Papers by M. Van Esbroeck
Clinical Infectious Diseases, Nov 15, 2002
A 47-year-old Belgian woman acquired yellow fever during a 1-week vacation in The Gambia; she had... more A 47-year-old Belgian woman acquired yellow fever during a 1-week vacation in The Gambia; she had never been vaccinated against yellow fever. She died of massive gastrointestinal bleeding 7 days after the onset of the first symptoms. This dramatic case demonstrates that it is important for persons to be vaccinated against yellow fever before they travel to countries where yellow fever is endemic, even if the country, like The Gambia, does not require travelers to be vaccinated. World Health Organization (WHO) data suggest that the rate of yellow fever transmission is increasing, especially in sub-Saharan Africa. The WHO estimates that, after adjustment for underreporting, ∼200,000 cases of yellow fever occur each year . In most of west Africa, with the exception of The Gambia, yellow fever vaccination coverage is low, and there are regular epidemics of yellow fever that fluctuate according to the sylvatic cycle.
Cell and Tissue Banking, Mar 9, 2021
We report on two living donors of explanted hearts while receiving heart transplantation that tes... more We report on two living donors of explanted hearts while receiving heart transplantation that tested positive for SARS-CoV-2 on the day of donation, although clinically asymptomatic. They underwent heart transplantation for ischaemic and hypertrophic obstructive cardiomyopathy, respectively. After evaluation of donor hearts, we cryopreserved and stored two pulmonary valves for clinical application and one aortic valve for research. Light microscopy of myocardium, mitral valve and aortic and pulmonary arterial wall and RT-PCR SARS-CoV-2 test of myocardium, mitral and tricuspid valve and aortic wall for detection of SARS-CoV-2 were performed. Presence of ACE2 in tissues was assessed with immunostaining. Light microscopy revealed a mild eosinophilic myocarditis in the ischemic cardiomyopathy heart, whereas enlarged cardiomyocytes with irregular nucleus and some with cytoplasmic vacuoles in the hypertrophic obstructive cardiomyopathy heart. Aortic and pulmonary wall were histologically normal. Immunostaining revealed diffuse presence of ACE2 in the myocardium of the heart with eosinophilic myocarditis, but only discrete presence in the hypertrophic cardiomyopathy heart. The RT-PCR SARS-CoV-2 test showed no presence of the virus in tested tissues. Despite eosinophilic myocarditis in the ischemic cardiomyopathy heart, no viral traces were found in the myocardium and valve tissues. However, ACE2 was present diffusely in the ischemic cardiomyopathy heart. SARS-CoV-2 could not be detected in the cardiac tissues of these COVID-19 asymptomatic heart donors. In our opinion, clinical application of the valves from these donors presents negligible risk for coronavirus transmission. Nonetheless, considering the uncertainty regarding the risk of virus transmission with the human tissue transplantation, we would not release in any case the pulmonary valve recovered from the eosinophilic myocarditis heart. In contrast, we may consider the release of the pulmonary valve from the dilated cardiomyopathy heart only for a life-threatening situation when no other similar allograft were available.
The Open parasitology journal, Mar 5, 2010
Although inexpensive and easy to perform, the negative staining technique of Heine for the detect... more Although inexpensive and easy to perform, the negative staining technique of Heine for the detection of Cryptosporidium spp. has been largely neglected. The lack of familiarity with the negative staining technique, the misconception that a phase-contrast microscope is indispensible and inferior results due to Köhler-illumination, are possible explanations for its low popularity. While the modified Ziehl-Neelsen staining technique is still considered the Gold Standard for the detection of Cryptosporidium spp., the negative staining technique of Heine should be reconsidered as the screening technique of first choice. Advantages of the negative staining technique of Heine over the modified Ziehl-Neelsen staining are discussed.
Emerging Infectious Diseases, Oct 1, 2015
parasites are frequently found in fecal samples of nonhuman primates (NHPs) in zoos (1). This gas... more parasites are frequently found in fecal samples of nonhuman primates (NHPs) in zoos (1). This gastrointestinal pathogen is the causative agent of invasive amebiasis in NHPs, which may result in hemorrhagic dysentery, liver abscess or other extraintestinal pathologies, and even death (2). E. histolytica infection is the cause of invasive amebiasis in humans and can also cause experimentally invasive amebiasis in NHPs (3). The host specificity of E. nuttalli and E. histolytica parasites remains largely unknown. Although molecular analyses indicate that E. nuttalli parasites are genetically different from E. histolytica parasites (4), and hence provide a unique marker to identify zoonotic transmission, molecular tools have not been applied extensively to determine the presence of E. nuttalli in humans (5). Moreover, studies suggesting transmission have been based on clinical outbreaks in animal caretakers (2), and because infections may not always be symptomatic, the results of those studies may underestimate the incidence. We conducted a study to assess the occurrence of zoonotic transmission of E. nuttalli and other gastrointestinal parasites in animal caretakers in 5 zoos in Belgium and the Netherlands. A previous cross-sectional survey (6) in these zoos indicated that >80% of the 67 groups of NHPs (40 species, 400 animals, and 1,435 samples) were infected with at least 1 of the 13 gastrointestinal parasites found. In that survey, the most frequently detected parasites were E. nuttalli (found in 7 [10.4%] of the 67 groups of NHPs), Trichuris trichiura (12 [17.9%]), Balantidium coli (14 [20.9%]), and Giardia duodenalis (26 [38.8%]). These parasites can cause clinical symptoms in animals and humans. In our study, caretakers of NHPs in each zoo were screened on a voluntary basis for LETTERS
Epidemiology and Infection, Apr 2, 2014
Arboviral infections are emerging among tourists travelling to (sub)tropical regions. This study ... more Arboviral infections are emerging among tourists travelling to (sub)tropical regions. This study aims to describe the importation of chikungunya virus (CHIKV) and West Nile virus (WNV) into Belgium over a 6-year period from 2007 to 2012. Clinical samples were obtained from travellers presenting at the outpatient clinic of the Institute of Tropical Medicine (ITM), Antwerp, Belgium or submitted to the Central Laboratory for Clinical Biology of the ITM. Testing was performed by serology and/or by real-time reverse transcriptase-polymerase chain reaction. A total of 1288 returning travellers were investigated for CHIKV infection resulting in 34 confirmed and two probable diagnoses (2•80%). Out of 899 patients, four confirmed and one probable imported WNV infections were diagnosed (0•55%). No locally acquired cases have been registered in Belgium until now and the geographical origin of the imported infections reflects the global locations where the viruses are circulating.
Archives of Disease in Childhood, Oct 1, 2012
Background and Aims Eosinophilia may be associated with parasitic infection. To our knowledge the... more Background and Aims Eosinophilia may be associated with parasitic infection. To our knowledge the predictive value of eosinophilia has not been determined in internationally adopted children (IAC). Methods Eosinophilia definition: absolute count ≥ 450/µl. Eosinophil counts were available in 285/314 IAC seen between 01/01/2008 and 31/03/20012. Feces and serological examinations for Strongyloides and Schistosoma were done in all children. We calculated the positive predictive value, negative predictive value and likelihood ratios of eosinophilia ≥ 450/µl for all parasites, solely pathogenic and solely tissue invading parasites in all 285 and 197 Ethiopian children. Any parasites No parasites
Journal of Travel Medicine, Sep 23, 2020
Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and plat... more Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity. Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare. We present a case of a 56-year-old Caucasian man with fever, headache, cognitive problems at the emergency department. He received a primary YF vaccination 4 weeks prior to symptom onset. Cerebrospinal fluid tested positive (POS) for YF virus by reverse transcriptase polymerase chain reaction and confirmed diagnosis of YEL-AND. The patient recovered with symptomatic treatment. We reviewed published clinical reports on YEL-AND indexed for MEDLINE. We identified and analyzed 53 case reports. Forty-five patients were male and eight were female. Twentynine cases met criteria for definite YEL-AND and twenty-four for suspected YEL-AND according to YF Vaccine Safety Working Group. We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barré Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five. Thirty-five patients recovered or improved; however, not all cases had a complete follow-up. The prognosis of YEL-AND presenting with GBS, ADEM or myelitis was poor. Fourteen patients received therapy (corticosteroids, intravenous immunoglobulins and/or plasmapheresis). In conclusion, YF vaccine-associated neurotropic disease is a very rare but SAE after YF vaccination. We described a case of YEL-AND and propose a standardized clinical workup of this condition based on a review of the literature. Centralized registration of complications of YF vaccination is encouraged.
Travel Medicine and Infectious Disease, 2008
Eosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the t... more Eosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the tropics is infection with the rat lungworm Angiostrongylus cantonensis. In this report, we describe a case of eosinophilic meningitis due to infection with this nematode in a traveller who presented with slight headache, diarrhoea, general malaise and thoracic radicular pain after a trip through Latin America and the Fiji Islands. She responded less than optimally to repeated steroid and albendazole treatments, but finally recovered completely.
The Lancet Global Health, May 1, 2018
We welcome the comments by Kevin Ariën and colleagues on our recent Correspondence, in which we p... more We welcome the comments by Kevin Ariën and colleagues on our recent Correspondence, in which we presented epidemiological data showing a large decline in detected dengue virus infection cases in Salvador, Brazil, following the 2015 Zika virus outbreak. 1 Our aim was to raise the hypothesis that massive population exposure to Zika virus might have an inhibitory role in dengue virus transmission and symptomatic infections, and to open a new avenue for discussion, experimental studies, and epidemiological data analyses from other groups. We appreciate that Ariën and colleagues did neutralisation assays to investigate the biological basis of our hypothesis. After examining 21 clinical samples of dengue virus-naive patients with Zika virus infection confirmed by RT-PCR or neutralisation assays, they found that one sample (5%) showed weak cross-neutralisation against dengue virus serotype 2, and argued that Zika virus infections are unlikely to cross-protect against dengue. However, the majority of the Salvador and Latin American population are not dengue virus-naive, and have been infected by dengue virus before the Zika virus outbreak. Following Zika virus infections, the antibodies produced in dengue virus-immune people against the Zika virus nonstructural 1 protein (NS1) cross-react extensively against dengue virus NS1, whereas in dengue virus-naive individuals less cross-reaction occurs. A potential cross-protection elicited by Zika virus is also supported by studies showing that envelopespecific antibodies produced during Zika virus infection cross-react with the envelope protein of all four dengue virus serotypes, regardless of previous dengue virus infection. 2 More We declare no competing interests.
Emerging Infectious Diseases, Mar 1, 2008
Chikungunya fever has spread through several Indian Ocean islands and India, including popular tr... more Chikungunya fever has spread through several Indian Ocean islands and India, including popular travel destinations. To compare usefulness of diagnostic tests and to understand reasons for the magnitude and severity of an outbreak, we used 3 diagnostic methods to test 720 samples from 680 patients returning to Europe from the Indian Ocean region in 2006. Chikungunya infection was confi rmed for 24.4% patients in the fi rst half of the year and for 9.9% in the second half. Reverse transcription-PCR was positive for all samples taken up to day 4 after symptom onset. Immunofl uorescence detected immunoglobulin (Ig) M on day 1 and IgG on day 2 for some patients, and in all patients from day 5 onward. Soon after onset of symptoms, patients had IgG and IgM and high viral loads (some >10 9 copies/mL plasma). These data will help healthcare providers select diagnostic tests for returning travelers.
Archives of Virology
Although transmitted mainly through direct (sexual) contact, mpox virus (MPXV) can be detected in... more Although transmitted mainly through direct (sexual) contact, mpox virus (MPXV) can be detected in ambient air. We explored the use of air sampling for diagnosis or (genomic) surveillance of mpox in a sexual health clinic. For six out of six patients who were infected with MPXV, all four of our ambient air PCR tests were positive. For 14 uninfected patients, PCR was positive in three ambient air samples, albeit with higher cycle threshold (Ct) values. Genomic sequencing of samples from two positive patients showed matching sequences between air and clinical samples.
International Journal of Infectious Diseases
Sexually Transmitted Diseases
Background Manually performed nontreponemal assays, such as rapid plasma reagin (RPR), are labor ... more Background Manually performed nontreponemal assays, such as rapid plasma reagin (RPR), are labor intensive and time consuming. Recently, commercial automated RPR assays gained attention. The aim of this study was to compare the qualitative and quantitative performance of the AIX1000 (RPR-A; Gold Standard Diagnostics) to a manual RPR test (RPR-M; Becton Dickinson Macrovue) within a high-prevalence setting. Methods A retrospective panel of 223 samples was selected for comparison between RPR-A and RPR-M, including 24 samples from patients with known syphilis stages and 57 samples from 11 patients in follow-up. In addition, 127 samples obtained during routine syphilis diagnosis with RPR-M were analyzed prospectively with AIX1000. Results Overall qualitative concordance (percent agreement) between both assays was 92.0% in the retrospective and 89.0% in the prospective panel. Of 32 discordances, 28 were explained by a treated syphilis infection still positive in one assay and already nega...
Frontiers in Cellular and Infection Microbiology
Although the power of genetic surveillance tools has been acknowledged widely, there is an urgent... more Although the power of genetic surveillance tools has been acknowledged widely, there is an urgent need in malaria endemic countries for feasible and cost-effective tools to implement in national malaria control programs (NMCPs) that can generate evidence to guide malaria control and elimination strategies, especially in the case of Plasmodium vivax. Several genetic surveillance applications (‘use cases’) have been identified to align research, technology development, and public health efforts, requiring different types of molecular markers. Here we present a new highly-multiplexed deep sequencing assay (Pv AmpliSeq). The assay targets the 33-SNP vivaxGEN-geo panel for country-level classification, and a newly designed 42-SNP within-country barcode for analysis of parasite dynamics in Vietnam and 11 putative drug resistance genes in a highly multiplexed NGS protocol with easy workflow, applicable for many different genetic surveillance use cases. The Pv AmpliSeq assay was validated u...
IDCases, 2021
We present a case of infective endocarditis (IE) on a prosthetic pulmonary valve in a 36-year-old... more We present a case of infective endocarditis (IE) on a prosthetic pulmonary valve in a 36-year-old patient with tetralogy of Fallot (TOF). The patient underwent valve replacement surgery and active antibiotic treatment against Gram-negative cocci (Piperacillin Tazobactam then Ceftriaxone) for a total duration of 42 days with a favourable outcome. The causative agent was Neisseria mucosa which was identified on the infected valve by sequencing of 16S ribosomal RNA. To our knowledge, this is the first described case of a N. mucosa infective endocarditis on a pulmonary valve. Initially, serologies performed in clinical settings by immunofluorescence for Coxiella burnetii antibodies showed a major increase in phase I IgG titers at 1024 (normal values <16) corresponding with the diagnostic criteria for Q fever endocarditis. However, this diagnosis could not be confirmed by the National Reference Center, making it the first reported case of a false positive serology for C. burnetii during an infection due to Neisseria spp.
Transboundary and Emerging Diseases, 2021
Endemic Q fever in small ruminants remains an ongoing challenge for veterinary and human public h... more Endemic Q fever in small ruminants remains an ongoing challenge for veterinary and human public health agencies. Though surveillance programs are implemented in Belgium, infection patterns and vaccination profiles, driving variables, as well as geographical clustering were not presented until now. Based on data from a decade of bulk tank milk analysis between 2009 and 2019, shedding in dairy goat herds declined from 16% (8/50) to 6% (10/162), whereas seroprevalence remained between 32% and 40%. Merely up to two shedding dairy sheep flocks were detected until 2019; seroprevalence peaked in 2017 (43%, 12/28) and declined thereafter. The number of animals in the holding influenced significantly (p = 0.048) the likelihood of shedding, whereas other established risk factors such as uncovered manure, high abortion rates and diversified farm structure could not be confirmed to significantly affect infection on Belgian herd level. Intermittent, incomplete and unsynchronized vaccinated herds shed Coxiella burnetii significantly more often and longer (p<0.001) than continuously, complete and synchronized vaccinated herds. Spatial analyses revealed restricted but matching, homogenous clusters with ≤35km diameter, concentrated in the coastal region close to the border to the Netherlands from 2009-2012, and broadened, heterogeneous clusters with ≥45km diameter between 2014 and 2016 spreading south-west. Though the majority of human cases was notified in this region, the animal clusters could not be allied with Q fever cases. The impact of environmental factors as well as the role of wildlife, rodents and ticks on the transmission between flocks and to humans remains to be elucidated to harness additional epidemiological drivers of Q fever in Belgium. In conclusion, attempts to reduce the burden of Q fever in Belgium should particularly focus on the timely, complete and synchronized vaccination of flocks, including the breeding sire, and particularity in high risk areas. This article is protected by copyright. All rights reserved.
Tick-borne encephalitis - The Book, 2019
In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochtho... more In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochthonous infection, were diagnosed at the National Reference Centre (NRC) of Arbovirus (The Institute of Tropical Medicine, Antwerp, Belgium).
Eurosurveillance, 2017
Leptospirosis is an under-reported and emerging zoonotic disease which is potentially fatal in hu... more Leptospirosis is an under-reported and emerging zoonotic disease which is potentially fatal in humans. Rodents are the main reservoirs for pathogenic Leptospira spp., but diagnosis in these animals is difficult, and their infection, which does not induce symptoms, usually goes unoticed. Although the exposures of most human cases of leptospirosis are poorly documented, we were able to identify six human cases of leptospirosis which were associated with direct contact with pet rodents (mice or rats) in Belgium and France between 2009 and 2016. All cases had severe disease and for all, the presence of Leptospira spp. DNA in the kidneys of their pet animals was confirmed, strongly suggesting that excretion of leptospires in urine was the way of transmission. Half of the cases shared the serogroup Icterohaemorrhagiae, which is usually associated with severe disease, with the pet rats which they were in contact with. With the popularity of rats and mice as pets, this study should contribu...
Emerging Infectious Diseases, 2017
Visceral pentastomiasis is usually found incidentally during surgery. We describe a case of visce... more Visceral pentastomiasis is usually found incidentally during surgery. We describe a case of visceral pentastomiasis discovered during inguinoscrotal hernia surgery for a man from Benin, Africa. Because surgical removal of nymphs is needed for symptomatic patients only, this patient's asymptomatic pentastomiasis was not treated and he recovered from surgery uneventfully.
Journal of Travel Medicine, 2018
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Papers by M. Van Esbroeck