Chikungunya strikes the golden years - the unexpected visitor

Chikungunya, a viral infection transmitted by mosquitoes, has rapidly spread worldwide in recent years. While typically viewed as a self-limiting illness, this disease can trigger severe and debilitating symptoms, especially in elderly patients with underlying conditions. First described during an outbreak in southern Tanzania in 1952, it has now been identified in nearly 40 countries in Asia, Africa, Europe and, most recently, the Americas. Symptoms usually begin 4 to 8 days after a mosquito bite. However, they can appear anywhere from 2 to 12 days. Here, we present an intriguing case report of a senior citizen with multiple comorbidities, who experienced a week of acute onset of fever, excruciating joint pain involving both ankles and wrists, and macular rash more prominently on the lower limbs. With no history of recent travel or water activity and mainly home-bound, the patient's initial lab results revealed a viral picture with a white cell count of 6.8 x 109/L, a hemoglobin level of 12.5 g/dL, and a platelet count of 184 x 109/L. Extensive investigations for tropical infections like dengue and leptospirosis yielded negative results. Autoimmune screening was not significant. However, her Chikungunya IgM was positive, indicating recent chikungunya infection. This case report underscores the significance of considering chikungunya as a differential diagnosis in elderly patients with fever and joint pain. Moreover, it highlights an urgent need for further research on optimal management strategies for this disease in the aging population

Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa

BACKGROUND: Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. METHODS: A cohort study that included HIV-uninfected pregnant women was performed. Lay community- based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition. RESULTS The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86). CONCLUSIONS: Maternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa

Helicobacter pylori Flagellar Hook-Filament Transition Is Controlled by a FliK Functional Homolog Encoded by the Gene HP0906

Helicobacter pylori is a human gastric pathogen which is dependent on motility for infection. The H. pylori genome encodes a near-complete complement of flagellar proteins compared to model enteric bacteria. One of the few flagellar genes not annotated in H. pylori is that encoding FliK, a hook length control protein whose absence leads to a polyhook phenotype in Salmonella enterica. We investigated the role of the H. pylori gene HP0906 in flagellar biogenesis because of linkage to other flagellar genes, because of its transcriptional regulation pattern, and because of the properties of an ortholog in Campylobacter jejuni (N. Kamal and C. W. Penn, unpublished data). A nonpolar mutation of HP0906 in strain CCUG 17874 was generated by insertion of a chloramphenicol resistance marker. Cells of the mutant were almost completely nonmotile but produced sheathed, undulating polyhook structures at the cell pole. Expression of HP0906 in a Salmonella fliK mutant restored motility, confirming that HP0906 is the H. pylori fliK gene. Mutation of HP0906 caused a dramatic reduction in H. pylori flagellin protein production and a significant increase in production of the hook protein FlgE. The HP0906 mutant showed increased transcription of the flgE and flaB genes relative to the wild type, down-regulation of flaA transcription, and no significant change in transcription of the flagellar intermediate class genes flgM, fliD, and flhA. We conclude that the H. pylori HP0906 gene product is the hook length control protein FliK and that its function is required for turning off the σ(54) regulon during progression of the flagellar gene expression cascade

An assessment of proximity technology adoption from a user's perspective

The rapid growth and convenience in mobile technologies has attracted every individual in today’s era. Consumer convenience and comfort has remained key focus in almost every industry and such services are also existing and progressing in the domain of other service. Whereas, stakeholders of digital service providers are trying to change the exchange system from one to other society. Whilst, MPs has advanced in some countries, but few are still facing the resistance by people due to dominancy of old system and lack of MP solutions. Whereas, in Pakistan existing MP services are generally offered by FIs and telecom sector. Despite a major share in the market these stakeholders have not played the important role for driving the country towards digital society and bringing the uncovered population of the country into inclusion network. Therefore, this study aims to assess the obstacles in acceptance and use of MPs by using UTAUT model with external variables

Serological Markers of Viral Infections (Rubella Virus, Human Cytomegalovirus and Arboviruses) among Symptomatic Pregnant Women in Rural and Urban Areas of Mwanza, Tanzania

Viral infections have been associated with poor pregnancy outcomes. We investigated the magnitude of rubella virus (RV), dengue virus (DENV), Zika virus (ZIKV) and human cytomegalovirus (HCMV) among symptomatic pregnant women in rural and urban areas of Mwanza. A cross-sectional study was conducted between July 2017 and April 2018 in Mwanza. A rapid immunochromatographic test was done to detect ZIKV IgM and IgG as well as DENV IgM and IgG antibodies. A multiplex_RT-PCR was also done to detect the viral RNA genome. Enzyme immunoassays were done to detect RV and HCMV. Out of 171 participants, 1 (0.6%) was found to be seropositive for ZIKV_IgM antibodies, while 5 (2.9%) were ZIKV_IgG seropositive. DENV seropositivity was 9 (5.3%) and 3 (1.8%) for IgM and IgG, respectively, with all being PCR negative. Two participants (1.2%) were RV_IgM seropositive. 100% were HCMV_IgG seropositive and none was HCMV_IgM seropositive. Among 70 women with high HCMV_IgG titters, 10 (14.3%) had a low avidity index, indicating recent infections. Residing in rural areas (p = 0.044) and advanced age (p = 0.024) independently predicted ZIKV/DENV seropositivity. A substantial proportion of pregnant women had markers for viral infections. There is a need for introducing routine screening and monitoring pregnancy outcomes of positive cases to establish the relationship of these viruses and adverse pregnancy outcomes in endemic areas

Variations in Helicobacter pylori Lipopolysaccharide To Evade the Innate Immune Component Surfactant Protein D

Helicobacter pylori is a common and persistent human pathogen of the gastric mucosa. Surfactant protein D (SP-D), a component of innate immunity, is expressed in the human gastric mucosa and is capable of aggregating H. pylori. Wide variation in the SP-D binding affinity to H. pylori has been observed in clinical isolates and laboratory-adapted strains. The aim of this study was to reveal potential mechanisms responsible for evading SP-D binding and establishing persistent infection. An escape variant, J178V, was generated in vitro, and the lipopolysaccharide (LPS) structure of the variant was compared to that of the parental strain, J178. The genetic basis for structural variation was explored by sequencing LPS biosynthesis genes. SP-D binding to clinical isolates was demonstrated by fluorescence-activated cell sorter analyses. Here, we show that H. pylori evades SP-D binding through phase variation in lipopolysaccharide. This phenomenon is linked to changes in the fucosylation of the O chain, which was concomitant with slipped-strand mispairing in a poly(C) tract of the fucosyltransferase A (fucT1) gene. SP-D binding organisms are predominant in mucus in vivo (P = 0.02), suggesting that SP-D facilitates physical elimination. Phase variation to evade SP-D contributes to the persistence of this common gastric pathogen

Expression of Surfactant Protein D in the Human Gastric Mucosa and during Helicobacter pylori Infection

Helicobacter pylori establishes persistent infection of gastric mucosa with diverse clinical outcomes. The innate immune molecule surfactant protein D (SP-D) binds selectively to microorganisms, inducing aggregation and phagocytosis. In this study, we demonstrated the expression of SP-D in gastric mucosa by reverse transcription-PCR and immuohistochemical analysis. SP-D is present at the luminal surface and within the gastric pits, with maximal expression at the surface. Levels of expression are significantly increased in H. pylori-associated gastritis compared to those in the normal mucosa. Immunofluorescence microscopy was used to demonstrate binding and agglutination of H. pylori by SP-D in a lectin-specific manner. These activities resulted in a 50% reduction in the motility of H. pylori, as judged on the basis of curvilinear velocity measured by using a Hobson BacTracker. Lipopolysaccharides extracted from three H. pylori strains were shown to bind SP-D in a concentration-dependent manner, and there was marked variation in the avidity of binding among the strains. SP-D may therefore play a significant role in the innate immune response to H. pylori infection