Journal of Tropical Medicine最新文献

Background: In the last two decades, Human immune deficiency virus has been a major health concern in sub-Saharan Africa particularly in Ethiopia. The objective of this study was to identify determinants associated with CD4 cell count and disclosure status among first-line antiretroviral therapy patients treated at Felege Hiwot Comprehensive Specialized Hospital, Ethiopia. Methods: This retrospective study was conducted at Felege Hiwot Comprehensive Specialized Hospital. Data analysis was conducted using Statistical System Analysis (SAS) software Version 9.4. In this study, quasi-Poisson mixed-effects model for CD4 cell count, a binary logistic regression model for disclosure status, and joint modeling were used. Result: Out of 300 adult participants, around 76% of the patients were discloses their disease status to their family members. The correlation between CD4 cell count and disclosure was positive (0.4607). The current study indicates that among the predictor variables, noneducators (β = -0.6185, p-value < 0.01), primary educators (β = -0.3687, p-value < 0.01), employed patients (β = 0.3888, p-value < 0.01), adherent patients (β = 0.2274, p-value < 0.01), and patients who did not had social support (β = -0.1148, p-value = 0.030) have a significant effect for CD4 cell count. Similarly, noneducators (AOR = 0.000145, p-value < 0.01), primary educators (AOR = 0.004413, p-value < 0.01), employed patients (AOR = 3.4562, p-value = 0.021), adherent patients (AOR = 1.564, p-value < 0.01), and patients who did not had social support (AOR = 0.075, p-value = 0.0078) had a significant effect for disclosure status. Conclusion: This study concluded that patients who had disclosed their disease status to near relatives or families have a positive correlation with CD4 cell count through time. This study also concluded that significant determinants affected both the variables of interest were educational level, occupation, adherence, and social support. Health professionals should give more attention to these important determinants to create good status of patients. In addition, health staff should conduct health-related studies for individuals to understand better ART follow-up. Patients should be adhere to their prescribed HIV medication properly on time and disclose their disease status without fearing stigma and discrimination to the community; this may help to increase their CD4 cell count. The family members should give social support to the infected patients, and the government should work on education; this may help to improve their CD4 cell count and increase the prevalence of disclosure of the disease status. The authors also recommended that further studies of this nature include other important variables that are not included in this study such as income of the patients and many other covariates.

Vitamin D is an important modulator of host immune response during immunity development in context to several diseases in children. This study included 280 pediatric dengue cases, which were further stratified as dengue fever (DF), dengue with warning signs (DWS), and severe dengue (SD), wherein naturally circulating vitamin D metabolite, 25(OH)D was assessed, followed by statistical analysis for elucidating the role of serum 25(OH)D in dengue severity. qRT-PCR based serotyping showed that dengue virus (DENV)-2 was the major circulating DENV serotype in the patients. Among DENV cases, 92 (32.86%), 108 (38.57%), and 80 (28.57%) were diagnosed with DF, DWS, and SD, respectively. Among SD patients, serum 25(OH)D deficiency and insufficiency were observed in 37 (46.25%) and 43 (53.75%) patients, respectively, and found to be significantly associated with SD (p < 0.05) in comparison to DF and DWS. Serum 25(OH)D sufficiency had a protective effect against dengue severity and could be a determinant for DENV outcome in children.

Hepatitis B virus (HBV) infection remains a critical global health issue, particularly in high-burden regions with substantial global morbidity and mortality. Despite the efficacy of the hepatitis B vaccine in inducing immunity, a subset of vaccinated individuals fails to achieve adequate immunity. This study investigated the factors influencing immunological response to the hepatitis B vaccine among Nigerian adults. A cohort study was conducted at Usmanu Danfodiyo University Teaching Hospital, Sokoto, involving 307 participants aged 19-60 who had not previously received the hepatitis B vaccine. Data were collected using structured questionnaires assessing demographic characteristics, medical history, and lifestyle factors. Participants received GeneVac-B, a recombinant hepatitis B vaccine, and 0-, 1-, and 2-month schedule anti-HB levels were measured post-vaccination using a commercial enzyme-linked immunosorbent assay (ELISA) kit (AccuDiag ELISA, Diagnostic Automation/Cortez Diagnostics, Inc., USA) to classify vaccine response. The association between demographic and lifestyle factors and vaccine response was analyzed using IBM SPSS Statistics (Version 25). Of the 307 participants, 209 received the first vaccine dose, and 192 completed all three doses. Anti-HB quantification revealed that 94.3% of the participants achieved protective immunity (≥ 10 IU/L), while 5.7% were classified as nonresponders (< 10 IU/L). Statistical analysis indicated significant differences in the immune response based on gender (p = 0.031), with females exhibiting higher mean anti-HB levels than males. Negative correlations were observed between age and vaccine response (ρ = -0.296, p < 0.01) and between body mass index (BMI) and response, although the latter was not statistically significant (ρ = -0.131, p = 0.071). Prior tuberculosis, malaria, measles, smoking, and alcohol use showed no significant impact on the immune response, although recurrent malaria, measles, and smoking were associated with slightly lower mean antibody levels. The study indicates gender and age significantly influence hepatitis B vaccine response, with females and younger individuals demonstrating stronger immunity.

Introduction: A. baumannii and P. aeruginosa belong to the multidrug-resistant Gram-negative bacteria group, posing significant challenges in treatment. Colistin is considered the last-line antibiotic for treating this bacterium. It is essential to determine the minimum inhibitory concentration (MIC) to adjust the appropriate dosage. Method: A cross-sectional descriptive study using data from January 2020 to December 2024 was conducted. Results: The infections caused by A. baumannii and P. aeruginosa showed an increasing trend over the years, accounting for 17.4% and 9.6% of common multidrug-resistant Gram-negative bacteria, respectively. A. baumannii exhibited higher resistance rates than P. aeruginosa with multiple tested antibiotics. Although no Colistin-resistant strains were observed for either bacterium of interest during the observation period, both bacteria of interest showed a statistically significant change during the survey period (p < 0.05). In addition, the MIC value of ≤ 0.75 μg/mL was the most prevalent over 80% from 2020 to 2021, but its percentage declined strongly by 60%-65% in the next 3 years (p < 0.0001). Meanwhile, the MIC value of 1.0 μg/mL became the most common over 70% with a statistically significant difference (p < 0.0001). Regarding the MIC value based on infection types, the MIC value for P. aeruginosa causing septicemia was considerably concentrated at 1.0 μg/mL at 84.6%, while its percentage was lower in A. baumannii at 37.9% (p < 0.0001). Looking into MIC values based on carbapenem-resistant proportions, the MIC values from 1.0 to 2.0 μg/mL were higher in imipenem-resistant strains of both bacteria of interest compared with nonresistant strains (p < 0.0001). This difference was also observed in meropenem-resistant A. baumannii but was not demonstrated in P. aeruginosa. Conclusions: Although no colistin-resistant strains were observed, A. baumannii and P. aeruginosa showed statistically significant changes in the most prevalent colistin MIC values, which have been approaching the resistance threshold over the years. It is essential to implement control measures of colistin usage before bacteria become completely resistant.

Objectives: Neglected tropical diseases (NTDs), such as leprosy, significantly impact mental health and overall well-being. This study aims to evaluate the effectiveness and acceptability of a mental health intervention targeting individuals affected by leprosy in Ethiopia. The intervention utilizes the Traumatic Stress Relief (TSR) program to target symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to improve overall mental health. Methods: This exploratory randomized controlled trial (RCT) will recruit participants with lived experiences of leprosy. Participants will receive four group sessions of a low-intensity TSR intervention. The intervention will be administered by a pair of trained facilitators, including one mental health practitioner and one community member with lived experience of leprosy. Data will be collected through self-report questionnaires to assess changes in PTSD symptoms, anxiety, and depression. In addition, interviews will provide further insights into participants' experiences and the acceptability of the intervention. Discussion: This exploratory trial will provide insights into the feasibility of mental health interventions for individuals affected by leprosy. The findings will inform the design of future trials to evaluate the effectiveness of such programs on a larger scale and in more diverse contexts. Trial Registration: The UK's Clinical Study Registry: ISRCTN868254411.

Introduction: Herpes zoster is a viral dermatosis that occurs after reactivation of the varicella-zoster virus (VZV). The aim of this study is to illustrate the epidemiological and clinical aspects, as well as the complications, of herpes zoster in children. Materials and Methods: This is a descriptive, prospective study of a series of 25 children followed for herpes zoster over a 3 year period in the dermatology department of CHU Ibn Rochd in Casablanca. Results: There were 16 boys and 9 girls, with a mean age of 8.05 years. None of the patients had been vaccinated against varicella. Nine patients were immunocompromised. All patients were treated with antivirals, analgesics, antiseptics, and antibiotics (for seven infected patients). All patients had a favorable outcome with no sequelae. Discussion: VZV belongs to the Herpesviridae family, an enveloped virus with a DNA genome. It has a particular affinity for the skin, nervous system, and lungs. Shingles is a rare disease in children, which typically follows a favorable course without sequelae. In children with shingles, if the history and physical examination are normal, laboratory testing for occult immunodeficiency or malignancy is not necessary. The diagnosis is primarily clinical. Except for ophthalmic forms, complicated cases, and immunocompromised patients, no specific treatment is required. In immunocompromised children, the infection is usually severe and disseminated, leading to high morbidity and mortality, and requires specific intravenous antiviral treatment. Conclusion: Herpes zoster is a rare condition in children, typically evolving without sequelae.

Toxoplasmosis, caused by the parasite Toxoplasma gondii, affects approximately 30% of the human population worldwide. Reactivation of latent infection in immunocompromised people leads to fatal disease. This study aimed to determine the seropositivity of toxoplasmosis by enzyme-linked immunosorbent assay (ELISA), confirmed by primary polymerase chain reaction (PCR) and nested PCR (nPCR), and validate ELISA against nPCR among a group of cancer patients. Of the 321 participants, six (1.9%) patients were positive for nPCR and both IgG and IgM ELISA tests while 36 (11.2%) and 131 (40.8%) showed evidence of possibly acute and past infection, respectively, and 15 (4.7%) were indeterminate. Among them, 19 (5.9%) nPCR positives would have been ignored as having evidence of past infection. Four (1.2%) patients would not have been treated at all if only ELISA had been performed as they had indeterminate ELISA results. This is the first study that used primary and nPCR with B1 gene amplification for confirmation of toxoplasmosis among cancer patients in Sri Lanka. These findings emphasize the need for confirmatory tests, such as nPCR, particularly in cancer patients who exhibit a weak antibody response. Implementing such tests can aid clinicians in effectively managing these patients, given the rising incidence and mortality rates of cancer in Sri Lanka.

Background: Tuberculosis increases human immunodeficiency virus replication and accelerates human immunodeficiency virus progression in both tuberculosis and human immunodeficiency virus coinfected patients. The objective of this study was to determine the incidence rate, survival rate, and predictors for virological failure among adult tuberculosis/human immunodeficiency virus coinfected clients. Methods: A retrospective cohort study was conducted at the University of Gondar Compressive Specialized Hospital from March 2017 to 2022. Secondary data sources were extracted based on inclusion criteria for adult tuberculosis/human immunodeficiency virus coinfected patients. The Cox proportional hazards model was used for adult tuberculosis/human immunodeficiency virus coinfected patients data. Result: The overall incidence rate of virological failure was 9.23 per 1000 person-months observations. Out of 148 coinfected patients, about 24.3% had virological failure. More than half of the patients, 52.7% and 54.1% in this study had a CD4 cell count ≥ 200/mm³ and a weight < 50 kg, respectively. Gender (hazard ratio = 1.3291, 95% CI: 1.1878-1.4873), bedridden functional status (hazard ratio = 4.7174; 95% CI: 1.2263-14.1470), WHO clinical Stage IV (hazard ratio = 1.1122, 95% CI: 1.2072-5.9693), patients with opportunistic infections (hazard ratio = 1.2849, 95% CI: 1.4289-3.8504), cotrimoxazole preventive therapy users (hazard ratio = 0.2039, 95% CI: 0.0496-0.8386), patients disclosure status (hazard ratio = 0.1609, 95% CI: 0.0279-0.9286), baseline viral load count < 1000 (hazard ratio = 0.0819, 95% CI: 0.3619-0.8447), and CD4 cell count ≥ 200 (hazard ratio = 0.2728, 95% CI: 0.0749-0.9924) were significant predictors at 5% level of confidence for time to virological failure. Conclusion: The incidence and survival rate of virological failure were high. The current study revealed that male coinfected patients, bedridden functional status, WHO clinical Stage IV, and opportunistic infections other than tuberculosis were associated with a higher time to virological failure while patients disclosed the disease to a family member, cotrimoxazole preventive therapy users, baseline viral load < 1000 copies/mL, and CD4 cell count ≥ 200/mm³ had significantly lower time to virological failure. Therefore, public health organizations should be given special attention based on these important predictors to improve their health and prolong the lives of coinfected patients.

Background: Toxoplasma gondii and rubella virus are significant health concerns among women. Therefore, it is crucial to determine the prevalence of their antibodies. Objective: This study aimed to explore the prevalence of rubella and toxoplasmosis immunoglobulin G (IgG) antibodies among females who attended different clinics in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Method: A retrospective observational study was conducted among nonpregnant women who attended various clinics at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The study included 540 female participants who visited various clinics, with a mean (standard deviation [SD]) age of 31.92 (6.175) years and a median (interquartile range [IQR]) of 32 (8). These women were tested for rubella and toxoplasmosis IgG and immunoglobulin M (IgM) from January 2021 to June 2022. ELISA test for detecting antitoxoplasmosis and antirubella IgG and IgM antibodies was conducted using kits manufactured by Abbott, located at Max-Planck-Ring 2, 65,205 Wiesbaden, Germany. Results: The majority of the participants were from Saudi Arabia (78.1%). Most females (73.3%) had positive results for rubella IgG, while only 5.6% tested positive for toxoplasmosis IgG. A significantly higher percentage of positive rubella-G antibodies was seen between those with positive toxoplasmosis IgG and those with negative toxoplasmosis IgG (93.3% vs. 76.4%, p=0.032). Non-Saudi females had a significantly higher rate of positive toxoplasmosis IgG than Saudi women (15.4% vs. 2.9%, p < 0.001). Conclusion: The study revealed a high prevalence of rubella antibodies and a low prevalence of toxoplasmosis antibodies among females living in Saudi Arabia, with a higher prevalence of toxoplasmosis antibodies seen among non-Saudi females. A significant association between the prevalence of rubella and toxoplasmosis antibodies was found. Therefore, raising awareness about the risks and prevention measures of toxoplasmosis is crucial, emphasizing hygiene practices.

Background: Staphylococcus epidermidis is an important cause of nosocomial infections in children. The study undertaken identified antibiotic resistance markers among biofilm-forming S. epidermidis. Methods: A total of 105 bacteremia-positive samples from hospitalized children were processed for identification of S. epidermidis using species-specific rdr gene. Phenotypic antibiotic resistance was checked through Kirby-Bauer disc diffusion method. 96-well microtiter plate assays and PCR were used for biofilm production and antibiotic-resistant genes, respectively. Results: Among 105 clinical isolates, rdr gene was detected in 34 (32.38%) isolates. The rdr detected isolates exhibited biofilm formation (n = 34; 100%). Multidrug-resistant (MDR) pattern was observed among S. epidermidis, while the frequency of MDR was higher in very strong biofilm-forming S. epidermidis (n = 18; 52.9%, p ≤ 0.002) as compared to weak biofilm-forming S. epidermidis (n = 6; 17.6%). All S. epidermidis strains were resistant to cefoxitin, penicillin, and augmentin (n = 34; 100%). High resistance was observed against erythromycin (n = 29; 85.29%) and ciprofloxacin (n = 25; 73.5%). S. epidermidis displayed complete susceptibility (n = 34; 100%) toward vancomycin, tetracycline, and linezolid. Among the S. epidermidis isolates, the methicillin resistance gene (mecA, n = 29; 85.2%, p ≤ 0.000), the erythromycin resistance gene (msrA, n = 19; 55.7%) and the beta-lactamase resistance gene (blaZ, n = 17; 50%) were detected. Detection of mecA (n = 17; 94.4%), msrA (n = 8; 44.4%) and blaZ (n = 11; 61.1%) significantly (p ≤ 0.0052) correlated with very strong biofilm-forming S. epidermidis. Conclusion: Biofilm formation is significantly associated with antibiotic resistance. The study's result will help to understand the molecular mechanism of antimicrobial resistance in biofilm-forming S. epidermidis among pediatric patients.