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Online Discussion: Tracking new emerging diseases and the next pandemic


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    Posted: November 01 2019 at 4:47pm

Bat Warning: Evidence of Cross-Species Virus Transmission From Bats to Humans
TOPICS:BatsDuke-NUS Medical SchoolInfectious DiseasesVirologyVirus

By Duke-NUS Medical School November 1, 2019

Bat in Cave

Infectious diseases spilling over from wildlife are not new as of 2008, approximately 70 percent of all known emerging diseases are thought to have originated from wild animals. In the last 50 years, several viruses, such as Ebola, Marburg, Severe Acute Respiratory Syndrome (SARS), Hendra, swine flu, and Nipah have appeared in areas with close human-animal contact. Tropical areas where hunted wildlife often supplements the locals meager diets such as in Africa, South and Southeast Asia are hotspots for pathogen spillovers. During such spillovers, viruses from hunted wild animals or bush meat infect humans and can lead to large scale outbreaks.

In Nagaland, bat-hunting is practiced by the Bomrr, who are a clan of the Longpfurii Yimchungii sub-tribe. According to their narratives, the Bomrrs have held a bat-harvesting festival in mid-October every year for at least seven generations.

During the harvesting, which usually lasts for two to three days, the Bomrr smoke out entire caves in which the bats roost, and the hunters are often scratched and bitten by bats trying to escape the smoky cave, exposing them to viruses shed by the bats, says Pilot Dovih, the studys lead author.

In this study, two species of bats, as well as humans engaged in hunting these bats, were found to have been exposed to viruses in the family Filoviridae, which includes Ebola and Marburg viruses. Although antibodies against two and three distinct filoviruses were found in the human and bat blood samples, respectively, no viral genetic material was detected in the samples. The pattern of reactivity of anti-filovirus antibodies carried by the humans were similar to those found in one bat species (Eonycteris spelaea), which makes these bats the most probable source of the viral spillover event.

Biodiversity, high human density, and changes in land use due to human activities make India a hotspot for emerging infectious diseases. That said, how do we scientifically study how spillovers happen? asks NCBS professor Uma Ramakrishnan, who is Dovihs mentor, and co-author of the study. Our results show that spillover events do not always result in outbreaks, she adds.

Bats are known to be natural reservoirs for several severe viral diseases, such as rabies, Marburg, and Nipah. However, these animals are an essential part of our ecosystem because they are major pest control, pollination, and seed dispersal agents, says Dr. Ian Mendenhall, Principal Research Scientist from Duke-NUS Emerging Infectious Diseases Programme, who is the senior author of the study. Dr. Mendenhall, who has studied animal reservoirs of infectious disease for the past 20 years, further adds, We want to make sure that our work does not result in demonization of bats and emphasizes protecting their natural habitats.

The team now plans to carry out additional investigations in another site in India where a similar harvesting event happens every year. Since such surveillance is expensive and time-consuming, the researchers are trying to develop more effective field and laboratory techniques for quick detection of viral spillovers. In addition, viral sequence data are also being investigated to understand the evolutionary history of these viruses, and their potential to cause outbreaks.

The team has also expanded their sampling range to better determine the geographic distribution of the bats and their viruses. By discovering and characterizing filoviruses across Southeast and South Asia, they hope to better understand why we have not (yet) witnessed a major bat-borne filovirus outbreak in this region.

The researchers published their findings in PLoS Neglected Tropical Diseases on October 31, 2019.

Reference: Filovirus-reactive antibodies in humans and bats in Northeast India imply zoonotic spillover by Pilot Dovih, Eric D. Laing, Yihui Chen, Dolyce H. W. Low, B. R. Ansil, Xinglou Yang, Zhengli Shi, Christopher C. Broder, Gavin J. D. Smith, Martin Linster, Uma Ramakrishnan and Ian H. Mendenhall, 31 October 2019, PLoS Neglected Tropical Diseases.
DOI: 10.1371/journal.pntd.0007733

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Format: Abstract

Emerg Infect Dis. 2020 Jan 17;26(1). doi: 10.3201/eid2601.191144. [Epub ahead of print]

Locally Acquired Human Infection with Swine-Origin Influenza A(H3N2) Variant Virus, Australia, 2018.

Deng YM, Wong FYK, Spirason N, Kaye M, Beazley R, Grau M, Shan S, Stevens V, Subbarao K, Sullivan S, Barr IG, Dhanasekaran V.

In 2018, a 15-year-old female adolescent in Australia was infected with swine influenza A(H3N2) variant virus. The virus contained hemagglutinin and neuraminidase genes derived from 1990s-like human seasonal viruses and internal protein genes from influenza A(H1N1)pdm09 virus, highlighting the potential risk that swine influenza A virus poses to human health in Australia.

Australia; H3N2v; Influenza virus; influenza; influenza A(H1N1)pdm09 virus; influenza surveillance; pH1N1; pandemic influenza; respiratory infections; swine influenza; viruses; zoonoses


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Eye Worms From Cows in California

News : World : Americas

Parasitic worms found in woman’s eye as scientists warn of ‘emerging’ disease

Patient remembers ‘swatting the flies from her face and spitting them out of her mouth’

    21 hours ago

'Thelazia gulosa' are typically found in cattle and carried by flies ( Richard S Bradbury et al/Clinical Infectious Diseases 2019 )

A parasitic worm typically found in cattle has been discovered in a woman’s eye in what scientists have warned may be an “emerging zoonotic disease” in the US.

The 68-year-old woman is the second human to have become infected by the parasite.

She was jogging on a trail near the coast in California in March 2018 when she ran around a corner into a swarm of flies, according to a case report in the journal Clinical Infectious Diseases.

The report said she remembered “swatting the flies from her face and spitting them out of her mouth”.

A month later, she experienced irritation in her right eye and when she flushed it out with tap water, she discovered a transparent roundworm around half an inch long, Live Science reported.

Air pollution linked to fertility issues in women

Inspecting her eye more closely, she found and removed a second worm.

The next day she visited an opthalmologist in Monterey, California, who removed a third parasite and sent it to the Centers for Disease Control and Prevention for identification.

Researchers there analysed the sample and identified it as a species of eye worm called Thelazia gulosa.

The parasitic worms are typically found in cattle and carried by certain types of flies.

Despite being prescribed an antibiotic ointment, she continued to feel irritation in both eyes.

Another doctor inspected her eyes but did not find any worms, instead diagnosing her with papillary conjunctivitis.

But she later found a fourth worm and after removing it, her conjunctivitis went away.

Only one other case of a human becoming infected by T gulosa has been reported before.

A 26-year-old woman from Oregon became infected in August 2016.

The second case within two years “suggest[s] this may represent an emerging zoonotic disease in the US,” the authors wrote, describing a disease that is transferred from animals to people.

Absence of proof is not proof of absence.
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You are doing great, Techno! Keep it up!!
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Thank you!
Absence of proof is not proof of absence.
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Vaccinia Virus Reported in Colombian Farm-Workers

Emerging Zoonotic Vaccinia Virus outbreak near Cundinamarca Department Colombia

November 16th, 2019 – According to a recent investigation, there is evidence for the possible emergence of vaccinia virus (VACV) in Columbia, South America.

This is important news since VACV, an orthopoxvirus used in the smallpox vaccine has caused previous human outbreaks in countries, such as Brazil.

This US Centers for Disease Control and Prevention (CDC) early release report published on November 14, 2019, found VACV infections were identified among 31 percent of farmworkers tested in Colombia in 2014.

And, seropositivity was linked to a history of clinical symptoms in 13 percent of the study participants, suggesting a substantial disease burden.

he CDC said ‘without an identifiable reservoir, control efforts are limited to hygiene and isolation strategies. And, prior smallpox vaccination is not necessarily protective against VACV during outbreaks, likely because of waning immunity.

Another potential concern is the transmission of VACV through the milk of affected cows.

VACV is a member of the genus Orthopoxvirus within the family Poxviridae. Other notable viruses in this lineage include cowpox and monkeypox.

VACV is probably an emerging zoonosis in Colombia and poses a substantial health risk for the populations affected, namely, farm workers involved in the dairy industry.

In this investigation, the descriptions of VACV-like infections in this population revealed mostly localized, painful, cutaneous lesions affecting the hands, similar to other descriptions of bovine-related VACV infections.

More than half of the patients also reported accompanying systemic symptoms such as fever and malaise, and most of those affected required medical attention and time off work, indicating substantial economic ramifications.

In addition, two-thirds of the persons who were seropositive and reported a history of symptomatic lesions were ineligible to have received a smallpox vaccine, supporting the idea that unvaccinated persons are at greater risk for symptomatic disease.

More important, nearly one-third of participants who were seropositive would have been ineligible for smallpox vaccination, signifying an ongoing risk for population transmission.

After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed, says the CDC.

Smallpox eradication remains one of the most important achievements in science and public health and, during that time, many different VACV strains were used as vaccines around the world.

Consequently, its escape to the field is a plausible event.

However, because of concern that variola virus might be used inappropriately, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it, if a smallpox outbreak were to occur.

The CDC says you should get the smallpox vaccine if you are a lab worker who works with a virus that causes smallpox or other viruses that are similar to it.

People who are being vaccinated for the first time have a stronger reaction than those who are being revaccinated.
Smallpox vaccine news

    November 14, 2019 – A Denmark based vaccine company announced the results from the pivotal Phase 3 efficacy trial of its smallpox vaccine, Jynneos™ (MVA-BN®), which has been peer-reviewed and published in The New England Journal of Medicine (NEJM). Importantly, a single dose of MVA-BN induced neutralizing antibody titers comparable with ACAM2000 on Day 14, indicating the potential for use of the vaccine to protect the general population.
    September 3, 2019 – Emergent BioSolutions Inc. announced the U.S. Department of Health and Human Services (HHS) has awarded an agreement valued at approximately $2 billion dollars over 10 years for the continued supply of ACAM2000, a smallpox vaccine.

The city of Medina was the center of the VACV investigation. Medina is located in the department of Cundinamarca, a central region of the Andes Mountains in South America.

Therefore, living in Medina would be expected to be associated with seropositivity.

However, because our investigation was geographically centered on Medina, very few participants resided outside this municipality.

A more extensive investigation of other dairy-producing areas in the country might reveal differing results. VACV has been detected in unpasteurized dairy products, but the effect of such contamination on VACV transmission is unknown.

The findings of this investigation are similar to results from studies carried out in Brazil that found a positive correlation between age and seropositivity, although the effect of prior smallpox immunization could not be ruled out.

This outbreak investigation reveals that VACV is likely to become an increasingly important zoonosis in this part of the world, concluded these researchers.

Dr. Rene Styczynski is an infectious disease fellow at Stanford University in Palo Alto, California, USA. Her primary research interests include global infectious disease epidemiology and emerging infections.

These researchers did not disclose any relevant financial relationships.

Vaccinia virus news published by Vax-Before-Travel

Absence of proof is not proof of absence.
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Aspergillus felis in Patient with Chronic Granulomatous Disease

Cite This Article

We report a case of Aspergillus felis infection in a patient with chronic granulomatous disease who had overlapping features of invasive pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Identifying the species responsible for aspergillosis by molecular methods can be crucial for directing patient management and selection of appropriate antifungal agents.

A 42-year-old man with X-linked chronic granulomatous disease (CGD) sought care at a hospital in Paris, France, for a 2-week history of cough and night sweats. He had been receiving long-term prophylaxis with itraconazole (400 mg/d) and had normal trough levels (1,240 μg/L) 1 month before his hospital visit.

At admission, blood counts showed mild leukocytosis (leukocytes 9.6 × 109 cells/L, reference range 4–10 × 109 cells/L), with neutrophils at 6.1 × 109 cells/L (reference range 1.5–7 × 109 cells/L) and eosinophils at 2 × 109 cells/L (reference <0.5 × 109 cells/L). Computed tomography (CT) revealed an upper left lobe consolidation (Appendix Figure). We administered broad-spectrum antimicrobial drugs (2 g meropenem 3×/d and 20 mg/kg/d amikacin). Results of bacterial and mycological cultures from sputum were negative, as was serum galactomannan.

The patient’s condition did not improve, so we administered liposomal amphotericin B (5 mg/kg/d) and caspofungin (70 mg/d loading dose followed by 50 mg/d). Bronchoalveolar lavage demonstrated hypercellularity (1.22 × 106 cells/mL); manual differential showed 12% macrophages and 76% eosinophils. Results of bacterial, mycological, and mycobacterial cultures were negative. Pathology studies from a transbronchial biopsy revealed numerous eosinophilic granulomas alongside Charcot-Leyden crystals (Appendix Figure). Grocott methenamine silver staining revealed rare septated filamentous hyphae, but results of mycological cultures were negative. The patient had elevated total serum IgE (1,210 IU/mL, reference <114 IU/mL), elevated serum A. fumigatus IgE (7 IU/mL, reference <0.1 IU/mL) and A. fumigatus IgG (54 IU/mL, reference <5 IU/mL), and precipitating antibodies to A. fumigatus (2 arcs of precipitation in immunoelectrophoresis). Results of parasitologic examination of fecal samples and serologic testing for alternative causes of eosinophilia were negative.

Eosinophilia persisted (1.8–2 × 109 cells/L) despite antiparasitic treatment with ivermectin (5 mg/kg/d at days 1 and 7) and albendazole (400 mg/d for 7 d). Pathology findings from a transthoracic percutaneous biopsy revealed granulomas with Grocott-positive septated hyphae. Result of an Aspergillus section Fumigati PCR on a biopsy specimen were positive, and mycological cultures yielded a mold morphologically identified as Aspergillus. After 5 weeks of liposomal amphotericin B therapy (including 2 weeks of combination therapy with caspofungin), we switched treatment to oral voriconazole (loading dose of 400 mg 2×/d, followed by 200 mg 2×/d). Normalization of eosinophilia occurred at 6 weeks.

We sent mycological cultures from the biopsy specimens to the French National Center for Invasive Mycoses and Antifungals (Paris). Molecular identification based on the partial sequence of the internal transcribed spacer 2, 5.8S ribosomal RNA gene, and internal transcribed spacer 2 (525/526 bp; 99% similarity to the type strain, CBS 130245; GenBank accession no. KF558318.1) and the β-tubulin target gene enabled the identification of Aspergillus felis (109/109 bp; 100% similarity to the type strain, CBS DTO_131-E3 β-tubulin [benA] gene, partial cds; GenBank accession no. KY808576.1). The European Committee for Antimicrobial Susceptibility Testing (EUCAST) MICs with broth microdilution methods (1) were 4 μg/L for voriconazole, 4 μg/L for itraconazole, 0.25 μg/L for posaconazole, 2 μg/L for caspofungin, and 4 μg/L for amphotericin B. Based on EUCAST MIC breakpoints for A. fumigatus (2), we switched treatment to oral posaconazole (loading dose of 300 mg 2×/d, followed by 300 mg/d). Chest CT performed 12 months after treatment initiation showed noticeable improvement of pulmonary lesions.

Invasive pulmonary aspergillosis (IPA) remains a leading cause of death during CGD and IPA typically manifests as subacute pneumonia, with little or no angioinvasion (3). This patient had pulmonary infection caused by A. felis with overlapping features of IPA and allergic bronchopulmonary aspergillosis (ABPA) (4). Sensitization to Aspergillus spp. in patients with CGD (5) and tissue eosinophilia in lung pathology studies during invasive fungal infections (6) have been reported but do not seem to be common features of IPA in patients with CGD (3,7). There was some uncertainty about whether A. felis was responsible for this overlapping phenotype between IPA and ABPA (Table).

A. felis is a member of the A. viridinutans complex, a group of cryptic species belonging to Aspergillus section Fumigati (8). Such fumigati-mimetic molds are increasingly being recognized as sporadic causes of IPA (9). A. felis has been reported as a cause of sino-orbital aspergillosis in cats, but less frequently in humans (8). In one such case of IPA, and in the few reported cases in patients with CGD of IPA caused by the closely related A. pseudoviridinutans and A. udagawae, the course of infection was more protracted than for A. fumigatus infections, and dissemination occurred in a contiguous manner (10). Nonfumigatus Aspergillus spp. exhibit decreased in vitro susceptibility to commonly used antifungal drugs. Most previously reported antifungal susceptibilities from A. felis isolates showed high MICs for voriconazole and itraconazole but lower MICs for posaconazole (8).

Because isolates may be misidentified as A. fumigatus, culture-based morphological identification of invasive fungal infections in CGD may sometimes be insufficient. In cases of breakthrough fungal infections, or when faced with an atypical or refractory course of infection, identification of the fungus at a species level by molecular methods appears to be critical to guiding proper patient management.

Dr. Paccoud is an infectious diseases resident at Necker Hospital, Paris, France. His primary interests include care for immunocompromised patients, fungal infections, and infectious disease epidemiology.

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Monkey infects scientist with deadly herpes B virus in a Japanese laboratory in countrys first human case of the extremely rare brain-damaging infection

    The patient is now in a critical condition after having headaches and a fever
    They worked in research for an unidentified pharmaceutical company
    Primates, like macaque monkeys, carry the virus mostly with no symptoms
    Only 50 cases have occurred in humans, causing 21 deaths

By Vanessa Chalmers Health Reporter For Mailonline

Published: 16:35, 29 November 2019 | Updated: 16:53, 29 November 2019

A monkey has infected a lab worker in Japan with the deadly herpes B virus, officials say.

The scientist has not been named but is reportedly in a critical condition after suffering headaches and a fever.

They are an employee of an unidentified pharmaceutical company who use macaque monkeys to conduct research.

The virus is harmless to primates but nearly always fatal to humans if untreated, causing inflammation of the brain and spinal cord.

It's the first time a human case has been reported in Japan, and worldwide just 50 cases have occurred in 88 years.

Most of these people got infected after they were bitten or scratched by a monkey. In 1997, a researcher died from B virus infection after bodily fluid from an infected monkey splashed into her eye.

Officials in Kagoshima City, western Japan, said the patient was working at a local company involved in the research and development of drugs.

The employee reportedly assisted in studies involving monkeys, according to NHK Japan.

The person visited a hospital complaining of a headache and fever. Other symptoms of the virus include shortness of breath, poor co-ordination and flu-like aches.

The National Institute of Infectious Diseases confirmed earlier this month that the patient contracted the B virus and is in critical condition.

There is no record of the employee being bitten by a monkey, and it remains unknown how the infection occurred.

Health ministry officials and local authorities said they found no problems with the management and control of the research lab.

Of the 50 people infected with herpes B since 1932, 21 of them have died, according to The US Centers for Disease Control and Prevention.

The CDC says the risk of human infection is extremely low even if they are bitten or scratched by wild monkeys.

The last death was Elizabeth Griffin, 22, in 1997. She was working as primate researcher at Yerkes Regional Primate Research Center in Atlanta, Georgia, when a rhesus monkey flicked a bodily fluid in her eye.

Ten days later, her eye was inflamed. And then six weeks after that, she died of herpes B virus complications which paralysed her body.

Brian Lee, 60, is one of the few people in the world living with herpes B virus - which he says has been a 'nightmare' for ten years.

Mr Lee, of San Antonio, Texas, was struck down with it while working at Texas Biomedical Research Institute, where 2,500 primates are tested for research into diseases such as AIDS.

His job was to clean enclosures and feed monkeys. Every day he layered up in a protective bodysuit and glasses to protect him from splashes and bites.

But in the summer of 2008, water splashed in his eye when he was spraying down a cage. He was also cut by a shard of plastic that tore his bodysuit.

Last year, the grandfather-of-four revealed his face and body is turning numb, but doctors are unable to understand why.

He said: 'It is scary because I don't know what the future holds for me.

'Even with the antiviral therapy, most patients die of the encephalomyelitis or complications of the virus.

'I feel like I'm alone dealing with this because I can't talk to anybody else who has it.'

There has been only one reported case of human to human infection.



Herpes B virus kills around 70 per cent of sufferers unless they are treated immediately.

It is spread via macaque monkeys.

Macaques that are housed in primate facilities usually become infected by adulthood but often have no symptoms.

Infection in humans is extremely rare.

Since the virus was discovered in 1932, there have been 50 documented human cases, of which 21 were fatal.

Most of these infections resulted from animal bites or scratches, or from contaminated materials, such as a needle, entering broken skin.

However, a scientist died in 1997 after being splashed in the eye with an infected animal's bodily fluid.

Vets and lab workers are most at risk.

The herpes B virus can survive for hours on objects, particularly if they are moist.

Disease onset usually occurs within a month of virus exposure but can be as little as three days.

Symptoms include:

    Blisters at the site of exposure
    Pain, numbness or itching at the site
    Flu-like aches and pains
    Fever and chills
    Headaches that last more than a day
    Poor co-ordination
    Shortness of breath

If the virus is not treated immediately and therefore enters the central nervous system, most patients die even with treatment.

The most common cause of death is respiratory failure with paralysis, which starts in the lower limbs and moves up.

The few who survive often have lasting brain damage.

If a person suspects they may be infected, preventative anti-viral therapy may be required up to five times a day for two weeks.

Treatment depends on whether the central nervous system is thought to be affected but usually involves anti-viral drugs given intravenously twice-a-day.

There is no vaccine for herpes B.

Those who work with macque monkeys should wear proper protective clothing, including gloves and a face shield.

The animals should also be handled humanely to reduce the risk of bites and scratches.

Source: Center for Disease Control and Prevention
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