Study: Clinical signs vary in fatal chikungunya-dengue co-infections
Seven patients who died following hospitalization for chikungunya and dengue virus co-infection all had fever and joint pain yet varied in terms of the viruses' effect on organ function and overall pathology, according to a study today in Eurosurveillance.
Researchers from the National Institute of Health of Colombia and the country's Universidad del Norte identified seven fatalities related to co-infection between September 2014 and October 2015. Time from symptom onset to hospitalization ranged from 1 to 4 days.
Six patients with chikungunya were also infected with dengue serotype 2, and one was co-infected with dengue serotype 3. Four people had underlying medical conditions, and an additional patient was pregnant and gave birth to a live infant on the second day she was hospitalized, the authors said.
All patients reported fever, arthralgia, and muscle pain; 5 had a rash; and 4 experienced hemorrhagic manifestations, including the pregnant woman, who suffered a hemorrhagic stroke 4 days after giving birth. Lab tests showed variable results, with evidence for leukocytosis in 3 patients, thrombocytopenia in 5, and renal failure in 3, the authors said.
Causes of death included multiorgan dysfunction syndrome in 5 cases and shock in 1. The pregnant woman's death was attributed to sepsis stemming from nosocomial Acinetobacter baumannii infection and was not directly related to viral co-infection, the authors said.
Postmortem histopathologic results were available for four cases and showed evidence of coagulative hepatocellular necrosis in three fatalities, one of whom also had signs of pericarditis, and another of whom had tubulointerstitial nephritis, the authors said. The pregnant woman's postmortem results were consistent with septic shock.
Additional studies on immune response and virology related to co-infection are needed to better understand fatal cases, said the authors. They noted that co-infection with dengue and chikungunya may alter the manifestations associated with a single arbovirus infection, adding, "These data emphasise the need for a multidimensional diagnostic approach in these clinical situations."
Jun 2 Eurosurveill study
H7N9 avian flu sickens Beijing man
Signaling Beijing's first H7N9 case of the year, city health officials reported a recent infection in a 49-year-old man, according to a May 30 weekly epidemiologic report translated and posted today by Avian Flu Diary (AFD), an infectious disease blog.
The report had few details but noted the man is from Tongzhou district. It did not say how the patient was exposed to the virus.
Since the virus first emerged in 2013, Beijing has reported seven H7N9 illnesses. The latest case lifts China's H7N9 total to 791, according to a case list maintained by FluTrackers, an infectious disease news message board.
Iowa resumes egg safety inspections after 1-year hiatus
The Iowa Department of Agriculture and Land Stewardship (IDALS) began inspecting egg-producing facilities yesterday after a year's pause in the program, according to a story yesterday in the Des Moines Register.
Agriculture officials said that egg inspections were halted in May 2015 as a precaution against outbreaks of H5N2 avian flu in 18 Iowa counties. The state ceased its regular 18-month inspections of facilities containing 3,000 birds or fewer, a move that coincided with the US Department of Agriculture's suspension of larger egg-production systems, the Register said.
The decision to stop inspections last year garnered some controversy because it was never made public until the Register reported on it in March. Iowa eggs were implicated in a nationwide Salmonella outbreak that sickened thousands of people in 2010, and inspections are considered a key part of ensuring a safe egg supply, the Register said.
There were no known food safety consequences to the year's break in inspections, said Dustin Vande Hoef, IDALS communications director, adding that the timing is now right to once again begin inspecting egg facilities. The wild bird migration season is over, and summer presents a low risk of avian flu, he said.
Inspectors this year will follow a new biosecurity protocol that involves wearing booties and gloves in egg-handling areas and a full-body protective suit in barns. Though Iowa has not had a new bird flu case since June 2015, losses due to the outbreak last year are estimated to reach $1.2 billion, the Register said.
Jun 1 Des Moines Register story
More than $3 million awarded for development of Ebola drug cocktail
Two Texas institutes have been given a $3.4 million contract to study the effects of combined cepharanthine and chloroquine therapy on combatting Ebola virus, according to a Global Biodefense update yesterday.
The Defense Threat Reduction Agency (DTRA) awarded the funding to the Southwest Research Institute (SwRI) of San Antonio, Texas, which will develop the combination drug and test its efficacy in Texas Biomedical Research Institute's (Texas Biomed's) biosafety level 4 laboratory, Global Biodefense said.
Cepharanthine, which has been used safely for more than 40 years to treat numerous conditions, and the antimalarial chloroquine both have shown efficacy in stopping Ebola virus replication at high individual doses. The new grant will enable SwRI and Texas Biomed to formulate a bioavailable dose of the two drugs, a combination that previously has shown an ability to treat malaria, Global Biodefense said.
"We have a unique approach to repurpose two existing drugs that we believe will more effectively work together to target emerging bio-threats like Ebola," said Joe McDonough, PhD, SwRI director of the pharmaceuticals and bioengineering department.
Jun 1 Global Biodefense report