BACKGROUND: The mechanisms that mediate immune protection in individuals with subclinical (SC) or asymptomatic infection with L. braziliensis are largely unknown. Neutrophils (PMNs) have been implicated in progressive symptomatic cutaneous leishmaniasis (CL), but their potential participation in maintenance of subclinical infection is unexplored. The aim of this study was to compare the phenotypic and functional profiles of PMNs in individuals with SC infection versus patients with symptomatic CL due to L. braziliensis.
METHODS: Subjects were recruited in the endemic region of Corte de Pedra, Bahia, Brazil. Surface markers to define activation status were characterized by flow cytometry. Functional responses of PMNs including phagocytic capacity, production of oxidative species, and oxidative killing of intracellular parasites were studied in vitro.
RESULTS: PMNs from individuals with SC infection displayed a more activated phenotype and greater ability to control the infection than PMNs from patients with CL. In contrast, PMNs from patients with CL exhibited higher expression of HLA-DR and higher production of oxidative species than PMNs from subjects with SC infection.
CONCLUSIONS: PMNs from individuals with SC infection can control the infection more efficiently than PMNs from patients with CL, despite the lower production of oxidants. Our observations suggest that L. braziliensis may evade microbicidal mechanisms of PMNs from patients with CL, contributing to parasite dissemination and the establishment of disease.

Hepatitis E virus (HEV) is hyperendemic in South Asia and Africa accounting for half of total Global HEV burden. There are eight genotypes of HEV. Among them, the four common ones known to infect humans, genotypes 1 and 2 are prevalent in the developing world and genotypes 3 and 4 are causing challenge in the industrialized world. Asymptomatic HEV viremia in the general population, especially among blood donors, has been reported in the literature worldwide. The clinical implications related to this asymptomatic viremia are unclear and need further exploration. Detection of viremia due to HEV genotype 1 infection, apparently among healthy blood donors is also reported without much knowledge about its infection rate. Similarly, while HEV genotype 3 is known to be transmitted via blood transfusion in humans and has been subjected to screening in many European nations, instances of transmission have also been documented albeit without significant clinical consequences. Epidemiology of HEV genotype 1 in endemic areas often show waxing and waning pattern. Occasional sporadic occurrence of HEV infection interrupted by outbreaks have been frequently seen. In absence of known animal reservoir, where HEV exists in between outbreak is a mystery that needs further exploration. However, occurrence of asymptomatic HEV viremia due to HEV genotype 1 during epidemiologically quiescent period may explain that this phenomenon may act as a dynamic reservoir. Since HEV genotype 1 infection cannot cause chronicity, subclinical transient infection and transmission of virus might be the reason it sustains in interepidemic period. This might be the similar phenomenon with SARS COVID-19 corona virus infection which is circulating worldwide in distinct phases with peaks and plateaus despite vaccination against it. In view of existing evidence, we propose the concept of \"Dynamic Human Reservoir.\" Quiescent subclinical infection of HEV without any clinical consequences and subsequent transmission may contribute to the existence of the virus in a community. The potential for transmitting HEV infection by asymptomatic HEV infected individuals by fecal shedding of virus has not been reported in literature. This missing link may be a key to Pandora\'s box in understanding epidemiology of HEV infection in genotype 1 predominant region.

Lumpy skin disease (LSD) is a transboundary viral infection, affecting cattle with characteristic manifestations involving multiple body systems. A distinctive characteristic of lumpy skin disease is the subclinical disease manifestation wherein animals have viremia and shed the virus through nasal and ocular discharges, while exhibiting no nodules but enlarged lymph nodes that are easily oversighted by inexperienced vets. Further research on the role of subclinically ill animals in the transmission of LSD virus (LSDV) can contribute to the development of more effective tools to control the disease worldwide. Thus, this study aims to determine the potential role of subclinical infection in virus transmission in a non-vector-borne manner. To achieve this, we inoculated animals with the recombinant vaccine-like strain (RVLS) Udmurtiya/2019 to cause clinical and subclinical LSDV infection. After the disease manifestation, we relocated the subclinically ill animals to a new clean facility followed by the introduction of another five animals to determine the role of RVLS-induced subclinical infection in the virus transmission via direct/indirect contact. After the introduction of the naïve animals to the relocated subclinically ill ones in a shared airspace, two introduced animals contracted the virus (clinically and subclinically), showing symptoms of fever, viremia, and seroconversion in one animal, while three other introduced animals remained healthy and PCR-negative until the end of the study. In general, the findings of this study suggest the importance of considering LSDV subclinical infection as a high-risk condition in disease management and outbreak investigations.

UNASSIGNED: The usual cause of a distal tibial fracture is a high-energy trauma. Although multiple options are available for their treatment such as intramedullary nailing, open plating, and external fixator, each of these options might result in a non-union. Knowing the type of non-union not only allows us to guess the cause but also directs us toward the best possible treatment. Despite this, we might still get surprises on the operating table due to pre-operative misdiagnosis.
UNASSIGNED: Reporting a case of a 42-year-old male with a 15-month-old left distal tibia non-union. The index injury was a grade 1 distal third tibia fibula fracture which was fixed with a plate and screws 15 months back. All the clinical and biochemical signs hinted toward the diagnosis of an aseptic non-union and the treatment was planned accordingly. However, intraoperative findings were much different due to which the surgeons had to improvise and change the intervention to an antibiotic-coated nail.
UNASSIGNED: Although each variety of non-union has its set of signs and symptoms, they can be misleading. Different etiologies can coexist making it difficult to give a perfect pre-operative diagnosis and management. Non-unions, especially in the tibia, thus need meticulous understanding of the underlying disease process and extensive treatment strategies.

BACKGROUND: Mycobacterium avium subspecies paratuberculosis (MAP) causes a chronic and progressive granulomatous enteritis and economic losses in dairy cattle in subclinical stages. Subclinical infection in cattle can be detected using serum MAP antibody enzyme-linked immunosorbent assay (ELISA) and fecal polymerase chain reaction (PCR) tests.
OBJECTIVE: To investigate the differences in blood parameters, according to the detection of MAP using serum antibody ELISA and fecal PCR tests.
METHODS: We divided 33 subclinically infected adult cattle into three groups: seronegative and fecal-positive (SNFP, n = 5), seropositive and fecal-negative (SPFN, n = 10), and seropositive and fecal-positive (SPFP, n = 18). Hematological and serum biochemical analyses were performed.
RESULTS: Although the cows were clinically healthy without any manifestations, the SNFP and SPFP groups had higher platelet counts, mean platelet volumes, plateletcrit, lactate dehydrogenase levels, lactate levels, and calcium levels but lower mean corpuscular volume concentration than the SPFN group (p < 0.017). The red blood cell count, hematocrit, monocyte count, glucose level, and calprotectin level were different according to the detection method (p < 0.05). The SNFP and SPFP groups had higher red blood cell counts, hematocrit and calprotectin levels, but lower monocyte counts and glucose levels than the SPFN group, although there were no significant differences (p > 0.017).
CONCLUSIONS: The cows with fecal-positive MAP status had different blood parameters from those with fecal-negative MAP status, although they were subclinically infected. These findings provide new insights into understanding the mechanism of MAP infection in subclinically infected cattle.

The aetiologic agent of COVID-19 is a novel coronavirus, SARS-CoV-2. Like other coronaviruses, it generally induces enteric and respiratory diseases in animals and humans. COVID-19 may be subclinical, and symptomatic, ranging from mild-to-severe disease. The spectrum of presentation is the result of several factors ranging from the inoculum size, inherent host susceptibility, possible cross-reacting circulating antibodies. Subclinical viral infections are associated with widespread community transmission and in some cases like Polio, herd immunity. An understanding of the biology and immune behavior in subclinical coronavirus disease 2019 (COVID-19) might be useful in the quest for vaccine development as well as the current control efforts against the COVID-19 pandemic. We carried out a narrative review of the available literature on the biology, etiopathogenesis, clinical manifestation of SARS-CoV-2 viral infection, focusing on our current understanding of the disease mechanisms and its clinical manifestation, and the host immune response to the infection. We also highlighted some of the research gaps regarding subclinical infection in COVID-19 and its potential application for vaccine development and other preventive efforts toward containing the current COVID-19 pandemic.

UNASSIGNED: Dengue infection is spreading worldwide. The clinical spectrum is broad and includes asymptomatic infections. This review provides an overview of the different proportions of asymptomatic infections described in epidemiological studies according to definitions, study designs, and detection methods.
UNASSIGNED: Medline and Embase databases were searched without restriction of date or language. Studies were included if they reported data on the incidence or prevalence of asymptomatic dengue infections. The data were summarized and classified according to the definitions of the term \'asymptomatic\'.
UNASSIGNED: A total of 74 studies were included. The mean proportion of asymptomatic infections among dengue-infected persons was 54% in 50 included studies. The prevalence of dengue infections detected in healthy persons was 0.2% in 24 included studies. The term \'asymptomatic\' has been used to refer to \'clinically undetectable infection\', but also to \'undiagnosed infection\' or \'mild infection\'. Only 8% were clinically undetectable laboratory-confirmed dengue infections.
UNASSIGNED: The proportion of asymptomatic dengue infections varied greatly. Studies proving data on clinically undetectable laboratory-confirmed dengue infections were very few, but provided consistent results of low proportions of asymptomatic infections. These data challenge the assumption that the majority of dengue cases are asymptomatic.

Lumpy skin disease virus (LSDV) is a vector-transmitted capripox virus that causes disease in cattle. Stomoxys calcitrans flies are considered to be important vectors as they are able to transmit viruses from cattle with the typical LSDV skin nodules to naive cattle. No conclusive data are, however, available concerning the role of subclinically or preclinically infected cattle in virus transmission. Therefore, an in vivo transmission study with 13 donors, experimentally inoculated with LSDV, and 13 naïve acceptor bulls was performed whereby S. calcitrans flies were fed on either subclinical- or preclinical-infected donor animals. Transmission of LSDV from subclinical donors showing proof of productive virus replication but without formation of skin nodules was demonstrated in two out of five acceptor animals, while no transmission was seen from preclinical donors that developed nodules after Stomoxys calcitrans flies had fed. Interestingly, one of the acceptor animals which became infected developed a subclinical form of the disease. Our results show that subclinical animals can contribute to virus transmission. Therefore, stamping out only clinically diseased LSDV-infected cattle could be insufficient to completely halt the spread and control of the disease.

BACKGROUND: The reliance on blood for thin and thick blood smear microscopy-using a relatively invasive procedure has presented challenges to the use of reliable diagnostic tests in non-clinical settings at the point-of-need (PON). To improve the capacity of non-blood-based rapid diagnostic tests to confirm subclinical infections, and thereby identify and quantify the human reservoir at the PON, a cross-sectoral collaboration between university researchers and commercial partners produced an innovative, non-invasive saliva-based RDT capable of identifying novel, non-hrp2/3 parasite biomarkers. While this new saliva-based malaria asymptomatic and asexual rapid test (SMAART-1) shows increased detection sensitivity and precision potential by identifying a new P. falciparum protein marker (PSSP17), appraising its utility in the field-particularly with respect to its adoption potential with children and adults in high risk, endemic regions-is necessary to warrant its continued development.
METHODS: The purpose of this study was to assess the acceptability and adoption potential of the SMAART-1 at select PON sites in the Kinshasa Province. Teachers, community health workers, nurses, and laboratory technicians participated in data collection at three distinct community sites in Kinshasa Province, Democratic Republic of the Congo. Three data collection methods were utilized in this mixed methods study to provide an overarching acceptability evaluation of the SMAART-1 at PON field sites: observation checklists of SMAART-1 implementation, focus group discussions, and surveys with local health care practitioners-particularly teachers and community health workers.
RESULTS: Findings indicate participants were interested in and supportive of the SMAART-1 protocol, with approximately 99% of the participants surveyed indicating that they either \"agreed\" or \"strongly agreed\" with the statement that they \"would use the saliva-based malaria asymptomatic rapid test as part of a community malaria detection and treatment programme.\" Data also suggest that the protocol was broadly appealing for its testing sensitivity and ease of use.
CONCLUSIONS: The SMAART-1 protocol\'s clinically reliable results demonstrate a promising new level of sensitivity and precision for detecting parasite biomarkers. This study\'s mixed-methods assessment of the protocol\'s utility and adoption potential in the field, with a target user audience, advances its development and points to opportunities to formalize and expand evaluation efforts.

Dogs are the only non-equid species to develop the fatal form of African horse sickness (AHS). Research conducted in 2013 questioned the long-held belief that naturally occurring cases of AHS in dogs were contracted exclusively through the ingestion of contaminated horse meat. Culicoides midges, the vector of AHS virus (AHSV) for horses, have an aversion to dog blood meals and dogs were believed to be dead-end or incidental hosts. More recently, dog mortalities have occurred in the absence of horse meat consumption and vector transmission has been suspected. The current study is a retrospective serological survey of AHSV exposure in dogs from an endemic area. Dog sera collected from dogs (n = 366) living in the city of Tshwane, Gauteng Province, South Africa, were randomly selected from a biobank at a veterinary teaching hospital, corresponding to the years 2014-2019. The study used a laboratory in-house indirect recombinant VP7 antigen-based enzyme-linked immunosorbent assay (iELISA) with a test cut-off calculated from AHSV exposure-free dog sera (n = 32). Study AHSV seroprevalence was 6 % (22/366) with an estimated true prevalence of 4.1 % (95 % confidence interval (CI) = 1.3-8.1 %). Incidence was estimated for dogs with multiple serological results with seroconversion occurring at a rate of 2.3 seroconversions per 10 dog years at risk (95 % CI = 0.6-6.2). A subsection of the study sera was tested with AHSV viral neutralisation test (VN) (n = 42) for serotype determination. Antibodies to AHSV serotype 6 were most prevalent (90 %) in VN seropositive dogs (n = 20) with most dogs seemingly subclinically infected (>95 %). Seroprevalence descriptively varied by year and identified risk factors were annual rainfall > 754 mm (odds ratio (OR) = 5.76; 95 % CI = 2.22 - 14.95; p < 0.001), medium human population densities, 783-1663 people/km2 (OR = 7.14; 95 % CI = 1.39 - 36.73; p = 0.019) and 1664-2029 people/km2 (OR = 6.74; 95 % CI = 1.40 - 32.56; p = 0.018), and the month of March (OR = 5.12; 95 % CI = 1.41 - 18.61; p = 0.013). All identified risk factors were consistent with midge-borne transmission to dogs. The relatively high seroprevalence and seroconversion rates suggest frequent exposure of dogs to AHSV and indicates the need to investigate the role dogs might play in the overall epidemiology and transmission of AHSV.