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Syndromic cholera diagnosis masks diverse causes of diarrhoeal disease in Burundi revealed by portable metagenomics.

BACKGROUND: Cholera outbreaks remain a major public-health challenge in sub-Saharan Africa, where diagnostic capacity is limited and clinical case definitions are non-specific and re ly heavily on syndromic diagnosis. Rapid identification of Vibrio cholerae is critical, yet cholera-suspected diarrhoea can have multiple infectious causes not captured by targeted diagnostics. METHODS: We evaluated a mobile, culture-independent metagenomic sequencing workflow for on-site detection of gastrointestinal pathogens directly from faecal samples in Burundi. The offline workflow combined long-read Oxford Nanopore Technologies (ONT) sequencing with rapid, laptop-based taxonomic and antimicrobial resistance (AMR) screening and was deployed across a health centre, a district hospital, and a refugee transit camp. The frontline and real-time results were verified using both conventional culturing and in-depth bioinformatic analyses. RESULTS: V. cholerae signals were only detected in a subset of suspected cholera cases, while many samples were dominated by alternative bacterial taxa, most frequently Escherichia coli. V. cholerae abundance correlated strongly with detection of the C holera T oxin P hage CTXφ, supporting differentiation between toxigenic signal and background exposure. AMR genes were detected across samples, providing early situational insight into resistance determinants among gastrointestinal bacteria. CONCLUSIONS: Mobile, offline metagenomic sequencing enables rapid frontline characterization of gastrointestinal disease, especially cholera-suspected, in resource-limited settings and complements existing diagnostics by improving etiological resolution and outbreak response.

Humans

Spatiotemporal patterns of Rift Valley fever virus in Africa: a retrospective genomic epidemiology and phylodynamic modelling study.

BACKGROUND: Rift Valley fever virus (RVFV) is a mosquito-borne zoonotic pathogen causing outbreaks in humans and ruminants across Africa and the Arabian Peninsula. Originally restricted to the Great Rift Valley, RVFV has expanded geographically, prompting its classification by WHO as a pathogen of pandemic potential. We investigated the evolutionary and spatial dynamics of RVFV across Africa. METHODS: We used genomic data generated at the International Livestock Research Institute Nairobi genomic laboratory (BioProject PRJNA1106221) and combined with publicly available datasets retrieved from the National Center for Biotechnology (NCBI) GenBank nucleotide database. In retrieving RVFV genome sequences from the NCBI GenBank, we applied the search terms "Rift Valley fever virus segment L AND 6404[SLEN]", "Rift Valley fever virus segment M AND 3885[SLEN]", and "Rift Valley fever virus segment S AND 1520:1690[SLEN]" for L (Large), M (Medium), and S (Small) segments, respectively. For sequences without additional spatiotemporal information, we searched PubMed to extract the associated sequence metadata. We performed molecular clock analysis, phylogenetic inference, phylodynamic modelling (continuous phylogeographic reconstruction), and landscape phylogeography on the three RVFV genome segments (L, M, and S). We aimed to assess evolutionary rates, dispersal patterns, and environmental drivers. Focus was placed on lineage C, the most widely distributed variant. FINDINGS: The global dataset used in this study consisted of large (n=236), medium (n=237), and small (n=247), which were further filtered to exclude potential reassortants and vaccine strains. Genome sequences retrieved from NCBI GenBank database comprised large (n=180), medium (n=184), and small (n=202). The genome sequences from retrospective human and livestock isolates comprised large (n=56), medium (n=53), and small (n=45) collected in Burundi (2018), Kenya (2007, 2018, 2019, 2021, and 2022), and Rwanda (2018 and 2022). Our dataset revealed that RVFV exhibited low overall genetic diversity. Lineage C, however, showed evidence of active evolution, with substitution rates ranging from 3·58 × 10-4 to 9·76 × 10-4 substitutions per site per year. This lineage probably originated in Zimbabwe in the mid-1970s and has since expanded across eastern and southern Africa. Phylogeographic reconstructions revealed rapid spread, with diffusion coefficients exceeding 50 000 km2 per year. INTERPRETATION: Lineage C appears capable of establishing endemic transmission in new regions, with ongoing diversification observed during interepidemic periods. These observations reinforce the value of continuous genomic surveillance, particularly during cryptic transmission phases when adaptive mutations might emerge. Although further evidence is needed, observed trends in climate variability and land-use change point to the potential benefit of targeted surveillance in settings that could be at increased risk, including urban centres and wetlands. FUNDING: This work was supported by the German Federal Ministry for Economic Cooperation and Development, the Rockefeller Foundation, and the Africa Centres for Disease Control and Prevention.

Rift Valley fever virus

Gastric ulcer in Zaria, Nigeria.

In 1971 to 1977, 34 patients were operated for gastric ulcer at Zaria in the Savannah region of Northern Nigeria. The most frequent operation (35%) was for perforation. The frequency of perforation is similar to Ibadan's but smaller than Dakar's. Compared with Ibadan and Burundi, there are fewer women, more Type I ulcers and more frequent haemorrhages. There were three giant lesser curvature ulcers. Only a few combined duodenal and gastric ulcers were seen suggesting that gastric stasis is not the immediate factor in the production of gastric ulcer in this region.

Adolescent

[Malignant pustule in province of Milan, Italy (author's transl)].

Preliminary the statistical data are reported about human malignant pustule denounced in Italy in different Districts, in Lombardia and in Province of Milan. Correlatively the outbreaks and cases of haematic anthrax in animals declared in Italy, in different Districts, in Lombardia and in Province of Milan. Then the outbreaks of malignant pustule in Province of Milan are related in 1975-1977 period in the resident population where is considerable concentration of the leather manufactures. The epidemiological and microbiological researches have determined the relation among the outbreak of malignant pustule and the working of the hides imported from African Countries (Nigeria, Tanzania, Ethiopia, South Africa, Burundi-Kenya, Uganda) containing the spores of b. anthrax. The spores besides to cause infections of the workmen employed in the hide manufacture (industrial anthrax) through the effluents and solid refuses from the tanneries, are dispended upon the tiled ground and determine outbreak the haematic anthrax in the animals and agricultural coutaneus anthrax in the men.

Adolescent

Further data on HBs subtypes: geographical distribution.

1123 HBs antigens from silent carriers of different parts of Europe, Africa and Asia were subtyped and classed in the eight categories previously described: a1y(w1), a2yl(w2), a2(3)y(w3), a3y(w4), ayr, a2ld(w2), a3d(w4) and adr: We have showed that w can be subdivided into the system of a subdeterminants, but for the present time, we do not know if r is a fifth subdeterminant of a. Subtyping was performed by CIEP and by ID using antisera from guinea pigs and goats immunized with selected HBs antigens. With these 8 categories it is possible to greatly increase our knowledge about the geographical distribution of HBs antigen: in Africa six areas can be distinguished: North Africa with a predominance of a2ly(w2) (75%) and with none a3y(w4); areas between North and West Africa where a2ly(w2) and a3y(4) represent respectively 62.8% and 25.7%; West Africa with a great predominance of a3y(w4) (84.5%); Central Africa with less a3y(w4) (53.4%), appearance of a2ld(w2) (8.7%) and presence of a2ly(w2) (37%); East Africa appears to be especially a2ld(w) (only 3 sera from Burundi); South Africa with a great predominance of a2ld(w2) (86%) and with ay subtype represented by a2(3)y(w3), very exceptional in the other parts of Africa. In France, The Netherlands, Hungary, a2ld(w) subtype is predominant, respectively 73.3%, 74% and 63%, a2(3)y(w3) is the main ay subtype in France and the only one in The Netherlands whereas in Hungary the same amount of a2ly(w) and a2(3)(w) is encountered. In Rumania, Italy and Greece, a great predominance of ay subtype is found (80%): a2ly(w2) is predominant in Rumania (66%) and Italy (as in North Africa) whereas a weak predominance of a2(3)y(w3) over a2ly(w2) is found in Greece. In the Antilles, 75% of a2ld(w2) are encountered. In the Far East, a great predominance of adr is found in Laos, Japan and Thailand (100% and 84% respectively) but no adr is encountered in Vietnam where 8 a1y(w1) and 1 ayr are found of of 11 HBs sera. This a1y(w1) subtype has also been found, although infrequently, in some countries of Africa. Among French people who have lived in Africa, many examples are found which show that the HBs subtype is related to the country and does not seen to depend on the host. Among the French who have been contaminated in Indochina all are carriers of adr HBsAg and none exhibits an a1y(w1) subtype.

Africa

[Reflections on dermatophytes].

In light of his experiences especially in tropical regions, the author makes some remarks about dermatophytes and dermatophytia, which they cause. The following main items are: 1. The dermatophytes lead a saprophytic life. 2. Exceptionally, they can invade nonkeratinized tissue and cause "dermatophytic disease", perhaps mycetomas. 3. 45 percent of the ringworm of the scalp heal before puberty. 4. In the tropical regions, trichophytosis caused by endothrix-species are often of inflammatory nature, the favus appears often without scutula formation (afavic). 5. One can heal a substantial percentage of the ringworm of the scalp with a single dosis of 12 tablets (125 mg each) of fine particle griseofulvin. 6. Athlete's foot has also other causes than only dermatophytes.

Adolescent