Chikungunya virus (CHIKV) spread rapidly throughout the Caribbean region in 2014, and the first serologically confirmed case was seen in Grenada in July. This study investigated the outbreak of CHIKV in Grenada to identify the distinguishing clinical manifestations and the symptoms that corresponded the closest with serological test results. Sera were tested by IgM enzyme-linked immunosorbent assay and polymerase chain reaction to distinguish between cases positive or negative for CHIKV. Of 493 cases, 426 (86%) tested positive for CHIKV. The diagnostic decision rule, “Define as CHIKV positive a patient presenting with joint pain and any combination of fever, body pain, or rash,” produced the closest agreement (85%) with the serological test results (Cohen's kappa, k = 0.289, P value < 0.001). When laboratory facilities are not available for diagnostic confirmation, syndromic surveillance using these four symptoms could be useful to define cases during a CHIKV outbreak when CHIKV is the predominant circulating arbovirus.

In high-income countries patients with Huntington disease (HD) typically present to healthcare providers after developing involuntary movements, or for pre-symptomatic genetic testing if at familial risk. A positive family history is a major guide when considering the decision to perform genetic testing for HD, both in affected and unaffected patients. Management of HD is focused upon control of symptoms, whether motor, cognitive, or psychiatric. There is no clear evidence to date of any disease-modifying agents. Referral of families and caregivers for psychological and social support, whether to HD-focused centers, or through virtual communities, is viewed as an important consequence of diagnosis. The experience of healthcare for such progressive neurodegenerative diseases in low- and middle-income nations is in stark contrast with the standard of care in high-income countries. An extended family with many members affected with an autosomal dominantly inherited movement disorder came to medical attention when one family member presented following a fall. Apart from one family member who was taking a benzodiazepine for involuntary movements, no other affected family members had sought medical attention. Members of this family live on several resource-limited Caribbean islands. Care of the chronically ill is often the responsibility of the family, and access to specialty care is difficult to obtain, or is unavailable. Computed tomography scan of one patient’s brain revealed severe caudate atrophy and moderate generalized cortical atrophy. Genetic diagnosis of HD was obtained. Through family recollection and by direct observation we identified four generations of individuals affected with HD. Outreach programs and collaborations helped to provide medical imaging and genetic diagnosis. Additionally these efforts helped with patient and family support, education, and genetic counseling to many members of this family. Affected members of this family have limited healthcare access, and rely heavily on family support for care. Genetic and clinical diagnosis of these patients was impeded by lack of resources and lack of access to specialty care. Importantly, obtaining a definitive diagnosis has had a positive impact for this family by facilitating genetic counseling, education, community outreach, and dispelling myths regarding this hereditary disease and its progression.

SARS-CoV-2 is a highly contagious virus that infects humans, wildlife, domesticated and farmed animals. An increase in SARS-CoV-2 variants and human–animal interactions could have implications for the global maintenance and perpetuation of the virus. This study aimed to detect SARS-CoV-2 infection in dogs and cats living in households with and without SARS-CoV-2-positive owners by real-time reverse transcription polymerase chain reaction (qRT-PCR) in Grenada. This cross-sectional study was conducted from August 2020 to April 2022 from dogs (139) and cats (22) in households (96) in Grenada. Nasopharyngeal and oropharyngeal swabs were taken from the dogs and cats to detect SARS-CoV-2. qRT-PCR tests were performed targeting the E and RdRP genes, respectively. Notably, 12% (17/139) of dogs and 23% (5/22) of cats tested positive for SARS-CoV-2. The positive animals were found in 17 (18%) households, all with at least one positive individual. No positive cases of pets were detected in households without infected humans. A statistically significant association (p < 0.0001) was observed between humans with SARS-CoV2 and their pets. Phylogenetic tree analysis showed evidence of a relationship between the Grenadian SARS-CoV-2 E gene and other SARS-CoV-2 E gene sequences available in the NCBI database. This study confirmed the concurrent SARS-CoV-2 human/companion animal infection from households in Grenada. Humans and pet animals were positive synchronously; however, the direction of transmission from pets to humans or vice versa remains unknown. This study suggests that pets could play a role in the maintenance, transmission, and prolongation of infection of human-adapted pathogens such as SARS-CoV-2.