Haemophilus paraphrophilus brain abscess in a 9-year-old boy: Case report and literature review

Human diseases due to A. paraphrophilus aren’t usual. The following case report describes the first isolated case of A. paraphrophilus brain abscess in our laboratory. A 9-year-old boy presented to pediatric emergencies for frontal headache, vomiting, blurred vision and left hemiparesis. Radiological diagnosis consists with a frontal abscess. Gram staining of purulent samples showed abundant neutrophils with gram negative bacilli. Culture was made on blood agar, chocolate agar, Chapman’s agar and incubated in 5% CO2 at 37°C for 24 hours. Positive culture was detected only on chocolate agar. It was monomicrobial with small yellowish non-hemolytic colonies. Gram stain of colonies showed pleomorphic gram-negative coccobacilli. The strain required V factor for growth. The isolated strain was sensitive to all antibiotics tested.  The interest of this case is that it shows the emergence of A. paraphrophilus as a causative agent of brain abscesses on pediatric population without associated congenital heart disease. It may also help identifying risk factors of these infections and how to prevent them

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Haemophilus paraphrophilus brain abscess in a 9-year-old boy: Case report and literature review

Human diseases due to A. paraphrophilus aren’t usual. The following case report describes the first isolated case of A. paraphrophilus brain abscess in our laboratory. A 9-year-old boy presented to pediatric emergencies for frontal headache, vomiting, blurred vision and left hemiparesis. Radiological diagnosis consists with a frontal abscess. Gram staining of purulent samples showed abundant neutrophils with gram negative bacilli. Culture was made on blood agar, chocolate agar, Chapman’s agar and incubated in 5% CO2 at 37°C for 24 hours. Positive culture was detected only on chocolate agar. It was monomicrobial with small yellowish non-hemolytic colonies. Gram stain of colonies showed pleomorphic gram-negative coccobacilli. The strain required V factor for growth. The isolated strain was sensitive to all antibiotics tested.  The interest of this case is that it shows the emergence of A. paraphrophilus as a causative agent of brain abscesses on pediatric population without associated congenital heart disease. It may also help identifying risk factors of these infections and how to prevent them

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders