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In 2019, an outbreak of chikungunya virus infection occurred in Mandalay, Myanmar, and 3.2% of blood donors and 20.5% of patients who were children were confirmed as being infected. The prevalence rate was up to 6.3% among blood donors. The East Central/South African genotype was predominantly circulating during this outbreak.

Chikungunya (CHIK) is an emerging tropical disease caused by CHIK virus (CHIKV; family Togaviridae, genus Alphavirus), of which there are 3 genotypes: Asian, East/Central/South African (ECSA), and West African (1). [...]

The dengue virus (DENV) has been endemic in Myanmar since 1970, causing outbreaks every 2–3 years. DENV infection symptoms range from mild fever to lethal hemorrhage. Clinical biomarkers must be identified to facilitate patient risk stratification in the early stages of infection. We analyzed 45 cytokines and other factors in serum samples from the acute phase of DENV infection (within 3–5 days of symptom onset) from 167 patients in Yangon, Myanmar, between 2017 and 2019. All of the patients tested positive for serum DENV nonstructural protein 1 antigen (NS1 Ag); 78.4% and 62.9% were positive for immunoglobulin M (IgM) and G (IgG), respectively; and 18.0%, 19.8%, and 11.9% tested positive for serotypes 1, 3, and 4, respectively. Although the DENV-4 viral load was significantly higher than those of DENV-1 or DENV-3, disease severity was not associated with viral load or serotype. Significant correlations were identified between disease severity and CCL5, SCF, PDGF-BB, IL-10, and TNF-α levels; between NS1 Ag and SCF, CCL5, IFN-α, IL-1α, and IL-22 levels; between thrombocytopenia and IL-2, TNF-α, VEGF-D, and IL-6 levels; and between primary or secondary infection and IL-2, IL-6, IL-31, IL-12p70, and MIP-1β levels. These circulating factors may represent leading signatures in acute DENV infections, reflecting the clinical outcomes in the dengue endemic region, Myanmar.

BackgroundDengue (DEN) is a neglected tropical disease, and surveillance of dengue virus (DENV) serotypes and genotypes is critical for the early detection of outbreaks. Risk factors for outbreaks include the emergence of new genotypes and serotype shifting.Methodology and principal findingsTo understand the genomic and viral characteristics of DENV-infected patients, we conducted a cross-sectional descriptive study among pediatric patients admitted at the 550-bedded Mandalay Children Hospital during the 2018 DEN endemic season. We conducted virus isolation, serological tests, viremia level measurement, and whole-genome sequencing. Among the 202 serum samples, we detected 85 samples with DENV (46 DENV-1, 10 DENV-3, 26 DENV-4 and three multiple serotype co-infections) via reverse transcription quantitative/real-time PCR (RT-qPCR), and we obtained 49 DENV isolates (31 DENV-1, 10 DENV-3 and 8 DEN-4). We did not detect DENV-2 in this study. The viral genome levels in serum did not differ significantly among virus serotypes, infection status (primary versus secondary) and disease severity. Based on the phylogenetic analysis, we identified DENV-1 genotype-1, DENV-4 genotype-1 and DENV-3 genotype-3 and genotype-1 which was detected for the first time. Next-generation sequencing analysis revealed greater frequencies of nonsynonymous and synonymous mutations per gene in the nonstructural genes. Moreover, mutation rates were also higher among DENV-1.Conclusion/significanceIn conclusion, there was an increasing trend of DENV-3 cases during DENV endemic season in 2018 with the first detection of the genotype 1. However, DENV-1 has remained the predominant serotype in this study area since 2013, and we identified stop codon mutations in the DENV-1 genome. This report is the first to feature a complete genome analysis of the strains of DENV-3 and DENV-4 circulating among pediatric patients in Myanmar. This study highlighted the importance of annual surveillance for a better understanding of the molecular epidemiology of DENVs.

Dengue virus (DENV) infection remains a major public health concern in many parts of the world, including Southeast Asia and the Americas. Sri Lanka experienced its largest dengue outbreak in 2017. Neurological symptoms associated with DENV infection have increasingly been reported in both children and adults. Here, we characterize DENV type 2 (DENV-2) strains, which were isolated from cerebrospinal fluid (CSF) and/or serum of patients with dengue encephalitis. Acute serum and CSF samples from each patient were subjected to dengue-specific non-structural protein 1 (NS1) antigen test, IgM and IgG enzyme-linked immunosorbent assay (ELISA), virus isolation, conventional and real-time polymerase chain reaction (PCR), and next-generation sequencing (NGS). Among the 5 dengue encephalitis patients examined, 4 recovered and 1 died. DENV-2 strains were isolated from serum and/or CSF samples of 3 patients. The highest viral genome levels were detected in the CSF and serum of the patient who succumbed to the illness. A phylogenetic tree revealed that the DENV-2 isolates belonged to a new clade of cosmopolitan genotype and were genetically close to strains identified in China, South Korea, Singapore, Malaysia, Thailand, and the Philippines. According to the NGS analysis, greater frequencies of nonsynonymous and synonymous mutations per gene were identified in the nonstructural genes. The full genomes of serum- and CSF-derived DENV-2 from the same patient shared 99.7% similarity, indicating that the virus spread across the blood-brain barrier. This is the first report to describe neurotropic DENV-2 using whole-genome analysis and to provide the clinical, immunological, and virological characteristics of dengue encephalitis patients during a severe dengue outbreak in Sri Lanka in 2017.

Dengue fever, caused by the mosquito-borne dengue virus (DENV), has been endemic in Myanmar since 1970 and it has become a significant public health burden. It is crucial that circulating DENV strains are identified and monitored, and that their transmission efficiency and association with disease severity is understood. In this study, we analyzed DENV-1, DENV-2, DENV-3, and DENV-4 serotypes in 1235 serum samples collected in Myanmar between 2017 and 2019. Whole-genome sequencing of DENV-1–4 demonstrated that most DENV-1–4 strains had been circulating in Myanmar for several years. We also identified the emergence of DENV-3 genotype-I in 2017 samples, which persisted through 2018 and 2019. The emergence of the strain coincided with a period of increased DENV-3 cases and marked changes in the serotype dynamics. Nevertheless, we detected no significant differences between serum viral loads, disease severity, and infection status of individuals infected with different DENV serotypes during the 3-year study. Our results not only identify the spread of a new DENV-3 genotype into Yangon, Myanmar, but also support the importance of DENV evolution in changing the epidemic dynamics in endemic regions.

The Lyhamyar deposit is a large Sb deposit in the Southern Shan Plateau, Eastern Myanmar. The deposit is located in the Early Silurian Linwe Formation, occurring as syntectonic quartz-stibnite veins. The ore body forms an irregular staircase shape, probably related to steep faulting. Based on the mineral assemblages and cross-cutting relationships, the deposit shows two mineralization stages: (1) the pre-ore sedimentary and diagenetic stage, and (2) the main-ore hydrothermal ore-forming stage (including stages I, II, and III), i.e., (i) early-ore stage (stage I) Quartz-Stibnite, (ii) late-ore stage (stage II) Quartz-calcite-Stibnite ± Pyrite, and (iii) post-ore stage (stage III) carbonate. The ore-forming fluid homogenization temperatures from the study of primary fluid inclusions in quartz and calcite indicate that the ore-forming fluid was of a low temperature (143.8−260.4 °C) and moderate to high-salinity (2.9−20.9 wt. % NaCl equivalent). Hydrogen and oxygen isotopes suggest that the ore-forming fluids of the Lyhamyar deposit were derived from circulating meteoric water mixed with magmatic fluids that underwent isotopic exchange with the surrounding rocks. Sulfur in Lyhamyar was dominated by thermochemical sulfate reduction (TSR) with dominant magmatic source sulfur. The lead isotope compositions of the stibnite indicate that the lead from the ore-forming metals was from the upper crustal lead reservoir and orogenic lead reservoir. On the basis of the integrated geological setting, ore geology, fluid inclusions, (H-O-S-Pb) isotope data, and previous literature, we propose a new ore-deposit model for the Lyhamyar Sb deposit: It was involved in an early deposition of pyrite in sedimentary and diagenetic stages and later Sb mineralization by mixing of circulating meteoric water with ascending magmatic fluids during the hydrothermal mineralization stage.

Activated neutrophils release myeloperoxidase that produces the potent oxidant hypochlorous acid (HOCl). Exposure of the oxygen transport protein horse heart myoglobin (hhMb) to HOCl inhibits Iron III (Fe(III))-heme reduction by cytochrome b5 to oxygen-binding Iron II (Fe(II))Mb. Pathological concentrations of HOCl yielded myoglobin oxidation products of increased electrophoretic mobility and markedly different UV/Vis absorbance. Mass analysis indicated HOCl caused successive mass increases of 16 a.m.u., consistent serial addition of molecular oxygen to the protein. By contrast, parallel analysis of protein chlorination by quantitative mass spectrometry revealed a comparatively minor increase in the 3-chlorotyrosine/tyrosine ratio. Pre-treatment of hhMb with HOCl affected the peroxidase reaction between the hemoprotein and H2O2 as judged by a HOCl dose-dependent decrease in spin-trapped tyrosyl radical detected by electron paramagnetic resonance (EPR) spectroscopy and the rate constant of 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid (ABTS) oxidation. By contrast, Mb catalase-like antioxidant activity remained unchanged under the same conditions. Notably, HOCl-modification of Mb decreased the rate of ferric-to-ferrous Mb reduction by a cytochrome b5 reductase system. Taken together, these data indicate oxidizing HOCl promotes Mb oxidation but not chlorination and that oxidized Mb shows altered Mb peroxidase-like activity and diminished rates of one-electron reduction by cytochrome b5 reductase, possibly affecting oxygen storage and transport however, Mb-catalase-like antioxidant activity remains unchanged.

Objective: We propose a new scoring system (I‐PET) combining whole body scan (WBS) and FDG findings to identify patients who have or are likely to become refractory to radioactive iodine. Design: Retrospective analysis of 142 patients age >18 with differentiated thyroid cancer who had a F‐18 labelled fluoro‐2‐deoxyglucose (18F‐FDG) positron emission tomography (PET) and WBS within a 6‐month period between 2010 and 2020. Pairs of 18F‐FDG PET and WBS were reviewed by three independent nuclear medicine physicians and an I‐PET score was assigned: I‐PET [0]: Iodine −ve/FDG −ve, I‐PET [1]: Iodine +ve/FDG −ve, I‐PET [2]: Iodine +ve/FDG +ve and I‐PET [3]: Iodine −ve/FDG +ve. Patients with FDG +ve lesions (I‐PET [2] and I‐PET [3]) were further classified into groups A and B if SUVmax was ≤5 or >5, respectively. Follow‐up data were obtained by chart review. Progression was defined as structural progression as per RECIST 1.1 or further surgical intervention; or biochemical progression as unstimulated thyroglobulin increasing >20% from baseline. Results: Of 142 patients included in the study 121 patients had follow‐up data available for review. At baseline, 49 patients were classified as I‐PET [0], 10 as I‐PET [1], 16 as I‐PET [2] and 46 as I‐PET [3]. Progression was seen in 11/49 (22%) of I‐PET [0], 4/10 (40%) of I‐PET [1], 10/16 (63%) of I‐PET [2] and 34/46 (74%) of I‐PET [3] (p < 0.001). I‐PET [2B] and I‐PET [3B] had a progression rate of 88% (7/8) and 78% (25/32), respectively. I‐PET [3B] were 9.6 times more likely to commence multikinase inhibitor therapy (p = 0.001) and had 8 times greater mortality (p = 0.003) than patients in other I‐PET groups combined. Conclusion: I‐PET is a simple readily acquired imaging biomarker that potentially enhances the dynamic risk stratification and guide treatment in thyroid cancer. [ABSTRACT FROM AUTHOR]