Objectives: To assess the frequency of diagnostic errors in older adults presenting to the emergency department (ED) with symptoms suggestive of Chikungunya virus infection (CVI) and to compare the rates of misdiagnosis of older and younger adults.
Design: Cross-sectional study performed in the University Hospitals of Martinique from retrospective cases.
Setting: Emergency department.
Participants: Individuals aged 65 and older who attended the ED and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for CVI between January and December 2014 (n=333, mean age 80±8) were considered eligible and were compared with a randomly selected sample of younger adults (< 65) (n=143, mean age 45±13).
Measurements: Misdiagnosis rates.
Results: The rate of misdiagnosis of CVI in the ED was 30.6% in individuals aged 65 and older and 6.3% in those younger than 65 (p<.001). The overdiagnosis rate was 9.0% in individuals aged 65 and older and 3.5% in those younger than 65 (p=.04). The underdiagnosis rate was significantly higher (p<.001) in individuals aged 65 and older (21.6%) than in those younger than 65 (2.8%).
Conclusion: Misdiagnosis of CVI during an epidemic is statistically more frequent in older than younger adults because clinical presentation is often atypical in older adults. Specific diagnostic tools for older adults and better awareness of ED physicians of different presentations in different age groups could help to reduce the rate of misdiagnosis of CVI in the ED.
Chikungunya virus (CHIKV) is mainly transmitted by the invasive mosquito () in tropical and subtropical regions worldwide. However, genetic adaptations of the virus to the peri domestic mosquito vector () has resulted in enhanced vector competence and associated epidemics and may contribute to further geographic expansion of CHIKV. However, evidence-based data on the relative role of in CHIKV transmission dynamics are scarce, especially in regions where is the main vector, such as in Brazil.
We studied the viromes of three dominant mosquito species in Wenzhou, a coastal city in Zhejiang Province, using metavirome sequencing, with 18 viral families identified. Viral sequences were verified by RT-PCR. The JEV E gene was most closely related to the 1988 Korean strain.
Lymph node (LN) lymphatic endothelial cells (LEC) actively acquire and archive foreign antigens. Here, we address questions of how LECs achieve durable antigen archiving and whether LECs with high levels of antigen express unique transcriptional programs. We used single cell sequencing in dissociated LN tissue and spatial transcriptomics to quantify antigen levels in LEC subsets and dendritic cell populations at multiple time points after immunization and determined that ceiling and floor LECs archive antigen for the longest duration.
Climate change and pollution are a major existential threat. Healthcare contributes a noteworthy 4-6% to the total carbon footprint and 5-7% of the total greenhouse gas (GHG) emissions. Environmental pollution and modern lifestyles are also contributing to the increased prevalence of autoimmune and lifestyle-related rheumatic disease.
Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany.
The genus Alphavirus harbors arboviruses of great concern, such as the Chikungunya virus and the equine encephalitis viruses. Transmission of pathogenic alphaviruses by mosquitoes could be influenced by insect-specific alphaviruses such as Eilat virus (EILV). However, insect-specific alphaviruses are rarely found in wild mosquitoes and only a few have been described in the literature.
