A review of dengue and dengue haemorrhagic fever amidst the COVID-19 pandemic in Thailand: A raising concern and public health nested crises
Dengue and dengue haemorrhagic fever caused by the dengue virus (DENV) belonging to the Flaviviridae family has become a significant public health concern that has led to more than 1000000 cases and 1076 deaths in Thailand between 2009 and 2021. The patients infected with the dengue virus can be represented with severe headaches eye pain muscle and joint pains nausea vomiting diarrhoea swollen glands and rash. Coexisting with the COVID-19 pandemic affects humans in morbidity and mortality in Thai individuals including effects on the healthcare system. COVID-19 and Its impacts confirmed that cases of dengue fever in 2021 in Thailand had been reported to decrease irregularly compared with the previous year; however trends have increased in dengue cases since early 2022. Therefore to overcome current burdens and challenges caused by dengue and dengue haemorrhagic fever amidst COVID-19 in Thailand exposing various perspectives on the dengue situation recommendations for dengue fever control and approaches to promote accurate understanding.
Investigating Klebsiella pneumoniae Biofilm Preservation for Scanning Electron Microscopy
Klebsiella pneumoniae biofilm formation is associated with chronic and relapsing infections. Scanning electron microscopy (SEM) is a powerful tool for characterizing biofilm structure and studying their formation. Reliable visualization of biofilm structure requires careful sample preservation otherwise there may be loss of non-covalent interactions that are susceptible to damage during the dehydration and washing preparation steps. However no standard procedure has been adopted in literature to fix K. pneumoniae biofilm for scanning electron microscopy studies. This lack of standardization makes it challenging to compare results between studies and determine the degree to which native structures have been preserved. To advance this critical area of study we investigated different scanning electron microscopy fixation methods for K. pneumoniae biofilm preservation. Our study reveals the impact preparation steps can have on retaining in biofilm architecture observed using scanning electron microscopy. Using fixation methods developed through our studies we show that although species that overproduce capsular extracellular polysaccharides produced more robust biofilms K. pneumoniae can form a developed biofilm in the absence of capsular polysaccharides.
Lower respiratory tract microbiome composition and community interactions in smokers
The lung microbiome impacts lung function making any smoking-induced changes in the lung microbiome potentially significant. The complex co-occurrence and co-avoidance patterns between the bacterial taxa in the LRT microbiome were explored for a cohort of active (AS) former (FS) and never (NS) smokers. Bronchoalveolar lavages (BAL) were collected from 55 volunteer subjects (nine NS 24 FS and 22 AS). The LRT microbiome composition was assessed using 16S rRNA amplicon sequencing. Identification of differentially abundant taxa co-occurrence patterns discriminant analysis and biomarker inferences were performed. The data show that smoking results in a loss in the diversity of the lower respiratory tract (LRT) microbiome change in the co-occurrence patterns and a weakening of the tight community structure present in healthy microbiomes. The increased abundance of Ralstonia genus in the lung microbiomes of both former and active smokers is significant.
Partial least square discriminant and DESeq2 analyses suggested a compositional difference between the cohorts in the LRT microbiome. The groups were sufficiently distinct from each other suggesting that cessation of smoking may not be sufficient for the lung microbiota to return to a composition similar to that of never smokers. The LEfSe analyses identified several bacterial taxa as potential biomarkers of smoking status. Network-based clustering analysis highlighted different co-occurring and co-avoiding microbial taxa in the three groups. The analysis found a cluster of bacterial taxa that co-occur in smokers and non-smokers alike. The clusters exhibited tighter and more significant associations in NS compared to FS and AS. Higher degree of rivalry between clusters was observed in the AS. The groups were sufficiently distinct from each other suggesting that cessation of smoking may not be sufficient for the lung microbiota to return to a composition similar to that of never smokers.
Synergistic antimicrobial effect of ascorbic acid and nicotinamide with rifampicin and vancomycin against SCCmec type IV Methicillin-Resistant Staphylococcus aureus (MRSA)
Background: MRSA is a pathogenic bacteria involved in a wide spectrum of human diseases. Many virulence factors promote this widespread propagation. One important factor is acquiring antibiotic resistance genes which leads to a reduction in availability and efficacy of therapy options. Recently research suggests antioxidants remarkable antimicrobial effect against superbugs like MRSA showing synergistic effect when accompanied by antimicrobial therapy. Henceforth the article is aimed to examine the synergistic effect of ascorbic acid and nicotinamide with a panel of antibiotics used in antimicrobial therapy of MRSA.
Material and Methods: 2 SCCmec type IV MRSA reference strains (EMRSA-15 and USA300) and 10 MRSA clinical isolates were used in this article. SCCmec typing was conducted on the 10 clinical isolates via multiplex PCR after identification. Synergy experiments of antioxidants and antibiotics were evaluated via checkerboard assay. MIC of each agent was conducted in accordance with CLSI M100 guidelines through 2-fold microdilution assay.
Results and Discussion: synergy (FIC<0.5) was demonstrated for ascorbic acid (1/2-1/4 MIC) with rifampicin (1/2-1/8 MIC) also 1/2 to 1/16 MIC of ascorbic acid when associated with vancomycin at 1/2 MIC. Similarly nicotinamide (1/2-1/16 MIC) showed synergistic response when paired with low concentrations of rifampicin (1/2-1/16 MIC) also when associating nicotinamide (1/4-1/16 MIC) with vancomycin (1/2 MIC). All reduced MICs due to synergistic combinations demonstrated statistical significance (P<0.05).
Conclusion: The synergistic activity demonstrated in associating antioxidants and antibiotics is a promising notion in managing superbugs. However more research required to better understand the synergy mechanism and for utilization in clinical care.
A case series and literature review of infections due to Myroides spp. – Identification of contributing factors and emerging antibiotic susceptibility trends.
Introduction: Infections by Myroides spp. can lead to significant morbidity and mortality particularly in immunocompromised patients with underlying co-morbidities. Recent reports have highlighted its intrinsic and acquired drug resistance making it a particularly challenging infectious agent to combat.
Methods: Myroides spp. isolated and reported in clinically significant urine samples were considered for the study. Identification of the organism was done by VITEK 2C BioMerieux. Antibiotic Susceptibility Testing was done using both manual and automated methods following Clinical and Laboratory Standards Institute (CLSI) guidelines. Existing literature was searched on MEDLINE using PubMed.
Results: We present a series of five catheter associated urinary tract infections (CAUTI) due to M. odoratimimus with sensitivity to only minocycline. This is the first case from Western India and the third case in existing literature that shows Myroides sensitivity only to minocycline. Our literature review is the first to systemize possible contributory factors to infection allowing us to devise a clinically relevant tool that delineates contributory factors and efficacious drugs in Myroides spp. infection.
Conclusion: Myroides spp. infections earlier considered rare and opportunistic need cognizance and diagnostic suspicion especially in certain associated conditions.
Importance of database curation in taxonomic assignation of 16S data.
Microbial identification is the key component to microbial community analysis. Since mid-2000s with the advent of Next-generation sequencing techniques it has been necessary to use increasingly refined and complete databases to uniquely assign the taxonomy of each sequence or taxonomic unit. In this study we evaluate the relevance of the database curation in this assignation process.
Prosthetic valve endocarditis due to Candida parapsilosis- a rare case report
Editorial office note: The received date on the following peer review reports Reviewer 1 (https://doi.org/10.1099/acmi.0.000462.v2.3) and Reviewer 3 (https://doi.org/10.1099/acmi.0.000462.v2.1) have been amended to display correctly in the Review Status Breakdown box. These reports were received on 12 October 2022 and 27 September 2022 respectively.
Fungal endocarditis is a rare and fatal condition most frequently caused by the Candida and Aspergillus species. Fever and changing heart murmur are the most common clinical manifestations. The diagnosis of fungal endocarditis is challenging especially that of prosthetic valve endocarditis is extremely difficult. The optimal management of the condition still remains debatable. We hereby present a case of prosthetic valve endocarditis caused by Candida parapsilosis managed empirically with liposomal amphotericin B and later on was shifted to combination therapy with high dose echinocandin and fluconazole but had a fatal outcome because he could not undergo timely surgical intervention. Treating Candida parapsilosis endocarditis cases are difficult because of their ability of biofilm production on native and prosthetic heart valves. A combined approach consisting of high index of clinical suspicion early diagnosis by using serological markers followed by culture or PCR and prompt initiation of appropriate antifungals may aid in improving the outcome.
Prevalence of Hepatitis B Virus Surface Antigen (HBsAg) among the Out-patients in a Tertiary Institution in Nigeria.
Hepatitis B virus (HBV) infection is considered to be the ninth leading cause of death and is one of the major public health problems in the world. The prevalence of hepatitis in Nigeria has been rated to be 8.3%. Hence this study investigate the prevalence of hepatitis B virus infection in a tertiary institution in Oyo State. Informed consent were obtained from the out-patients attending institution clinics. The design was a cross-sectional study and questionnaires were administered to investigate their knowledge and attitude towards safer practices against the spread of HBV. The seroprevalence of the participants were examined with LabAcon rapid kit with 98.2% - 100% and 97.2% - 99.8 for specificity and sensitivity respectively. The population distribution was observed to 45 (90%) female and 5 (10%) male. The prevalence of the HBsAg was found to be 10%. The prevalence of HBsAg among female participants was 11.1%. The relationship between knowledge of HBV infection and sex was insignificant (0.546) however the relationship between knowledge of HBV infection and age was significant (0.004). The occurrence of HBV infection is still area of concern because of the possibility of the virus to spread. This spread could better be curtailed based on regular awareness about the infection.
Building Blocks of Biofilms – an engaging and hands-on microbiology outreach activity for school children and the general public
Biofilms are naturally occurring communities of microorganisms attached to a surface and often embedded in a matrix of self-produced polymeric substances. Biofilms are widely implicated in human infections particularly on prostheses and medical implants. Such biofilms are difficult to eradicate often leading to replacement of the prosthesis and resulting in a significant burden to healthcare. Here we present a fun and engaging interactive activity targeted toward primary school/early secondary school children introducing the concept of natural and healthcare-associated biofilms using dental plaque as an archetypal example. Dental plaque forms as a result of poor oral/dental hygiene and develops according to a typical series of defined stages: attachment and adherence to the surface followed by colonisation and maturation of the biofilm structure and eventually dispersal. This activity uses dental disclosing tablets to visualise real biofilms (plaque) on the participants teeth and uses interlocking building-blocks to represent microorganisms where children build three-dimensional ‘biofilms’ of varying shapes and structural integrities. Each of the stages of development are discussed in detail and after building the biofilms balls of different shapes sizes and weights can be used as ‘antimicrobials’ to disrupt the biofilm structure. The outcomes of the activity are to enhance knowledge and general understanding of biofilms; their ubiquitous presence in the natural environment development implications in healthcare and challenges of treatment. The various ‘antimicrobial’ balls also provide a basis to introduce and discuss drug selection for infections and the importance of using the correct antimicrobial for different infections to avoid development of resistance.
Detection of OXA-48 and NDM-1 genes in ESBL producing Ochrobactrum anthropi from urine samples of Out-patients.
Background: Treatment of the urinary tract infections (UTIs) is vast becoming worrisome because prominent antibiotic resistance among the bacteria involve in the infection. Species of Ochrobacterum are also involve in the infection affecting urinary tract and profusely resistance to antibiotics.
Methods: Urine samples were collected from out-patients of some hospitals and the bacteria were isolated and identified based on the morphological and biochemical characteristics. The most resistant isolate was selected for molecular identification by amplifying 16S rRNA gene. The bacterial isolates were subjected to antibiotic susceptibility assay and interpreted using standard of CLSI. The resistant isolate was evaluated for the presence of ESBL genes MBL genes biofilm gene and efflux pump gene.
Results: Fourteen (14) Ochrobactrum spp. were isolated from urine samples. Only 3 (21%) of the isolates were resistance to all the twenty-one (21) antibiotics while 7 (50%) were resistance to twenty (20) antibiotics. However resistance was observed to atleastnine (9) antibiotics in all the antibiotics by the bacterial isolates. The selected isolated was identified to be Ochrobactrum anthropic strain U0145 with occurrence of blaTEMblaSHV and blaCTX-M-9 as ESBLs genes while blaOXA-48 and blaNDM-1 genes as MBLs genes however there was no occurrence of GES 1-911 gene. The bacterium possessed biofilm production gene while there was no efflux pump gene.
Conclusion: O. anthropi is becoming prominent among the bacteria responsible for nosocomial-associated infection especially when catheter is involved and treatment may be tasking therefore adequate infection control should be put in place.
Evaluation of five commercial DNA extraction kits using Salmonella as a model for implementation of rapid Nanopore sequencing in routine diagnostic laboratories
Oxford Nanopore long-read sequencing offers advantages over Illumina short-reads for the identification and characterization of bacterial pathogens for outbreak detection and surveillance activities within a diagnostic public health laboratory context. Compared to Illumina Nanopore is more cost-effective for small batches has a lower capital cost and has a faster turnaround time in addition to the ability to assemble complete bacterial genomes. The quantity and quality of DNA required for Nanopore sequencing is higher than Illumina and DNA extraction methods recommended for obtaining high molecular weight DNA are different from those typically used in diagnostic laboratories. Using a Salmonella isolate with a previously closed PacBio genome as a model Enterobacteriaceae organism we evaluated the quantity quality and fragmentation of five commercial DNA extraction kits. Nanopore sequencing performance was evaluated for the top three methods: Qiagen EZ1 DNA Tissue Qiagen DNeasy Blood and Tissue and a modified in-house version of the MasterPure Complete DNA and RNA purification. To evaluate the effect of post-extraction DNA purification methods we subjected extracted DNA from the three selected extraction methods to purification by AMPure beads or ethanol precipitation and compared these outputs with untreated DNA as a control. All methods are suitable for routine Whole Genome Sequencing (WGS) since all 60 replicates had very high genome recovery rates with ≥ 98% of the reference genome covered by mapped Nanopore reads. For 85% of the replicates assembly was able to produce a complete circular chromosome using either Flye or Canu. In most cases it is recommended to move directly from extraction to sequencing as untreated DNA had the highest rates of genome closure regardless of extraction method. Using our evaluation criteria the Qiagen DNeasy Blood and Tissue kit was found to be the best overall method due to its low-cost ability to scale from single tube to 96-well plates and high consistency in yield and sequencing performance.
Vaccine-induced neutralizing antibodies against SARS-CoV-2 Omicron variant isolated in Osaka, Japan
To study vaccine-induced neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants isolated in Osaka Japan microneutralization tests were performed on serum samples from 32 subjects who received a second dose of vaccination and 10 of those who received the third dose of vaccination. Geometric Mean Titres (GMTs) for the D614G strain Alpha variant Delta variant and Omicron BA.1 of the subjects after the second dose of vaccination were 19.5 21.8 6.3 and 2.0 respectively. The GMT for the Delta variant was significantly lower than that for the D614G strain and Alpha variant and the GMT for the Omicron BA.1 was significantly lower than that for the Delta variant. Among the subjects who received three doses of vaccination the GMTs for the Omicron BA.1 (62.8) and BA.2 (38.6) were significantly higher than that for the Omicron BA.1 after the second dose. Thus in the present study the second dose of vaccination induced neutralizing antibodies against SARS-CoV-2 strains and the reactivity of neutralizing antibodies to the variants was thought to be enhanced by the third dose of vaccination. The serum samples used in this study will be useful in evaluating the reactivity of vaccine-induced antibodies to newly emerging variants.
Gene Sequencing: Key for Analyzing Mutation in SARS-CoV-2
Genomic sequencing is a sole platform that recognizes and characterizes novel mutants of microorganisms existing in various clinical samples. The main objective of this article is to summarize and provide relevant information regarding genomic sequencing platforms that are widely applied for analyzing mutations in SARS-CoV-2. Various data and literature were reviewed from scientific database like PubMed Scopus Google scholars and internet in order to provide collective and reliable information on genomic sequencing. Various Variants of Concern (VOC) and Variants of Interest (VOI) with higher transmissibility and infectivity are detected around the globe among which Nepal is also at high risk stage. According to the Ministry of Health and Population (MOHP) delta variants (B.1.617.2) alpha variants (B.1. 1.7) kappa variants(B.1.617.1) and newly emerged sub lineage of delta variants (A.Y.1) are the predominant one that are circulating in the country. Therefore severe acute respiratory syndrome coronavirus 2 whole genome sequencing Next generation sequencing (Illumina MiSeq. and Oxford Nanopore Minion) or Sanger method based on amplicon sequencing are the best optional platforms for the detection of VOC and VOI and to continue monitoring of widespread SARS-CoV-2 for proper therapy and prevention of COVID-19. Besides variations occurring in the fragment of virus genome may produce gene dropout obstructing with laboratory molecular assays and epidemiological surveys therefore it is very crucial to detect those markers with the aid of gene sequencing methods in order to establish higher molecular testing strategies.
INTERMEDIATE VAGINAL FLORA IS ASSOCIATED WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN HIV POSITIVE PREGNANT WOMEN ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN KISUMU, KENYA.
Introduction A number of studies have linked Highly Active Antiretroviral Therapy (HAART) to adverse pregnancy outcome but the mechanism is not well understood. Hypothesis This study postulated abnormal vaginal flora (AVF) as the link between HAART and adverse pregnancy outcome. Objective The study was designed to determine correlates of AVF with special emphasis on the association between AVF and HAART in HIV-1 positive pregnant women on HAART in Kisumu Kenya. Method This cross sectional study was carried out at Lumumba sub county hospital. The facility receive patients from Kisumu county and its surrounding; a region with high HIV and BV prevalence plus high maternal and neonatal morbidities and mortalities. Willing 76 pregnant women who started HAART on or before first trimester were enrolled after signing informed consent forms. Using formatted questionnaire participants were interviewed on demographic clinical and behavioral information. The samples were collected in second trimester and BV determined by Nugent’s criteria. Fisher Exact Chi square test and multinomial logistic regression was used to determine the association of HAART and participants characteristics with AVF. Results Vaginal douching any time earlier than two weeks to specimen collection [9.67(1.03-90.41)] and non efavirenz based HAART [24.57(2.39-253.14)] were positively associated with BV and intermediate vaginal flora respectively while self-employment [0.06(0.01-0.88)] and one sexual partner in the last two months [0.13(0.02-0.70)] being negatively associated with intermediate vaginal flora. Meanwhile non efavirenz based HAART [17.10(1.18-247.34)] and vaginal douching anytime earlier than two weeks to specimen collection [12.70(1.10-146.)] had independent positive association with intermediate vaginal flora and BV respectively. Conclusion This study found a positive independent association between HAART and intermediate vaginal flora. Similar to BV it has been discovered that intermediate vaginal flora is linked to poor pregnancy outcome. This study has therefore proved that HAART alters vaginal flora leading to adverse pregnancy outcome.
Comparison of diagnostic accuracy of Xpert MTB/RIF and Geno type MTBDRplus line probe assayfor diagnosis of tuberculous pleural effusion
Background: Tuberculous pleural effusion (TPE) occurs in up to 25% of TB patients. Owing to the pauci-bacillary nature of the pleural fluid the diagnosis of TPE is a challenge. Newer diagnostic tools are required for the rapid diagnosis of TPE.
Objectives: To compare the sensitivity and specificity of Xpert MTB/RIF and Geno type MTBDRplus line probe assay (MTBDRplus) for diagnosing TPE.
Methods: A prospective cross-sectional study was performed at Aga Khan University Hospital Karachi Pakistan from August 2014 to January 2016. Patients with suspected TPE were recruited on the basis of history exudative lymphocytic nature of effusion and raised adenosine daminase level. Pleural fluid samples were tested for AFB smear culture Xpert MTB/RIFand MTBDR plus .
Results: We enrolled 99 patients with mean age of 50.4±20.3 years. AFB culture was positive in 14 (14.14%) cases. Considering AFB culture as Gold standard the sensitivity of Xpert MTB/RIF was found to be 57.14% (95% CI: 28.86 – 82.34%) and specificity was 97.65% (95% CI: 91.76 - 99.71%) and the sensitivity of MTBDR plus was 35.71% (95% CI: 12.76 – 64.86%) and specificity was 98.82% (95% CI: 93.62 - 99.90%).The sensitivity of Xpert MTB/RIF in TPE was higher than MTBDRplus (p 0.013) while specificity was similar.
Conclusion: Xpert MTB/RIF is more sensitive for detecting TPE than MTBDRplus and AFB smear microscopy. A multicenter large-sample study is needed to evaluate this method for early TPE diagnosis.
Bacillus circulans septicemia in a premature infant: a case report
In immunocompromised patients Bacillus circulans is primarily regarded an opportunistic pathogen. This is a case report of septicaemia caused by Bacillus circulans in an extremely low birth weight preterm baby with respiratory distress. Although a laboratory contaminant but in immunocompromised host isolation of B. circulans should not be overlooked.
Deep phylotaxonogenomic revision of the genus Xanthomonas within family Xanthomonadaceae and proposal of novel family Frateuriaceae within order Xanthomonadales
Genus Xanthomonas is primarily comprise phytopathogenic species. In a recent study by carrying out deep phyto-taxonogenomics we reported that even the genera Xylella Stenotrophomonas and Pseudoxanthomonas are miss-classified and belong to genus Xanthomonas. Hence to understand the breadth of the genus we carried out deep phylo-taxonogenomics of the order Xanthomonadales. Such investigation revealed that at least four more genera belong to genus Xanthomonas with prominent being Lysobacter. Further order level deep phylo-taxonogenomics revealed two major families. One being the original family Xanthomonadaceae and other is proposed as Frateuriaceae fam. nov. as synonym of family Rhodanobacteraceae with novel genus Frateuria gen. nov.
Human brucellosis: An observational study from a tertiary care centre in northern India
Brucellosis is a neglected zoonotic disease that affects both humans and animals. In humans brucellosis begins with chronic illness leading to great financial losses from not being able to work well and continued treatment costs. Joint pain is the common presentation of brucellosis and there are several risk factors associated with brucellosis. But few such researches have come from northern India. We studied to detect and characterize the Brucella species from patients having complaints of joint pain and also to know the potential causes of human brucellosis. A total of 200 blood samples were collected from the participants having joints pain from September 2019 to September 2021 at Gandhi memorial and associated hospital of King George’s Medical University Lucknow Uttar Pradesh and tested by serology for anti brucella IgM and IgG molecular tests by RTPCR conventional PCR and automated blood culture system. The study showed positive results by anti-brucella IgM ELISA 19 (9.5%) anti brucella IgG 23 (11.5%) and of those 1 (0.5%) was positive for both anti-brucella IgM and anti-brucella IgG ELISA. Out of 19 anti-brucella IgM ELISA positive 8 (4%) samples were positive for PCR/ RT-PCR and that was negative for anti-brucella IgG ELISA. All blood culture reports of all patients were negative. Our study concluded that anti-brucella IgM ELISA was more accurate than anti-brucella IgG ELISA in detecting human brucellosis. Consumption of animal products (i.e. milk a dairy product of cow buffalo goat and meat of goat) and contact with animals were the main risk factors that were identified for brucella disease.
Cloning and expression of α-Amylase from novel specie, Enterobacter xiangfangensis; locally isolated from Pakistani flora
Living in an era of industrialization there is an utmost need to replace chemical catalysts with biocatalysts owing their cost effectiveness milder reaction conditions eco-friendly nature and specificity. α-amylase is one of the top commercial enzymes of industrial importance. It hydrolyzes internal α (1 4) glycosidic linkages in polysaccharides and yields oligosaccharides of varying length. The aim of present study was to clone and express α-amylase from a novel species Enterobacter xiangfangensis. Amplified product was cloned by A and T overhangs and transformed into cloning host; E. coli DH5α cells. Gene encoding α-amylase (1488bp) was sequenced to confirm the adequate amplification digested with BamH1 and Xho1 cloned into expression vector; pET28b (+) and transformed into expression host; E. coli strain BL21 CodonPlus (DE3) cells.
The expression of α-amylase was induced by IPTG and optimized with varying IPTG concentrations and its induction intervals. The maximum expression was observed after 8 hours of 1mM IPTG induction. The results showed that α-amylase from novel specie Enterobacter xiangfangensis has a potential to expresses itself in heterologous expression system so this recombinant α-amylase is ray of hope for enormous downstream applications.
The emerging human monkeypox in Thailand: a mini-review
Monkeypox virus infection is a newly emerging viral infectious disease that has become the current public health threat. Formerly monkeypox was a crucial zoonotic virus endemic limited to the central and west African regions never been reported in Southeast Asia. Humans can be infected with the monkeypox virus by contact with infected humans and animals. However the recent emergence of monkeypox worldwide including in Thailand is of significant interest and shall be surveillance. In addition the recent evidence from the recent outbreaks worldwide demonstrates that infection can be transmitted by sexuality. The author reviewed and represented important information on this disease in this mini-review.