Mapping the antigenicity of the parasites in Leishmania donovani infection by proteome serology.
... Roy S, et al. (2006) Mapping the Antigenicity of the Parasites in Leishmania donovani Infection by Proteome Serology. PLoS ONE 1(1): e40. doi:10.1371/journal.pone.0000040 the development of vaccines. In addition, the antigens can be instrumental in immune monitoring of infection, disease and resistance to disease, and be used in the development of new diagnostics. ... days. The time that had elapsed since the diagnosis of VL does not indicate the time of infection, which most likely had occurred months before, but is a rough indication of the time of obvious symptoms with high fever as indicator of vigorous immune responses against the infection. Seven patients were receiving sodium antimone gluconate for therapy, 8 had ... individual serospecificities need to be determined for proper assessment of the immune responses in the patients, and for correlating these responses with the clinical outcomes of the infections and, possibly, immune protection. As secondary, IgG-dominated antibody responses depend on T cell help, knowledge of immunodominant serospecificities can lead to the
Vaccine-mediated immune responses to experimental pulmonary Cryptococcus gattii infection in mice.
... included in a subunit vaccine to induce prolonged protection against pulmonary C. gattii infection. Citation: Chaturvedi AK, Hameed RS, Wozniak KL, Hole CR, Leopold Wager CM, et al. (2014) Vaccine-Mediated Immune Responses to Experimental Pulmonary Cryptococcus gattii Infection in Mice. PLoS ONE 9(8): e104316. doi:10.1371/journal.pone.0104316 Editor: Robert ... the predominant etiological agents of cryptococcosis, are encapsulated fungal pathogens that cause life-threatening infections of the central nervous system (CNS) . Cryptococcal meningoencephalitis is the most common disseminated fungal infection in AIDS patients . Global estimates suggest that nearly one million cases of cryptococcal meningitis ... gattii is traditionally considered to predominantly cause life-threatening fungal meningitis and infections of the lung and skin in otherwise healthy individuals . However, C. gattii is now known to cause a significant proportion of opportunistic cryptococcal infections in HIV-infected individuals in sub-Saharan Africa [5,6]. The geographical distribution
Clonal dissemination, emergence of mutator lineages and antibiotic resistance evolution in Pseudomonas aeruginosa cystic fibrosis chronic lung infection.
... of these infections despite extensive antimicrobial therapy [4–9]. One of the hallmarks of P. aeruginosa chronic respiratory infections, in contrast to acute processes, is the high prevalence PLOS ONE | www.plosone.org 1 August 2013 | Volume 8 | Issue 8 | e71001 Clonal Dissemination of Mutators and in a few cases of hospital-acquired infections ... respiratory infection by Pseudomonas aeruginosa is a major driver of morbidity and mortality in cystic fibrosis patients [1,2]. Traditionally, initial colonization is considered to be produced by unique strains acquired from environmental sources that undergo an extensive adaptation within the patient’s lungs, leading to lifelong persistent infections ... Hospital Universitario Son Espases, Palma de Mallorca, Spain Abstract Chronic respiratory infection by Pseudomonas aeruginosa is a major cause of mortality in cystic fibrosis (CF). We investigated the interplay between three key microbiological aspects of these infections: the occurrence of transmissible and persistent strains, the emergence of variants
Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.
... COPD patients with and without asymptomatic PAD As shown in Table 1, the COPD patients with asymptomatic PAD were significantly older and shorter in height than the COPD patients without asymptomatic PAD (p,0.05). With regards to cardiovascular risk factors, a significantly higher proportion of the COPD patients with asymptomatic PAD had hyperlipidemia (47.1% ... prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (,65 years of age, n = 118) and 10% in the elderly participants ($65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic ... and 309 were aged $65 years (elderly COPD patients). The prevalence of asymptomatic PAD was 2.5% in the younger COPD patients and 10% in the elderly COPD patients. Because of the small number of asymptomatic PAD subjects (n = 3) in the 2 May 2013 | Volume 8 | Issue 5 | e64714 Asymptomatic Peripheral Arterial Disease in COPD Table 1. Demographic
Interferon-alpha administration enhances CD8+ T cell activation in HIV infection.
... turnover in chronic HIV infection include the type I interferons. Type I interferons play an important role in innate and adaptive immune defenses against viral replication and in immune cell maturation [14,15]. In HIV infection, although interferon levels in blood have been difficult to detect and may vary with the stage of infection , PLoS ONE ... in HIV infection [58–60]. These observations suggest that increased endogenous expression of type I interferons may contribute to the high levels of CD38 expression on CD8+ T cells that are characteristic of HIV infection and are recognized predictors of disease progression , but that other phenotypic markers of immune activation seen in HIV infection ... demonstrable and broad upregulation of interferon responsive genes in chronic HIV infection [17,20]. Our findings suggest that type I interferon may contribute to the heightened immune activation profile seen in chronic HIV infection but that the activation phenotype in chronic infection is not precisely recapitulated by systemic interferon administration. While
Distinct Macrophage Fates after in vitro Infection with Different Species of Leishmania: Induction of Apoptosis by Leishmania (Leishmania) amazonensis, but Not by Leishmania (Viannia) guyanensis.
... During infection, amastigotes replicate inside macrophages and are transmitted to healthy cells, leading to amplification of the infection. Although transfer of amastigotes from infected to healthy cells is a crucial step that may shape the outcome of the infection, it is not fully understood. Here we compare L. amazonensis and L. guyanensis infection ... particularly in L. amazonensis infection, and disintegrated cells containing amastigotes (yellow arrows), particularly in L. guyanensis infection. In L. amazonensis infection apoptotic cells that seem to have been ingested by (or are attached to) other macrophages (red arrows) could also be observed. In L. guyanensis infection, at later periods, it was ... of infection, correlates with chronic infection, regardless of its severity. We present evidence suggestive that macrophages phagocytize L. amazonensis-infected cells, which has not been verified so far. The ingestion of apoptotic infected macrophages by healthy macrophages could be a way of amastigote spreading, leading to the establishment of infection. PLOS
Atrophy rates in asymptomatic amyloidosis: implications for Alzheimer prevention trials.
... trial. We conclude that hippocampal atrophy may be a feasible outcome measure for secondary prevention studies in asymptomatic amyloidosis. Citation: Andrews KA, Modat M, Macdonald KE, Yeatman T, Cardoso MJ, et al. (2013) Atrophy Rates in Asymptomatic Amyloidosis: Implications for Alzheimer Prevention Trials. PLoS ONE 8(3): e58816. doi:10.1371/journal.pone.0058816 Editor: ... the mid-70 s are ,0.3–0.4%/year for brain and ,0.4–0.6%/yr for combined hippocampi, and higher rates of loss in asymptomatic (CSF or PIB positive) amyloidosis of ,0.7–0.9%/yr for brain and ,1.3–1.4%/ yr for hippocampi. It is notable that in asymptomatic amyloidosis, rates are not only intermediate between ‘‘normality’’ and those seen in mild cognitive ... understanding of the relationship between atrophy and amyloid load in asymptomatic amyloidosis. Further larger studies with longer follow-up are required to explore these issues in more detail, but our results suggest that there does appear already to be a ‘‘signal’’ of excess atrophy in the asymptomatic amyloidosis group, which could be exploited for the
Effect of Delta-9-tetrahydrocannabinol on mouse resistance to systemic Candida albicans infection.
...  infections, but nothing is known about the effects of D9-THC on fungal infections. In the present study, we investigated the effects of chronic D9-THC treatment on the resistance to systemic C. albicans infection in mice. Specifically, we studied the effect of chronic D9-THC treatment on mouse resistance to a primary, acute systemic C. albicans infection ... is known to suppress the immune responses to bacterial, viral and protozoan infections, but its effects on fungal infections have not been studied. Therefore, we investigated the effects of chronic D9-THC treatment on mouse resistance to systemic Candida albicans (C. albicans) infection. To determine the outcome of chronic D9-THC treatment on primary, ... resistance to systemic C. albicans infection, the fungal infection must be measurable (i.e. weight loss, mortality and activity level). Any intervention to alleviate pain (other than euthanasia) would have obfuscated the results by altering animal behavior and changing observable symptoms. Therefore, it was required that upon yeast infection, the experiments
Natural cross chlamydial infection between livestock and free-living bird species.
... e13512 Cross Chlamydial Infection Table 1. Effects of kestrel species and Chlamydiaceae infection on immunoglobulin levels. F Chlamydophila abortus Infection 29.62 Species 39.14 Infection * species 42.09 Chlamydia muridarum Infection 0.25 Species 0.13 Infection * species 0.03 Chlamydia suis Infection 6.21 Species 5.43 Infection ... in rapid deterioration and death [18,19]. Death outbreaks due to chlamydiosis can be found in wild bird species and are presumed to be due to infection with a strain uncommon to the host or due to secondary infections . Chlamydiosis has been reported to be transferred by translocation of birds of prey, to spread during falconry bird flight or to ... e13512 Cross Chlamydial Infection multiply in, or be shed by these wild birds, indicating whether or not these species of birds are natural hosts or biologic vectors of these strains. However, considering the heterogeneity of the chlamydial species, certain birds may harbour strains that are associated with naturally occurring infections in some animals.
Identification of a 251 gene expression signature that can accurately detect M. tuberculosis in patients with and without HIV co-infection.
... The concurring epidemic of HIV infection in areas endemic for TB infection has resulted in a high burden of HIV/TB coinfection, and TB is currently estimated to be the leading cause of death in HIV-infected patients in these areas [3,4,5,6]. The weakening of the host’s immune system by HIV increases risk of de-novo co -infection with TB, or reactivation ... America Abstract Background: Co -infection with tuberculosis (TB) is the leading cause of death in HIV-infected individuals. However, diagnosis of TB, especially in the presence of an HIV co -infection, can be limiting due to the high inaccuracy associated with the use of conventional diagnostic methods. Here we report a gene signature that can identify a tuberculosis infection ... of HIV Infection To further validate our 251-gene signature and to determine its specificity for the presence of TB, we used five independent, previously published TB datasets available in GEO (Methods, Table 2) [22,26]. These datasets also allowed us to test the accuracy of the signature in classifying TB infections in the absence of an HIV infection,
Functional analysis of the Borrelia burgdorferi bba64 gene product in murine infection via tick infestation.
... e19536 Function of BBA64 in Mouse Infection via Tick Bite needle-inoculated bba64 mutants are capable of establishing an infection in mice . Recent studies have identified additional B. burgdorferi genes that play a role in facilitating mammalian infection by tick bite. Inactivation of bba07 resulted in murine infection via needle inoculation ... invading microorganisms [46,47]. Studies have determined that MyD88deficient mice display a severe defect in host defense against B. burgdorferi infection [48,49]. We found that the bba64 mutant did not establish an infection in the MyD88-deficient mice via nymphal infestation, unlike the WT and complement isolates (Table 3). These findings indicate that ... Volume 6 | Issue 5 | e19536 Function of BBA64 in Mouse Infection via Tick Bite 19. Gilmore RD Jr., Howison RR, Schmit VL, Nowalk AJ, Clifton DR, et al. (2007) Temporal expression analysis of the Borrelia burgdorferi paralogous gene family 54 genes BBA64, BBA65, and BBA66 during persistent infection in mice. Infect Immun 75: 2753–2764. 20. Guo BP,
Generalized Liver- and Blood-Derived CD8+ T-Cell Impairment in Response to Cytokines in Chronic Hepatitis C Virus Infection.
... the marked decrease of CD127 expression on bulk CD8+ T-cells in HIV infection [46–49]. In addition, receptor expression was not associated with age in HCV infection, unlike in HIV infection . It is not PLOS ONE | DOI:10.1371/journal.pone.0157055 June 17, 2016 11 / 18 HCV Infection Impairs CD8+ T-Cells Non-Specifically likely that other ... lower in HCV infection and inversely related to the degree of liver fibrosis. In liver-derived CD8+ T-cells, STAT5 activation could not be increased with cytokine stimulation and basal Bcl-2 levels of liver-derived CD8+ T-cells were lower than bloodderived counterparts in HCV infection. Therefore, generalized CD8+ T-cell impairment in HCV infection is ... perforin expression [12, 13]. Hence, CD8+ T-cell dysfunction in HCV infection is a generalized phenomenon. While there is no specific clinical immunodeficiency in hepatic viral infections, cirrhosis-associated immune dysfunction syndrome (CAIDS)  and increased risk of community-acquired infections such as pneumonia [15, 16] are not uncom- mon. There
Occurrence of Co-Infection of Helicobacter pullorum and Campylobacter spp. in Broiler and Village (Indigenous) Chickens
... Campylobacter spp. Co -infection Helicobacter pullorum Village chickens ABSTRACT The reports on prevalence of Helicobacter pullorum in broiler chickens are rather limited and lacking in village chickens. This study aimed to determine the occurrence of H. pullorum in broiler and village chickens in Selangor, Malaysia and to report the detection of co -infection ... Eleven (50%) of these positive chickens (nine in broiler and two in village chickens) showed co -infection with Campylobacter spp. ©2012 PVJ. All rights reserved To Cite This Article: Wai SS, AA Saleha, Z Zunita, L Hassan and A Jalila, 2012. Occurrence of co -infection of Helicobacter pullorum and Campylobacter spp. in broiler and village (indigenous) ... poultry meat and products have been implicated as a primary source of Campylobacter infection in man in developed countries, causing acute gastroenteritis and diarrhea (Wingstrand et al., 2006). Most campylobacteriosis are self-limiting; however prolonged cases and severe infections may occur which require antibiotic treatment. Several studies have indicated
Early and late pathogenic events of newborn mice encephalitis experimentally induced by itacaiunas and curionopolis bracorhabdoviruses infection.
... 3 days post-inoculation (dpi) and the first clinical signs were observed at 4 and 8 dpi, respectively. After Curionopolis infection, the mortality rate was 100% between 5 and 6 dpi, and 35% between 8 and 15 dpi after Itacaiunas infection. We identified CNS mice cell types both in vivo and in vitro and the temporal sequence of neuroanatomical olfactory ... after intracere- bral infection with Itacaiunas (A–D) and Curionopolis (E–H) virus. Meningeal congestion, parenchymatous edema with multiple foci of congestion and altered leukocytes characterized by a flat morphology and plasma membrane adhering to the capillary endothelium (margination phenomenon) were observed 96 h after infection with Itacaiunas ... neuronal cultures. Control cultures of normal cells (A) and after Itacaiunas (B) and Curionopolis (C, D) infection at 4 and 5 days post-inoculation, respectively. Apoptotic cells (C) and virus budding (rectangle and arrows) (C, D) after Curionopolis infection. Itacaiunas virus particles (arrows) in culture at 5 days post-inoculation (B). N: nucleus; AN:
Streptococcus agalactie associated to meningoencefalitis and systemic infection from tilapia (Oreochromis niloticus) in Brazil.
... associado à meningoencefalite e infecção sistêmica em tilápia-do-nilo (Oreochromis niloticus) no Brasil [Streptococcus agalactie associated to meningoencefalitis and systemic infection from tilapia (Oreochromis niloticus) in Brazil] H.C.P. Figueiredo, D.O. Carneiro, F.C. Faria, G.M. Costa Departamento de Medicina Veterinária – UFLA Caixa postal ... antimicrobial disk susceptibility tests, ed. Vilanova, USA: NCCLS 1990. Document M2-A4. NOMOTO, R.; MUNASINGHE, L.I.; JIN, D-H. et al Lancefield group C Streptococcus dysgalactiae infection responsible for fish mortalities in Japan. J. Fish Dis., v.27, p.679-686, 2004. PLUMB, J.A.; SCHACHTE,J.H.; GAINES, J.L. et al Streptococcus sp. from marine fishes along
Primary seronegative but molecularly evident hepadnaviral infection engages liver and induces hepatocarcinoma in the woodchuck model of hepatitis B.
Design and methods of the Ludwig-McGill longitudinal study of the natural history of human papillomavirus infection and cervical neoplasia in Brazil
... objectives of this study are to: 1) study the epidemiology of persistent cervical HPV infection in asymptomatic women, 2) investigate whether persistent HPV infection increases risk of low-grade and high-grade cervical lesions, 3) search for determinants of persistent HPV infection, 4) search for molecular variants of HPV that may be associated with an ... measuring the prevalence and incidence of persistent cervical HPV infection in asymptomatic women • testing the hypothesis that persistent HPV infection increases risk of low-grade and high-grade cervical lesions • identifying the epidemiologic determinants of persistent cervical HPV infection • identifying specific molecular variants of oncogenic types ... of HPV testing are low in most asymptomatic women because of the relatively high prevalence of subclinical HPV infection in the general population. Most of these infections are transient and are probably of little significance. The concern resides, however, with the small proportion of women who harbor persistent HPV infections. These women have a much greater
Toxocara canis infection of children in a Caribbean community
... statistically correlated, perhaps becauseof the asymmetric distribution of infection in the population. We suggest that the apparently high seroprevalence of infection of children with 1: canis in the study village could arise from a combination of factors: a high prevalence of infection in a large, untreated, and unconstrained dog population; generally ... and spleen Palpableaxillary lymph nodes 14 2 62 Anthropometry: < 80% Weightfor age < 95% Height for age < 90% Weightfor height 18 45 16 Canine infections. Table 2 shows the prevalence of canine nematode infections in Anse-la-Raye, as determined by analysis of fecal specimens collected from 22 locations. Thirty-two per cent of these specimens contained ... animals may make the major contribution to the dissemination of I[: canis ova in the environment (1 l), although the highest prevalence of infection is in pups under six months old (12, 13). Even if the prevalence of canine infection is not abnormally high, increased environmental contamination with 2Y canis ova could still occur if the infected dog population
Serum IgM as an indicator of intrauterine infection in Colombian newborns
... INTRAUTERINE INFECTION IN COLOMBIAN NEWBORNS1 David N. McMurray, 2 Ana Carlina de Aly,3 and Humberto Rey* Highb elevated levels of serum IgM (over 50 mg per cent) and aktectable leveis of serum IgA (over 1 mg per cent) were correlated with overt infection in less than I per cent of 2,029 Colombian newboms. Toxoplasmosis and cytomegalovirus infection ... evaluate the usefulness of measuring serum IgM as an indicator of intrauterine infection in Colombian newborns; (2) to determine the incidence of infection in a poor urban population; and (3) to identify some of the specific microbial pathogens responsible for intrauterine infections in this population. Patients and Methods A total of 2,029 infants ... their families. The eight remaining infants with overt disease at birth became asymptomatic during the follow-up period. Six appeared normal upon physical examination at 2 months of age. Eight of the asymptomatic infants could not be located after leaving the hospital. However, none of the remaining asymptomatic children, including the two with significant IgM antibody titers
Salmonella infection in market swine, Trinidad and Tobago
... syndromes: peracute septicemia, acute enteritis, or chronic enteritis. The main source of infection among animals is the infected domestic or wild animal or bird, which contaminates pasture, feed, or drinking water with feces containing the organism (I). The major vehicles of infection for humans are foods of animal origin, particularly frozen or dried egg ... in Bradford, England, there was evidence to incriminate the abattoir as the most important source of Salmonella infection in man, and the pig as the main animal reservoir (9). Riley, working in Australia (II), showed that 27 per cent of normal slaughtered pigs were positive for Salmonella infection when intestinal contents and mesenteric lymph nodes were examined. In a survey ... Publishing Company, 1962. (5) Groves, B. I., N. A. Fish, and W. R. Mitchell. The occurrence of Salmonella infection in market swine in southwestern Ontario. Can VetJ 12(1):11, 1971. (6) Groves, B. I., N. A. Fish, and D. A. Barnum. An epidemiological study of Salmonella infection in swine in Ontario. Can J Public Health 61:396, 1970. (7) Gould, K. L., J . M. Gooch,
Septicémie Éberthienne et infection vesiculaire
... 512 OFICINA Réceptivité SANITARIA aux Taxi-Infections PANAMERICANA et Réactivité Antitoxique ’ Zoeller 4 montre que la sensibilité à la toxine n’implique pas toujours la récepLe seul indice certain de la receptivit6 c’est ... chez un sujet spontanbment ou artificiellement immunisé l’antitoxine et la réactivité antitoxique jouent un rôle prépondérant dans l’état réfractaire. Septicémie Éberthienne et Infection Vésiculaire Les auteurs 5 résument l’observation d’un malade qui, après une fièvre typhoïde compliquée à la fin d’une cholécystite hydropique aiguë avec ictère, fit ... l’évolution tubertuberculeux. culeuse et l’intensité de la cuti-réaction au filtrat. Un processus atténué, en particulier pleural, comporte une cuti-réaction forte au filtrat: une infection grave, une filtro-réaction cutanée négative. Si, ches les malades sur qui ont porté les observations, la filtro-cuti-réaction est dépourvue de valeur spécifique quant
Observations on the parasite Leishmania mexicana amazonensis and its natural infection of the sand fly Lutzomyia olmeca nociva
... six-year period ending in December 1984 and from whom Leisbmania was isolated and identified, only five (2 % ) had casesof infection with Le. m. amazonensis.* TABLE1. Resultsobtained by testing 5,039 sand flies captured in the Manaus area for infection with Le. m. amazonensis. No. No. Collectionarea Sand fly species examined positive Parquedas Lu. 0. nociva 2,374 Laranjeiras ... transmission is still unclear. The low prevalence of human leishmaniasis due to Le. m. amazonensis in the Manaus area is in harmony with the low infection rates found in Lu. j’aviscuteZZata and Lu. o. no&a. Although the infection rate in Lu. flavisczcteddatawas over five times as high as in Lu. o. nociva, the number of infected sand flies caught in the traps ... three Lu. o. nociva, and four Lzc. flaviscuteclata were characterized as Le. m. amazonem’s by monoclonal antibody techniques (10). RE suns Table 1 shows the Le. m. amaxonensis infections found in female sand flies captured at the two collection sites. While the Parque das Laranjeiras site yielded no positive results, four Lu. o. no&a and six Lzc.fi7aviscczcte~Zata from the
Dynamics of transmission of Trypanosoma Cruzi in a rural area of Argentina: II. Household infection patterns among children and dogs relative to the density of infected Triatoma infestans
... time. Relationships between T. cmczz? ?infection among household children under age 10 and T. crmzz? ?infection among household-associated dogs are shown in Table 5. Only dogs less than four years old were considered, because all of the older animals tested were infected. The degree of association between these child and canine infections was assessedusing the ... households were more likely to acquire the infection than children inhabiting the same house; that the presence of infected household dogs may increase the risk of T. crxzi transmission to human residents; that the status of T. crmi infection among dogs can provide a basis for assessingthe likelihood of T. crxzi infection of young children; and that dogs ... than 100 (p
Canadian experiences with AIDS and HIV infection
... individual countries and by comparing cultural differences in the control of HIV transmission. The article presented here describes Canadian experiences with AIDS and HIV infection. ? ?Infection Control Service, Department of nity Health, Montreal General Hospital, Street, Montreal, Canada, H3H 2K3. 2Montreal Regional Sexually Transmitted Control Program. 3Montreal ... mid-1984, and hence they account for a declining share of overall AIDS cases, a share currently representing about 10% of the new cases in Quebec. HIV Infection Knowledge of the epidemiology of HIV infection in Canada is inadequate. Only limited seroprevalence studies among homosexual men have been carried out to date. Nevertheless, on the basis of ... future. CANADIAN RESPONSES SurveiIIance Surveillance of AIDS and HIV infection is critical to successful public health efforts designed to prevent transmission and care for those infected. As with other communicable diseases, effective surveillance permits evaluation of the nature and scope of the infection, facilitates rational planning of health services,
Prevalence of infection with human immunodeficiency virus in Cuba
... had already died. for HIV infection of the U.S. Centers for More than 97% of the seropositives Disease Control (CDC). identified acquired the infection sexually, Seropositive with heterosexual transmission predomiindividuals nating in absolute terms. However, male No. Group (%) homosexuals and bisexuals experienced a I (acute infection) trans(0.0) higher ... the (opportunistic) infections predominated. Table 2. Distribution of individuals seropositive for HIV according to the classification Table 3. Distribution of the 33 HIV seropositive individuals in CDC Group IV (other diseases). Group lV subgroup A (systemic disease) B (neurologic disease) C (secondary infections) Subgroup category 1” C (secondary infections) D ... absolute terms. However, male No. Group (%) homosexuals and bisexuals experienced a I (acute infection) trans(0.0) higher relative risk. Heterosexual II (asymptomatic mission in both directions (man to (65.2) 148 infection) woman and woman to man) has been III (persistent generalized as have both directions of (20.3) confirmed, lymphadenopathy) 46 (active to (14.5)