BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lav...BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lavage fluid),and cryptococcal antigen(CrAg)testing are helpful for a definitive diagnosis.However,these tests are sometimes falsely negative.PC is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms,poor imaging specificity,and false-negative laboratory tests.CASE SUMMARY We report two female patients who underwent computed tomography-guided percutaneous needle pulmonary biopsy of a lung nodule for a confirmed diagnosis.In both patients,the CrAg test on the lung biopsy tissue homogenate was positive,while the serum CrAg test was negative.Combined with the lung tissue pathology,we made the diagnosis of PC.Antifungal therapy was effective in both patients.CONCLUSION Given the findings of our cases and the literature review,lung tissue homogenate CrAg testing can be helpful in improving the diagnosis of PC.展开更多
After the policy adjustment,China no longer carries out COVID-19 PCR testing for all people,and antigen testing has become the main way to detect and manage infectious sources.We developed a dynamic model to evaluate ...After the policy adjustment,China no longer carries out COVID-19 PCR testing for all people,and antigen testing has become the main way to detect and manage infectious sources.We developed a dynamic model to evaluate and compare the effects between PCR and antigen testing for controlling the pandemic.Due to the increase of contact degree,the peak reduction effect of PCR testing in population is lower than that of antigen testing.Even if it was only 20%of people isolated at home after antigen testing,the peak of the epidemic could be reduced by 9.46%.If the proportion of antigen testing is further increased to 80%,the peak of the pandemic can be reduced by 31.41%.Antigen testing performed better effects in school(reduction proportion 29.27%)and community(29.34%)than in workplace(27.75%).Therefore,we recommend that antigen testing in the popu-lation should be encouraged during the pandemic,and home isolation of infected persons should be advocated,especially in crowded places.To improve the availability of antigen,the testing proportion should be further enhanced.展开更多
The number of coronavirus disease 2019(COVID-19)cases continues to surge,overwhelming healthcare systems and causing excess mortality in many countries.Testing of infectious populations remains a key strategy to conta...The number of coronavirus disease 2019(COVID-19)cases continues to surge,overwhelming healthcare systems and causing excess mortality in many countries.Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak,delay the exponential spread of the disease,and flatten the epidemic curve.Using the Omicron variant outbreak as a background,this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies,analyze the factors associated with testing effectiveness,and optimize testing strategies based on these influencing factors.We developed a stochastic,agent-based,discrete-time susceptible–latent–infectious–recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission.Antigen testing and its combination strategies were more efficient than polymerase chain reaction(PCR)-related strategies.Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds.The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts.The main advantage of antigen testing strategies is the short turnaround time,which is also a critical factor to be optimized to improve PCR strategies.After modifying the turnaround time,the strategies with less frequent testing were comparable to daily testing.The choice of testing strategy requires consideration of containment goals,test efficacy,community prevalence,and economic factors.This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.展开更多
Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis. The Central African Republic is not spared. The emergence of variants and the...Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis. The Central African Republic is not spared. The emergence of variants and their impact require health monitoring despite the obligation of vaccination. The purpose of this campaign was to determine the circulation of pending second-wave variants. Patients and Methods: A second mass screening campaign took place from 02 to 22 July 2021 in the main land and river entry points of Bangui (Exit North-PK12, Exit South-PK9, Port Beach) and at the LNBCSP. Antigenic and RT-PCR tests carried out on nasopharyngeal samples made it possible to select strains which were finally sequenced. Results: Of 2687 participants included in the study, 53 (1.97%) were positive for SARS-CoV-2. Thirteen (1.53%) were male and 40 (2.18%) female. The analyses carried out on the LumiraDx analyzer were positive for 109 samples against 53 on the RT-PCR. The prevalence was higher in the most tested age groups (30 to 50 years) with two clusters identified. B.1.617.2 (Delta) variants were predominant (57%). Conclusion: SARS-CoV-2 continues to circulate. The acquisition of automated antigenic tests (LumiraDx®) with sensitivity and specificity close to those of the reference test (RT-PCR) will allow better mass diagnosis for an optimization of the surveillance of COVID-19 in our countries with limited resources. The predominance of the B.1.617.2 (Delta) variant would suggest a third wave in the Central African Republic.展开更多
AIM： To evaluate the agreement between a mAb-based stool test （HP STAR） and the urea breath test （UBT） in monitoring （H pylon） infection after eradication therapy. METHODS： Patients with discordant results on ...AIM： To evaluate the agreement between a mAb-based stool test （HP STAR） and the urea breath test （UBT） in monitoring （H pylon） infection after eradication therapy. METHODS： Patients with discordant results on UBT and Hp STAR underwent endoscopy with biopsies for rapid urease test, culture, and histology to confirm H pylori status. RESULTS： Among 250 patients （50±14 years）, 240 （96.0%） had concordant UBT and Hp STAR tests with a significant correlation between DOB and A values （R = 0.87; P〈0.0001）. The remaining 10 （4.0%） patients had discordant tests （positive Hp STAR and negative UBT） with the Hp STAR inaccurate in five cases （false positive） and UBT inaccurate in the other five cases （false negative）. The “maximal expected” sensitivity, specificity, ＋PV, -PV, ＋LR, and -LR were 91%, 100%, 100%, 97.4%, ∞, and 8.2 respectively, for the UBT, and 100%, 97.4%, 91%, 100%, 38.8, and 0, respectively, for the Hp STAR. Overall accuracy for both tests was 98%. CONCLUSION： Both the UBT and the Hp StAR are equally accurate in monitoring H pylori infection. Nowadays, the choice of the “best” non-invasive H pylori test in the post-treatment setting should be done not only in terms of diagnostic accuracy but also in view of cost and local facilities.展开更多
Responding to the fast-spreading SARS-CoV-2 Omicron variant, to improve screening efficiency, rapid antigen tests(RATs) were first added as a supplementary detection method in China in mid-March, 2022. What and how bi...Responding to the fast-spreading SARS-CoV-2 Omicron variant, to improve screening efficiency, rapid antigen tests(RATs) were first added as a supplementary detection method in China in mid-March, 2022. What and how big a role RATs should play need to be supported by clinical data. Here, RAT performance and relevant factors in comparison with nucleic acid amplification tests(NAATs) were assessed in Omicron-infected inpatients. From the NAAT results, nasopharyngeal swabs(NPs) performed better than oropharyngeal swabs(OPs). RATs tested on NAAT positive NPs performed better than those with OP-positive samples. The RAT positivity rate was strongly associated with high levels of N and OFR1ab genes, especially in NPs where patients also had significantly longer hospital stays and shorter days from symptom onset to RAT testing. Self-performed RATs had a detection accuracy that was comparable to professionally performed RATs when the subjects were well guided. The antigen negative rate of the studied patients was 100% at discharge. These findings suggest that, in addition to a supplementary detection role, RATs can be an important strategy for evaluating the disease progression of Omicron-infected inpatients. This study provides important clinical data to support better rules regarding RATs under China’s COVID-19 prevention and control policy.展开更多
BACKGROUND The global outbreak of coronavirus disease 2019(COVID-19)leads to the development of accessible and cost-effective rapid antigen-detection tests(RATs),as quick and accurate diagnosis is crucial to curb the ...BACKGROUND The global outbreak of coronavirus disease 2019(COVID-19)leads to the development of accessible and cost-effective rapid antigen-detection tests(RATs),as quick and accurate diagnosis is crucial to curb the pandemic.AIM To evaluate the Humasis COVID-19 Ag Test(Humasis Co.,Ltd.,Gyeonggi-do,Republic of Korea)in the diagnosis of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).METHODS This retrospective study was carried out at the Croatian Institute of Public Health and included patients with clinical symptoms of COVID-19 lasting no longer than 5 d prior to testing,whose nasopharyngeal swabs were primarily tested with RAT.Negative RAT samples underwent confirmatory real-time reverse transcription-polymerase chain reaction(RT-PCR).Diagnostic efficacy was determined compared to RT-PCR.The patients were divided into three age groups(<18,19-65,>65 years).Statistical analysis was performed with the significance level set at P<0.05.RESULTSIn total,2490 symptomatic patients were tested;953 samples were positive on RAT,and 1537 werenegative.All negative RAT samples were subjected to RT-PCR;266 samples were positive andmarked as false-negative results on RAT.The calculated negative predictive value as a measure ofRAT efficacy was 82.69%.The χ^(2) test and Kruskal-Wallis test showed a significant difference in theproportion of false negatives(P<0.001)and RT-PCR cycle(Ct)values for false-negative RATs(P=0.012)among the age groups.The young age group was significantly less likely to be falsenegative,whereas the false negatives from the elderly group experienced significantly lower Ctvalues than the other two age groups.CONCLUSIONEvaluated RAT demonstrated satisfactory performance with more reliable results in youngerpatients.Humasis COVID-19 Ag RAT is potentially a valuable tool in areas where access tomolecular methods is limited;however,RT-PCR remains a gold standard for SARS-CoV-2detection.展开更多
At present,many researchers focused on the point-of-care testing（POCT）,a method of disease markers detection without large-scale instruments and specialized persons.However,most POCT diagnostic methods were suffered...At present,many researchers focused on the point-of-care testing（POCT）,a method of disease markers detection without large-scale instruments and specialized persons.However,most POCT diagnostic methods were suffered from poor detection sensitivity or inefficiency in quantitative detection.Herein,we developed a newly QD-immune fluorescence test strips（QD-IFTS） based on quantum dots（QDs） as the fluorescence nanocarrier to prepare the immune fluorescence probes in the classical immunochromatography detection system for sensing carcino-embryonic antigen（CEA）,a kind of glycoprotein produced by intestinal tissue and a broad spectrum of tumor marker for cancer diagnosis.And we designed a homemade strips fluorescence reader for detection of fluorescence intensity of QDs on the QD-IFTS.Under the optimized reaction conditions,chromatographic time of the newly QD-IFTS was only25 min,sample volume of the newly QD-IFTS was only 40 m L and the LOD of the newly QD-IFTS was 0.72 ng/m L.In addition,the efficiency and robustness of the newly QD-IFTS were confirmed by successfully application in 300 clinical serum samples,and the results revealed great potential in clinical POCT of other biomarkers.展开更多
AIM： To compare two different H pylori stool antigen tests as noninvasive diagnostic methods. METHODS： The study population consisted of 22 upper gastrointestinal system bleeding patients. Urea breath test （UBT）, ...AIM： To compare two different H pylori stool antigen tests as noninvasive diagnostic methods. METHODS： The study population consisted of 22 upper gastrointestinal system bleeding patients. Urea breath test （UBT）, rapid urease test （RUT） and histopathological examination were applied to all patients. Stool specimens from these patients were examined by rapid STPIP!HpSA and one step simple H pylori antigen cassette test for the detection of Hpylori antigens. RESULTS： For these 22 patients, 15 （68.2%） were diagnosed as positive and seven （31.8%） were diagnosed negative for H pylori infection by the gold standard methods. Whereas 10 （45.5%） were positive and 12 （54.5%） were diagnosed negative by the rapid STPIP!HpSA test. The sensitivity, specificity, positive and negative predictive values were 60%, 86%, 90% and 50%, respectively. When compared to the gold standard methods, these differences were not significant. However, six patients （27.3%） were positive, and 16 （72.7%） were negative by the simple H pylori stool antigen cassette test. The sensitivity, specificity, positive and negative predictive values were 33%, 86%, 83% and 38%, respectively. Compared to the gold standard methods, the simple H pylori stool antigen cassette test results were significantly different （P = 0.012）. CONCLUSION： Rapid STRIP!HpSA test could be used as a routine diagnostic tool in the microbiology laboratory for assessing clinical significance and eradication control of H pylori in upper gastrointestinal system bleeding patients.展开更多
Defining con-founders that affect the reliability of diagnostic tests for coronavirus disease 2019 is vital to breaking the chain of infection.The elderly population is a higher risk group for the emerging virus.Howev...Defining con-founders that affect the reliability of diagnostic tests for coronavirus disease 2019 is vital to breaking the chain of infection.The elderly population is a higher risk group for the emerging virus.However,gender seems to exert a critical role in modifying the infection risk among women owing to hormonal changes.The menopause transition is an exceptional period for older women where the protective and immunomodulatory effects of the estrogen hormone are lost.Accordingly,attention should be given to postmenopausal women since they will have an increased risk compared to their pre-menopausal peers.展开更多
Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and...Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.028, diarrhoea p = 0.038, loose or watery stool p = 0.021 and mild general condition p = 0.02 remained independently associated with Salmonella infection. Conclusion: Typhoid Fever being endemic, laboratory diagnosis was a key for confirmation after clinical diagnosis. SAT can accurately be used to detect the disease where culture is unavailable. However, antibiotic sensitivity tests were crucial when determining the drug of choice as Salmonella isolates were multi-drug resistant. Establishment of prescribing antimicrobial policies and guidelines can periodically monitor the antibiogram patterns.展开更多
Background: Helicobacter pylori (H. pylori) is considered as one of the most prevalent gastric infections which cause chronic gastritis and predispose to cancer stomach. So, diagnosis and eradication should be rapid t...Background: Helicobacter pylori (H. pylori) is considered as one of the most prevalent gastric infections which cause chronic gastritis and predispose to cancer stomach. So, diagnosis and eradication should be rapid to decrease the risk of gastric cancer. Aim of the study: To evaluate the role of rapid urease test (RUT) and faecal antigen test (FAT) added to serological test for rapid diagnosis of active H. pylori infection. Patients and methods: 270 patients with dyspepsia and positive serology for H. pylori infection were included. Two antral and two corporal gastric biopsies were taken for RUT and Histopathological examination. Fresh stool samples were obtained from all patients for FAT. Results: The mean age of the studied patients was 45 ± 25. H. pylori infection was found in 256 (94.8%) of the included patients: 236 (92.18%) with positive all tests, 5 (1.95%) with positive both RUT and FAT, 8 (3.12%) with positive both histology and RUT and 7 (2.73%) with positive histology and FAT. The sensitivity, specificity and positive predictive values for RUT were as follows: 97.27%, 85.71% and 99.20% respectively and 96.88%, 85.71% and 99.20% respectively for FAT. Conclusions: RUT or FAT in patients with positive serological test could be used for rapid diagnosis of active H. pylori infection with good sensitivity and specificity without waiting for the results of histology or culture.展开更多
BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test...BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H.pylori,4-8 weeks post-therapy,with 86%sensitivity and 92%specificity.AIM To assess the H.pylori eradication rate of standard triple therapy and factors affecting the eradication rate.METHODS We conducted a prospective,multicenter follow-up study in Addis Ababa,Ethiopia,at selected healthcare facilities among dyspeptic patients with positive stool H.pylori antigen tests from June 1,2023 to October 30,2023 to assess the H.pylori eradication rate.After completing the standard triple therapy,the eradication was confirmed using a stool antigen test 4 weeks later.The data were analyzed using bivariate and multivariate logistic regression methods.RESULTS The H.pylori eradication rate was 85.4%.Patients with a previous diagnosis of H.pylori infection,smokers,and local alcohol consumption were associated with a lower H.pylori eradication rate,with adjusted odds ratio(AORs)of 0.159[95%confidence interval(CI):0.050-0.511],0.206(95%CI:0.052-0.822),and 0.228(95%CI:0.052-0.997),respectively.Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement,AOR=5.383,95%CI:1.74-21.089.CONCLUSION H.pylori eradication rate was lower than expected.Post-treatment testing is crucial to confirm eradication and guide further management,such as susceptibility testing.展开更多
Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication t...Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication therapy.Only highly accurate tests should be used in clinical practice,and the sensitivity and specificity of an adequate test should exceed 90%.The choice of tests should take into account clinical circumstances,the likelihood ratio of positive and negative tests,the cost-effectiveness of the testing strategy and the availability of the tests.This review concerns some of the most recent developments in diagnostic methods of H.pylori infection,namely the contribution of novel endoscopic evaluation methodologies for the diagnosis of H.pylori infection,such as magnifying endoscopy techniques and chromoendoscopy.In addition,the diagnostic contribution of histology and the urea breath test was explored recently in specific clinical settings and patient groups.Recent studies recommend enhancing the number of biopsy fragments for the rapid urease test.Bacterial culture from the gastric biopsy is the gold standard technique,and is recommended for antibiotic susceptibility test.Serology is used for initial screening and the stool antigen test is particularly used when the urea breath test is not available,while molecular methods have gained attention mostly for detecting antibiotic resistance.展开更多
BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histolog...BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.展开更多
Background:After alleged stop of transmission of schistosomiasis and further down the line in post elimination settings,sensitive tools are required to monitor infection status to prevent potential re-emergence.In Rah...Background:After alleged stop of transmission of schistosomiasis and further down the line in post elimination settings,sensitive tools are required to monitor infection status to prevent potential re-emergence.In Rahala,where transmission cycle of Schistosoma haematobium is interrupted since 2004 but where 30%of snails are still infected by S.bovis,potential human S.bovis infection can’t be excluded.As methods based on egg-counts do not provide the required sensitivity,antibody or antigen assays are envisaged as the most appropriate tools for this type of monitoring.Methods:In this pilot study,the performances of three assays were compared:two commercially available antibody tests(ELISA and haemagglutination format)indicating exposure,and an antigen test(lateral flow strip format)demonstrating active infection.All 37 recruited study participants resided in Rahala(Akka,province Tata,Morocco).Participants had been diagnosed and cured from schistosomiasis in the period between 1983 and 2003.In 2015 these asymptomatic participants provided fresh clinical samples(blood and urine)for analysis with the aforementioned diagnostics tests.Results:No eggs were identified in the urine of the 37 participants.The haemagglutination test indicated 6 antibody positives whereas the ELISA indicated 28 antibody positives,one indecisive and one false positive.ELISA and haemagglutination results matched for 18 individuals,amongst which 5 out of 6 haemagglutination positives.With the antigen test(performed on paired serum and urine samples),serum from two participants(cured 21 and 32 years ago)indicated the presence of low levels of the highly specific Schistosoma circulating anodic antigen(CAA),demonstrating low worm level infections(less than 5 pg/ml corresponding to probably single worm pair).One tested also CAA positive with urine.ELISA indicated the presence of human anti-Schistosoma antibodies in these two CAA positive cases,haemagglutination results were negative.Conclusions:To prevent reemergence of schistosomiasis in Morocco current monitoring programs require specific protocols that include testing of antibody positives for active infection by the UCP-LF CAA test,the appropriate diagnostic tool to identify Schistosoma low grade infections in travelers,immigrants and assumed cured cases.The test is genus specific will also identify infections related to S.bovis.展开更多
Background:The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus(GAS)positive cases with penicillin.The aim of the study was to evaluate ...Background:The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus(GAS)positive cases with penicillin.The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit.Methods:We analyzed retrospectively the data on microbiological studies and blood tests done,and data on prescribing of antibiotics,of 200 children admitted for febrile exudative tonsillitis.Results:After the clinical diagnosis of exudative tonsillitis,antigen test and/or culture for GAS identifi cation was done in>95%of cases.All the 32(16%)children with GAS infection,but also 52(38%)of the 137 children without any evidence of bacterial infection received antibiotics.Additional laboratory studies were done in 96%of children.Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis.No serious bacterial infection was diagnosed.Conclusions:The Finnish Current Care Guidelines lead to over-treatment with antibiotics.None of the 200 children returned after discharge,suggesting that undertreatment did not happen.展开更多
A recent article Is onchocerciasis elimination in Africa feasible by 2025:a perspective based on lessons learnt from the African control programmesH in Infectious Diseases of Poverty claimed that undue influence on Af...A recent article Is onchocerciasis elimination in Africa feasible by 2025:a perspective based on lessons learnt from the African control programmesH in Infectious Diseases of Poverty claimed that undue influence on African programs by concepts developed by the Onchocerciasis Elimination Program of the Americas(OEPA)is detrimental to stopping mass drug administration(MDA)in Africa.This claim is made despite a record year for MDA stoppage in four African countries of>3.5 million treatments in 2018,far exceeding any past OEPA or African Program for Onchocerciasis Control(APOC)stop MDA success.展开更多
文摘BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lavage fluid),and cryptococcal antigen(CrAg)testing are helpful for a definitive diagnosis.However,these tests are sometimes falsely negative.PC is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms,poor imaging specificity,and false-negative laboratory tests.CASE SUMMARY We report two female patients who underwent computed tomography-guided percutaneous needle pulmonary biopsy of a lung nodule for a confirmed diagnosis.In both patients,the CrAg test on the lung biopsy tissue homogenate was positive,while the serum CrAg test was negative.Combined with the lung tissue pathology,we made the diagnosis of PC.Antifungal therapy was effective in both patients.CONCLUSION Given the findings of our cases and the literature review,lung tissue homogenate CrAg testing can be helpful in improving the diagnosis of PC.
基金supported by the National Key Research and Development Program of China (2021YFC2301604)Guiding projects of Science and Technology Program in Fujian Province (2019D014).
文摘After the policy adjustment,China no longer carries out COVID-19 PCR testing for all people,and antigen testing has become the main way to detect and manage infectious sources.We developed a dynamic model to evaluate and compare the effects between PCR and antigen testing for controlling the pandemic.Due to the increase of contact degree,the peak reduction effect of PCR testing in population is lower than that of antigen testing.Even if it was only 20%of people isolated at home after antigen testing,the peak of the epidemic could be reduced by 9.46%.If the proportion of antigen testing is further increased to 80%,the peak of the pandemic can be reduced by 31.41%.Antigen testing performed better effects in school(reduction proportion 29.27%)and community(29.34%)than in workplace(27.75%).Therefore,we recommend that antigen testing in the popu-lation should be encouraged during the pandemic,and home isolation of infected persons should be advocated,especially in crowded places.To improve the availability of antigen,the testing proportion should be further enhanced.
基金supported by grants from the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2020-I2M-1-001 and 2021-I2M-1-044)。
文摘The number of coronavirus disease 2019(COVID-19)cases continues to surge,overwhelming healthcare systems and causing excess mortality in many countries.Testing of infectious populations remains a key strategy to contain the COVID-19 outbreak,delay the exponential spread of the disease,and flatten the epidemic curve.Using the Omicron variant outbreak as a background,this study aimed to evaluate the effectiveness of testing strategies with different test combinations and frequencies,analyze the factors associated with testing effectiveness,and optimize testing strategies based on these influencing factors.We developed a stochastic,agent-based,discrete-time susceptible–latent–infectious–recovered model simulating a community to estimate the association between three levels of testing strategies and COVID-19 transmission.Antigen testing and its combination strategies were more efficient than polymerase chain reaction(PCR)-related strategies.Antigen testing also showed better performance in reducing the demand for hospital beds and intensive care unit beds.The delay in the turnaround time of test results had a more significant impact on the efficiency of the testing strategy compared to the detection limit of viral load and detection-related contacts.The main advantage of antigen testing strategies is the short turnaround time,which is also a critical factor to be optimized to improve PCR strategies.After modifying the turnaround time,the strategies with less frequent testing were comparable to daily testing.The choice of testing strategy requires consideration of containment goals,test efficacy,community prevalence,and economic factors.This study provides evidence for the selection and optimization of testing strategies in the post-pandemic era and provides guidance for optimizing healthcare resources.
文摘Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis. The Central African Republic is not spared. The emergence of variants and their impact require health monitoring despite the obligation of vaccination. The purpose of this campaign was to determine the circulation of pending second-wave variants. Patients and Methods: A second mass screening campaign took place from 02 to 22 July 2021 in the main land and river entry points of Bangui (Exit North-PK12, Exit South-PK9, Port Beach) and at the LNBCSP. Antigenic and RT-PCR tests carried out on nasopharyngeal samples made it possible to select strains which were finally sequenced. Results: Of 2687 participants included in the study, 53 (1.97%) were positive for SARS-CoV-2. Thirteen (1.53%) were male and 40 (2.18%) female. The analyses carried out on the LumiraDx analyzer were positive for 109 samples against 53 on the RT-PCR. The prevalence was higher in the most tested age groups (30 to 50 years) with two clusters identified. B.1.617.2 (Delta) variants were predominant (57%). Conclusion: SARS-CoV-2 continues to circulate. The acquisition of automated antigenic tests (LumiraDx®) with sensitivity and specificity close to those of the reference test (RT-PCR) will allow better mass diagnosis for an optimization of the surveillance of COVID-19 in our countries with limited resources. The predominance of the B.1.617.2 (Delta) variant would suggest a third wave in the Central African Republic.
文摘AIM： To evaluate the agreement between a mAb-based stool test （HP STAR） and the urea breath test （UBT） in monitoring （H pylon） infection after eradication therapy. METHODS： Patients with discordant results on UBT and Hp STAR underwent endoscopy with biopsies for rapid urease test, culture, and histology to confirm H pylori status. RESULTS： Among 250 patients （50±14 years）, 240 （96.0%） had concordant UBT and Hp STAR tests with a significant correlation between DOB and A values （R = 0.87; P〈0.0001）. The remaining 10 （4.0%） patients had discordant tests （positive Hp STAR and negative UBT） with the Hp STAR inaccurate in five cases （false positive） and UBT inaccurate in the other five cases （false negative）. The “maximal expected” sensitivity, specificity, ＋PV, -PV, ＋LR, and -LR were 91%, 100%, 100%, 97.4%, ∞, and 8.2 respectively, for the UBT, and 100%, 97.4%, 91%, 100%, 38.8, and 0, respectively, for the Hp STAR. Overall accuracy for both tests was 98%. CONCLUSION： Both the UBT and the Hp StAR are equally accurate in monitoring H pylori infection. Nowadays, the choice of the “best” non-invasive H pylori test in the post-treatment setting should be done not only in terms of diagnostic accuracy but also in view of cost and local facilities.
基金funded by the Medical Science and Technology Project of Zhejiang Province (Grant Numbers 2021KY394 and 2018KY912)
文摘Responding to the fast-spreading SARS-CoV-2 Omicron variant, to improve screening efficiency, rapid antigen tests(RATs) were first added as a supplementary detection method in China in mid-March, 2022. What and how big a role RATs should play need to be supported by clinical data. Here, RAT performance and relevant factors in comparison with nucleic acid amplification tests(NAATs) were assessed in Omicron-infected inpatients. From the NAAT results, nasopharyngeal swabs(NPs) performed better than oropharyngeal swabs(OPs). RATs tested on NAAT positive NPs performed better than those with OP-positive samples. The RAT positivity rate was strongly associated with high levels of N and OFR1ab genes, especially in NPs where patients also had significantly longer hospital stays and shorter days from symptom onset to RAT testing. Self-performed RATs had a detection accuracy that was comparable to professionally performed RATs when the subjects were well guided. The antigen negative rate of the studied patients was 100% at discharge. These findings suggest that, in addition to a supplementary detection role, RATs can be an important strategy for evaluating the disease progression of Omicron-infected inpatients. This study provides important clinical data to support better rules regarding RATs under China’s COVID-19 prevention and control policy.
文摘BACKGROUND The global outbreak of coronavirus disease 2019(COVID-19)leads to the development of accessible and cost-effective rapid antigen-detection tests(RATs),as quick and accurate diagnosis is crucial to curb the pandemic.AIM To evaluate the Humasis COVID-19 Ag Test(Humasis Co.,Ltd.,Gyeonggi-do,Republic of Korea)in the diagnosis of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).METHODS This retrospective study was carried out at the Croatian Institute of Public Health and included patients with clinical symptoms of COVID-19 lasting no longer than 5 d prior to testing,whose nasopharyngeal swabs were primarily tested with RAT.Negative RAT samples underwent confirmatory real-time reverse transcription-polymerase chain reaction(RT-PCR).Diagnostic efficacy was determined compared to RT-PCR.The patients were divided into three age groups(<18,19-65,>65 years).Statistical analysis was performed with the significance level set at P<0.05.RESULTSIn total,2490 symptomatic patients were tested;953 samples were positive on RAT,and 1537 werenegative.All negative RAT samples were subjected to RT-PCR;266 samples were positive andmarked as false-negative results on RAT.The calculated negative predictive value as a measure ofRAT efficacy was 82.69%.The χ^(2) test and Kruskal-Wallis test showed a significant difference in theproportion of false negatives(P<0.001)and RT-PCR cycle(Ct)values for false-negative RATs(P=0.012)among the age groups.The young age group was significantly less likely to be falsenegative,whereas the false negatives from the elderly group experienced significantly lower Ctvalues than the other two age groups.CONCLUSIONEvaluated RAT demonstrated satisfactory performance with more reliable results in youngerpatients.Humasis COVID-19 Ag RAT is potentially a valuable tool in areas where access tomolecular methods is limited;however,RT-PCR remains a gold standard for SARS-CoV-2detection.
基金financially supported by the National Natural Science Foundation of China(Nos.51373117,51303126 and 31600800)Tianjin Natural Science and Technology Foundation(No.16ZXMJSY00010)
文摘At present,many researchers focused on the point-of-care testing（POCT）,a method of disease markers detection without large-scale instruments and specialized persons.However,most POCT diagnostic methods were suffered from poor detection sensitivity or inefficiency in quantitative detection.Herein,we developed a newly QD-immune fluorescence test strips（QD-IFTS） based on quantum dots（QDs） as the fluorescence nanocarrier to prepare the immune fluorescence probes in the classical immunochromatography detection system for sensing carcino-embryonic antigen（CEA）,a kind of glycoprotein produced by intestinal tissue and a broad spectrum of tumor marker for cancer diagnosis.And we designed a homemade strips fluorescence reader for detection of fluorescence intensity of QDs on the QD-IFTS.Under the optimized reaction conditions,chromatographic time of the newly QD-IFTS was only25 min,sample volume of the newly QD-IFTS was only 40 m L and the LOD of the newly QD-IFTS was 0.72 ng/m L.In addition,the efficiency and robustness of the newly QD-IFTS were confirmed by successfully application in 300 clinical serum samples,and the results revealed great potential in clinical POCT of other biomarkers.
文摘AIM： To compare two different H pylori stool antigen tests as noninvasive diagnostic methods. METHODS： The study population consisted of 22 upper gastrointestinal system bleeding patients. Urea breath test （UBT）, rapid urease test （RUT） and histopathological examination were applied to all patients. Stool specimens from these patients were examined by rapid STPIP!HpSA and one step simple H pylori antigen cassette test for the detection of Hpylori antigens. RESULTS： For these 22 patients, 15 （68.2%） were diagnosed as positive and seven （31.8%） were diagnosed negative for H pylori infection by the gold standard methods. Whereas 10 （45.5%） were positive and 12 （54.5%） were diagnosed negative by the rapid STPIP!HpSA test. The sensitivity, specificity, positive and negative predictive values were 60%, 86%, 90% and 50%, respectively. When compared to the gold standard methods, these differences were not significant. However, six patients （27.3%） were positive, and 16 （72.7%） were negative by the simple H pylori stool antigen cassette test. The sensitivity, specificity, positive and negative predictive values were 33%, 86%, 83% and 38%, respectively. Compared to the gold standard methods, the simple H pylori stool antigen cassette test results were significantly different （P = 0.012）. CONCLUSION： Rapid STRIP!HpSA test could be used as a routine diagnostic tool in the microbiology laboratory for assessing clinical significance and eradication control of H pylori in upper gastrointestinal system bleeding patients.
文摘Defining con-founders that affect the reliability of diagnostic tests for coronavirus disease 2019 is vital to breaking the chain of infection.The elderly population is a higher risk group for the emerging virus.However,gender seems to exert a critical role in modifying the infection risk among women owing to hormonal changes.The menopause transition is an exceptional period for older women where the protective and immunomodulatory effects of the estrogen hormone are lost.Accordingly,attention should be given to postmenopausal women since they will have an increased risk compared to their pre-menopausal peers.
文摘Background: Typhoid disease remains a major public health problem globally, especially in developing countries in sub-Saharan Africa. Symptoms associated with typhoid disease mimic those of other febrile illnesses and are thus difficult to make an accurate diagnosis. A confirmed diagnosis requires the determination or isolation of the bacteria in well-equipped laboratories. Developing countries are faced with a huge limitation of the laboratory infrastructure to diagnose typhoid disease, which would otherwise guide in treating, managing, controlling, and halting the spread of drug resistant mutants. Objective: This study, therefore, was aimed at determining the clinical presentation, performance of diagnostic tests and antibiotic susceptibility testing of Salmonella among adults attending Kangema Sub-County Hospital. Study Population: The study population was residents of Kangema Sub-County in Murang’a County, Kenya while the target population was adults. Methods: The study adopted a cross-sectional study design that employed a systematic random sampling procedure. The study took place between April and June 2021. The sample size was 97 respondents who all consented and were enrolled in the study. Interviewing the respondents was carried out by administering structured questionnaires to collect quantitative data. Stool samples were obtained and cultured in Cary Blair transport media and then cultured in appropriate media at the Murang’a County Referral Hospital Laboratory. A rapid Salmonella Antigen (SAT) test was also performed on all the stool samples. Data Analyses: Word Statistics and Data (STATA) v 13 was used for statistical analysis. Results: The prevalence of Typhoid Fever was at 6.2% (95% CI) which included S. Typhi (n = 1;16.7%) and S. Paratyphi B (n = 5;83.3%). No isolate showed resistance to Ciprofloxacin. The sensitivity of SAT is 100% and a specificity of 98.9% with a kappa statistic of almost perfect agreement (0.9641) with culture. Patients who had fever p = 0.001, abdominal distention p = 0.028, diarrhoea p = 0.038, loose or watery stool p = 0.021 and mild general condition p = 0.02 remained independently associated with Salmonella infection. Conclusion: Typhoid Fever being endemic, laboratory diagnosis was a key for confirmation after clinical diagnosis. SAT can accurately be used to detect the disease where culture is unavailable. However, antibiotic sensitivity tests were crucial when determining the drug of choice as Salmonella isolates were multi-drug resistant. Establishment of prescribing antimicrobial policies and guidelines can periodically monitor the antibiogram patterns.
文摘Background: Helicobacter pylori (H. pylori) is considered as one of the most prevalent gastric infections which cause chronic gastritis and predispose to cancer stomach. So, diagnosis and eradication should be rapid to decrease the risk of gastric cancer. Aim of the study: To evaluate the role of rapid urease test (RUT) and faecal antigen test (FAT) added to serological test for rapid diagnosis of active H. pylori infection. Patients and methods: 270 patients with dyspepsia and positive serology for H. pylori infection were included. Two antral and two corporal gastric biopsies were taken for RUT and Histopathological examination. Fresh stool samples were obtained from all patients for FAT. Results: The mean age of the studied patients was 45 ± 25. H. pylori infection was found in 256 (94.8%) of the included patients: 236 (92.18%) with positive all tests, 5 (1.95%) with positive both RUT and FAT, 8 (3.12%) with positive both histology and RUT and 7 (2.73%) with positive histology and FAT. The sensitivity, specificity and positive predictive values for RUT were as follows: 97.27%, 85.71% and 99.20% respectively and 96.88%, 85.71% and 99.20% respectively for FAT. Conclusions: RUT or FAT in patients with positive serological test could be used for rapid diagnosis of active H. pylori infection with good sensitivity and specificity without waiting for the results of histology or culture.
文摘BACKGROUND Standard triple therapy is an effective treatment for eradicating Helicobacter pylori infection,but it is encountered with drug resistance.The stool antigen test is a cost-effective and easy-to-perform test to confirm the eradication of H.pylori,4-8 weeks post-therapy,with 86%sensitivity and 92%specificity.AIM To assess the H.pylori eradication rate of standard triple therapy and factors affecting the eradication rate.METHODS We conducted a prospective,multicenter follow-up study in Addis Ababa,Ethiopia,at selected healthcare facilities among dyspeptic patients with positive stool H.pylori antigen tests from June 1,2023 to October 30,2023 to assess the H.pylori eradication rate.After completing the standard triple therapy,the eradication was confirmed using a stool antigen test 4 weeks later.The data were analyzed using bivariate and multivariate logistic regression methods.RESULTS The H.pylori eradication rate was 85.4%.Patients with a previous diagnosis of H.pylori infection,smokers,and local alcohol consumption were associated with a lower H.pylori eradication rate,with adjusted odds ratio(AORs)of 0.159[95%confidence interval(CI):0.050-0.511],0.206(95%CI:0.052-0.822),and 0.228(95%CI:0.052-0.997),respectively.Patients with complete symptom resolution were 5.383 times more likely to achieve eradication than patients without symptom improvement,AOR=5.383,95%CI:1.74-21.089.CONCLUSION H.pylori eradication rate was lower than expected.Post-treatment testing is crucial to confirm eradication and guide further management,such as susceptibility testing.
文摘Considering the recommended indications for Helicobacter pylori(H.pylori)eradication therapy and the broad spectrum of available diagnostic methods,a reliable diagnosis is mandatory both before and after eradication therapy.Only highly accurate tests should be used in clinical practice,and the sensitivity and specificity of an adequate test should exceed 90%.The choice of tests should take into account clinical circumstances,the likelihood ratio of positive and negative tests,the cost-effectiveness of the testing strategy and the availability of the tests.This review concerns some of the most recent developments in diagnostic methods of H.pylori infection,namely the contribution of novel endoscopic evaluation methodologies for the diagnosis of H.pylori infection,such as magnifying endoscopy techniques and chromoendoscopy.In addition,the diagnostic contribution of histology and the urea breath test was explored recently in specific clinical settings and patient groups.Recent studies recommend enhancing the number of biopsy fragments for the rapid urease test.Bacterial culture from the gastric biopsy is the gold standard technique,and is recommended for antibiotic susceptibility test.Serology is used for initial screening and the stool antigen test is particularly used when the urea breath test is not available,while molecular methods have gained attention mostly for detecting antibiotic resistance.
文摘BACKGROUND A reliable test is essential for diagnosing Helicobacter pylori(H.pylori)infection,and crucial for managing H.pylori-related diseases.Serving as an excellent method for detecting H.pylori infection,histologic examination is a test that clinicians heavily rely on,especially when complemented with immunohistochemistry(IHC).Additionally,other diagnostic tests for H.pylori,such as the rapid urease test(CLO test)and stool antigen test(SA),are also highly sensitive and specific.Typically,the results of histology and other tests align with each other.However,on rare occasions,discrepancy between histopathology and other H.pylori diagnostic tests occurs.AIM To investigate the discordance between histology and other H.pylori tests,the underlying causes,and the impact on clinical management.METHODS Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018.Reports were included in the study only if there were other H.pylori tests within seven days of the biopsy.These additional tests include CLO test,SA,and H.pylori culture.Concordance between histopathology and other tests was determined based on the consistency of results.In instances where histology results were negative while other tests were positive,the slides were retrieved for re-assessment,and the clinical chart was reviewed.RESULTS Of 1396 pathology reports were identified,each accompanied by one additional H.pylori test.The concordance rates in detecting H.pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments.117 discrepant cases were identified.Only 20 cases(9 with CLO test and 11 with SA)had negative biopsy but positive results in other tests.Four cases initially stained with Warthin-Starry turned out to be positive for H.pylori with subsequent IHC staining.Among the remaining 16 true discrepant cases,10 patients were on proton pump inhibitors before the biopsy and/or other tests.Most patients underwent treatment,except for two who were untreated,and two patients who were lost to follow-up.CONCLUSION There are rare discrepant cases with negative biopsy but positive in SA or CLO test.Various factors may contribute to this inconsistency.Most patients in such cases had undergone treatment.
文摘Background:After alleged stop of transmission of schistosomiasis and further down the line in post elimination settings,sensitive tools are required to monitor infection status to prevent potential re-emergence.In Rahala,where transmission cycle of Schistosoma haematobium is interrupted since 2004 but where 30%of snails are still infected by S.bovis,potential human S.bovis infection can’t be excluded.As methods based on egg-counts do not provide the required sensitivity,antibody or antigen assays are envisaged as the most appropriate tools for this type of monitoring.Methods:In this pilot study,the performances of three assays were compared:two commercially available antibody tests(ELISA and haemagglutination format)indicating exposure,and an antigen test(lateral flow strip format)demonstrating active infection.All 37 recruited study participants resided in Rahala(Akka,province Tata,Morocco).Participants had been diagnosed and cured from schistosomiasis in the period between 1983 and 2003.In 2015 these asymptomatic participants provided fresh clinical samples(blood and urine)for analysis with the aforementioned diagnostics tests.Results:No eggs were identified in the urine of the 37 participants.The haemagglutination test indicated 6 antibody positives whereas the ELISA indicated 28 antibody positives,one indecisive and one false positive.ELISA and haemagglutination results matched for 18 individuals,amongst which 5 out of 6 haemagglutination positives.With the antigen test(performed on paired serum and urine samples),serum from two participants(cured 21 and 32 years ago)indicated the presence of low levels of the highly specific Schistosoma circulating anodic antigen(CAA),demonstrating low worm level infections(less than 5 pg/ml corresponding to probably single worm pair).One tested also CAA positive with urine.ELISA indicated the presence of human anti-Schistosoma antibodies in these two CAA positive cases,haemagglutination results were negative.Conclusions:To prevent reemergence of schistosomiasis in Morocco current monitoring programs require specific protocols that include testing of antibody positives for active infection by the UCP-LF CAA test,the appropriate diagnostic tool to identify Schistosoma low grade infections in travelers,immigrants and assumed cured cases.The test is genus specific will also identify infections related to S.bovis.
文摘Background:The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus(GAS)positive cases with penicillin.The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit.Methods:We analyzed retrospectively the data on microbiological studies and blood tests done,and data on prescribing of antibiotics,of 200 children admitted for febrile exudative tonsillitis.Results:After the clinical diagnosis of exudative tonsillitis,antigen test and/or culture for GAS identifi cation was done in>95%of cases.All the 32(16%)children with GAS infection,but also 52(38%)of the 137 children without any evidence of bacterial infection received antibiotics.Additional laboratory studies were done in 96%of children.Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis.No serious bacterial infection was diagnosed.Conclusions:The Finnish Current Care Guidelines lead to over-treatment with antibiotics.None of the 200 children returned after discharge,suggesting that undertreatment did not happen.
文摘A recent article Is onchocerciasis elimination in Africa feasible by 2025:a perspective based on lessons learnt from the African control programmesH in Infectious Diseases of Poverty claimed that undue influence on African programs by concepts developed by the Onchocerciasis Elimination Program of the Americas(OEPA)is detrimental to stopping mass drug administration(MDA)in Africa.This claim is made despite a record year for MDA stoppage in four African countries of>3.5 million treatments in 2018,far exceeding any past OEPA or African Program for Onchocerciasis Control(APOC)stop MDA success.
