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1.  Analysis of Diagnostic Findings From the European Mobile Laboratory in Guéckédou, Guinea, March 2014 Through March 2015 
Kerber, Romy | Krumkamp, Ralf | Diallo, Boubacar | Jaeger, Anna | Rudolf, Martin | Lanini, Simone | Bore, Joseph Akoi | Koundouno, Fara Raymond | Becker-Ziaja, Beate | Fleischmann, Erna | Stoecker, Kilian | Meschi, Silvia | Mély, Stéphane | Newman, Edmund N. C. | Carletti, Fabrizio | Portmann, Jasmine | Korva, Misa | Wolff, Svenja | Molkenthin, Peter | Kis, Zoltan | Kelterbaum, Anne | Bocquin, Anne | Strecker, Thomas | Fizet, Alexandra | Castilletti, Concetta | Schudt, Gordian | Ottowell, Lisa | Kurth, Andreas | Atkinson, Barry | Badusche, Marlis | Cannas, Angela | Pallasch, Elisa | Bosworth, Andrew | Yue, Constanze | Pályi, Bernadett | Ellerbrok, Heinz | Kohl, Claudia | Oestereich, Lisa | Logue, Christopher H. | Lüdtke, Anja | Richter, Martin | Ngabo, Didier | Borremans, Benny | Becker, Dirk | Gryseels, Sophie | Abdellati, Saïd | Vermoesen, Tine | Kuisma, Eeva | Kraus, Annette | Liedigk, Britta | Maes, Piet | Thom, Ruth | Duraffour, Sophie | Diederich, Sandra | Hinzmann, Julia | Afrough, Babak | Repits, Johanna | Mertens, Marc | Vitoriano, Inês | Bah, Amadou | Sachse, Andreas | Boettcher, Jan Peter | Wurr, Stephanie | Bockholt, Sabrina | Nitsche, Andreas | Županc, Tatjana Avšič | Strasser, Marc | Ippolito, Giuseppe | Becker, Stephan | Raoul, Herve | Carroll, Miles W. | De Clerck, Hilde | Van Herp, Michel | Sprecher, Armand | Koivogui, Lamine | Magassouba, N'Faly | Keïta, Sakoba | Drury, Patrick | Gurry, Cèline | Formenty, Pierre | May, Jürgen | Gabriel, Martin | Wölfel, Roman | Günther, Stephan | Di Caro, Antonino
The Journal of Infectious Diseases  2016;214(Suppl 3):S250-S257.
Background. A unit of the European Mobile Laboratory (EMLab) consortium was deployed to the Ebola virus disease (EVD) treatment unit in Guéckédou, Guinea, from March 2014 through March 2015.
Methods. The unit diagnosed EVD and malaria, using the RealStar Filovirus Screen reverse transcription–polymerase chain reaction (RT-PCR) kit and a malaria rapid diagnostic test, respectively.
Results. The cleaned EMLab database comprised 4719 samples from 2741 cases of suspected EVD from Guinea. EVD was diagnosed in 1231 of 2178 hospitalized patients (57%) and in 281 of 563 who died in the community (50%). Children aged <15 years had the highest proportion of Ebola virus–malaria parasite coinfections. The case-fatality ratio was high in patients aged <5 years (80%) and those aged >74 years (90%) and low in patients aged 10–19 years (40%). On admission, RT-PCR analysis of blood specimens from patients who died in the hospital yielded a lower median cycle threshold (Ct) than analysis of blood specimens from survivors (18.1 vs 23.2). Individuals who died in the community had a median Ct of 21.5 for throat swabs. Multivariate logistic regression on 1047 data sets revealed that low Ct values, ages of <5 and ≥45 years, and, among children aged 5–14 years, malaria parasite coinfection were independent determinants of a poor EVD outcome.
Conclusions. Virus load, age, and malaria parasite coinfection play a role in the outcome of EVD.
doi:10.1093/infdis/jiw269
PMCID: PMC5050480  PMID: 27638946
Filovirus; Ebola virus disease; malaria; Guinea; epidemic; mobile laboratory
2.  Multiple Co-infections of Rodents with Hantaviruses, Leptospira, and Babesia in Croatia 
Abstract
Hantaviruses, Leptospira spp., and Babesia spp. are rodent-borne pathogens present worldwide. We studied multiple co-infections of small rodents in Croatia with all three pathogens. Twenty-eight Apodemus flavicollis and 16 Myodes glareolus were tested for the presence of hantavirus RNA by real-time RT-PCR, Leptospira strains by renoculture method and Babesia DNA by PCR. Anti-hantavirus antibodies and anti-Leptospira antibodies were detected by serological methods. Very high infection rates with each pathogen were found in A. flavicollis: 20 of 28 rodents (71%) were infected with Dobrava virus, 13 rodents (46%) were infected with Leptospira, and 5 rodents (18%) were infected with Babesia. Multiple co-infections with all three pathogens were found in 3 of 28 (11%) A. flavicollis animals, suggesting that the same rodent host can be infected with several pathogens at the same time. Dual infections with both hantaviruses and Leptospira were found in 7 of 44 rodents (16%), with hantaviruses and Babesia in 2 rodents (5%), and double infection with both Leptospira and Babesia were found in 1 rodent (2%). Since hantaviruses, Leptospira, and Babesia have similar geographical distributions, it is to be expected that in other parts of the world multiple co-infections, representing a serious threat to public health, can be found.
doi:10.1089/vbz.2011.0632
PMCID: PMC3353761  PMID: 22217170
Babesia; Hantavirus; Leptospirosis; Rodent-borne; Zoonosis
3.  Diagnostic Assays for Crimean-Congo Hemorrhagic Fever  
Emerging Infectious Diseases  2012;18(12):1958-1965.
On-site testing would diminish time, costs, and risks involved in handling of highly infectious materials.
Crimean-Congo hemorrhagic fever (CCHF) is a highly contagious viral tick-borne disease with case-fatality rates as high as 50%. We describe a collaborative evaluation of the characteristics, performance, and on-site applicability of serologic and molecular assays for diagnosis of CCHF. We evaluated ELISA, immunofluorescence, quantitative reverse transcription PCR, and low-density macroarray assays for detection of CCHF virus using precharacterized archived patient serum samples. Compared with results of local, in-house methods, test sensitivities were 87.8%–93.9% for IgM serology, 80.4%–86.1% for IgG serology, and 79.6%–83.3% for genome detection. Specificity was excellent for all assays; molecular test results were influenced by patient country of origin. Our findings demonstrate that well-characterized, reliable tools are available for CCHF diagnosis and surveillance. The on-site use of such assays by health laboratories would greatly diminish the time, costs, and risks posed by the handling, packaging, and shipping of highly infectious biologic material.
doi:10.3201/eid1812.120710
PMCID: PMC3557897  PMID: 23171700
Crimean-Congo hemorrhagic fever; vector-borne infections; viruses; CCHFV; diagnostics; ELISA; IFA; qRT-PCR; multicenter; serology; molecular; diagnosis; reverse transcription PCR; PCR; immunofluorescent assay; tick-borne infections; CCHF
4.  Anaplasma phagocytophilum in ticks in Slovenia 
Parasites & Vectors  2010;3:102.
Ticks act as vectors of many pathogens of domestic animals and humans. Anaplasma phagocytophilum in Europe is transmitted by the ixodid tick vector Ixodes ricinus. A. phagocytophilum causes a disease with diverse clinical signs in various hosts. A great genetic diversity of the groESL operon of A. phagocytophilum has been found in ticks elsewhere. In Slovenia, the variety of the groESL operon was conducted only on deer samples. In this study, the prevalence of infected ticks was estimated and the diversity of A. phagocytophilum was evaluated. On 8 locations in Slovenia, 1924 and 5049 (6973) I. ricinus ticks were collected from vegetation in the years 2005 and 2006, respectively. All three feeding stages of the tick's life cycle were examined. The prevalence of ticks infected with A. phagocytophilum in the year 2005 and in the year 2006 was 0.31% and 0.63%, respectively, and it did not differ considerably between locations. The similarity among the sequences of groESL ranged from 95.6% to 99.8%. They clustered in two genetic lineages along with A. phagocytophilum from Slovenian deer. One sequence formed a separate cluster. According to our study, the prevalence of A. phagocytophilum in ticks is comparable to the findings in other studies in Europe, and it does not vary considerably between locations and tick stages. According to groESL operon analysis, two genetic lineages have been confirmed and one proposed. Further studies on other genes would be useful to obtain more information on genetic diversity of A. phagocytophilum in ticks in Slovenia.
doi:10.1186/1756-3305-3-102
PMCID: PMC2988007  PMID: 21050436

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