In contrast to transplant recipients, there is a paucity of data regarding frequency and clinical significance of viraemia in children receiving conventional chemotherapy. In a prospective observational study, we assessed the frequency of and clinical impact of viraemia with cytomegalovirus (CMV), Epstein-Barr virus (EBV), adenovirus, human herpesvirus-6 (HHV6) and herpes-simplex virus 1/2 (HSV1/2) in paediatric cancer patients at diagnosis, at a routine examination during intensive chemotherapy, and during febrile neutropenia (FN). Seventy-nine patients (median age 6 years; 66 children with haematological malignancies) were included in the study. Overall, 362 blood samples were analysed, 72 from the time at diagnosis (11.1% with positive PCR result), 118 during a regular control after chemotherapy (11.0% positive), and 159 during FN (8.8% positive). The overall positivity rate was 9.6% (CMV 3.3%, HHV6 2.7%, HSV 2.2%, EBV 0.8% and adenovirus 0.3%). There were no significant differences between FN episodes with and without viraemia in terms of duration of fever or neutropenia/lymphopenia, severity of mucositis (> II0), incidence of diarrhea and ICU admission. Our results indicate that viraemia in paediatric cancer patients generally does not have a major clinical impact, and may help in the decision regarding the indication of routine evaluation for viraemia in febrile neutropenic, but otherwise asymptomatic children.

Hepatitis B virus (HBV) is a frequent cause of chronic hepatitis worldwide, with an estimated 5.6 million children under 5 years being infected. In Romania, there are no available epidemiology reports on large cohorts in children. We aimed to assess the profile of pediatric chronic HBV infection in southern Romania. We conducted an observational retrospective study on 506 HBV-infected children. Based on alaninaminotransferase (ALT), HBV serology and viremia, we identified four states of the disease. We correlated age, gender, household HBV infection, coinfection with other viruses and laboratory parameters. Most patients were in a positive HBV envelope antigen (HBeAg) immune-active state (65.4%). Age at diagnosis was significantly lower for those with household infection (p < 0.05). ALT values were not significantly different between positive or negative HBeAg patients in the immune-active state (p = 0.780). ALT values were higher in patients with hepatitis D virus (HDV)-associated infection (p < 0.001). Children with a household HBV infection had a high viraemia more frequently when compared to those with no infected relative (79.3% vs. 67.4%) (p < 0.001), but the ALT values were not significantly different (p = 0.21). Most of the patients are in an immune-active state (high ALT, high viremia). The percentages of HBV- and HDV-associated infections are high, but lower than the reported prevalence in Romania in the general population.

We report the first case of monkeypox virus (MPXV) associated acute respiratory distress syndrome (ARDS). A 34-year-old French woman with no medical history was admitted to the intensive care unit (ICU) for fever, altered mental status, hypotension and hypoxaemia. She presented with a diffuse skin rash with vesiculopustular lesions involving the four limbs and perineal ulcers with a skin swab positive for MPXV. On day 2, the patient presented moderate ARDS requiring invasive mechanical ventilation. She also had pleural empyema due to Streptococcus pyogenes. MPXV PCR was positive in the bronchoalveolar lavage, the pleural effusion and the blood. The patient was treated with tecovirimat. Despite the treatment, she had persistent viraemia for at least ten days. The patient condition rapidly improved; she was weaned from mechanical ventilation on day 18 despite the persistence of radiological lung opacities. She fully recovered and was discharged home on day 38 after admission.
CONCLUSIONS: This is the first case of monkeypox virus associated ARDS in a young woman with no medical historyBiological follow-up showed disseminated MPXV and persistent viraemiaTecovirimat was well tolerated.

Hepatitis E virus (HEV) is considered an emerging threat in Europe, owing to the increased number of human cases and the widespread presence of the virus in pigs at farms. Most cases in industrialized countries are caused by the zoonotic HEV-3 genotype. The main transmission route of HEV-3 in Europe is foodborne, through consumption of raw or undercooked liver pork and wild boar meat. Pigs become susceptible to HEV infection after the loss of maternal immunity, and the majority of adult pigs test positive for IgG anti-HEV antibodies. Nonetheless, HEV-infected pigs in terms of liver, faeces, and rarely blood are identified at slaughterhouses. The present study aimed to investigate the prevalence of HEV-positive batches of Italian heavy pigs at slaughterhouses, assessing the presence of animals still shedding HEV upon their arrival at the slaughterhouse by sampling faeces collected from the floor of the trucks used for their transport. The occurrence of viraemic animals and the seroprevalence of anti-HEV antibodies were also assessed. The results obtained indicated the presence of anti-HEV IgM (1.9%), and a high seroprevalence of anti-HEV total antibodies (IgG, IgM, IgA; 89.2%, n = 260). HEV RNA was not detected in either plasma or faecal samples. Nevertheless, seropositive animals were identified in all eight batches investigated, confirming the widespread exposure of pigs to HEV at both individual and farm levels. Future studies are needed to assess the factors associated with the risk of HEV presence on farms, with the aim to prevent virus introduction and spread within farms, thereby eliminating the risk at slaughterhouse.

Droplet digital PCR (ddPCR) recently has been shown to be a potential diagnostic tool for adults with bloodstream infections (BSIs); however, its application in children remains obscure. In this study, 76 blood samples of children with suspected BSIs were synchronously detected by traditional blood cultures (BCs) and ddPCRs. Our team validated the diagnostic performance of ddPCR including sensitivity, specificity, and positive and negative predictive values. The 76 pediatric patients from the hematology department (67.1%), the pediatric intensive care unit (PICU, 27.6%), and other departments (5.2%) were enrolled. The positive rate of ddPCR results was 47.9%, whereas that for BC was 6.6%. In addition, the time consumption of ddPCR was shorter, only for 4.7 ± 0.9 h, in comparison with the detection timing of BC (76.7 ± 10.4 h, p < 0.01). The levels of agreement and disagreement between BC and ddPCR were 96.1% and 4.2%, and the negative agreement reached 95.6%. The sensitivity of ddPCR was 100%, with corresponding specificities ranging from 95.3 to 100.0%. In addition, a total of nine viruses were identified by ddPCR. In China, the multiplexed ddPCR first could be a tool for the rapid and accurate diagnosis of children with suspected BSIs and can be an early indicator of the possibility of viraemia in children with immunosuppression.

UNASSIGNED: Worldwide, 5-10% of people with chronic hepatitis B virus infection are co-infected with hepatitis D virus. In Qatar, there are no data on hepatitis D virus infection among patients positive for hepatitis B surface antigen (HBsAg).
UNASSIGNED: To determine the seroprevalence of hepatitis D virus infection among patients with chronic hepatitis B virus infection in Qatar and assess the characteristics of these patients.
UNASSIGNED: This was a retrospective cohort study of all HBsAg-positive individuals tested for hepatitis D virus between 1 January 2010 and 29 December 2019 within the Hamad Medical Corporation. Data were retrieved from electronic records and included demographic and clinical information of the patients.
UNASSIGNED: Of the 2348 HBsAg-positive patients, 125 were positive for hepatitis D virus (seroprevalence 5.3%). The median age of hepatitis D positive patients was significantly higher than for hepatitis D negative patients (P = 0.001). Most of the patients with hepatitis D had a hepatitis B viral load < 2000 IU/mL (53.6%) and were negative for hepatitis B e antigen (93.6%). A significantly greater proportion of hepatitis D positive patients than hepatitis D negative patients were infected with hepatitis C virus (P < 0.001), and had liver cirrhosis (P < 0.001) and hepatocellular carcinoma (P = 0.006).
UNASSIGNED: Hepatitis D virus infection is associated with lower hepatitis B virus viraemia and more advanced liver disease in the study population.
الانتشار المصلي والنتائج السريرية للعدوى بالتهاب الكبد D في قطر.
تسنيم عبد الله، توحيدة إبراهيم، محمد حاج موسى، محمد عبد القيوم، عفراء الحسن،، علياء أبو سبيب، مني بابكر، شيماء عبد الرحيم، جوان دغفل، معتز دربالة.
UNASSIGNED: لقد وجد أن 5–10٪ من المصابين بعدوى مزمنة بفيروس التهاب الكبد B على مستوى العالم، مصابون أيضًا بفيروس التهاب الكبد D. ولكن في قطر لا توجد بيانات عن عدوى فيروس التهاب الكبد D بين المرضى الإيجابيين للمستضد السطحي لالتهاب الكبد B (HBsAg).
UNASSIGNED: هدفت هذه الدراسة الى تحديد الانتشار المصلي لعدوى فيروس التهاب الكبد D بين المصابين بعدوى مزمنة بفيروس التهاب الكبد B في قطر، وتقييم السمات المميزة لهؤلاء المرضى.
UNASSIGNED: هذه الدراسة دراسة أترابية استعادية لجميع الأشخاص الإيجابيين للمستضد السطحي لالتهاب الكبد B، الذين أُجري لهم اختبار الكشف عن فيروس التهاب الكبد D بين 1 يناير / كانون الثاني 2010 و29 ديسمبر / كانون الأول 2019 ضمن مؤسسة حمد الطبية. وقد استُُرجعت البيانات من السجلات الإلكترونية وشملت السمات السكانية والبيانات السريرية للمرضى.
UNASSIGNED: من بين المرضى الإيجابيين للمستضد السطحي لالتهاب الكبد B، البالغ عددهم 2348 مريضًا، كان هناك 125 مريضًا إيجابيًّا لفيروس التهاب الكبد D (الانتشار المصلي 5.3٪). وكان العمر الوسيط للمرضى الإيجابيين لالتهاب الكبد D أكبر بكثير منه للمرضى السلبيين لالتهاب الكبد D (القيمة الاحتمالية = 0.001). وعند معظم المرضى المصابين بالتهاب الكبد D، كان الحمل الفيروسي لفيروس التهاب الكبد B أقل من 2000 وحدة دولية/ ميلِِّّي لتر (53.6٪) وكانت نتائجهم سلبية لمستضد e لالتهاب الكبد (93.6٪). وعند المقارنة بين المرضى الإيجابيين لالتهاب الكبد D والمرضى السلبيين له، كانت نسبة الإصابة أكبر بكثير بين المرضى الإيجابيين، وذلك لفيروس التهاب الكبد C (القيمة الاحتمالية < 0.001)، وتشمُّع الكبد (القيمة الاحتمالية < 0.001)، والورم الكبدي الخبيث (القيمة الاحتمالية = 0.006).
UNASSIGNED: ترتبط الإصابة بفيروس التهاب الكبد D بانخفاض انتقال فيروس التهاب الكبد B عبر مجرى الدم والإصابة بمرض الكبد الأكثر تقدمًا لدى الفئة الخاضعة للدراسة.
Séroprévalence et issue clinique de l\'infection par le virus de l\'hépatite D au Qatar.
UNASSIGNED: À l\'échelle mondiale, 5 à 10 % des personnes atteintes d\'une hépatite B chronique sont co-infectées par le virus de l\'hépatite D. Au Qatar, on ne dispose d\'aucune donnée sur l\'infection par le virus de l\'hépatite D chez les patients positifs pour l\'antigène de surface du virus de l\'hépatite B (HBsAg).
UNASSIGNED: Déterminer la séroprévalence de l\'infection par le virus de l\'hépatite D chez les patients atteints d\'hépatite B chronique au Qatar et évaluer les caractéristiques de ces patients.
UNASSIGNED: Il s\'agissait d\'une étude de cohorte rétrospective de toutes les personnes positives pour l\'antigène de surface du virus de l\'hépatite B ayant subi un test de dépistage du virus de l\'hépatite D entre le 1er janvier 2010 et le 29 décembre 2019 au sein des établissements de la Hamad Medical Corporation. Les données ont été extraites de dossiers électroniques et comprenaient des informations démographiques et cliniques sur les patients.
UNASSIGNED: Sur les 2348 patients positifs pour l\'HBsAg, 125 étaient positifs pour le virus de l\'hépatite D (séroprévalence de 5,3 %). L\'âge médian des patients positifs au virus de l\'hépatite D était significativement plus élevé que celui des patients négatifs à ce même virus (p = 0,001). La plupart des patients atteints d\'hépatite D avaient une charge virale pour l\'hépatite B inférieure à 2000 UI/mL (53,6 %) et étaient négatifs pour l\'antigène e du virus de l\'hépatite B (93,6 %). Une proportion significativement plus importante de patients positifs au virus de l\'hépatite D par rapport aux patients négatifs à ce même virus étaient infectés par le virus de l\'hépatite C (p < 0,001) et présentaient une cirrhose (p < 0,001) et un carcinome hépatocellulaire (p = 0,006).
UNASSIGNED: L\'infection par le virus de l\'hépatite D est associée à une virémie plus faible du virus de l\'hépatite B et à une maladie hépatique plus avancée dans la population de l\'étude.

Introduction. Human bocavirus 1 (HBoV1) infection occurs with viral genome presence in respiratory secretions (RS) and serum, and therefore both samples can be used for diagnosis.Gap statement. The diagnostic sensitivity of HBoV1 DNA detection in serum and the duration of DNAaemia in severe clinical cases have not been elucidated.Aim. To determine HBoV1 DNA in serum and RS of paediatric patients hospitalized for lower acute respiratory infection (LARI) and to analyse the clinical-epidemiological features of positive cases.Methodology. This was a prospective, transverse study. Physicians selected the clinical situations and obtained paired clinical samples (RS and serum) that were tested by PCR/qPCR for HBoV1. Positive cases were analysed considering time of specimen collection, co-detection, clinical manifestations and viral load; statistical significant level was set at α=0.05.Results. HBoV1 was detected in 98 of 402 cases included (24 %); 18/98 (18 %) patients had the virus detectable in serum and 91/98 (93 %) in RS (P<0.001). Positivity rates were not significantly different in patients with RS and serum collected within or beyond 24 h of admission. Single HBoV1 infection was identified in 39/98 patients (40 %), three patients had HBoV1 in both clinical samples (3/39, 8 %) and 32 (32/39, 82 %) only in RS, 22 of them (69 %) with both clinical samples within 24 h of admission. Cough (P=0.001) and rhinitis (P=0.003) were significantly frequent among them and most patients were diagnosed with bronchiolitis (22/39, 56 %) and pneumonia (9/39, 23 %), which was more frequent compared to cases with co-infection (P=0.04). No significant differences were identified among patients with high, medium or low viral load of HBoV1 regarding rate of positivity in both clinical samples, the time of collection of RS and serum, co-detection, first episode of LARI, clinical manifestations, comorbidity or requirement for assisted ventilation. Intensive care unit (ICU) patients had a significantly higher frequency of detection (P<0.001) and co-detection (P=0.001) compared to patients on standard care.Conclusions. HBoV1 is prevalent among infant patients hospitalized for LARI and including it in the standard testing can add to the aetiological diagnosis in these cases, especially for patients admitted to the ICU. HBoV1 detection in serum did not contribute significantly to the diagnosis as compared to detection in respiratory secretions.

UNASSIGNED: Human herpes simplex virus-6 (HHV-6) is the causative agent of exanthema subitum. Transmission mainly occurs through salivary secretions, yet blood transfusions and organ transplantations have also been reported as routes of transmission. Studies of seroprevalence of HHV-6 in the Middle East and North Africa (MENA) region and other parts of Asia are scarce. As such, this study aimed to estimate the seroprevalence of HHV-6 among healthy blood donors in Qatar.
UNASSIGNED: In total, 620 healthy blood donors from different nationalities residing in Qatar, mainly from the MENA region and Southeast Asia, were tested using a commercial anti-HHV-6 immunoglobulin G (IgG) enzyme-linked immunosorbent assay kit. In addition, HHV-6 DNA from randomly selected samples was tested and quantified using quantitative reverse transcriptase polymerase chain reaction.
UNASSIGNED: Anti-HHV-6 IgG was detected in 71.7% (445/620) [95% confidence interval (CI) 68.2-75.3%] of the tested samples, while 24.3% (61/251) (95% CI 20.0-29.6%) had detectable HHV-6 viraemia. Only 22.5% of individuals with positive IgG status had detectable HHV-6 DNA in their blood, indicating a weak association between viraemia and IgG positivity (P=0.08). Furthermore, no significant difference was associated between HHV-6 viraemia and demographic characteristics, except for nationality.
UNASSIGNED: The seroprevalence of HHV-6 in Qatar was found to be similar to rates reported in other parts of the world.

In Cameroon, COVID-19 infection spread rapidly and nationwide, with up to 721 deaths reported. To the best of our knowledge, no study reported the on-theground data using a large patients\' dataset to give a comprehensive knowledge on COVID-19 pandemic in Cameroon. The objective of this study was to shade lights on the epidemiological, virological and clinical features of COVID-19 in the Cameroonian context. An observational study was conducted among symptomatic and asymptomatic individuals tested for SARS-CoV-2 by PCR on nasopharyngeal samples from April 22nd, 2020 to January 5th, 2021. Out of 14119 individuals (59.8% male), overall SARS-CoV-2 positivity was 12.7% (from 7.9% in <10 years to 17.3% in >60 years, p<0.001). The positivity rate of symptomatic individuals was 36.1% versus 9.8% among asymptomatic ones, p<0.001. Age group ≤10 [aOR (95%CI): 0.515 (0.338-0.784), p=0.002] and being symptomatic [aOR (95% CI): 5.108 (4.521-5.771), p<0.001] were predictors of SARS-CoV-2 positivity. Regarding PCR Cycle Threshold (CT), 53.8% of positive individuals had a CT <30. According to age, compared to older individuals, those aged 21-40 years showed a higher proportion with high viraemia (CT<20; 21.3% versus 12.5% respectively, p=0.003). Similarly, symptomatic individuals showed a higher proportion with high viraemia (22.4%), when compared to asymptomatic (13.9%); p<0.001. During this first wave of the pandemic, overall SARS-CoV-2 positivity remained high (>10%) and was associated with the presence of symptoms and older age. Most of the infection is among young and asymptomatic individuals, suggesting the \"track-and-test\" strategy should target these potential transmitters.

Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmission risk. Methods: To formulate this narrative review, a comprehensive literature search was performed to analyse results of existing clinical trials examining KT from HCV-positive donors to HCV-negative recipients with peri-operative DAA regimes. Results: 13 studies were reviewed (11 single centre, four retrospective). Outcomes for 315 recipients were available across these studies. A sustained virological response at 12 weeks (SVR12) of 100% was achieved in 11 studies. One study employed an ultra-short DAA regime and achieved an SVR12 of 98%, while another achieved SVR12 of 96% due to treatment of a missed mixed genotype. Conclusion: HCV+ KT is safe and may allow increased utilisation of organs for transplantation from HCV+ donors, who often have other favourable characteristics for successful donation. Findings from US clinical trials can be applied to the United Kingdom transplant framework to improve organ utilisation as suggested by the NHSBT vision strategy \"Organ Donation and Transplantation 2030: meeting the need\".