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Although sickness behaviour in response to non-lethal parasites has been documented in wild animals, it remains unclear how social and environmental stress might also shape an animal's behavioural response to parasitism, nor do we know whether simultaneous infection with more than one parasite changes the way animals respond. Here, we combine physiological, environmental, behavioural and parasite measures to investigate behavioural responses to infection in wild vervet monkeys (Chlorocebus pygerythrus) living in a semi-arid region of South Africa. We quantified both activity budget and behavioural predictability to investigate the occurrence of sickness behaviour and infection with two non-lethal gastrointestinal parasite genera. Higher parasite load was linked to an increase in the time spent resting. However, the nature of the relationship with other behaviours was contingent on both the parasite genus in question and parasite species interacted, highlighting the importance of considering co-infection. Overall, food availability was the dominant predictor of behavioural change suggesting that, for monkeys living in a more extreme environment, coping with ecological stress may override the ability to modulate behaviour in response to other physiological stressors. Our findings provide insight into how animals living in harsh environments find ways to cope with parasite infection, avoidance and transmission. Significance statement: Sickness behaviour is a suite of behaviours that occur in response to infection that may serve as an adaptive response to cope with infection. For wild animals, the ability to express sickness behaviour will be modulated by the presence of other competing stressors. Hence, the patterns shown are likely to be more complex than under captive conditions, which is where most of our knowledge of sickness behaviour comes from. Using physiological, environmental, behavioural and parasite measures, we demonstrate that although vervet monkeys (Chlorocebus pygerythrus) living in a semi-arid region of South Africa do exhibit sickness behaviours, this is contingent on the parasite genus in question. Further, food availability was the dominant predictor of behavioural change suggesting that, for monkeys living in a more extreme environment, coping with severe ecological stress may override the ability to express sickness behaviour in an adaptive fashion. [ABSTRACT FROM AUTHOR]

Paroxysmal Nocturnal Hemoglobinuria (PNH) originates from an acquired genetic defect in a multipotent hematopoietic stem cell that becomes stem-cell-like in its ability to survive, expand, and self-renew. PNH is a rare condition characterized by intravascular hemolysis. PNH can arise anew or in the setting of an underlying bone marrow disorder such as aplastic anemia (AA), myelodysplastic syndrome (MDS), or primary myelofibrosis (PMF). This case presentation documents the challenging diagnosis of PNH in the obstetric setting, in which other possible causes for a hemolytic anemia could be considered. We discuss the management of a pregnancy in the presence of PNH in a low-to-middle income setting. [ABSTRACT FROM AUTHOR]