Analysis of Zika Virus Sequence Data Associated with a School Cohort in Haiti.

Zika virus (ZIKV) infections occurred in epidemic form in the Americas in 2014-2016, with some of the earliest isolates in the region coming from Haiti. We isolated ZIKV from 20 children with acute undifferentiated febrile illness who were part of a cohort of children seen at a school clinic in the Gressier region of Haiti. The virus was also isolated from three pools of Aedes aegypti mosquitoes collected at the same location. On phylogenetic analysis, three distinct ZIKV clades were identified. Strains from all three clades were present in Haiti in 2014, making them among the earliest isolates identified in the Western Hemisphere. Strains from all three clades were also isolated in 2016, indicative of their persistence across the time period of the epidemic. Mosquito isolates were collected in 2016 and included representatives from two of the three clades; in one instance, ZIKV was isolated from a pool of male mosquitoes, suggestive of vertical transmission of the virus. The identification of multiple ZIKV clades in Haiti at the beginning of the epidemic suggests that Haiti served as a nidus for transmission within the Caribbean.

Isolation of a Novel Recombinant Canine Coronavirus From a Visitor to Haiti: Further Evidence of Transmission of Coronaviruses of Zoonotic Origin to Humans.

We isolated a novel coronavirus from a medical team member presenting with fever and malaise after travel to Haiti. The virus showed 99.4% similarity with a recombinant canine coronavirus recently identified in a pneumonia patient in Malaysia, suggesting that infection with this virus and/or recombinant variants occurs in multiple locations.

Orthobunyaviruses in the Caribbean: Melao and Oropouche virus infections in school children in Haiti in 2014.

We report the identification of two orthobunyaviruses, Melao virus (MELV) and Oropouche virus (OROV), in plasma specimens from Haitian children with acute febrile illness who presented during outbreaks caused by alpha- and flaviviruses in 2014. Heretofore not described as a human pathogen, MELV was isolated in cell culture from the plasma of five case patients. OROV RNA was detected in the plasma of an additional child, using an unbiased sequencing approach, with phylogenetic inference suggesting a close relationship with strains from Brazil. Abdominal pain was reported by four case patients with MELV infections, with lymphadenopathy noted in two cases. Our findings document the occurrence of these orthobunyaviruses within the Caribbean region and highlight the critical importance of surveillance with viral genome sequence analyses to identify outbreaks caused by these and other emerging viruses.

Isolation of Mayaro Virus from a Venezuelan Patient with Febrile Illness, Arthralgias, and Rash: Further Evidence of Regional Strain Circulation and Possible Long-Term Endemicity.

Fifty-two febrile patients living in Barquisimeto, Venezuela, were screened for arbovirus infection by virus culture during an outbreak of what was thought to be Zika virus infection. We report identification of Mayaro virus (MAYV) on culture of plasma from one patient, an 18-year-old woman with acute febrile illness, arthralgias, and psoriasiform rash. The strain was sequenced and was found to be most closely related to a 1999 strain from French Guiana, which, in turn, was related to two 2014 strains from Haiti. By contrast, previously reported outbreak-related MAYV strains from a sylvatic area approximately 80 miles from where the case patient lived were most closely related to Peruvian isolates. The two strain groups show evidence of having diverged genetically approximately 100 years ago.

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas.

Venezuela's tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela's health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

Alice in Wonderland syndrome: a novel neurological presentation of Zika virus infection.

Zika virus (ZIKV) is a flavivirus endemic in Africa and Southern Asian countries, which has recently emerged in unprecedented epidemic proportions around the world. Although ZIKV infection is often asymptomatic or distinguished by non-specific influenza-like symptoms, an increase in its pathogenicity and biological behavior has been the hallmark of the current pandemic. Increasing evidence suggests that neurotropic strains of ZIKV have evolved from less pathogenic strains of the virus. Neurological manifestations of ZIKV infection include a spectrum of congenital and non-congenital clinical entities, however visual somatosensory perceptual disorders have not been recorded to date. Herein, we report a case of a 15-year-old female who presented with a constellation of perceptual symptoms (metamorphopsia, telopsia, and pelopsia) following acute ZIKV infection. Although such symptoms may have originated from direct viral injury, a post-ZIKV autoimmune reaction to previously unexposed neuronal surface antigens or through molecular mimicry cannot be excluded. The development of Alice in Wonderland syndrome in our patient highlights the ever-increasing expanding spectrum of neurological symptoms associated to ZIKV infection.

Complete Genome Sequence of Dengue Virus Serotype 2, Asian/American Genotype, Isolated from the Urine of a Venezuelan Child with Hemorrhagic Fever in 2016.

The complete genome sequence was obtained for a Dengue virus 2 isolate from the urine of an 8-year-old girl who was hospitalized with dengue hemorrhagic fever in 2016 in Venezuela.

Madariaga Virus: Identification of a Lineage III Strain in a Venezuelan Child With Acute Undifferentiated Febrile Illness, in the Setting of a Possible Equine Epizootic.

We report identification of Madariaga virus (MADV) in plasma and urine samples from a child with acute undifferentiated febrile illness in Venezuela. Our data document the occurrence of milder MADV infections (ie, without encephalitis), with a symptom complex that resembles that seen with other arboviral infections, including dengue and zika.

Evidence for Mother-to-Child Transmission of Zika Virus Through Breast Milk.

Zikavirus (ZIKV) is an emerging viral pathogen that continues to spread throughout different regions of the world. Herein we report a case that provides further evidence that ZIKV transmission can occur through breastfeeding by providing a detailed clinical, genomic, and virological case-based description.

Ocular flutter following Zika virus infection.

Zika virus (ZIKV) is an emerging flavivirus which has been linked to a number of neurologic manifestations such as Guillain-Barré syndrome (GBS), transverse myelitis, and meningo-encephalitis. Ophthalmologic manifestations are increasingly being reported; however, ocular dyskinesias have not been described in this context to date. Herein, we report a case of a 22-year-old female who presented with ocular flutter and associated Guillain-Barré syndrome following acute ZIKV infection. We speculate that although such symptoms may have originated from a direct viral insult, a post-infectious autoimmune mechanism may not be excluded. Physicians should include ZIKV as well as other flaviviruses in their diagnostic workup for all patients with ocular flutter/opsoclonus, after excluding other non-infectious causes of central nervous system pathology. To the best of our knowledge, this is the first report on the association of ocular flutter, GBS, and ZIKV infection.

Complete Genome Sequences of Identical Zika virus Isolates in a Nursing Mother and Her Infant.

Complete genome sequences were obtained for Zika viruses isolated from the breast milk of a Venezuelan patient and her child, who was exclusively breastfeeding at the time. These sequences are the first to be reported from a presumptive autochthonous postnatal transmission case from mother to child in Venezuela.

Ophthalmologic aspects of chikungunya infection.

Chikungunya fever, a viral disease epidemic in some parts of the world is newly introduced in the Americas. This is of considerable international concern, with a growing incidence owing to developing urbanization, tourism, and trade. Ocular manifestations of chikungunya fever are not frequent, but of great relevance. Common manifestations include conjunctivitis, optic neuritis, iridocyclitis, episcleritis, retinitis and uveitis. Diagnostic and monitoring investigations would include optical coherence tomography, fundus fluorescein and indocyanine green angiography, visual field analysis, and electrophysiologic tests. There have been no prospective, randomized therapeutic trials, and it is unclear if the disease is self-limiting or if treatment is actually beneficial. Prognosis varies, ranging from full resolution to permanent vision loss despite intervention.

The prevalence and persistence of sigma virus, a biparentally transmitted parasite of Drosophila melanogaster.

QUESTION: How do vertically transmitted parasites persist? ORGANISMS: Drosophila melanogaster (host) and sigma virus (parasite). FIELD SITE: Peach stands in northern Georgia, USA, on a transect between Macon and Athens. EMPIRICAL METHODS: We estimated prevalence in the field. We also estimated male and female transmission in the laboratory, using field-collected animals as parents. We further quantified patrilineal (father to son) transmission in the laboratory, and estimated cost of infection (virulence) by quantifying decreased egg production of infected flies. MATHEMATICAL METHODS: Discrete-time, deterministic models for prevalence; analysis of stability of disease-free and endemic equilibria; numerical computation of equilibria based on empirical estimates. KEY ASSUMPTIONS: Random mating, discrete generations, cost of infection to females only. PREDICTIONS AND CONCLUSIONS: The model allows persistence under parameter estimates obtained for this population. Uncertainty in parameters leads to wide confidence intervals on the predicted prevalence, which may be systematically underestimated due to Jensen's inequality. Male transmission is required for persistence, and multiple generations of strictly patrilineal transmission are possible in the laboratory, albeit with decreasing transmission efficiency.