Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Phon K[original query] |
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Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014-2015
Rouet F , Nouhin J , Zheng DP , Roche B , Black A , Prak S , Leoz M , Gaudy-Graffin C , Ferradini L , Mom C , Mam S , Gautier C , Lesage G , Ken S , Phon K , Kerleguer A , Yang C , Killam W , Fujita M , Mean C , Fontenille D , Barin F , Plantier JC , Bedford T , Ramos A , Saphonn V . Clin Infect Dis 2017 66 (11) 1733-1741 Background: In 2014-2015, 242 individuals aged 2-89 were newly HIV-1 diagnosed in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods: We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C and B viruses (HCV, HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV, and HBcIgM Ab for HBV. We performed evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed health care practitioner were obtained from 193 cases and 1499 controls during interviews. Results: Cases were co-infected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (<130 days) HIV infections. Phylogeny of 202 HIV env C2V3 sequences showed a 198-sample CRF01_AE strains cluster, with time to most recent common ancestor (tMRCA) in September 2013 (95% highest posterior density, August 2012-July 2014), and a peak of 15 infections/day in September 2014. Three geospatial HIV hotspots were discernible in Roka and correlated with high exposure to the practitioner (P=0.04). Fifty-nine (38.6%) of 153 tested cases showed recent (<180 days) HCV infections. Ninety HCV NS5B sequences formed three main clades, one containing 34 subtypes 1b with tMRCA in 2012, and two with 51 subtypes 6e and tMRCAs in 2002-2003. Conclusions: Unsafe injections in Cambodia most likely led to an explosive iatrogenic spreading of HIV, associated with a long-standing and more genetically-diverse HCV propagation. |
Maternal death from influenza in tropical Thailand
Thongnoi P , Praphasiri P , Dawood FS , Lindblade KA . Lancet 2017 389 (10068) 571-572 At 0033 h on Sept 9, 2015, a 17-year-old Thai woman, 33 weeks and 4 days into her first pregnancy and no medical history of note, presented to the emergency room of Phon Thong district hospital with a 1 day history of fever, cough, and sore throat. On presentation she was febrile (temperature 39·2°C) and tachycardic (pulse 129 beats per min) with a respiratory rate of 22 breaths per min and blood pressure 130/81 mm Hg. She was diagnosed with bronchitis, prescribed amoxicillin, paracetamol, and bromhexine, and discharged home. | She attended a scheduled antenatal care clinic appointment the next morning at 0800 h and was afebrile (temperature 37·1°C). Ultrasonography showed twin infants with estimated bodyweights of 1900 g and 2000 g and on stress test fetal heart beats were normal. She returned to hospital for a third time at 2030 h after experiencing contractions. On examination, her cervix was found to be dilated to 3 cm. She was febrile (39·0°C) and tachycardic (pulse 136 beats per min), with a respiratory rate of 20 breaths per min and blood pressure 144/81 mm Hg. At 2045 h, her blood pressure rose to 150/100 mm Hg and she reported mild dyspnoea. Fetal heart monitoring showed fetal tachycardia. At 2100 h, her respiratory rate increased to 28 breaths per min with oxygen saturation (SpO2) 86% on room air and 96% on 10 L oxygen. Fine crepitations were noted on lung examination, and she was started on ceftriaxone. At 2130 h, before being transferred to the provincial hospital, she developed tachycardia (pulse 140 beats per min), tachypnoea (respiratory rate 30 breaths per min), hypertension (blood pressure 200/120 mm Hg), and hypoxia (SpO2 70% on room air). She was intubated (400 mL of pink frothy sputum was noted on endotracheal aspiration) and given 4 g of intravenous MgSO4 to prevent seizures. During transfer she was started on external positive end expiratory pressure ventilation, and SpO2 improved to 88–90%. Fetal heart sounds decreased to 80–90 beats per min. |
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