Prevalence of Coinfection Malaria-Covid-19 at the International Hospital Center of Kinshasa during the 3rd Wave of the Pandemic

Background: Since 2019, Covid-19 pandemic has afflicted the world and countries of Africa. Despite the limited resources, these countries already disturbed by multiple diseases that have not yet been controlled such as malaria, must face this pandemic whose success in the management depends on the early detection of the disease. The objective of this study was to determine the prevalence of Malaria-Covid-19 coinfection in our environment. Methods: This was a retrospective analysis of patients’ data with Covid-19 infection from May to July 2021 at the International Hospital center of Kinshasa “CHIK”. We collected data and analysis was performed on the sociodemographic parameters, the notion of anticovid-19 vaccination as well as the duration of the symptomatology before the consultation, the clinical manifestations and the laboratory data available while including the data of the thick drop. Results: A total of 84 patients were registered with an average age of 35.23 ± 12.74 years. The male sex was predominant (82.1%). The Indian community was the most affected (44.2%). The average of days elapsed before the consultation of 3.63 days. The anti-Covid-19 vaccination rate was 20.3%. The prevalence of Malaria-Covid-19 coinfection was 29.76%. In coinfected patients, fever and cough were more reported (64%). Regarding biological and inflammatory parameters, 31.8% of coinfected patients had a platelet count less than 150,000 elements/mm3 compared to 11.6% in non-Co-infected (p = 0.046). Conclusion: The Malaria-Covid-19 comorbidity prevalence is high in Malaria endemic country like Democratic Republic of Congo (DRC). It is necessary to make better distinction, to detect early the comorbidity in order to better guide care and not be limited to treating malaria, letting the Covid-19 evolve.

A high frequency of GBV-C/HGV coinfection in hepatitis C patients in Germany

AIM To detect infection rate of GBV-C/HGV inhepatitis C patients,to determine the methodsof higher sensitivity and the primers of higherefficiency for GBV-C/HGV RNA detection and tostudy the dominant subtype and mutation ofGBV-C/HGV.METHODS Quantitative RT-PCR for detectionpf HCV RNA concentration in serum samples,RT-nested PCR with two sets of primers fordetection of GBV-C RNA,RT-PCR ELISA with twosets of primers for detection of HGV RNA,nucleotide sequence and putative amino acidsequence analysis.RESULTS The positive rates of GBV-C RNA atthe 5’-NCR and NS3 region in 211 serums amplesfrom the patients with HCV infection were 31.8%and 22.8% respectively.The positive rates ofHGV RNA at the 5’-NCR and NS5 region in thesame samples were 47.9% and 31.8%respectively.The total positive rate of GBV-C/HGV RNA was as high as 55.5%.HCV copynumbers in the patients without GBV-C/ HGVcoinfection were statistically higher than that inthe patients with GBV-C/ HGV coinfection(P【0.01).Frequent mutation of nucleotideresidue was present in the amplificationproducts.Frameshift mutation was found in twosamples with GBV-C NS3 region nucleotidesequences.All nucleotide sequences fromamplification products showed higher homologyto HGV genome than to GBV-C genome even though part of the sequences were amplifiedwith GBV-C primers.CONCLUSION A high frequency of GBV-C/ HGV coinfection existed in the hepatitis C patients. RT-PCR ELISA was more sensitive than RT-nested PCR for detection of GBV-C/ HGV RNA. The primers derived from the 5 -NCR was more efficient than those derived from the NS3 and NS5 regions. A reverse relationship was found to exist between HCV RNA concentration and GBV-C/ HGV infection frequency. HGV was the dominant subtype of the virus in the local area. The major mutations of GBV-C/ HGV genomes were random mutation of nucleotide residue.

A case report of pulmonary coinfection of Strongyloides stercoralis and Pneumocystis jiroveci

A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muniz Hospital.At diagnosis,the patient presented cough with mucopurulent expectoration,dyspnea,fever,bilateral pulmonary infiltrates on the chest X-ray,negative bacilloscopy for acid fast bacteria and a CD4^+ T lymphocytes count of 52 cells/μ L.The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage,while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates,pathognomonic of the pulmonary pneumocystosis.It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy.Other complementary stains(a rapid modification of Grocott,Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy.Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients,such as those with AIDS.

Coinfection with hepatitis C virus and schistosomiasis:Fibrosis and treatment response

AIM:To assess whether schistosomiasis coinfection with chronic hepatitis C virus (HCV) influences hepatic fibrosis and pegylated-interferon/ribavirin (PEG-IFN/ RIB) therapy response. METHODS:This study was designed as a retrospective analysis of 3596 chronic HCV patients enrolled in the Egyptian National Program for HCV treatment with PEG-IFN/RIB. All patients underwent liver biopsy and anti-schistosomal antibodies testing prior to HCV treatment. The serology results were used to categorize the patients into group A (positive schistosomal serology) or group B (negative schistosomal serology). Patients in group A were given oral antischistosomal treatment(praziquantel, single dose) at four weeks prior to PEG-IFN/RIB. All patients received a 48-wk course of PEG-IFN (PEG-IFNα2a or PEG-IFNα2b)/RIB therapy. Clinical and laboratory follow-up examinations were carried out for 24 wk after cessation of therapy (to week 72). Correlations of positive schistosomal serology with fibrosis and treatment response were assessed by multiple regression analysis. RESULTS:Schistosomal antibody was positive in 27.3% of patients (15.9% females and 84.1% males). The patients in group A were older (P = 0.008) and had a higher proportion of males (P = 0.002) than the patients in group B. There was no significant association between fibrosis stage and positive schistosomal serology (P = 0.703). Early virological response was achieved in significantly more patients in group B than in group A (89.4% vs 86.5%, P = 0.015). However, significantly more patients in group A experienced breakthrough at week 24 than patients in group B (36.3% vs 32.3%, P = 0.024). End of treatment response was achieved in more patients in group B than in group A (62.0% vs 59.1%) but the difference did not reach statistical significance (P = 0.108). Sustained virological response occurred in significantly more patients in group B than in group A (37.6% vs 27.7%, P = 0.000). Multivariate logistic regression analysis of patient data at treatment weeks 48 and 72 showed that positive schistosomal serology was associated with failure of response to treatment at week 48 (OR = 1.3, P = 0.02) and at week 72 (OR = 1.7, P < 0.01). CONCLUSION:Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy.

Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

Hepatitis C virus(HCV) infection is one of the mostfrequent causes of comorbidity and mortality in the human immunodeficiency virus(HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals(DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa(Peg-IFN) + ribavirin(RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCVgenotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.

Viral hepatitis and human immunodeficiency virus coinfections in Asia

Hepatitis B virus(HBV), hepatitis C virus(HCV),and human immunodeficiency virus(HIV) affect many people in Asian countries, although there are geographic differences. Both HBV and HIV(HBV/HIV) and HCV/HIV co-infections are highly prevalent in Asia. Hetero- and homosexual, injection drug use, and geographic area are strong predictors of HBV, HCV, and HIV serostatus. In HBV endemic regions, the prevalence and genotype distribution of HBV/HIV coinfection is almost comparable with that in the general population. In Japan, where HBV has low endemicity, the prevalence of HBV/HIV co-infection is approximately 10-fold higher than that in the general population, and HBV Ae is the most common subgenotype among HIV infected individuals. Highly active antiretroviral therapy(HAART) is an effective treatment for HIV/Acquired Immune Deficiency Syndrome. Lamivudine, a component of HAART, is an effective treatment for HBV, HIV, and HBV/HIV co-infection; however, cost, emerging drug resistance, antiretroviral-associated liver toxicity and liver-related morbidity due to HCV progression are particular concerns. HCV/HIV co-infection may accelerate the clinical progression of both HCV and HIV. The high prevalence of HBV/HIV and HCV/HIV co-infections in Asia underscores the need to improve prevention and control measures, as fewer evidencebased prevention strategies are available(compared with Western countries). In this review, the most recent publications on the prevalence of HBV/HIV and HCV/HIV co-infections and related issues, such as therapy and problems in Asia, are updated and summarized.

Dynamic Pathology and Antigen Location Study on Broiler Breeders with Coinfection of Marek's Disease Virus and Reticuloendotheliosis Virus

To further understand the generation and development of coinfection of Marek＇s disease virus （MDV） and reticuloendotheliosis virus （REV） in broiler breeders, and then find the method and optimal time of differential diagnosis for complex clinic multiple infection, the authors studied the pathohistological changes, apoptosis, immunohistochemistry （immunofluorescence）, and ultrastructure of tumor tissues of broiler breeders inoculated with MDV and REV. The study showed that proliferation of small lymphocytes was seen in the main organs at the age of 1 week, then immature lymphocytes, all kinds of lymphocytes, primitive reticulum cells, and Marek＇s disease cells （MDCs） were observed at 2-9 weeks. Apoptosis of lymphocytes could not be seen until the age of 10 weeks in the immune system. Immunohistochemistry detection showed that the positive signs of MDV and REV antigen were observed in the main organs at 2 weeks of age. Multi-morphology lymphocytes, MDV, and REV, mitotic figures and apoptosis of lymphocytes were observed with the help of transmission electron microscopy. MDV cooperating with REV promotes the course of disease of coinfection. Differential diagnosis can be done by immunohistochemistry in the early stage （before 2 weeks）, and histopathology in the late stage （post 4 weeks）. MDCs, primitive reticulum cells, immature lymphocytes, and two kinds of virions can serve as a basis for bistopathology differential diagnosis.

Advances in Studies on Prevalence and Interaction Mechanism of Acquired Immunodeficiency Syndrome and Tuberculosis Coinfection

Human immunodeficiency virus(HIV) and tuberculosis(TB) coinfection is a serious public health problem. HIV and TB promote each other, accelerating development of HIV to acquired immunodeficiency syndrome(AIDS) and heightening TB mortality. Determining interaction mechanism between HIV and Mycobacterium tuberculosis can lead to development of effective treatments. This study summarizes prevalence status of AIDS and TB coinfection and research advances concerning their interaction mechanism.

Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci,from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient.Our review of literature identified this coinfection as unusual presentation.Opportunistic infections associated with HIV infection are increasingly recognized.It may occur at an early stage of HIV-infection.Whereas concurrent opportunistic infections may occur,coexisting Pneumocystis jiroveci pneumonia(PCP)and disseminated cryptococcosis with cryptococcal pneumonia is uncommon.The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease.Pneumonia is the leading HIV-associated infection.We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV.Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid.In patients with<200/microliter CD4-lymphocytes,a bronchoalveolar lavage should be performed.This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole.After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

Non-related contact lens coinfection with Acanthamoeba and Fusarium

Rationale: Microbial keratitis caused by coinfection with more than one species of pathogens is a severe condition with an unfavorable prognosis. Patient concerns: An immunocompetent Nepali woman complained of pain in the left eye, redness, watering and decreased vision for 5 months. Interventions: The patient was discarded and accurately diagnosed with coinfection with Fusarium sp. and Acanthamoeba sp. The habit of washing the eyes with tap water from a domestic storage tank was the most likely source of infection since it was found to be contaminated with cysts of Acanthamoeba sp. The woman received eye drops of fluconazole and natamycin(5%), cefazoline(50 mg/m L), atropine, and tablets of itraconazole(100 mg), which were later switched to eye drops of clotrimazole(1%), natamycin(5%) and voriconazole(1%), and tablets of itraconazole. A full thickness penetrating keratoplasty was performed followed by treatment with eye drops of voriconazole(1%), natamet(5%), ofloxacin, atropine and carboxymethylcellulose for one week.Outcomes: After treatment, the condition of the patient significantly improved and was discharged one week after keratoplasty. Lessons: This is the first report of Acanthamoeba keratitis in Nepal and the first report of coinfection with Fusarium in this country and highlights the importance of early diagnosis of microbial keratitis both in single microorganism infections and coinfections, even in no contact lens wearers.

Spinal epidural abscess due to coinfection of bacteria and tuberculosis:A case report

BACKGROUND Spinal epidural abscess(SEA)is a rare condition that mostly results from infection with either bacteria or tuberculosis.However,coinfection with bacteria and tuberculosis is extremely rare,and it results in delays in diagnosis and antimicrobial treatment causing unfavorable outcomes.CASE SUMMARY A 75-year-old female visited the hospital with low back pain,and magnetic resonance imaging(MRI)revealed an SEA at the lumbosacral segment.Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis were identified from preoperative blood culture and intraoperative abscess culture,respectively.Thus,the patient underwent treatment with vancomycin medication for 9 wk after surgical drainage of the SEA.However,the low back pain recurred 2 wk after vancomycin treatment.MRI revealed an aggravated SEA in the same area in addition to erosive destruction of vertebral bodies.Second surgery was performed for SEA removal and spinal instrumentation.The microbiological study and pathological examination confirmed Mycobacterium tuberculosis as the pathogen concurrent with the bacterial SEA.The patient improved completely after 12 mo of antitubercular medication.CONCLUSION We believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens.Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.

Immunovirological and Biochemical Changes in Nigerian Patients with Hepatitis B Coinfection on Antiretroviral Therapy

Hepatitis B virus (HBV) co-infection with HIV is high among Nigerians. Some studies have suggested impaired CD4 recovery among coinfected patients compared to the HIV mono infected. This retrospective study of treatment-na?ve HIV infected patients was aimed at determining the trend of changes in CD4+ counts, HIV-RNA and renal and liver function tests in response to combined antiretroviral therapy (CART). A questionnaire was utilised to extract clinical and laboratory data of HBV co infected HIV/AIDS patients before treatment and at six, twelve and eighteen months of therapy with CART. Findings were compared to those of HIV mono infected. Relevant statistical instruments were used to analyse for comparisons of means of Log10 HIV viral load and CD4 count using SPSS package 15.0. All levels of sig-nificance were at 5 %. Two thousand five hundred and sixty two patients were analysed. Of these, 354(13.8%) were HBsAg positive. Majority (63.1%) were females. Most of the recruited patients were on combivir and nevirapine. The median CD4 count for the HBsAg negative was 104 cells/mm3 (IQR 34 – 171) and it was significantly higher than those of the positive (91 cells/mm3) (p < 0.05). ALT and AST were higher among HBsAg positives, while urea and creatinine levels were similar. The median change in CD4 count from baseline and during the course of therapy were similar in the two groups. Similarly, virological responses were not different in the two groups at the various time points. In con-clusion no significant difference in the rate of CD4 recovery and HIV-RNA decline in among coinfected and monoin-fected HIV patients at different stages of therapy.

COVID-19 and dengue coinfection in Brazil

The case we present here is a man who lives in a dengue-endemic area.Initially,the patient was diagnosed with dengue fever by clinical evaluation and laboratorial confirmation.Subsequently,he presented respiratory symptoms,and a concomitant severe acute respiratory syndrome coronavirus 2 infection was confirmed.He was hospitalized for 17 d and had a satisfactory recovery.

TB/HIV Coinfection and Other Medical Co-Morbidity in Older Adults (50 - 64 Years) in Botswana: Evidence from 2013 Botswana AIDS Impact Survey (BAIS IV)

Background: Many older adults (50 - 64 years) in Botswana with HIV do not know they are infected with TB. Some with TB disease are unaware of their HIV status, yet HIV/TB coinfection is high. The study aims to determine the prevalence of TB among older adults with HIV, their HIV/AIDS knowledge and vulnerability to hypertension, diabetes and asthma using the 2013 BAIS IV data. Material and Methods: The BAIS IV study, from which the data for this article is derived, used a stratified two-stage probability sampling design. The first stage was the selection of 297 Enumeration Areas (EAs) as Primary Sampling Units and second stage was selection of households (5,415) in the EAs. The study targeted all usual members of the selected households aged 6 weeks and above for the Biomarker or testing for HIV and those aged 10 - 64 years old for the behavioral questionnaire. Results: The study shows that the older adults (50 - 64 years) with TB have a low level of education and HIV prevalence is very high (44% for age 50 - 54, 40.6% for age 55 - 59 and 68.4% for age 60 - 64 years). The rate of HIV/TB coinfection, 21.9%, is high and prevalence of TB among the older adults is 8.6% (13%, males and 5.3%, females) while only 0.8% are currently on treatment. Only 67.2% know that if a pregnant mother is infected with HIV, there is a way of preventing transmission of the virus to the child. Age, level of education, marital status and employment status significantly (p Conclusion: The study concludes that lower education seems to be an obstacle to accessing TB treatment. Therefore, older adults’ awareness and knowledge of the symptoms of both diseases (TB and HIV), mode of infection and treatment need to adequately improve through increased education to overcome health challenges when infected with asthma, diabetes and high blood pressure/hypertension.

Buruli Ulcer and HIV Coinfection: Cases in Togo

Background: In Togo, as in all sub-Saharan countries, the burden of HIV infection remains high. The registration of new cases of Buruli ulcer every year also remains a major public health problem. Buruli ulcer (BU) is a disabling disease and the presentation of lesions is frequently severe. A feature of BU and HIV coinfection is the rarity of cases, which makes its study difficult, but, nevertheless, important to study its seroprevalence, biological data, risk factors and genetic diversity. The purpose of this study is to explore the comorbidity of Buruli ulcer and HIV by evaluating HIV seroprevalence in BU patients, assessing demographic data, reviewing biological data including CD4+ T cell count, hemoglobin levels, and viral loads, and evaluating clinical and therapeutic data. Methods: This is a cross-sectional study including only BU patients confirmed by Ziehl Neelsen staining and IS 2404 PCR. The patients were hospitalized in the National Reference Center for Tsevie. They were recovered patients and patients undergoing outpatient treatment in the Gati and Tchekpo Deve treatment centers, respectively, within the Sanitary Districts of Zio and Yoto of the Maritime Region during the period from August 2015 to March 2017. Results: The number of HIV-positive BU patients is 4 out of a total of 83 BU patients. All patients are HIV-1 positive. HIV prevalence among BU patients is 4.8% compared to 2.5% nationally and 3% at regional level. Three BU patients are seropositive out of a total of 46 female patients while one patient under 15 years is seropositive out of a total of 37 male BU patients. There are a greater proportion of female patients with BU/HIV coinfections. Half of the BU/HIV positive patients (BU/HIV+) have a CD4+ TL of fewer than 500 cells/μl and the difference is significant between those of the BU HIV- and those of the BU/HIV+ patients. Two patients have undetectable viral loads while the other two have more than 1000 copies/ml (33,000 and 1,100,000 copies/ml). Anemia is significantly present in BU/HIV+ patients with a p-value = 0.003. Half of BU patients have primary education, while three-quarters of BU/HIV+ patients have no education. All patients are either in stage I or stage II of the AIDS WHO classification. All patients are on first line ARV therapy and only ARV nucleoside reverse transcriptase inhibitors (NRTIs) are used. Conclusion: In Togo, the prevalence of HIV in BU patients, although higher, is not significantly different from that of national and regional. The relatively high CD4+ LT levels of relatively high BU HIV + patients, undetectable viral loads, and AIDS WHO stages I and II indicate good quality management. Author Summary: Buruli ulcer disease (BUD) is a mycobacterial skin disease that leads to extensive ulcerations and causes disabilities in approximately 25% of the patients. Co-infection with HIV is described by the authors through the prism of risk factors and the severity of ulcerations. Healing time is described as longer than in BU/HIV- patients. The scarcity of cases seems to be an obstacle for further study. Noteworthy are the study of cases in Benin and the study of cohort cases in Cameroon. However, no study appears to be based on the seroprevalence of this morbid association, the biological data and the antiretroviral regimens. These regimens, if poorly instituted, conflict with antimycobacterial drugs against Buruli ulcer. This study, although confronted with the particular configuration of Togo, a country with a low HIV prevalence of 2.8% national prevalence and an average of 55 cases of Buruli ulcer per year, is studying the biological aspects of co-infection HIV/BU, including seroprevalence of HIV, CD4+ LT levels, patient viral load and hemoglobin levels and ARV regimens. This study shows the need for future studies, including the study of the genetic diversity of circulating Mycobacterium ulcerans strains in Togo and the study of Buruli ulcer co-infection/HIV and tuberculosis.

Prevalence of Coinfection with Malaria and HIV among Children in Yaoundé, Cameroon: A Cross-Sectional Survey Performed in Three Communities in Yaoundé

Background: Malaria and HIV are endemic in Cameroon. But data on the prevalence of coinfection with malaria and HIV in Cameroonian children are essentially absent. This study was aimed at determining the prevalence of coinfection with malaria and HIV among children in Yaoundé, so as to advice control policies. Methods: In a cross-sectional survey, children (≤15 years) were recruited from 3 communities in Yaoundé namely: Efoulan, Biyem-assi and Cité-verte. A semi-structured questionnaire was used to collect demographic data. Participants were screened for malaria parasites by the examination of Giemsa-stained blood films meanwhile participants were screened for HIV following Cameroon’s national algorithm. The Pearson’s chi-square test was performed as part of the statistical analyses. Statistical significance was set at p Result: Three hundred and ten (310) children took part in the study. The mean age (±SD) of the participants was 75.64 (±63.23) months and a majority of them were males (56.1%). The prevalence was 19.7%, 4.8% and 1.2% for malaria, HIV, and coinfection with malaria and HIV respectively. The prevalence of malaria was associated with age (p = 0.009) meanwhile the prevalence of HIV was associated with study site (p = 0.024). Plasmodium falciparum was the only species identified as causing malaria in the target population. Conclusion: A substantial prevalence of malaria, HIV and coinfection with malaria and HIV was observed in this study. Efforts should be strengthened to control and eventually eliminate these diseases in the target population.

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.

The Prevalence and Clinical Manifestations of Co-Infection in Pediatric Infectious Mononucleosis: A Single-Centered, Retrospective Study

Background: Recent studies indicate that the incidence of infectious mononucleosis (IM) has increased in China. Furthermore, it has been shown that children diagnosed with IM are prone to acquiring other pathogens. However, there is limited research on the prevalence of these co-infections in children with IM. Thus, we conducted this study to determine the prevalence of coinfections and common pathogens, as well as to compare clinical manifestations in children with and without coinfections. Methods: This retrospective observational study was conducted at the Department of Pediatrics Zhongnan Hospital of Wuhan University, Wuhan, China, with data from January 2018 to January 2023. Data, including demographics, symptoms, lab results, and complications, were collected from the hospital&#8217;s electronic database and analyzed. The statistical analysis included descriptive statistics, independent samples t-tests and Mann-Whitney tests to compare the means of continuous variables. Statistical significance was determined by p-values less than 0.05. Results: The study involved 216 participants diagnosed with IM, predominantly males (61.6%) aged 0 - 4 years (50.9%). Coinfection was detected in 39.8% of children, with multiple pathogens present in 33.72% of these cases. Among coinfection cases, 40% occurred in children under 5 years old, and females made up 54.2% of these cases. Mycoplasma pneumoniae (MP) was the most prevalent pathogen, accounting for 18.1% of cases. Influenza B (IFB) and Influenza A (IFA) viruses were found in 16.7% and 13.9% of participants, respectively, indicating a notable occurrence of respiratory pathogen coinfections. Male gender, fever, tonsillopharyngitis, lower HGB levels, higher ESR, CRP, and AST levels were correlated with coinfections. Conclusion: In summary, the study revealed a high prevalence of coinfections among children diagnosed with IM, particularly involving Mycoplasma pneumoniae and influenza viruses. These coinfections were notably common in children under 5 years old and were more frequent among females. Clinical manifestations such as fever and tonsillopharyngitis, along with specific laboratory findings including lower hemoglobin levels, elevated ESR, CRP and AST levels, were found to be correlated with coinfections.

HBV-HCV Coinfection: Viral Interactions, Management, and Viral Reactivation

Hepatitis B virus(HBV)and hepatitis C virus(HCV)coinfec-tion is a complex clinical entity that has an estimated world-wide prevalence of 1–15%.Most clinical studies have shown that progression of disease is faster in HBV-HCV coinfected patients compared to those with monoinfection.Hepatocel-lular carcinoma development appears to have higher rate in coinfections.Viral replication in coinfected cells is character-ized by a dominance of HCV over HBV replication.There are no established guidelines for treatment of HBV-HCV coinfec-tion.Studies on interferon-based therapies and direct-acting antivirals have shown varying levels of efficacy.Clinical reports have indicated that treatment of HCV without sup-pression of HBV increases the risk for HBV reactivation.In this review,we appraise studies on both direct-acting antivirals and interferon-based therapies to evaluate the efficacy and rates of reactivation with each regimen.Screening for and prevention of coinfection are important to prevent serious HBV reactivations.

Coinfection with malaria and intestinal parasites, and its association with anaemia in children in Cameroon

Background:The purpose of this study was to determine the prevalence of coinfection with malaria and intestinal parasites,as well as to determine its association with anaemia in children aged 10 years and below in Muyuka,Cameroon.Materials and methods:This was a cross-sectional study.Participants were febrile children who were admitted to the Muyuka district hospital between April and October 2012.Blood and stool samples were collected from those participants who gave consent to take part in the study.Haemoglobin concentration(Hb)and complete blood count(CBC)were performed using an automated haematology analyser(Mindray®,BC-2800).Giemsa-stained blood film was examined to detect malaria parasites,while the formol-ether concentration technique was used to detect intestinal parasitic infections(IPIs).The Pearson’s chi-square,Student’s T-test and correlation analysis were all performed as part of the statistical analyses.Results:Four hundred and eleven(411)children successfully took part in this study.The prevalence of malaria,IPIs,malaria and IPI coinfection,and anaemia observed were 98.5%,11.9%,11.9%and 44.8%,respectively.Anaemia and IPIs were significantly associated with age;anaemia was more prevalent in children under five years of age(p=0.000),whereas IPIs were more prevalent in children aged between five and 10 years(p=0.006).The parasite species isolated included Ascaris lumbricoides(36[73.5%]),Entamoeba histolytica/dispar(9[18.4%])and hookworm(4[8.2%]).The mean Hb observed was 10.64 g/dl(±1.82).A significant negative correlation was observed between malaria parasite density and Hb.There was no significant difference in the prevalence of anaemia among children infected with malaria,IPIs,or malaria and IPI coinfection,or among non-infected children.Similarly,the mean Hb did not differ among infected and non-infected children.Conclusion:This study showed that malaria and IPIs still constitute a major public health problem in the study area despite a lack of any significant association between these infections and anaemia.The findings suggest that there is a need for the implementation of control measures to curb the rate of malaria and IPIs in the study area.