UK Role 4 Military Infectious Diseases at Birmingham Heartlands Hospital in 2005-9

Prevalence and Risk Factors of Coxiellosis at the Human-Animal-Environment Interface in the South Asian Countries: A Systematic Review and Meta-Analysis

Coxiellosis, a zoonotic bacterial infection caused by Coxiella burnetii, affects diverse mammalian hosts and is prevalent worldwide, including in South Asia. This study aimed to investigate the epidemiology of Coxiellosis in South Asia, focusing on distribution, host diversity, prevalence, and associated risk factors at the human-animal-environment interface. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and a registered protocol, online searches were conducted in Embase, PubMed, Scopus, and Web of Science on August 6, 2023, to retrieve articles from the South Asian countries without restrictions on hosts or timeframe. Two authors independently reviewed, extracted data, and assessed quality based on predefined criteria, which were then evaluated and compiled into a single document and analyzed. The review identified 112 articles published between 1954 and 2023. Among humans, the estimated pooled seroprevalence (EPSP) was 9.2%, and the estimated pooled carrier prevalence (EPCP) was 6.2%. Ruminant herd-level EPSP and EPCP were 77.3% and 74.6%, and at the individual level, were 11.9% and 5.3%, respectively. Seroprevalence was significantly influenced by country, tick infestation, reproductive disorders, age, and body condition of ruminants. Nonruminant mammals, such as dogs (16.8%), horses (6.0%), pigs (3.9%), and rodents (14.8%), were also seropositive. Several avian and reptile species showed EPSP rates of 14.5% and 29.2%, respectively. Bacterial DNA was detected in ticks and soil samples, with EPCP of 1.0% and 3.3%, respectively. We recommend prioritizing One Health surveillance and intervention to prevent infections among humans, livestock, poultry, pets, and wildlife. Special emphasis should be placed on aged and emaciated animals, tick infestations, and animals with reproductive disorders.

Unusual presentations of cutaneous larva migrans in British military personnel

Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services. Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points. There were 12 cases identified, of which five came from Brunei and three were from Belize. Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%). Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas. Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation. Military personnel may have unusual presentations of CLM due their unique military activities. In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).

UK Role 4 military infectious diseases and tropical medicine cases in 2005-2013

INTRODUCTION

Infectious diseases are a frequent cause of morbidity among British troops. The aim of this paper is to describe the spectrum of infectious diseases seen when UK service personnel are evacuated for definitive care to the Role 4 Medical Treatment Facility based at Birmingham Heartlands Hospital.

METHOD

A retrospective analysis of all military patients presenting with infectious diseases and treated at Birmingham Heartlands Hospital between 14 April 2005 and 31 December 2013 was undertaken.

RESULTS

During this period, 502 patients were identified. Infections originated in 49 countries, most commonly Afghanistan (46% cases), the UK (10% cases) and Belize (9% of cases). The most common presentations were dermatological conditions, gastroenterological illnesses and undifferentiated fevers.

CONCLUSION

UK service personnel in significant numbers continue to suffer a wide range of infectious diseases, acquired throughout the globe, which often require specialist tertiary infection services to diagnose and manage. Future prospective data collection is recommended to identify trends, which in turn will inform military training needs and future research priorities in the Defence Medical Services (DMS) and allows development of appropriate policies and clinical guidelines for management of DMS personnel with infectious diseases.

Seroconversion for infectious pathogens among UK military personnel deployed to Afghanistan, 2008-2011

Military personnel are at high risk of contracting vector-borne and zoonotic infections, particularly during overseas deployments, when they may be exposed to endemic or emerging infections not prevalent in their native countries. We conducted seroprevalence testing of 467 UK military personnel deployed to Helmand Province, Afghanistan, during 2008-2011 and found that up to 3.1% showed seroconversion for infection with Rickettsia spp., Coxiella burnetii, sandfly fever virus, or hantavirus; none showed seroconversion for infection with Crimean-Congo hemorrhagic fever virus. Most seroconversions occurred in personnel who did not report illness, except for those with hantavirus (70% symptomatic). These results indicate that many exposures to infectious pathogens, and potentially infections resulting from those exposures, may go unreported. Our findings reinforce the need for continued surveillance of military personnel and for education of health care providers to help recognize and prevent illnesses and transmission of pathogens during and after overseas deployments.

Social and Economic Burden of Human Leishmaniasis

Leishmaniasis continues to pose a major public health problem worldwide. With new epidemics occurring in endemic areas and the spread of the disease to previously free areas because of migration, tourism, and military activities, there is a great need for the development of an effective vaccine. Leishmaniasis is a disease of the poor, occurring mostly in remote rural villages with poor housing and little or no access to modern health-care facilities. In endemic areas, diagnosis of any form of leishmaniasis puts a huge financial strain on an already meagre financial resource at both the individual and community levels. Most often families need to sell their assets (land and livestock) or take loans from informal financial outfits with heavy interest rates to pay for the diagnosis and treatment of leishmaniasis. Here, we discuss the disease with special emphasis on its socioeconomic impact on the affected individual and community. In addition, we highlight the reasons why continued research aimed at developing an effective Leishmania vaccine is necessary.

Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan

BACKGROUND

More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish appropriate control measures for both.

METHODS AND MATERIALS

An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to the end of 2012 in Bamyan province of Afghanistan. A total of 100 cases were selected by random sampling with equal number of neighbor controls. Data were collected through structured questionnaire.

RESULTS

The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of brucellosis and Q fever.

CONCLUSION

Health educators should focus on families dealing with animals, especially on females. Pasturing, healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of preventive measures.