Sarah Anwar

As researchers continue to make strides in learning more about the mosquito-borne viruses that have been plaguing Brazil, a new study has found that the next disease epidemic to hit the country could be Chikungunya.

According to the results of a recently published 

 in Sergipe State, Brazil, were found to be “naturally infected” with the East-Central-South-African (ECSA) Chikungunya virus genotype. Although there have been thousands of Chikungunya cases identified in Brazil, until now, they have all been identified as travel-related.

The researchers collected 248 mosquitoes from inside and outside of homes in the urban areas of the city. Four mosquito strains were collected, the most common of which were 

 (20.2%) mosquitoes. The mosquitoes were tested for Zika, Dengue, and Chikungunya using QuantiTect Probe reverse transcription-polymerase chain reaction (qRT-PCR) and Mastercycler Realplex 2 thermocycler.

Mosquitoes from Aracuja were tested for these viruses because the city is known to be endemic for Dengue, and because Zika and Chikungunya cases had been confirmed in the city in 2016. In addition, studies have shown that co-infection with Zika and Chikungunya may lead to complications.

Of the collected mosquito pools, all pools tested negative for Zika and Dengue (genotypes 1-4). One female pool of 

 mosquitoes (38 mosquitoes) tested positive for Chikungunya virus, although all male pools (12 mosquitoes) tested negative. When the female mosquitoes in the 

 pool were individually tested, only one mosquito was positive for Chikungunya. According to the Centers for Disease Control and Prevention, 

 mosquitoes.” The authors note that they did not identify any 

 mosquitoes “in the inspected houses, although this species is endemic in Aracuja city.”

“Our findings constitute the first description of 

-[Chikungunya] genotype ECSA interaction in Brazil. These results reinforce the role of this species as an important vector of [Chikungunya] in urban areas of northeast regions in Brazil,” stated the authors of the study.

 Previous studies have shown that co-infection with Chikungunya and Zika may result in prolonged Zika virus RNA shedding, which may increase the severity of infections. “There may be a trend between 

 Editorial Advisory Board member Marta G. Cavalcanti, MD, PhD back in February 2017, in a session at the First International Conference on Zika virus. In addition, Dr. Cavalcanti noted that higher morbidity rates were identified among those with Zika and Chikungunya co-infection

Additional research analyzing the impact of the Zika virus epidemic in Brazil was recently published in 

 study analyzed the effects of the Zika epidemic in the Brazil between November 2015 and 2016, one year after the Ministry of Health declared Zika a Public Health Emergency of International Concern.

After collecting data on cases of Zika virus infection and microcephaly between January 1, 2015 and November 12, 2016, the authors found that of the total 1,673,272 reported cases of Zika virus in the country, 41,473 (2.5%) were reported to be pregnant women. A total of 1,950 cases of microcephaly resulting from congenital Zika infection were also confirmed.

The researchers discovered that there were “two distinct waves of Zika virus infection” that impacted all regions of Brazil in 2015 and 2016, with most cases occurring in the northeast region of the country after the first wave of Zika. The second wave of Zika was reported to have impacts in all regions of Brazil, and occurred between September 2015 and September 2016. The authors concluded that “occurrence of microcephaly was much lower than that following the first wave of Zika virus infection, reaching epidemic levels in all but the south of Brazil, with estimated monthly peaks varying from 3.2 cases to 15 cases per 10,000 births.”

authors concluded, “The distribution of infection-related microcephaly after Zika virus outbreaks has varied across time and Brazilian regions. Reasons for these apparent differences remain to be elucidated.”

 may be over in Brazil, the news of the potential for a Chikungunya epidemic in the same region begs the question, what will the clinical signs be for those with Zika virus infections who also acquire Chikungunya?

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As researchers discover Chikungunya-carrying mosquitoes in Brazil, a new study analyzes the impact of the Zika virus on the area.

Will Brazil's Next Epidemic Come from Another Mosquito-Borne Virus?

A recent study from the Centers for Disease Control and Prevention (CDC) reports on the prevalence of 

, shares data collected between 1995 and December 2016, reporting an 

 in southern US states. Findings show that 38 new counties in the south are reporting 

 presence — a 21% increase from the previous report – and 127 counties are reporting 

 presence (10% increase). This information is essential as this can help scientists estimate the spread of mosquito-borne viruses such as Chikungunya, Dengue, and Zika, the latter of which has been a cause for alarm among pregnant women and their families, as local transmission of the virus is expected to increase with the start of the summer. In fact, the CDC recently published a new article highlighting findings from 7 infants who died with congenital 

 infection shortly after birth, in their journal 

The infants examined in the article were from a northeastern state in Brazil, Ceará, who were most likely infected during the first trimester in 2015. Zika virus infection was diagnosed in all infants after real-time reverse transcription PCR (RT-PCR) of cerebrospinal fluid and tissue tested positive for the mosquito-borne virus. The infants were also tested for Dengue virus infection, which was diagnosed in just 1 infant.

Five of the mothers had Zika-like symptoms during the first trimester of pregnancy. Of these infants, 3 were female, and one of the males had “ambiguous genitalia” that was characterized after autopsy showed undescended testes. The gestational age for these infants “ranged from 30 to 42 weeks (median 37 weeks),” with “body weight within reference range for gestational age in all except neonate 6.” In addition, all infants presented with “remarkably decreased” brain weight which emphasizes “the neurotropism of Zika virus.”

The researchers reported that these findings are in-line with those from previous cases of congenital Zika virus infection. In addition, they noted that “the constellation of neuropathologic features (ventriculomegaly, mineralized neurons, and dystrophic calcification with band-like subcortical distribution) differs” from those observed in infants who present with other congenital infections, and warrants the suspicion of a Zika virus infection.

Although microcephaly was diagnosed in 6 of the 7 infants, only 1 with seemingly normal head circumference also had “morphologic changes typical of microcephaly.” The longest-surviving infant lived for 6 days, the second longest for 48 hours, while the rest lived for less than an hour. In addition, the researchers report that a major factor in mortality was pulmonary hypoplasia “defined as lung weight:body weight ratio of 

The authors conclude, “Our report confirms not only the neurotropism of the virus but also the occurrence of pathologic changes consistent with viral infection in multiple organs: liver (Councilman bodies and periportal lymphocytic infiltration), lungs (interstitial lymphocytic pneumonitis), and bladder (lymphocytic cystitis). PCR detection of Zika virus in liver, lung, and kidney tissue also strengthened our hypothesis that Zika virus can infect multiple tissues.”

Zika virus continues to be a threat to pregnant women and their developing fetuses. The CDC stresses the need for continued efforts for vector surveillance, urging state and local health departments to collaborate with “mosquito control districts” to control and prevent the spread of 

 mosquitoes, to curb the spread of Zika and other mosquito-borne viruses.

The CDC just released a study outlining areas where an increase of Aedes mosquitoes was observed in 2016. In addition, researchers report on Zika-related complications observed in 7 infants, postmortem.

CDC Reports Increase of Zika Vector in Some US States

As more and more bacteria become resistant to first-line antibiotics, the development of new agents is becoming increasingly important. Now, new research, published in 

, outlines how “commercial chemicals” found in researchers’ laboratories at Yale University can be used to synthesize “molecules related to the natural product 

This antibacterial is a fungal byproduct, the antibacterial qualities of which were first discovered in the 1950s. Through semisynthesis, researchers have been able to create thousands of derivatives of pleuromutilin. In addition, in the past decades, pleuromutilin was approved for treatment of “gram-positive bacterial skin infections,” according to the researchers. Nonetheless, many of the pleuromutilin derivatives “only vary at a single position in the molecule,” according to a 

. However, fully synthesizing pleuromutilin would allow for the development of new antibiotic agents, and this is what the Yale researchers set out to do.

Seth Herzon, PhD, professor of chemistry at Yale University, and member of the Yale Cancer Center, explained that he first tried to tackle this issue in 2008. He said, “We worked on this project for a few years when I started at Yale, but didn’t record much success. The pharmaceutical industry has historically been the driving force behind antibiotics development. However, antibiotics are essentially at the bottom of the list in terms of investment return. Consequently, most major pharmaceuticals have walked away from this area.”

According to Joseph Larsen, PhD, Director of the Biomedical Advanced Research and Development Authority (BARDA) with the US Department of Health and Human Services, developing 

 can take years, and only become profitable after an average of about 23 years. In addition, in an 

®, Robert W. Malone, MD, MS, CEO/CSO of Atheric Pharmaceuticals, LLC, mentioned that getting a new drug or vaccine on the market takes around $1 billion and approximately 10 years. However, there is less incentive in creating new antibiotics because of revenue. According to Dr. Larsen, “for the last 6 antibiotics approved in the United States, the projected first 2 years’ sales ranged between $30 million to $80 million, which is not much when compared to medications used to treat more chronic diseases, which routinely have first 2 years’ sales in excess of a billion dollars.”

In their most recent study, Dr. Herzon and his colleagues were able to “prepare an isomer of pleuromutilin — a compound that has the same connectivity, but with a different arrangement of atoms – and rearrange it in the final steps of the synthesis to pleuromutilin.” With this, the research group was able to fully synthesize pleuromutilin, which may allow for the development of more antibiotics. The group outlined their complete synthesis methods in their study.

The authors concluded, “We can envision adapting the strategy outlined herein to create additional derivatives with optimized structures (ring sizes, atomic substitution, and/or substitution patterns) that may further address constraints inherent to semisynthetic approaches and may be accessible by shorter, higher-yielding sequences. Recent successes in the development of convergent routes to tetracycline and macrolide antibiotics underscore the potential to generate new clinical antibacterial candidates by total synthesis.”

Researchers from Yale University have come up with a new “chemical process” that may aid in the development of a new class of antibiotics.

Yale Researchers Pave the Way for Development of New Antibiotics

In late April 2017, 2 adults in the MidCoast area in Maine were hospitalized due to infection with Powassan encephalitis.

According to the Centers for Disease Control and Prevention (CDC), patients infected with 

 do not usually exhibit symptoms. However, when they do, the symptoms are usually fever, headache, vomiting, weakness, confusion, loss of coordination, difficulty speaking, and sometimes seizures. The CDC notes that infection with Powassan virus can cause meningitis as well as encephalitis (inflammation of the brain). Encephalitis resulting from a Powassan virus infection is fatal in about 10% of cases.

 was the first human in the state to be diagnosed with Powassan virus. The patient developed severe complications, including seizures “that included rightward eye deviation and right arm stiffening,” for which he was hospitalized. According to the infant's physicians, MRIs showed signs consistent with encephalitis. After the infant was treated for the seizures, he was released from the hospital, only to develop other complications 1 month later. Researchers reporting on this case strongly recommended that, in areas endemic for ticks, patients presenting with encephalitis be tested for Powassan virus.

The 2 most recent cases were reported to the Maine Centers for Disease Control and Prevention in late May 2017, one month after patients were hospitalized. The patients were diagnosed based on testing conduced at the CDC in Fort Collins, Colorado; they have since been release from the hospital and are now recovering. There have only been 7 cases of Powassan virus reported in Maine since 2000 (not including these 2 most-recent cases).

Powassan virus is transmitted by infected 

 ticks that are not known to bite humans. Maine State Epidemiologist, Siiri Bennett, MD, said in a 

, “Powassan, although rare, can be serious, so it is important to be aware of your surroundings and take steps to avoid being bitten by ticks. Ticks are found in wooded and bushy areas, so use caution if you go into these areas.” She then went on to note that using the “No Ticks 4 Me approach,” can lower the risk of tick exposure as well as the risk for tick-borne diseases.

The No Ticks 4 Me approach includes wearing light-colored clothing that leaves ticks visible if they are on clothes, and wearing long-sleeve shirts and long pants so as to reduce the amount of exposed skin. The approach also includes using United States Environmental Protection Agency (EPA)-registered tick-repellent or Permethrin-treated clothing. Ticks can also hide on pets. Although 

-based products are safe to use in dogs, it is recommended to avoid their use in cats, as it can be poisonous to them.

As part of the approach, individuals are also urged to avoid “wooded and bushy areas with high grass.” It is recommended that those who do go into nature “stay in the middle of trails whenever possible,” and check their bodies for attached ticks, daily, especially once out of tick-endemic areas. In addition, showering immediately after returning from such areas is also highly recommended so as to remove ticks from the body, and protect from disease.

Two adults were hospitalized in Maine as a result of Powassan virus encephalitis.