Search

Since early May 2022, an outbreak due to Mpox virus (formerly called monkeypox) has occurred in many countries around the world. On July 23, the World Health Organization declared the outbreak ‘Public Health Emergency of International Concern’. In order to combat the outbreak, it is important to have effective infection prevention and control plans. The first step is to qualitatively and quantitatively determine the risks of infections, followed by the design and implementation of infection prevention and control measures. Mpox is transmitted through direct, indirect, and prolonged contact, through sexual transmission, and via the respiratory route. Men who have sex with men are identified as the most vulnerable population. Home pet-raisers, and health care workers are at risk of catching the disease. The outcome of infection is catastrophic among the elderly, immunocompromised individuals, pregnant female and children. The spillover to animals is of great concern. It is important to communicate the risks and have community engagement in the control of this outbreak. The availability of vaccines will add to the capability of containing the outbreak. It is critical to prevent the virus from spreading further. Hence, we review the recent findings on the risk management of Mpox along with the preventive strategies.

Objectives: Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses (ZIKV) highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. Methods: A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood samples were obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. Results: Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016. However, only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. Conclusion: Hence, a high proportion of pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating a risk for future epidemics in this region.

Abstract Background The rapid spread of SARS-CoV-2 has created a shortage of supplies of reagents for its detection throughout the world, especially in Latin America. The pooling of samples consists of combining individual patient samples in a block and analyzing the group as a particular sample. This strategy has been shown to reduce the burden of laboratory material and logistical resources by up to 80%. Therefore, we aimed to evaluate the diagnostic performance of the pool of samples analyzed by RT-PCR to detect SARS-CoV-2. Methods A cross-sectional study of diagnostic tests was carried out. We individually evaluated 420 samples, and 42 clusters were formed, each one with ten samples. These clusters could contain 0, 1 or 2 positive samples to simulate a positivity of 0, 10 and 20%, respectively. RT-PCR analyzed the groups for the detection of SARS-CoV-2. The area under the ROC curve (AUC), the Youden index, the global and subgroup sensitivity and specificity were calculated according to their Ct values that were classified as high (H: ≤ 25), moderate (M: 26–30) and low (L: 31–35) concentration of viral RNA. Results From a total of 42 pools, 41 (97.6%) obtained the same result as the samples they contained (positive or negative). The AUC for pooling, Youden index, sensitivity, and specificity were 0.98 (95% CI, 0.95–1); 0.97 (95% CI, 0.90–1.03); 96.67% (95% CI; 88.58–100%) and 100% (95% CI; 95.83–100%) respectively. In the stratified analysis of the pools containing samples with Ct ≤ 25, the sensitivity was 100% (95% CI; 90–100%), while with the pools containing samples with Ct ≥ 31, the sensitivity was 80% (95% CI, 34.94–100%). Finally, a higher median was observed in the Ct of the clusters, with respect to the individual samples (p

Objectives: To describe the clinical characteristics, laboratory results, imaging findings, and in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. Methods: A cohort study of laboratory-confirmed COVID-19 patients who were hospitalized from March 2020 to September 2020 in 25 hospitals. Data were collected from medical records using Research Electronic Data Capture (REDCap) tools. A multivariate Poisson regression model was used to assess the risk factors for in-hospital mortality. Results: For a total of 2,054 patients (52.6% male; median age of 58 years), the in-hospital mortality was 22.0%; this rose to 47.6% for those treated in the intensive care unit (ICU). Hypertension (52.9%), diabetes (29.2%), and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation, and 12.1% required kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1%, and acute heart failure in 3.6%. Age >= 65 years, chronic kidney disease, hypertension, C-reactive protein ≥ 100 mg/dL, platelet count < 100 × 109/L, oxygen saturation < 90%, the need for supplemental oxygen, and invasive mechanical ventilation at admission were independently associated with a higher risk of in-hospital mortality. The overall use of antimicrobials was 87.9%. Conclusions: This study reveals the characteristics and in-hospital outcomes of hospitalized patients with confirmed COVID-19 in Brazil. Certain easily assessed parameters at hospital admission were independently associated with a higher risk of death. The high frequency of antibiotic use points to an over-use of antimicrobials in COVID-19 patients.

A rapidly emerging global outbreak of monkeypox virus infection (MPXV) in over 50 non-endemic countries was identified in May 2022. We report the case and images of a patient with MPXV presenting with genital lesions later complicated by superimposed cellulitis in Colorado, USA. MPXV lesions are susceptible to bacterial superinfection, and with the advent of new cases, the early identification of skin lesions and their evolution during MPXV are imperative for treating clinicians. Clinicians should consider MPXV in differential diagnoses of sexually transmitted diseases presenting with genital lesions.

Background: Tick-borne diseases (TBD) and dirofilariosis are currently not under surveillance in most Latin American countries. In addition, there is a significant lack of studies describing the current situation in most endemic areas, including Colombia. Therefore, seroprevalence studies are crucial for understanding the epidemiology of these vector-borne diseases. Methods: A serosurvey for TBD and dirofilariosis among 100 dogs was carried out in the municipality of Pereira, located in the Coffee-Triangle region, Colombia. Samples were tested using a rapid assay test system (SNAP® 4Dx®); based on an enzyme immunoassay technique‚ screening for antibodies to Anaplasma phagocytophilum/platys (sensitivity 99.1%)‚ Borrelia burgdorferi s.l. (98.8%), and Ehrlichia canis/ewingii (96.2%) by using specific antigens and checking for Dirofilaria immitis antigen based on specific antibodies (99.2%). Bivariate analyses were performed on Stata®14, significant p

Herd immunity is considered to be a relevant aspect of COVID-19 epidemiology. In this regard, seroprevalence studies are essential for understanding how far countries and regions are from that potential point. This study analyzed seroprevalence data in nine studies from South America, which is a region that has been badly affected by COVID-19. Seroprevalence values ​​were high, with percentages up to 70.0% (95% CI 67.0-73.4%) in Iquitos, Peru. A meta-analysis of such data enabled a pooled seroprevalence to be obtained, estimated at 33.6% (95% CI 28.6-38.5%). Despite this, the COVID-19 pandemic in South America continues to significantly affect countries such as Brazil, Colombia, and Peru.

Abstract Background COVID-19 pandemics is a challenge for public health and infectious diseases clinicians, especially for the therapeutical approach that is not yet adequately defined. Amid this situation, investigational agents are being used, including chloroquine. We report here the clinical features and therapeutic course of the first reported patient with confirmed COVID-19 pneumonia that recovered in Colombia, after the use of chloroquine and clarithromycin. Case presentation A 34-year-old male, returning from Spain, presented with complaints of fever, and cough, and class-II obesity, being hospitalized. The respiratory viruses and bacteria tested by FilmArray® PCR were negative. Two days later, clarithromycin was started because the patient was suspected as community-acquired pneumonia. At the third day, the rRT-PCR confirmed the SARS-CoV-2 infection. A day later, chloroquine was started because of that. His chest computed tomography was performed and showed bilateral multifocal ground-glass opacities with consolidation, which suggested viral pneumonia as a differential diagnosis. Progressively his clinical condition improved and at day 9, patient rRT-PCR for SARS-CoV-2 became negative. The patient was discharged and isolated at home per 14 days. Conclusions Our patient improved significantly. This and other COVID-19 cases are urgently demanding results from clinical trials that support evidence-based therapeutical approaches to this pandemic and the clinical management of patients, especially those at critical care.

Introduction: Orthohantaviruses are still a significant public health threat in endemic countries, with high case fatality rates (CFR). In Bolivia, the reporting of small outbreaks occurred until 2012. The findings of 40 laboratory-confirmed cases diagnosed in two departments are reported herein. Methods: This was an observational, retrospective and cross-sectional study. Data on laboratory-confirmed cases in 2018 were collected from the hospitals and departmental health services (SEDES) of Santa Cruz and Tarija. An ELISA was used for the detection of IgM antibody to hantavirus in the patient blood samples. Results: Forty patients were IgM-positive. The median age of the patients was 24 years (interquartile range 19–41 years) and 72.5% were male. All patients were hospitalized; 57.5% were admitted to the intensive care unit and had cardiopulmonary compromise, with 83% of these presenting acute respiratory distress syndrome and 89.5% of these requiring mechanical ventilation. Six patients died (CFR 15%). Patients 60 years old were more prone to die (odds ratio 10.33, 95% confidence interval 1.411–75.694), as were those with comorbidities (odds ratio 16.5, 95% confidence interval 1.207–225.540). Conclusions: Orthohantavirus infections were associated with a high CFR. These cases occurred in areas with eco-epidemiological conditions facilitating viral transmission, including the presence of rodents, as well as the risk of spillover to humans due to social, environmental, and occupational factors. Keywords: Orthohantavirus, New World, Epidemiology, Pulmonary syndrome, Bolivia

Introdução: A infecção fúngica invasiva (IFI) continua sendo uma causa importante de hospitalização e mortalidade entre pacientes com leucemia. No entanto, há dados limitados de estudos de IFI em pacientes com neoplasias hematológicas na América Latina, portanto, este estudo foi desenhado com o objetivo de investigar a prevalência, epidemiologia, fatores preditivos e desfechos de IFI em pacientes com leucemia hospitalizados em quartos sem Filtro HEPA (configurações com recursos limitados) em um centro de referência na Colômbia. Métodos: Os dados clínicos de pacientes hospitalizados com leucemia foram recuperados retrospectivamente durante um período de 6 anos no centro de referência de hematologia da Colômbia em Bucaramanga, Santander. Prevalência, fatores preditores de IFI e resultados dos pacientes foram avaliados. Resultados: Em 92 pacientes, a prevalência de IFI comprovada/provável foi de 27,17% (25 casos). 10 foram causados por espécies de Candida (40%), seguidos por oito por Aspergillus spp. (32%), dois por Mucor spp. (8%), dois por Penicillium spp. (8%), um por Zygomycetes spp., Fusarium spp. e Trichosporon asahii (4% respectivamente). O pulmão foi o local mais comumente afetado (n = 20; 80%); três pacientes (12%) desenvolveram sinusite fúngica e 2 pacientes (8%) IFI disseminado. Após análise multivariada, o sinal do halo na TC e neutropenia com duração superior a 20 dias foram identificados como fatores associados a maior risco de IFI e a profilaxia com voriconazol ou posaconazol foi associada a uma menor ocorrência de IFI. Foi observada maior taxa de mortalidade hospitalar entre os pacientes que desenvolveram IFI comprovada/provável em comparação com pacientes não IFI (88,0% vs. 56,7%; p = 0,006). Conclusão: os pacientes com leucemia em locais com recursos limitados têm uma alta prevalência de IFI provável/comprovada (27%) com alta mortalidade (88%). O uso de profilaxia antifúngica com voriconazol e posaconazol foi associado a uma prevalência significativamente menor de IFI. Estratégias de diagnóstico e prevenção de infecções devem ser adotadas e implementadas para prevenir IFIs, especialmente em países da América Latina para melhorar os resultados clínicos de pacientes com leucemia.

Venezuelan Haemorrhagic Fever is an endemic zoonosis exhibiting a high lethality. Discovered decades ago, it is still causing seasonal hemorrhagic fever outbreaks. With the ongoing migration crisis, transmission and spreading to other countries in Latin America remains a latent threat that should be monitored, particularly in light of recent cases.

In North America, hantaviruses commonly cause hantavirus pulmonary syndrome (HPS). Clinical descriptions of hantavirus-associated renal disease in the Americas are scarce. Herein, we discuss the case of a 61-year-old man whose predominant manifestations were acute kidney injury and proteinuria. Clinical recognition of renal signs in hantavirus infections can reduce risk for death.

Abstract Background The aim of this study was to assess the knowledge and attitudes towards pregnancy-related issues of Zika virus (ZIKV) infection among general practitioners (GPs), a frontline healthcare worker group, in Indonesia. Methods A cross-sectional, online survey assessing knowledge and attitudes towards ZIKV infection on multiple-item scales was sent to GPs in the Sumatra and Java islands of Indonesia. The associations between independent factors and either knowledge or attitude were assessed with logistic regressions. The correlation and association between knowledge and attitude were estimated. Results We included 457 (53.7%) out of 850 responses in the analysis. Among these, 304 (66.5%) and 111 (24.2%) respondents had a good knowledge and attitude, respectively. No demographic, workplace, professional development, or experiential characteristics related to ZIKV infection were associated with knowledge. In the multivariate analysis, only contact experience was associated with attitude. There was a significant, positive correlation between knowledge and attitude scores. Conclusions Although knowledge of pregnancy-related complications of ZIKV infection is relatively high among GPs in Indonesia, more than 75% of them had a poor attitude towards pregnancy-related issues of Zika. Strategies for enhancing the capacity of GPs to develop positive attitudes and respond to ZIKV infection are needed.

Zika virus (ZIKV) infection, a public health emergency of international concern, has recently been confirmed in Indonesia. However, to date, there has been no study to assess how prepared healthcare workers in Indonesia are to confront this emerging infectious disease. The aim of this study was to assess the attitudes of medical doctors in Indonesia towards ZIKV infection and its associated explanatory variables. A cross-sectional self-administered online survey was conducted from 3 May to 3 June 2016 in Aceh province, Indonesia. A pre-tested questionnaire was used to collect data on doctors’ attitudes towards ZIKV infection and a range of explanatory variables (basic demographic data, professional characteristics, workplace characteristics and facilities, and medical experience related to ZIKV infection). Associations between attitude and explanatory variables were assessed using multiple-step logistic regression. We received 631 responses, 424 (67.19%) of which were included in the final analysis. Approximately 64% (271) of doctors had a poor attitude towards ZIKV infection. Experience considering ZIKV infection as a differential diagnosis and attendance at a national conference was associated with a good attitude, with odds ratios (OR) of 3.93 (95% confidence interval [CI]: 1.15–13.49) and 1.69 (95% CI: 1.03–2.76), respectively. Unexpectedly, doctors who had attended an international conference and those working at places that had molecular diagnostic (polymerase chain reaction based testing) facilities had lower odds of having a good attitude (OR: 0.35 [95% CI: 0.15–0.84] and 0.42 [95% CI: 0.19–0.95], respectively). In conclusion, the attitude towards ZIKV infection is relatively poor among doctors in Aceh. Therefore, strategies for enhancing their capacity to respond to ZIKV infection are needed. The survey concept and tools were well accepted by the participants of this study, suggesting that this rapid assessment could be rolled out across the Indonesian archipelago and elsewhere to identify and regionally differentiate unmet needs of disease and outbreak preparedness. Keywords: Zika virus, Zika fever, Attitude, Healthcare worker, Indonesia

This case report describes the clinical findings of a 22-year-old pregnant woman with confirmed Zika virus infection, at 16 weeks of gestation, in Sucre, Colombia. Her ultrasound revealed severe oligohydramnios, intrauterine growth restriction, and a complete absence of the urinary bladder of the fetus. The poor prognosis led to the decision to terminate the pregnancy. Autopsy of the fetus revealed severe bilateral renal hypoplasia. Keywords: Zika, Birth defects, Urinary bladder, Agenesis, Renal hypoplasia, Colombia

Summary: Geographical information systems (GIS) use for development of epidemiological maps in dengue has been extensively used, however not in other emerging arboviral diseases, nor in Central America. Surveillance cases data (2015) were used to estimate annual incidence rates of dengue and chikungunya (cases/100,000 pop) to develop the first maps in the departments and municipalities of Honduras. The GIS software used was Kosmo Desktop 3.0RC1®. Four thematic maps were developed according departments, municipalities, diseases incidence rates. A total of 19,289 cases of dengue and 85,386 of chikungunya were reported (median, 726 cases/week for dengue and 1460 for chikungunya). Highest peaks were observed at weeks 25th and 27th, respectively. There was association between progression by weeks (p 37%, both). Use of GIS-based epidemiological maps allow to guide decisions-taking for prevention and control of diseases that still represents significant issues in the region and the country, but also in emerging conditions. Keywords: Dengue, Chikungunya, Arboviruses, Infectious diseases epidemiology, Honduras

This report describes the case of a 30-year-old homeless man from Pereira, Colombia with tuberculosis, who presented with massive hemoptysis and associated aneurysm of the left upper lobe (Rasmussen aneurysm). Computed tomography angiography with three-dimensional reconstruction confirmed the aneurysm, and embolization was performed successfully. Keywords: Tuberculosis, Complications, Aneurysm, Colombia

The clinical findings of a pregnant woman from Colombia with a triple co-infection caused by dengue, chikungunya, and Zika viruses are described. Weekly obstetric ultrasounds from 14.6 to 29 weeks of gestation were normal. She remains under follow-up and management according to the standard guidelines for the management of Zika virus-infected pregnant women.

Background: Giardiasis is one of the most common intestinal infections in the world. There have been no national studies on the morbidity of giardiasis in Colombia. In this study, incidence rates of giardiasis were estimated for the years 2009–2013. Methods: An observational, retrospective study of the giardiasis incidence in Colombia, 2009–2013, was performed using data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS). Official population estimates from the National Department of Statistics (DANE) were used for the estimation of crude and adjusted incidence rates (cases/100 000 population). Results: During the period studied, 15 851 cases were reported (median 3233/year; 5-year cumulated crude national rate of 33.97 cases/100 000 population). Of these, 50.3% were female; 58.4% were

Summary: Malaria in children is still an important public health problem in endemic areas of South-East Asia and Latin America. Certain forms of the disease, such as Plasmodium vivax severe malaria, are still neglected. This descriptive study assessed the frequency of severe and benign P. vivax infection in Emberá children (

Pin-site myiasis is an underreported complication of surgical interventions. We present a case of myiasis caused by the New World screwworm fly (Cochliomyia hominivorax) in a pin site of a chronic nonhealed wound 12 years after the intervention. This infection apparently was the result of poor perfusion of the leg.

Trachoma is among the most common infectious causes of blindness. During January–May 2018, a total of 4 trachoma cases were diagnosed among Amerindians of the Yanomami ethnic group in 3 communities of southern Venezuela. This country has social and environmental conditions conducive to the endemicity of this neglected tropical disease.

Summary: Geographical Information Systems (GIS) have been used extensively for the development of epidemiological maps of malaria but not in the Coffee Triangle region of Colombia, endemic for P. vivax, P. falciparum and P. malariae. Surveillance case data (2007–2011) were used to estimate annual incidence rates per Plasmodium spp. (cases/100,000 pop) to develop the first malaria maps in the 53 municipalities of this region (departments Caldas, Quindío, Risaralda). The GIS software used was Kosmo Desktop 3.0RC1®. Thirty thematic maps were developed according to the municipalities, years, parasite etiology, and uncomplicated and complicated cases. A total of 6582 cases were reported (6478 uncomplicated and 104 complicated, 77.8% Risaralda), for a cumulated rate of 269.46 cases/100,000 pop. Among uncomplicated cases, 5722 corresponded to P. vivax (234.25 cases/100,000 pop), 475 to P. falciparum (19.45 cases/100,000 pop), 8 to P. malariae (0.33 cases/100,000 pop) and 273 mixed (P. falciparum/P. vivax) (11.18 cases/100,000 pop). The highest rate reported was in the more undeveloped and rural municipality of Risaralda (Pueblo Rico, 57.7 cases/1000 pop, 2009). The burden of disease was concentrated in one department (>75% of the region). The use of GIS-based epidemiological maps helps to guide decision-making for the prevention and control of this public health problem that still represents a significant issue in the region and the country, particularly in children. Keywords: Malaria, Geographic Information Systems, Maps, Epidemiology, Colombia

Background: Cardiovascular disease in the context of human immunodeficiency virus infection has become a major clinical concern in recent years. In the current report we assess hospitalizations due to cardiovascular disease in human immunodeficiency virus patients in a Social Security reference hospital in Peru. Methods: A retrospective study was carried out between January 1996 and December 2012 in a General Hospital in Lima, Peru. Results: We included 26 patients hospitalized due to cardiovascular disease. Mean age was 46.3 years (SD 12.5), predominantly male (57.7%). Ten patients (38.4%) were in Acquired Immunodeficiency Syndrome stages. Seventeen (65.4%) received high-active-antiretroviral therapy. Eleven (42.3%) had cardiac involvement and 15 (57.7%) had non-cardiac vascular involvement. The most frequent causes of cardiac involvement were pericardial effusion and myocardial infarction. On the other hand, deep vein thrombosis and stroke were the most frequent for non-cardiac vascular involvement. Conclusions: Cardiovascular disease is an important cause of hospitalization in Peruvian human immunodeficiency virus patients, with differences between immunosuppression stages. Further studies analyzing associated factors are warranted. Keywords: Cardiovascular diseases, HIV, Acquired Immunodeficiency Syndrome, Peru

Summary: Dengue continues to be the most important viral vector-borne disease in the world, particularly in Asia and Latin America, and is significantly affected by climate variability. The influence of climate in an endemic region of Colombia, from 2010 to 2011, was assessed. Epidemiological surveillance data (weekly cases) were collected, and incidence rates were calculated. Poisson regression models were used to assess the influence of the macroclimatic variable ONI (Oscillation Niño Index) and the microclimatic variable pluviometry (mm of rain for Risaralda) on the dengue incidence rate, adjusting by year and week. During the study period, 13,650 cases were reported. In 2010, the rates ranged from 8.6 cases/100,000 pop. up to a peak of 75.3 cases/100,000 pop. for a cumulative rate of 456.2 cases/100,000 pop. in that week. The climate variability in 2010 was higher (ONI 1.6, El Niño to −1.5, La Niña) than in 2011 (ONI −1.4, La Niña to −0.2, Neutral). The mean pluviometry was 248.45 mm (min 135.9–max 432.84). During El Niño, cases were significantly higher (mean 433.81) than during the climate neutral period (142.48) and during the La Niña (52.80) phases (ANOVA F = 66.59; p

Summary: Climate change and variability are common phenomena affecting various infectious diseases. Many studies have been performed on vector-borne diseases; however, few studies have addressed such influences on intestinal parasitic diseases (e.g., giardiasis). In this study, using nonlinear Poisson regression models, we assessed the potential associations between macroclimatic variation and giardiasis cases in children and school workers from three provinces of Cuba in the context of large sampling and parasitological assessment. Between 2010 and 2012, 293,019 subjects were assessed, resulting in 6357 positive for Giardia (216.95 cases/10,000 pop.; 95%CI 211.7–222.2). The variation in time for those giardiasis rates ranged from 35.8 to 525.8 cases/10,000 pop. Nonlinear Poisson regression models between the ONI index and the giardiasis incidence indicated a significant association (p

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P

Abstract Introduction Gram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon. Methods We conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020. Results Most bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes. Conclusion This is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

Introduction: The epidemics of mpox during 2022-2024 have been extensively studied, covering various aspects such as clinical features, diagnostic aspects, therapies, and vaccines. However, the factors influencing the reporting of Mpox cases and deaths have received limited attention. Notably, no studies have yet explored the intriguing relationship between LGBT+ rights and the morbidity and mortality from Mpox. Methods: An ecological study was conducted across 106 countries, utilising the LGBT+ rights index (LGBT-RI) per country. This index was obtained from a comprehensive range of reputable sources, including the State-Sponsored Homophobia Reports produced by ILGA, LexisNexis, Factiva, Amnesty International, Human Rights Watch, the U.S. State Department, and Velasco report (2020), from Our World in Data. The study also incorporated data on cases, incidence rates, and mortality rates from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). The annual variation of the variables was meticulously assessed, and non-linear regression models (exponential) were conducted at Stata/MP® v.14.0. Results: The non-linear regression models yielded significant findings, underscoring the importance of this study. The analysis revealed a positive relationship between LGBT-RI and reported Mpox cases (r2 = 0.1006; p = 0.0040), indicating that countries with higher LGBT-RI had higher Mpox cases. Similarly, higher LGBT-RI values were significantly associated with higher Mpox incidence rates (cases/100,000 pop) (r2 = 0.5062; p < 0.0001). The number of deaths notified and the Mpox mortality rate were also associated with the LGBT-RI (r2 = 0.0636; p = 0.0328 and r2 = 0.1390; p = 0.0005, respectively). Notably, the %CFR was not associated with LGBT-RI (r2 = 0.0216; p = 0.3287), as expected. Discussion: These findings underscore the significant influence of stigma and discrimination that may be associated with Mpox. In particular, LGBT+ rights allow trust in the health system, diagnosis and management. At the same, the proper notification of a Mpox case and its associated outcomes. Even in 2024, 88 countries or territories, especially in Africa, the Middle East, and Asia, have not yet reported even a single case of Mpox. Even in Latin America and the Caribbean, ten countries are included in that list. Despite the epidemics of 2022-2024, Mpox remains a neglected condition worldwide, with a resurgence in countries like the Democratic Republic of Congo in 2023-2024. Keywords: Mpox, Epidemics, LGBTI, Global, Surveillance. Conflicts of interest: There was no conflicts of interest. Ethics and financing: No financial support.

Introduction: Multiple aspects of the Mpox epidemics during 2022-2024 have been explored, including clinical features, diagnostic aspects, therapies, and vaccines. However, socioeconomic aspects have been poorly assessed regarding the epidemiological associated factors. No studies have been published on the relationships between international tourism, measured as the annual number of arrivals per country, and the morbidity and mortality from Mpox. Methods: This study was conducted globally, encompassing data from 114 countries. We collected arrivals data from the World Tourism Organization (UNWTO) (2022/2023), the Tourism Statistics Database, and disease incidence data from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). We calculated incidence rates and assessed the annual variation of these variables. Non-linear regression models were then applied using Stata/MP® v.14.0. Results: The non-linear regression models revealed significant findings. The relationship between epidemiological factors and arrivals was found to be significant. During this epidemic, a higher number of cases was observed in countries with a higher number of arrivals (r2 = 0.2663; p < 0.0001), as well as the incidence rates (cases per 100,000 pop.) were higher also in those with a higher number of arrivals (r2 = 0.3039; p < 0.0001). We found 88 countries (42.7%) globally that have not reported cases of Mpox and 118 that have reported Mpox (57.2%); 25 of them (28.4%) are low-income countries, and 33 (37.5%) are from Africa. Discussion/conclusions: Our findings have interesting implications. They highlight the role of tourism and international travel, which may play a significant role in viral circulation for emerging diseases, such as Mpox. This is particularly relevant, considering that those countries with the highest income tourism should consider preparedness for other similar emerging conditions in the future. Despite the epidemics of 2022-2024, Mpox remains a neglected condition worldwide; with a resurgence in countries like the Democratic Republic of Congo in 2023-2024, high-income countries may experience new epidemics of Mpox. These findings underscore the urgent need for further studies on multiple epidemiological factors of Mpox. Keywords: Mpox, Epidemics, Tourism, Global, Surveillance. Conflicts of interest: There was no conflicts of interest. Ethics and financing: No financial support.

Introduction: Multiple aspects of the epidemics of mpox during 2022-2024 have been explored, including clinical features, diagnostic aspects, therapies and vaccines. However, socioeconomic aspects have been poorly assessed in terms of the epidemiologically associated factors. No studies have been published on the relationships between the human development index (HDI) and the morbidity and mortality from Mpox. Methods: An ecological study for 104 countries was done using HDI data that were obtained from the United Nations Development Program (UNDP), and the cases, calculating the incidence rates (cases per 100,000 pop.), from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). Also, mortality rates (cases per 100,000 pop.) and case fatality rates (deaths per 100 cases, %CFR) were calculated. The annual variation of the variables was assessed, and non-linear regression models (exponential) were done at Stata/MP® v.14.0. Results: The non-linear regression models revealed significant findings. The relationship between epidemiological factors and HDI was found to be significant. During this epidemic, a higher incidence was observed in countries with high HDI (r2 = 0.4132; p < 0.0001), while mortality rates were significantly lower in these countries (r2 = 0.1317; p = 0.0007). Conversely, the case fatality rate (%CFR) was significantly higher in countries with lower HDI (r2 = 0.1595; p = 0.0001). Discussion/conclusions: These findings underscore the significant influence of socioeconomic indicators such as the HDI on the Mpox incidence and mortality rates and on %CFR globally, particularly in endemic countries. Despite the epidemics of 2022-2024, Mpox remains a neglected condition worldwide, with a resurgence in countries like the Democratic Republic of Congo in 2023-2024. Therefore, the need for further studies on multiple epidemiological factors of Mpox is paramount. Keywords: Mpox, Epidemics, Human Development, Global, Surveillance. Conflicts of interest: There was no conflicts of interest. Ethics and financing: No financial support.

Abstract Background and objective Monkeypox virus (MPXV) is the causative agent of monkeypox’s zoonotic infection and was declared a global emergency by the World Health Organization (WHO). Studies from different countries have shown insufficient knowledge among the general public on MPXV. This study aimed to assess the knowledge of the general public of Nepal on MPXV. Methods Three hundred people were interviewed in person in October 2022, and 282 complete responses were recorded. The questionnaire related to the knowledge of MPXV was derived from a previous study conducted among the general population of Saudi Arabia. Twenty-two questions were included that assessed the knowledge and attitude of Nepalese toward monkeypox. Statistical comparison between high and low knowledge was performed using Pearson’s Chi-square test. Logistic regression models were deployed to establish the relationship between participants’ knowledge and socio-demographic characteristics. Results Among the total respondents, 53.8% demonstrated high knowledge of monkeypox. People aged 18–25 years, unmarried people, and those living in urban areas had significantly higher levels of knowledge. Most respondents believed that MPXV is not a conspiracy or bioterrorism (63.1%) and agreed that it is likely to affect people’s social and economic life as COVID-19 did (67.0%). The history of COVID-19 vaccination (aOR: 2.980; 95%CI: 1.227, 7.236) and the younger age (aOR: 2.975; 95%CI: 1.097, 8.069) were found to be significant determinants of the knowledge of the participants on monkeypox. Conclusion We observed that most Nepalese populations had a high knowledge of monkeypox and that social media was the most valuable source of information.

The recent global resurgence of Mpox (formerly monkeypox), primarily transmitted via close contact and respiratory droplets, highlights a significant shift in its epidemiology, particularly among men who have sex with men (MSM). This resurgence underscores the need for robust public health responses and improved surveillance. This comprehensive review of current literature focuses on recent outbreaks, virology, and available treatments. Epidemiological data were gathered from various international health reports and analysed to understand transmission dynamics and outbreak patterns. Mpox, characterised by symptoms like fever and rash, has shown variable clinical presentations, particularly among immunocompromised individuals. Recent outbreaks have prompted the development of new diagnostic methods and treatments, including antivirals like Tecovirimat and vaccines such as MVA-BN. Studies have demonstrated the effectiveness of these vaccines in preventing infection, which is crucial for outbreak containment. The global response to the Mpox resurgence requires integrated strategies combining vaccination, antiviral treatments, and public health policies tailored to high-risk populations. Future efforts should focus on vaccine distribution equity and enhancing diagnostic capabilities to effectively manage and mitigate the impact of Mpox.