areas.

Epidemiological characteristics and molecular identification of Plasmodium species among cases of imported malaria in Kuwait during the COVID-19 pandemic.

Cases of imported malaria are reported each year in several malaria non-endemic countries, including Kuwait. PCR testing is the ideal method for identification of the infecting Plasmodium spp. The present study documented the epidemiologic characteristics of molecularly confirmed cases of imported malaria in Kuwait during the first year of COVID-19 pandemic. During the period from February 2020 to February 2021, 100 travelers with suspected malaria who had come from malaria-endemic countries of Africa (n = 60) and Asia (n = 40) were examined. Malaria diagnosis was made by microscopy of blood-stained smears and confirmed by a multiplex real-time PCR assay. Samples with discordant species identification results were sequenced. A total of 27 cases (27%) [P. falciparum, 14; P. vivax, 11; P. ovale, 1; mixed P. falciparum and P. malariae, 1] were detected, of whom 12 came to Kuwait for the first time and 15 were returning after visiting their home countries. Most of the returning travelers (12 out of 15 cases, 80%) had not received malaria chemoprophylaxis. Most cases of falciparum malaria (13/15) were Africans while most of the vivax cases (9/11) were Asians. Malaria was more common among subjects entering Kuwait for the first time (OR = 4.025, CI 1.07,15.1) and illiterates (OR = 13.8, CI 1.8,101.4). In conclusion, imported malaria caused mainly by P. falciparum and P. vivax was an ongoing problem during the COVID-19 pandemic. Travel history and education level were significant predictors of malaria among suspected cases.

Dynamics and Efficacy: A Comprehensive Evaluation of the Advanced Dengue Fever Surveillance and Early Warning System in Ningbo City, 2023.

Objective: To conduct a comprehensive evaluation of the Dengue Fever Surveillance and Early Warning System deployed in Ningbo City during 2023, focusing on its capacity for timely identification and reporting of dengue fever cases, particularly imported cases from endemic regions. Methods: A detailed data of patient clinical features and blood profile trends was collected from clinical records and surveillance reports, focusing on the rapid diagnostic processes and surveillance rigor. This study assessed the effectiveness of the system in identifying and reporting dengue cases and identified the limitations of the existing framework through a basic statistical approach. Results: The system demonstrated timely identification and reporting of dengue fever cases, with a particular emphasis on imported cases. However, several limitations were identified, including the need for more precise monitoring criteria and improved coordination with medical entities. Conclusion: The study underscores the critical role of public health bodies in managing disease outbreaks and advocates for enhanced methodologies to refine epidemic control efforts. The findings contribute to the advancement of early warning mechanisms and the improvement of proactive infectious disease monitoring in metropolitan environments, providing valuable insights for fortifying the Dengue Fever Surveillance and Early Warning System in Ningbo City.

Clinical and epidemiological features of imported loiasis in Beijing: a report from patients returned from Africa.

BACKGROUND: Loiasis is one of the significant filarial diseases for people living in West and Central Africa with wide endemic area but is not seen in China. As economy booms and international traveling increase, China faces more and more imported parasitic diseases that are not endemic locally. Loiasis is one of the parasitic diseases that enter China by travelers infected in Africa. The better understanding of the clinical and laboratory features of loa loa infection will facilitate the diagnosis and treatment of loiasis in China. METHODS: The study targeted travelers who were infected with L. loa in endemic Africa regions and returned to Beijing between 2014 and 2023. Epidemiological, clinical, and biological data as well as treatment of these patients were collected. RESULTS: Total 21 cases were identified as L. loa infection based on their typical clinical manifestations and parasite finding. All cases had a history of travel to Africa for more than 6 months, most of them are the construction workers dispatched to West Africa with outdoor activities. Calabar swelling (n = 19; 90.5%) and pruritus (n = 11; 52.4%) were among the most common clinical symptoms followed by muscle pain (n = 7; 33.3%) and skin rash (n = 2; 9.5%). The adult worms were observed in the eyelid or subconjunctiva (n = 2; 9.5%) and subcutaneous tissues (n = 2; 9.5%). Although all patients presented with a high eosinophil count (> 0.52 × 109/L), only two cases displayed microfilariae in fresh venous blood and positive for filarial antigen. A cut section of adult worm was observed through biopsy on a skin nodule surrounded by lymphocytes, plasma cells and eosinophils. All subjects were positive in PCR targeting L. loa ITS-1. The constructed phylogenetic tree based on the amplified ITS-1 sequences identified their genetical relation to the L. Loa from Africa. All patients treated with albendazole and diethylcarbamazine were recovered without relapse. CONCLUSION: This study provides useful information and guideline for physicians and researchers in non-endemic countries to diagnose and treat loiasis and L. loa infections acquired from endemic regions.

An observational study on imported COVID-19 cases in Hong Kong during mandatory on-arrival hotel quarantine.

Background: Hong Kong enforced stringent travel restrictions during the COVID-19 pandemic. Understanding the characteristics of imported COVID-19 cases is important for establishing evidence-based control measures. Methods: Retrospective cohort study summarising the characteristics of imported cases detected in Hong Kong between 13 November 2020 and 31 January 2022, when compulsory quarantine was implemented. Findings: A total of 2269 imported COVID-19 cases aged 0-85 years were identified, of which 48.6 % detected on arrival. A shorter median delay from arrival to isolation was observed in Delta and Omicron cases (3 days) than in ancestral strain and other variants cases (12 days; p < 0.001). Lower Ct values at isolation were observed in Omicron cases than in ancestral strain or other variants cases. No Omicron cases were detected beyond 14 days after arrival. Cases detected after 14 days of quarantine (n=58, 2.6 %) were more likely asymptomatic at isolation and had higher Ct value during isolation, some of them indicating re-positivity or post-arrival infections. Conclusions: Testing inbound travellers at arrival and during quarantine can detect imported cases early, but may not prevent all COVID-19 introductions into the community. Public health measures should be adapted in response to the emergence of SARS-CoV-2 variants based on evidence from ongoing surveillance.

Clinical significance of PLT for diagnosis and treatment monitoring in imported malaria.

To evaluate the clinical significance of PLT, MPV, and PDW in monitoring malaria treatment efficacy and predicting disease progression. A total of 31 patients with imported malaria were selected as the observation group, while 31 non-malaria patients with fever were selected as controls. The observation group was subdivided into a complication group and a non-complication group according to the occurrence of complications during treatment. Additionally, on the 1st day (within 24 h), the 3rd day, and the 5th day following admission, a comprehensive blood routine examination, Plasmodium microscopic examination, and colloidal gold assay were conducted. The blood routine examination results were compared before and after treatment among patients in the observation group and the control group. Moreover, the study involved dynamic monitoring and analysis of the levels and variations in PLT, MPV, and PDW within both the complication group and the non-complication group. The Plasmodium density was negatively correlated with PLT before treatment. There were significant differences were observed in PLT, MPV, and PDW (P < 0.05) within the observation group before and after treatment. Notably, there were no significant alterations in red blood cell (RBC), hemoglobin (Hb), and white blood cell (WBC) counts (P > 0.05) within the observation group before and after treatment. The PLT, MPV, and PDW levels in the complication group and the non-complication group exhibited an upward trend after treatment. Further, the PLT of patients in the complication group was significantly lower than that in the non-complication group. Additionally, the PLT, MPV, and PDW levels in the complication group and the non-complication group increased gradually from the time of admission to the 3rd and 5th day of treatment. Notably, the PLT in the complication group was consistently lower than that in the non-complication group. The continuous monitoring of PLT, MPV, and PDW changes plays a crucial role in assessing malaria treatment efficacy and prognosis in these individuals.

Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions?

BACKGROUND: The current definition of severe malaria in non-endemic areas follows WHO criteria, which mainly target children in malaria-endemic areas, potentially misclassifying cases in non-endemic regions. We assessed the performance of a modified severe malaria classification criteria within our patient cohort. METHODS: A cohort study of patients managed for malaria in a non-endemic setting (2005-2023) was analyzed. We classified patients into severe malaria (SM) using WHO 2013 criteria except for hyperparasitemia, where 2 % threshold was applied. Patients with SM were distinguished as very severe malaria (VSM) when presenting at least one of the following conditions: parasitemia >10 %, pulmonary edema, impaired consciousness, seizures, renal failure, metabolic acidosis or hyperlactatemia, shock or hypoglycemia. In patients with SM and no criteria for VSM, less severe malaria (LSM) was defined by: 2-10 % parasitemia, hyperbilirubinemia, prostration, anemia or minor bleeding. The primary composite outcome was death or the need for a life-saving intervention, as analyzed in the three comparative groups. Secondary outcome was the prevalence of co-infections. RESULTS: Among 506 patients with malaria, 176 (34.8 %) presented with SM. A total of 37 (7.3 %) patients developed a life-threatening condition, namely death (n = 4) and/or the need for life-saving interventions (n = 34). All fatalities and 33 out of the 34 life-saving interventions occurred in the VSM group. Patients in LSM group did not develop any life-threatening conditions. As to co-infections, 28 (5.5 %) patients had a community-acquired co-infection, with no differences between groups (p = 0.763). CONCLUSIONS: Severity criteria definitions would benefit from a review when assessing patients with malaria in non-endemic areas. Within the spectrum of SM, patients reclassified as LSM have a low risk of developing a life-threatening condition and present low co-infection incidence and could benefit from management out of intensive care units and a restrictive use of empirical antibiotics.

Forecasting and mapping dengue fever epidemics in China: a spatiotemporal analysis.

BACKGROUND: Dengue fever (DF) has emerged as a significant public health concern in China. The spatiotemporal patterns and underlying influencing its spread, however, remain elusive. This study aims to identify the factors driving these variations and to assess the city-level risk of DF epidemics in China. METHODS: We analyzed the frequency, intensity, and distribution of DF cases in China from 2003 to 2022 and evaluated 11 natural and socioeconomic factors as potential drivers. Using the random forest (RF) model, we assessed the contributions of these factors to local DF epidemics and predicted the corresponding city-level risk. RESULTS: Between 2003 and 2022, there was a notable correlation between local and imported DF epidemics in case numbers (r = 0.41, P < 0.01) and affected cities (r = 0.79, P < 0.01). With the increase in the frequency and intensity of imported epidemics, local epidemics have become more severe. Their occurrence has increased from five to eight months per year, with case numbers spanning from 14 to 6641 per month. The spatial distribution of city-level DF epidemics aligns with the geographical divisions defined by the Huhuanyong Line (Hu Line) and Qin Mountain-Huai River Line (Q-H Line) and matched well with the city-level time windows for either mosquito vector activity (83.59%) or DF transmission (95.74%). The RF models achieved a high performance (AUC = 0.92) when considering the time windows. Importantly, they identified imported cases as the primary influencing factor, contributing significantly (24.82%) to local DF epidemics at the city level in the eastern region of the Hu Line (E-H region). Moreover, imported cases were found to have a linear promoting impact on local epidemics, while five climatic and six socioeconomic factors exhibited nonlinear effects (promoting or inhibiting) with varying inflection values. Additionally, this model demonstrated outstanding accuracy (hitting ratio = 95.56%) in predicting the city-level risks of local epidemics in China. CONCLUSIONS: China is experiencing an increasing occurrence of sporadic local DF epidemics driven by an unavoidably higher frequency and intensity of imported DF epidemics. This research offers valuable insights for health authorities to strengthen their intervention capabilities against this disease.

Monitoring of Pesticide Residues in Chili Peppers Using International Pesticide Monitoring Data for Safety Management.

Repeated pesticide residue detection in chili peppers in the Republic of Korea has become a serious health concern. Thus, monitoring domestically grown and imported chili peppers for pesticide residues is of great significance. Here, we investigated pesticide residues detected in imported and domestically grown chili peppers using global pesticide residue monitoring data. Our analysis involved organizing inspection and detection data from different sources. Global pesticide residue monitoring data for chili peppers revealed 139 pesticide types, 43,532 inspections, and 3966 detections (detection rate, 9.11%). Peppers from Mexico were sampled the most (39,927 inspections) and showed the highest number of detected cases (2998 cases). Globally, the top 10 most frequently detected pesticides were clothianidin, imidacloprid, thiamethoxam, chlorpyrifos, thiacloprid, metalaxyl, myclobutanil, azoxystrobin, carbendazim, and cyhalothrin, with detection rates in the range of 10.52-28.66%. Furthermore, domestic chili pepper pesticide residue monitoring revealed 73 pesticide types, 3535 inspections, and 332 detected cases (detection rate, 9.39%), and the top 10 most frequently detected pesticides were chlorfenapyr, tebuconazole, flonicamid, dinotefuran, boscalid, pyraclostrobin, fluxametamide, thiamethoxam, pyridaben, and azoxystrobin, with detection rates in the range of 13.89-32.58%. These findings may serve as fundamental data for safety management related to chili pepper pesticide residues in the Republic of Korea.