SARS-CoV-2 outbreak among staff and evacuees at Operation Allies Welcome Safe Havens.

We report on five SARS-CoV-2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings.

Outcomes From Re-Treatment and Cerebrospinal Fluid Analyses in Patients With Syphilis Who Had Serological Nonresponse or Lack of Seroreversion After Initial Therapy.

BACKGROUND: We conducted an observational study to determine whether patients with syphilis who do not demonstrate serological cure or lack of seroreversion in nontreponemal (NT) antibody titers after initial therapy benefit from re-treatment and cerebrospinal fluid (CSF) analysis. METHODS: We enrolled patients with syphilis from sexually transmitted disease clinics in Guangzhou, China, who had persistent NT titers after therapy. Serological nonresponse was defined as a <4-fold decline in baseline NT titers after therapy. Lack of seroreversion was defined as demonstrating a ≥4-fold NT titer decline but without seroreversion to negative, or having persistent low-level titers (i.e., 1:1-1:2) after therapy. After consent, we abstracted medical record data regarding syphilis diagnoses, initial and re-treatment regimens, and serological outcomes. Nontreponemal titers were obtained from participants at enrollment and follow-up. We evaluated CSF findings among a subgroup of participants relative to re-treatment. RESULTS: From March 2012 to February 2016, we enrolled 135 HIV-negative patients with syphilis with persistent NT titers after initial therapy. Among 116 participants with ≥12 months of follow-up, 60 (52%) received re-treatment of syphilis. Overall, there were no significant differences in serological response between those who were re-treated and those who were not among serological nonresponders (29% vs. 27%; P = 1.0) or among participants without seroconversion (41% vs. 37%; P = 0.8). Of 60 participants who underwent CSF analyses, 8 (13%) had CSF abnormalities, but only 2 (3%) met the neurosyphilis criteria after re-treatment. CONCLUSIONS: Most HIV-negative patients with syphilis who have serological nonresponse or lack of seroreversion after therapy do not benefit from re-treatment in the short term, and neurosyphilis is uncommon.

The psychosocial conditions and intensified education that may affect school performance of HIV/AIDS orphaned children on antiretroviral drugs.

OBJECTIVE: This study begins with interpreting basic academic results from the House of Family (HOF) comprehensive project for HIV/AIDS orphaned children. We reviewed school performance during the academic period from 2007 to 2012. METHODS: All the children in the HOF project have vertically acquired HIV infection, with approximately 90% being with AIDS/Clinical Stage C at the time of admission. Initiation of antiretroviral drugs (ARV) was at the average age of 7 (mean 6.94, median 6.5, and a mode of 6). In the year 2007, 44 children had been receiving ARV. The majority of these children 32 (72.7%) were on ARV for at least 1 year, 6 (13.6%) of the children on ARV for 4 years, 7 (15.9%) were on ARV for 3 years, 5 (11.3%) for 2 years, 14 (31.8%) for 1 year, and 12 (27.2%) started ARV on that year. Later on, an additional 2 children started ARV in 2008, 1 child in 2009, and 4 children in 2010. RESULTS: We found that the total number of children achieving a certain academic level changed very little between each scholastic year. During the four years of school reviewed, it was noted that the Poor performers made improvement and an increase in Good performance grades was also achieved. The trend of Fair levels remained mostly unchanged at 65%, 70.2%, 68.5%, and 64.6% respectively. The overall passing performance, including both Fair and Good scores, improved from 67.5% in 2008 to 80.8% the following year of school. This passing rate of 80.8% in 2009 remains stable over the next two years at 80.3% and 80.3% respectively. CONCLUSION: Despite the late introduction of ARV medicine, limited family and social support, and deficient academic achievement, the children of HOF were able to improve their school performance due to intensified psychosocial and educational support provided at the HOF comprehensive project.

Cerebral malaria complicated with coma, multiorgan failure and psychosocial sequellae observed among non-immune travelers to Benin, Sudan and Madagascar.

OBJECTIVE: Severe malaria represents less than 10% of all malaria cases and is associated with significant mortality. The aim of this case series was to review severe malaria cases in travelers within the last 10 years in Slovakia. METHODS: All cases of severe malaria in travelers reported within last 10 years from the Inpatient Department in Slovakia to the Slovak Tropical Institute (STI) are reviewed. Only those traveling as tourist to Sub-Saharan Africa were included. RESULTS: During the last 10 years, eight (n=8) cases of cerebral malaria were reported, of which only one died (12.5%). Seven of all 8 cases had deep coma (87.5%), 4 (50%) required ventilator support, 4 (50%) required dialysis, 5 (62.5%) had liver failure and 6 (75%) had severe acidosis. CONCLUSION: Severe malarial cases were rarely detected among travelers returning to Slovakia within last 10 years. In survivors usually no sequellae remained. One patient treated with quinine alone died.

Nasopharyngeal bacterial colonisation in HIV-positive children in Cambodia.

OBJECTIVE: To determine patterns of nasopharyngeal colonisation in HIV-positive children. METHODS: Nasopharyngeal, nasal and ear swabs were prospectively taken from all children living in two paediatric nursing homes for HIV-positive orphans in Cambodia from 2004 to 2011. RESULTS: A total of 882 swabs were taken, of which 586 tested positive for bacteria. Staphylococcus aureus was the most frequently isolated species (178 isolates; 30.4%) followed by Streptococcus pneumoniae (103 isolates; 17.6%) and Klebsiella pneumoniae (99 isolates; 16.9%). The rate of S. pneumoniae decreased in 2009 when a vaccination programme was introduced. CONCLUSIONS: The respiratory tract of HIV-positive children receiving highly active antiretroviral therapy is commonly colonised by S. aureus and S. pneumoniae, while other species normally found in the respiratory tract, such as Moraxella catarrhalis, are far less frequent.

Confirmation of HIV-like sequences in respiratory tract bacteria of Cambodian and Kenyan HIV-positive pediatric patients.

BACKGROUND: Bacteria and yeasts isolated from respiratory tracts of 39 Cambodian and 28 Kenyan HIV-positive children were tested for the presence of HIV-1 sequences. MATERIAL/METHODS: Bacteria and yeasts from the respiratory tract (nose, pharyngeal swabs) were isolated from 39 Cambodian and 28 Kenyan HIV-positive children. Bacterial chromosomal DNA was prepared by standard protocol and by Qiagen kit. The PCR specific for HIV sequences was carried out using HIV-1-specific primers.The analysis was performed by colony and dot-blot hybridization using HIV-1-specific primers which represent gag, pol and env genes of the virus. The sequencing of some PCR products was performed on the ABI 373 DNA Sequencer. RESULTS: The majority of microbes were characterized as Staphylococcus aureus, Klebsiella pneumoniae, and resp. Candida albicans. In some cases E. coli, Streptococcus pyogenes, Proteus mirabilis and Candida tropicalis were identified. Bacteria of 16 Cambodian (41%) and 8 Kenyan (31%) children were found to be positive in colony and dot-blot DNA hybridization. By the sequencing of PCR products synthesized on the template of patients' bacterial DNA using primers 68;69 for env HIV-1 gene, homology of greater than 90% with HIV-1 isolate HXB2 (HIVHXB2CG) was revealed. CONCLUSIONS: Bacteria and yeasts from the respiratory tract of 41% of Cambodian and 31% of Kenyan HIV-positive children bear HIV-like sequences. The role of bacteria in the HIV disease process is discussed.

Colonization of the respiratory tract by drug-resistant bacteria in HIV-infected children and prior exposure to antimicrobials.

The aim of this short communication is to assess colonization by MRSA, penicillin-resistant pneumococci (PRP), fluconazole-resistant (FLU-R) Candida albicans (CA) and non-albicans Candida (NAC), and ciprofloxacin-resistant E. coli with regard to immune recovery due to CD4 T-cell increase depending on the duration of highly active antiretroviral therapy (HAART). Prior exposure to oral cephalosporins (P<0.01) was significantly related to MRSA colonization. Penicillin-resistant pneumococci were more frequently (40% vs. 12.5%, NS) related to prior cephalosporins, but not to penicillins or macrolides use. However, this association was not statistically significant. Prior receiving of fluconazole was also not associated with increased colonization by FLU-R Candida spp. (30% vs. 16.7%, NS). Cotrimoxazole (P<0.01) and amoxicillin/amoxicillin clavulanate (P<0.01) were surprisingly protective against colonization by fluconazole-resistant Candida spp. Exposure to quinolones was not a risk factor for colonization by ciprofloxacin-resistant E. coli, but receiving of rifampin was (P<0.01). Colonization by cefotaxime-resistant Klebsiella spp. and Enterobacter spp. was not significantly associated with cephalosporins, but it was with cotrimoxazole use (P<0.05). In addition, HIV-infected children on HAART who received any antibiotic were significantly more colonized by cotrimoxazole-resistant E. coli (P<0.01) than those not receiving any antibiotic prior to colonization. Exposure to cephalosporins and macrolides was significantly related to cotrimoxazole-resistant E. coli (100% vs. 20%, 75% vs. 10%; P<0.01 for both), but exposure to cotrimoxazole itself was not.