Prevalence of Chikungunya and Scrub Typhus Coinfection among Dengue Negative Patients in Kolkata, India-A Newly Emerging Public Health Hazard
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Abstract:
The chikungunya virus (CHIKV) and scrub typhus infection has scattered worldwide creating human health hazards in India and Asia specific region. We aimed to identify chikungunya, scrub typhus, and their co-infection in dengue-negative samples having undifferentiated febrile illnesses. Enzyme linked immunosorbent assay (ELISA) methods were used to detect the chikungunya and scrub typhus specific IgM antibody by using chikungunya IgM capture ELISA kit and scrub typhus IgM Microlisa ELISA kit, respectively. OD value was measured with the help of BeneSphera (India) ELISA microplate reader. Among 490 suspected patients, 57 (11.63%) samples were tested positive for chikungunya IgM antibodies, while 43 (8.77%) came positive for scrub typhus IgM antibodies, but all samples tested negative for dengue IgM antibodies. Additionally, 5% of the total positive cases were positive for both chikungunya and scrub typhus infection. Our study offers a hypothesis regarding one of the possible causes of the decline in the frequency of scrub typhus and chikungunya cases reported in Kolkata and other districts of West Bengal. As an outcome, physicians treating undifferentiated febrile patients in endemic locations should look for chikungunya, scrub typhus, and existing coinfection between them to avoid delayed diagnosis and provide proper treatment against these infections.Keywords:
Medical microbiology
To determine if antibodies to rickettsiae (scrub typhus, spotted fever, and typhus group rickettsiae) occur among persons living in the Kimberley (northern tropical) region of Western Australia, 920 sera collected in a non-random manner in 1996 from patients in Kununurra, Broome, Fitzroy Crossing, Wyndham, Derby, and Halls Creek were tested by micro-immunofluorescence for antibodies to a panel of rickettsial antigens. Of 920 sera examined, 52 (5.6%) were positive for antibodies to one or more of the three groups of rickettsial microorganisms. The largest group of sera (24; 2.6%) were positive for scrub typhus (Orientia tsutsugamushi). Eleven other sera (1.2%) were positive for scrub typhus and spotted fever group rickettsiae and four (0.4%) were positive for scrub typhus, spotted fever group, and typhus group rickettsiae. In addition 13 sera (1.4%) were positive only for spotted fever group rickettsiae. In this study, only titers > or = 1:256 were considered significant. Thus, there is serologic evidence for scrub typhus and spotted fever group rickettsial infections in the Kimberley region of Western Australia. Because of the method of serum collection, it is not possible to determine the prevalence of seropositivity, but the data support the need for a proper epidemiologic study of rickettsial diseases in this region of Australia.
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Results HIV-HBV coinfection prevalence was 19.9%. We noticed a slightly higher frequency of coinfection in males (53.2%), most patients belonging to the age group 20-29 (86.5%), the median age of the group being 25.56 years. The predominant route of transmission was parenteral (57.5%), heterosexual being found in a significant proportion (40.1%). The mean CD4 cell count was 246.20 cells/cmm, over 41% of the cases had levels between 200-499 CD4 cells/ cmm. Individual values of plasma HIV viral load varied from undetectable levels up to a maximum of 4,600,000 copies/mL, with a median value of 142,906 copies/mL. ALT levels in HIV and HBV coinfection varied between 10-323 U/L, the average being 49.90 U/L, more than 65% of subjects with pathological levels; 218% of the total cholesterol values were pathological, the mean for the group was 182.58 mg/dL. Only 16.8% in the coinfected group had serum triglyceride levels below the reference (160 mg/dL). All patients in the HIV-HBV coinfected group had antiretroviral therapeutic agents with dual action anti-HIV and anti-HBV, 87.3% receiving lamivudine alone or in coformulation; in a small number of cases (3.6%) we opted for tenofovir.
Medical microbiology
Parasitology
Tropical Medicine
Hepatitis virus
Hepatitis B
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The co-circulation of Chikungunya (CHIKV), Dengue (DENV) and Zika (ZIKV) viruses increased the risk of outbreaks and coinfections among them. Here, we report cases of coinfection in clinical samples from state of Tocantins, Brazil.In 2017, the Central Public Health Laboratory (LACEN) received samples of patients who consulted health units with symptoms compatible with arboviral infections. A total of 102 samples were sent to the Retrovirology Laboratory at the Federal University of São Paulo, where they were tested by RT-qPCR to confirm DENV, ZIKV and CHIKV infections and to detect coinfected patients.We identified with CHIKV monoinfection (52), DENV serotypes 1 (28) and serotypes 2 (22). We did not detect ZIKV. Five patients were characterized with coinfection involving CHIKV and DENV serotype 2.The presence of co-circulating arboviruses increases the chance of coinfection and demonstrates the importance of differential diagnosis and vector control.
Zika Virus
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Abstract The recent emergence of both chikungunya and Zika viruses in the Americas has significantly expanded their distribution and has thus increased the possibility that individuals may become infected by more than one Aedes aegypti -borne virus at a time. Recent clinical data support an increase in the frequency of coinfection in human patients, raising the likelihood that mosquitoes could be exposed to multiple arboviruses during one feeding episode. The impact of coinfection on the ability of relevant vector species to transmit any of these viruses (that is, their vector competence) has not been determined. Thus, we here expose Ae. aegypti mosquitoes to chikungunya, dengue-2 or Zika viruses, both individually and as double and triple infections. Our results show that these mosquitoes can be infected with and can transmit all combinations of these viruses simultaneously. Importantly, infection, dissemination and transmission rates in mosquitoes are only mildly affected by coinfection.
Zika Virus
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To the Editor, We would like to share our experience of a series of COVID-19 patients coinfected with pneumococcal pneumonia in a district hospital in Barcelona.Bacterial coinfections in patients with COVID-19 are uncommon [1] including those caused by Streptococcus pneumoniae [2], especially when compared with other seasonal respiratory viruses [3].However, the evidence on bacterial pneumonia in COVID-19 is still limited and diagnosis remains a challenge, as both diseases are associated with a similar clinical presentation, high inflammatory markers and radiological changes.Given the high mortality associated with S. pneumoniae infection, missing the diagnosis may pose a risk to already vulnerable COVID-19 patients.As such, we describe the prevalence, clinical characteristics and outcomes of pneumococcal infection in COVID-19 patients.We reviewed all microbiology results for patients admitted to Hospital Sant Joan Despí Moises Broggi (Barcelona, Spain) with PCR-confirmed COVID-19 on nasopharyngeal swabs between March 4, 2020, and November 4, 2020.Our hospital serves a population of 425.000, of which one-quarter are foreign-born, mainly Latin-American.Hospital guidelines for patients admitted with COVID-19 pneumonia recommend blood culture, pneumococcal and legionella urinary antigen tests based on clinical severity and at the clinician's discretion.Clinical samples were tested for pneumococcal antigen using a fluorescence immunoassay, SD Biosensor S. pneumoniae urinary antigen test (Republic of Korea), in accordance with
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2019-20 coronavirus outbreak
Betacoronavirus
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A 56-year-old female goat herder had scrub typhus that persisted after receiving doxycycline for 5 days. Her symptoms continued, prompting us to perform further examinations that revealed coinfection of Q fever and scrub typhus via molecular and serological testing. We also isolated Orientia tsutsugamushi using BALB/c mice and L929 cells.
Orientia tsutsugamushi
Q fever
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Malay
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Dengue fever and scrub typhus are common causes of acute febrile illness of unclear origin in Asia. Though coinfections of many vector-borne diseases have been described, articles on dengue and scrub typhus coinfection are distinctly limited. In case of coinfection with dengue and scrub typhus, vigilant monitoring of vitals, platelets transfusion, and timely treatment with doxycycline are necessary. High degree of suspicion has to be made for coinfection in a patient presenting with febrile illness with thrombocytopenia and deranged laboratory parameters in postmonsoon season in endemic regions in Asia.
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Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are the most common tick-borne diseases in South Korea. However, few studies have systematically examined the simultaneous presence of the two diseases. We found that two (4.9%) of 41 patients with suspected and confirmed SFTS had evidence of coinfection with scrub typhus. In addition, two (3.6%) of 55 suspected and confirmed scrub typhus patients were identified to have coinfection with SFTS. Our data suggest that diagnostic evaluation for coinfection in patients with tick-borne illness and empirical doxycycline treatment in patients with SFTS may be warranted in areas endemic for both diseases until coinfection with scrub typhus is ruled out.
Orientia tsutsugamushi
Tick-borne disease
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