Elevated transmission of upper respiratory illness among new recruits in military barracks in Thailand

Background

New recruits within military barracks present conditions favorable for the spread of respiratory pathogens. However, respiratory pathogen transmission in such confined settings in the tropics has not been well studied.

Methods

Recruits in four successive Royal Thai Army basic training classes living in military barracks were monitored for the symptoms of influenza-like illness (ILI) or upper respiratory illness (URI). Classes 1 and 2 were also monitored after basic training. Nasal/throat swabs from acute illnesses were collected and tested by influenza RT-PCR (all four classes). In addition, class 1 had multiplex PCR performed along with the analysis of bed locations within the barracks.

Results

Influenza-like illness/upper respiratory illness rates ranged from 4·7 to 6·9 per 100 recruit-weeks in the four classes and generally decreased during the course of basic training (P < 0·05 in three of four classes). Rates during basic training were 1·7 (95% CI: 1·29, 2·29) and 2·5 (95% CI: 1·5, 4·1) times higher than after basic training (classes 1 and 2, respectively). In class 1, coronavirus, parainfluenza virus, and rhinovirus were the most commonly identified respiratory pathogens; only one influenza PCR-positive infection was detected in all four classes. Bed locations of URI/ILI cases in class 1 tended to be in closer proximity to each other.

Conclusion

Basic training recruits in military barracks in the tropics had high rates of acute respiratory illnesses with illness patterns consistent with external seeding followed by substantial internal transmission. Our findings may contribute to control measures in similar confined settings both within and outside the military.     

Revision of genera in Asterinales

The order Asterinales comprises a single family, Asterinaceae. In this study, types or specimens of 41 genera of Asterinaceae are re-examined and re-described and illustrated by micrographs. Seventeen genera, namely Asterina (type genus), Asterinella, Asterotexis, Batistinula, Cirsosia, Echidnodella, Halbania, Lembosia, Meliolaster, Parasterinopsis, Platypeltella, Prillieuxina, Schenckiella (=Allothyrium), Trichasterina, Trichopeltospora, Uleothyrium and Vizellopsis, are maintained within Asterinaceae. Echidnodes, Lembosiella, Lembosina, Morenoina, and Thyriopsis are transferred to Aulographaceae based on morphological and molecular characteristics. Anariste is transferred to Micropeltidaceae, while Lembosiopsis is transferred to Mycosphaerellaceae. Placoasterella and Placosoma are morphologically close to taxa in Parmulariaceae, where they are transferred. Aulographina is placed in Teratosphaeriaceae, while Asterodothis, Asterinema, Dothidasteromella, Leveillella, Petrakina and Stephanotheca are transferred to Dothideomycetes, genera incertae sedis. Eupelte, Macowaniella, Maheshwaramyces, Parasterinella, and Vishnumyces are treated as doubtful genera, because of lack of morphological and molecular data. Aphanopeltis, Asterolibertia, Neostomella, Placoasterina, and Symphaster are synonyms of Asterina based on morphology, while Trichamelia, Viegasia, and Yamamotoa are synonyms of Lembosia. The characteristics of each family are discussed and a phylogenetic tree is included.     

Clinical predictive score for detecting nonalcoholic fatty liver disease with significant fibrosis in patients with metabolic syndrome

Patients with metabolic syndrome are at a higher risk of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis than the general population. Still, accessibility of screening method for NAFLD with significant fibrosis, such as transient elastography (FibroScan) are limited in some settings. This study aimed to develop a simple clinical predictive score for detecting NAFLD with significant fibrosis in patients with metabolic syndrome.A cross-sectional study was designed to obtain the data from medical records of all relevant patients who underwent transient elastography between January 2011 and December 2020 at Siriraj Hospital, Thailand. A liver stiffness cutoff value of 7.0 kilopascal was used to define the presence of significant liver fibrosis. To examine potential predictors, medical history and clinical data commonly assessed in routine practice were selected by following expert opinions and univariable statistical analysis. Backward and forward stepwise logistic regression was performed to acquire a final prediction model. To simplify the model, a weighted score was assigned for each categorized predictor. In addition, eligible cutoff values of the score and their predictive performances were determined.A total of 745 medical records were reviewed. The prevalence of NAFLD with significant fibrosis in patients with metabolic syndrome was 12.6%. Most clinical characteristics of patients with NAFLD with significant fibrosis and those non-NAFLD and NAFLD with no/mild fibrosis were quite disparate. The most practical model comprised globulin, aspartate transaminase, platelet count, and type 2 diabetes. It provided a good predictive performance with an area under the receiver operating characteristic curve of 0.828 (95% confidence interval [CI]: 0.782, 0.874). At the proper cutoff value, sensitivity and specificity were 76.6% (95% CI: 66.7%, 84.7%) and 72.4% (95% CI: 68.7%, 75.8%), respectively. The likelihood ratio of testing positive for NAFLD with significant fibrosis was 2.8 (95% CI: 2.34, 3.27) among patients with scores above the cutoff value.The first score for detecting of NAFLD with significant fibrosis in patients with metabolic syndrome was developed. This practical score, providing a good predictive performance, should be useful to help clinicians prioritize needs for further investigations among high-risk patients, especially in resource-limited settings.     

Actinomycosis presenting as a parotid tumor

Actinomycosis of the parotid gland is a rare chronic infection and can present with a slow-growing mass mimicking a tumor. The authors report five cases of parotid actinomycosis. All patients presented as having enlarging masses at the parotid area for 2-6 months without a history of obvious dental infection, trauma, or immunocompromised condition. Retrograde bacterial spread from colonization in the oral cavity via Stensen's duct is the possible pathophysiology. The diagnosis was made histopathologically by fine needle aspiration biopsy (FNAB). Treatment consisted of 1.5 months of intravenous penicillin, followed by 4.5 months of oral penicillin, with excellent results.     

Simultaneous and complete genome sequencing of influenza A and B with high coverage by Illumina MiSeq Platform

Active global surveillance and characterization of influenza viruses are essential for better preparation against possible pandemic events. Obtaining comprehensive information about the influenza genome can improve our understanding of the evolution of influenza viruses and emergence of new strains, and improve the accuracy when designing preventive vaccines. This study investigated the use of deep sequencing by the next-generation sequencing (NGS) Illumina MiSeq Platform to obtain complete genome sequence information from influenza virus isolates. The influenza virus isolates were cultured from 6 respiratory acute clinical specimens collected in Thailand and Nepal. DNA libraries obtained from each viral isolate were mixed and all were sequenced simultaneously. Total information of 2.6 Gbases was obtained from a 455 ± 14 K/mm² density with 95.76% (8,571,655/8,950,724 clusters) of the clusters passing quality control (QC) filters. Approximately 93.7% of all sequences from Read1 and 83.5% from Read2 contained high quality sequences that were ≥Q30, a base calling QC score standard. Alignments analysis identified three seasonal influenza A H3N2 strains, one 2009 pandemic influenza A H1N1 strain and two influenza B strains. The nearly entire genomes of all six virus isolates yielded equal or greater than 600-fold sequence coverage depth. MiSeq Platform identified seasonal influenza A H3N2, 2009 pandemic influenza A H1N1and influenza B in the DNA library mixtures efficiently.