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Prevalence of tick-borne encephalitis (TBE) is increasing in much of Europe. In May 2024, an autochthonous pediatric case of TBE was diagnosed in a 6-year-old girl in Belgium. Clinicians should recognize the symptoms and signs of TBE infections and consider this disease in patients with unexplained neurologic symptoms, regardless of travel history.

Background With the spread of coronavirus disease 2019 (COVID-19), an existing national laboratory-based surveillance system was adapted to daily monitor the epidemiological situation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Belgium by following the number of confirmed SARS-CoV-2 infections, the number of performed tests and the positivity ratio. We present these main indicators of the surveillance over a one-year period as well as the impact of the performance of the laboratories, regarding speed of processing the samples and reporting results, for surveillance. Methods We describe the evolution of test capacity, testing strategy and the data collection methods during the first year of the epidemic in Belgium. Results Between the 1 st of March 2020 and the 28 th of February 2021, 9,487,470 tests and 773,078 COVID-19 laboratory confirmed cases were reported. Two epidemic waves occurred, with a peak in April and October 2020. The capacity and performance of the laboratories improved continuously during 2020 resulting in a high level performance. Since the end of November 2020 90 to 95% of the test results are reported at the latest the day after sampling was performed. Conclusions Thanks to the effort of all laboratories a performant exhaustive national laboratory-based surveillance system to monitor the epidemiological situation of SARS-CoV-2 was set up in Belgium in 2020. On top of expanding the number of laboratories performing diagnostics and significantly increasing the test capacity in Belgium, turnaround times between sampling and testing as well as reporting were optimized over the first year of this pandemic.

The knowledge of circulating HCV genotypes and subtypes in a country is crucial to guide antiviral therapy and to understand local epidemiology. Studies investigating circulating HCV genotypes and their trends have been conducted in Belgium. However they are outdated, lack nationwide representativeness or were not conducted in the general population. In order to determine the distribution of different circulating HCV genotypes in Belgium, we conducted a multicentre study with all the 19 Belgian laboratories performing reimbursed HCV genotyping assays. Available genotype and subtype data were collected for the period from 2008 till 2015. Furthermore, a limited number of other variables were collected: some demographic characteristics from the patients and the laboratory technique used for the determination of the HCV genotype. For the study period, 11,033 unique records collected by the participating laboratories were used for further investigation. HCV genotype 1 was the most prevalent (53.6%) genotype in Belgium, with G1a and G1b representing 19.7% and 31.6%, respectively. Genotype 3 was the next most prevalent (22.0%). Further, genotype 4, 2, and 5 were responsible for respectively 16.1%, 6.2%, and 1.9% of HCV infections. Genotype 6 and 7 comprise the remaining <1%. Throughout the years, a stable distribution was observed for most genotypes. Only for genotype 5, a decrease as a function of the year of analysis was observed, with respectively 3.6% for 2008, 2.3% for 2009 and 1.6% for the remaining years. The overall M:F ratio was 1.59 and was mainly driven by the high M:F ratio of 3.03 for patients infected with genotype 3. Patients infected with genotype 3 are also younger (mean age 41.7 years) than patients infected with other genotypes (mean age above 50 years for all genotypes). The patients for whom a genotyping assay was performed in 2008 were younger than those from 2015. Geographical distribution demonstrates that an important number of genotyped HCV patients live outside the Belgian metropolitan cities. This national monitoring study allowed a clear and objective view of the circulating HCV genotypes in Belgium and will help health authorities in the establishment of cost effectiveness determinations before implementation of new treatment strategies. This baseline characterization of the circulating genotypes is indispensable for a continuous surveillance, especially for the investigation of the possible impact of migration from endemic regions and prior to the increasing use of highly potent direct-acting antiviral (DAA) agents.

Chlamydia psittaci is an established zoonotic agent causing respiratory disease in humans. An infection often remains asymptomatic but can also result in flu-like illness, pneumonia or even multi-organ failure. This paper describes three patients, hospitalised at AZ Sint-Lucas Hospital, with atypical pneumonia who were diagnosed with C. psittaci after an in-depth anamnesis and laboratory investigation in the midst of the COVID pandemic. All three infections were confirmed with PCR and serology, whereas viable bacteria were only present for one patient. Genotyping revealed the presence of genotype B for patient 1 and 2 whereas ompA genotyping was unsuccessful for patient 3. This case report demonstrates the importance of a thorough patient history as close contact with birds is one of the main risk factors to contract the pathogen. Once exposure to birds has been confirmed, a diagnosis by a combination of PCR and serology is essential in order to initiate a treatment with the proper antibiotics. As psittacosis is still an underestimated and underdiagnosed disease, communication between laboratory, clinicians and bird fanciers is encouraged.

Background Urinary antigen testing for Streptococcus pneumoniae (PAgT) is simple, rapid, and can still be used days after initiation of antibiotic therapy or when conventional methods are failing. PAgT is recommended by international guidelines in severe community acquired pneumonia (CAP). The test attains an excellent specificity (>90%) in adults but shows a varying sensitivity (60–85%). We aimed to analyze the PAgT sensitivity in a population with blood culture proven invasive pneumococcal disease (IPD) and to study its performance for the different pneumococcal serotypes. Methods PAgT (BinaxNOW®, Alere®) was introduced in 2009 in a large secondary care hospital in Ghent, Belgium. PAgT is requested by the attending physician or the clinical microbiologist in case of IPD suspicion. Pneumococci from blood are identified by standard methods (optochin susceptibility and bile solubility) and serotyped by the national reference center. Overall PAgT performance and test sensitivity for different serotypes were calculated. Results Over a 9-year period, (2009–2017), 235 bacteremia episodes in 234 patients were observed with an average of 26 episodes/year (range 12–36). 31/235 (13%) episodes occurred in pediatric patients. Most prevalent serotypes were 1, 12, 8, 3, 7, 9, 5, and 6 for the whole time period. PAgT was performed in 161/235 (69%), test execution for the individual most prevalent serotypes ranged from 55 to 86%. 99/161(61%) PAgT were positive. PAgT positive results varied according to the most prevalent serotypes: >70% for types 1, 3, 7and 5, 50% for type 9 and <50% for types 12, 8 and 6. From 2014 on, disappearance of serotype 1 and a significant decrease in serotype 7 were observed. Conclusion A 70% compliance to the diagnostic algorithm for IPD was observed. PAgT detects C-polysaccharide (teichoic acid) on the pneumococcal cell wall. Differences in concentration for the individual serotypes have been described and may account for the varying sensitivity in our dataset. Introduction of 10/13-valent childhood pneumococcal vaccines (2014) in Belgium has changed the overall serotype distribution, also possibly leading to a shift in PAgT performance. A dynamic validation of PAgT accuracy remains warranted. Disclosures All authors: No reported disclosures.

Kaposi’s sarcoma (KS) is a rare cutaneous tumor caused by human herpes virus-8 (HHV-8) infection that preferentially develops in case of severe immunosuppression, such as in HIV/AIDS disease. Haptoglobin (Hp), a polymorphic multifunctional plasma protein, exerts several immunomodulatory effects and is characterized by a genetic polymorphism leading to three major phenotypes (Hp 1-1, Hp 2-1 and Hp 2-2). This study investigated the influence of Hp genetic polymorphism on the development of KS in HIV-positive patients. 661 HIV patients were enrolled in the study with a median age of 35 years and a median follow-up time of 57 months. Hp phenotyping was performed using hemoglobin-supplemented starch gel electrophoresis. In case of low Hp concentration high pressure gel permeation chromatography (HPGPC) was used. The Hp 1-1 phenotype was associated with a significant higher risk of KS compared to the combined group of Hp 2-1 and Hp 2-2 patients ( p  < 0.0005) which remained significant after adjustment for possible confounding variables (age, gender and AIDS status) ( p  < 0.001). In contrast, the Hp 2-1 phenotype carried the lowest risk. These findings point to the involvement of Hp phenotypes in the pathogenesis of KS, which may be due to a difference in skin immunosurveillance between the Hp phenotypes.

Congenital toxoplasmosis (CT) and cytomegalovirus infection (cCMV) may cause significant morbidity and even fetal or neonatal mortality. We aimed to quantify the disease burden of CT and cCMV in Belgium in terms of disability-adjusted life years (DALYs) and identify data gaps. The public health impact of CT and cCMV in Belgium in 2013 was 188 (95% uncertainty interval [UI], 43–419) and 1976 (95% UI, 757–4067) DALYs, respectively. The major data gaps identified were representative Belgian studies; information on important sequelae, intrauterine mortality, and termination of pregnancy; and late onset sequelae. A scenario analysis showed important increases in years of life lost when the burden due to fetal losses was included and decreases in DALYs when comprehensive CT prevention measures were conducted. Addressing the key data gaps identified may allow generation of the data needed to break the vicious circle of underrecognition.

Enterococcus cecorum septicemia is rare in humans. This case describes a man with underlying liver cirrhosis, a comorbidity that contributes to half of the E. cecorum infections described in the current literature. The patient was successfully treated with ceftriaxone. Identification of this species was accurately made with Matrix-Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry and confirmed by 16S rDNA sequencing.

Enterococcus cecorum is a pathogen rarely involved in human infections. The rarity of these infections can be explained by the fact that E. cecorum is difficult to identify correctly and has probably been underestimated in the past. We report a case of a 78-year old man with underlying liver cirrhosis diagnosed with E. cecorum sepsis, who was successfully treated with a cephalosporin of third generation (C3). Flight Mass Spectrometry (MALDI-TOF®) was used to identify the pathogen and confirmed by 16S rDNA sequencing. In addition, we review previous cases withholding a common risk factor. Remarkably, half of the cases, including our case, had underlying decompensated liver cirrhosis. Meat-mediated origin has been hypothesized as the source of infection (ingestion of colonized poultry meat), impairment of neutrophil function by PPIs has been reported (increasing the risk of bacterial infection in this case) and difference in penicillin-binding proteins (due to phylogenetic difference) than those from other Enterococci species (E. faecaüs and E. faecium) make this pathogen susceptible for ceftriaxone. In conclusion, underlying decompensated liver cirrhosis and use of PPI may constitute an important risk factor for an E. cecorum infection in humans. The isolation and identification of this species remains a challenge. Phylogenetic differences of species has an impact of AB choice due to differences in AB resistance. Surveillance of veterinary pathogens, especially when it comes to bacterial resistance, might be more important in the near future, particularly with the upcoming patients with a state of immune-deficiency and in the context of bacterial pathogens that (might) play a role in both humans and animals.

Pterygium is a common eye disease, linked to an increased exposure to UV radiation and dry environments. The associated pathology culminates in visual impairment and, in some rare cases, blindness. However, there remains a lot of uncertainty concerning the pathogenesis of this fibrovascular lesion. As the composition of the tear film provides a reflection into the pathological changes at the ocular surface, tear analysis represents an ideal approach to gain insight in the progression of disease following pterygiectomy. This study enrolled 19 patients and age/gender-matched healthy controls. Tear film levels of interleukin- (IL-) 6, IL-8, and vascular endothelial growth factor (VEGF) were investigated over time, and preoperative concentrations were linked to corneal neovascularization and pterygium size. Diminished tear film levels were found in unilateral patients who show no clinical signs of pterygium recurrence over a period of one year. Hence, our results highlight the potential of using the course of IL-6, IL-8, and VEGF levels in tears as biomarkers for recovery. In addition, when focusing on the affected eyes (i.e., primary and recurrent pterygium), we detected fold changes in preoperative cytokine concentrations to correspond with disease severity. As our proposed biomarkers did not reveal a linear relationship with corneal neovascularization nor the invasive behaviour of pterygium, no exact role in the pterygium pathology could be established. Hence, our data point to these factors being contributors rather than decisive players in the pathological processes.