Research and Reports in Tropical Medicine最新文献

Allergic conditions, including asthma, allergic rhinitis, and atopic dermatitis, are increasingly recognized as critical global health concerns in tropical regions. The unique environmental characteristics of the tropics, such as high humidity, diverse vegetation, persistent pollen exposure, and elevated levels of mold and insect allergens, increase the prevalence and severity of allergic diseases. Addressing these challenges requires tailored strategies that are both practical and evidence-based. This review introduces a comprehensive seven-day and seven-step framework for managing allergies in tropical climates. This is designed to empower individuals with actionable steps and scientifically supported interventions. Databases such as PubMed, Scopus, Web of Science, and EMBASE were used. The search strategy includes specific keywords and Medical Subject Headings (MeSH) terms related to allergies or offering insights into preventive measures. The plan encompasses a structured approach, beginning with identifying triggers and creating an allergen-friendly environment. Symptoms management, prevention of cross-contamination, dietary optimization, and long-term evaluation. Emphasis is placed on the adaptability of these measures to resource-constrained settings in tropical regions by integrating modern scientific insights with practical, step-by-step guidance. This framework addresses the distinct challenges of managing allergies in tropical environments but also highlights the importance of education, environmental control, and community-level engagement. This review underscores the need for sustainable and locally relevant solutions to improve health outcomes and enhance the quality of life for individuals living in tropical climates.

Toxoplasma gondii is a world-wide parasite, with an estimated prevalence of approximately 30%. Toxoplasmosis is a severe disease in the immunocompromised, but few symptoms are exhibited by patients with an intact immune system, making this parasite a worldwide burden. Currently, few drugs exist in treating acute toxoplasmosis and no drugs exist to eliminate the bradyzoite of T. gondii. Effective therapies against acute and chronic toxoplasmosis are urgently needed to reduce the burden of this disease. This review aims to give a summary of recent findings in the bradyzoite form of Toxoplasma gondii and the implication of these findings on drug development. A thorough search of PubMed and Google Scholar databases was used to identify studies within the past 10 years that illustrate targetable key elements in the differentiation and formation of the bradyzoite form of T. gondii.

Background: The perception of black African subjects toward hemorrhoidal disease is surrounded by myths and misconceptions in sub-Saharan Africa. This study aimed to determine the magnitude of knowledge, attitudes, and practices (KAPs) of black African subjects toward hemorrhoidal disease and the impact of knowledge on their attitudes and practices.

Methods: A cross-sectional KAP survey was conducted through convenience sampling of 735 participants (mean age, 38.8 years; men, 59.2%) from urban and rural areas in Côte d'Ivoire. They received an auto questionnaire of 25 items on Likert scales depicting their KAP toward hemorrhoidal disease. A mean score of KAP < 50 points was considered low. Logistic and linear regression models were used to determine the factors associated with self-reported hemorrhoidal disease and the impact of knowledge on attitudes and practices.

Results: The overall Cronbach score was 0.75, and the sample proportions of self-reported or symptom-based hemorrhoidal disease were 44.4% (9% CI: 41-48) and 21.2% [95% CI: 18.4-24.4], respectively. The overall mean (SD) scores of KAP were low: 49 (34.4), 43.4 (18.7), and 33.6 (21.7), respectively. The attitudes and practices of the participants remained unchanged regardless of their knowledge. Hemorrhoidal disease was negatively associated with attitudes (beta = -3.1, p = 0.02) or practices (beta = -3.4, p < 0.05). Overall, the participants agreed that hemorrhoidal disease led to sexual dysfunction (85.2%) and infertility (67.1%). They preferred indigenous (52.4%) over modern treatments (30.2%) and perceived surgery for hemorrhoidal disease to be dangerous (24.4%) and not recommended (56.6%).

Conclusion: Knowledge did not change the attitudes and practices of black African subjects toward hemorrhoidal disease.

Background: Malaria is a major public health problem in the Central African Republic (CAR). Data on malaria epidemiology are often derived from confirmed cases of symptomatic malaria using passive detection approaches, with very limited knowledge of the extent of subclinical and submicroscopic infections.

Methods: A community-based cross-sectional study was conducted in Bangui, the capital of the CAR, to assess the prevalence of subclinical malaria parasitaemia. Proportions of positive tests for malaria parasites were determined by combining the results of antigen-based malaria rapid diagnostic test (mRDT), thick blood smear microscopy, and polymerase chain reaction (PCR).

Results: A total of 638 participants (mean age, 26.44 years (range, [1-75] years) with a sex ratio (M/F) of 1.22) were tested for malaria using all three detection methods. Proportions of positives were 32.45% by PCR, 27.59% by mRDT, and 23.51% by Giemsa-based thick blood smear microscopy, representing the burden of subclinical malaria. In addition, a 9.56% prevalence of submicroscopic infections was observed. Subclinical malaria was more common in individuals aged 15-49 years, and microspatial heterogeneity in positivity was observed, with the majority of cases occurring in semi-urban areas by mRDT and microscopy, respectively. Approximately, 80% of microscopy-positive subjects had a low parasite density (<1000 parasites/µL whole blood). Although P. falciparum was the most common species (98.55%), the transmission of P. ovale appears to be well-established in the area, occurring either as mono-infection (1.45%) or co-infection (1.93%) with P. falciparum.

Conclusion: This study of community malaria in Bangui highlights the high burden of subclinical malaria in the community and provides essential baseline data to guide future research on malaria parasites in the CAR, particularly regarding the circulating parasite species. The high prevalence of community malaria demonstrates its persistence as a major public health challenge in the country, highlighting the need to intensify its ongoing control using new tools such as the upcoming malaria vaccine.

Introduction: This paper presents (a) the progress made towards achieving the 2023 Lymphatic Filariasis (LF) Mass Drug Administration (MDA) campaign goals, (b) the estimated financial savings resulting from integrating LF MDA into Polio immunization campaigns, and (c) the best practices, challenges, and recommendations.

Methods: In 2023, 21,336,057 people in 83 districts were affected by LF and required Preventive Chemotherapy (PC). The National NTD Control Programme (NTDCP) conducted three phases of LF MDA campaigns in those districts. In the first phase, 24 districts received triple therapy of Ivermectin, Diethylcarbamazine, and Albendazole (IDA), while the remaining 59 districts continued to receive dual therapy of Diethylcarbamazine and Albendazole (DA) as before. The first phase (15 districts) was not integrated, while the second phase (61 districts) was conducted simultaneously with the Polio Supplementary Immunization Activities (SIA) fourth round. The third phase (7 districts) was combined with periodic intensification of routine immunization (PIRI) and vitamin A supplementation.

Results: In Phases 2 and 3, the campaign covered 99.97% of the targeted 12,208 villages, meaning only three villages remained untreated. In contrast, Phase 1 covered all the targeted 2,847 villages, attaining 100% geographic coverage. The 68 districts (Phase 2 and 3) that implemented an integrated approach attained an average therapeutic coverage of 76.6% (STDEV=8.3) compared to 73.2% (STDEV=6.7) among the 15 districts (Phase 1) that conducted MDA for LF without integration. The p-values for geographical and therapeutic coverage were below the significance level of 0.05, leading to the conclusion that the average geographic and therapeutic coverages for districts implementing LF MDA with and without integration into Polio immunization campaigns differed significantly. Integrating the LF MDA campaign into the Polio SIA and PIRI campaigns saved US$1,431,203.

Conclusion: Incorporating LF MDA into polio immunization campaigns can improve financial efficiency and effectiveness in meeting the objectives of LF programs.

Introduction: Raga County is an onchocerciasis-endemic area in the Western Bahr El Ghazal state of South Sudan, known to have a high prevalence of blindness. The objective of this study was to determine the causes of eye disease and blindness in Raga County as well as to assess the relationship of eye diseases with other prevalent conditions like onchocerciasis and epilepsy.

Methods: We reviewed unpublished pre-community directed treatment with ivermectin (CDTI) data about eye disease and onchocerciasis in Western Bahr El Ghazal including Raga. In addition, a cross-sectional study was conducted from 21^st March to 2^nd April 2023 in 11 villages in Raga County. Participants were persons with blindness or other eye/vision problems, recruited via a community-based approach. Two senior ophthalmic clinical officers, supervised by an experienced ophthalmologist, performed the following assessments on participants: visual acuity measurement with Snellen Charts, anterior chamber examination with a loupe, and fundoscopy to assess the posterior segment with direct and indirect ophthalmoscopes.

Results: Pre-CDTI data showed that the most severe vision problems in villages with a high prevalence of O. volvulus infection were caused by onchocerciasis eye disease. During the 2023 survey, in total, 1559 persons (3,118 eyes) were examined (mean age: 47 ± 19.2 years, 58.4% male). The most frequent eye diagnosis was allergic conjunctivitis, observed in 1453 (46.6%) eyes of the participants. The main causes of blindness were onchocerciasis-related blindness (22.6%, caused by onchocerciasis chorioretinitis (9.4%), sclerosing keratitis, punctate keratitis (5.6%), and onchocerciasis optic neuropathy (7.6%)), and cataract (9.3%). A significantly higher proportion of persons with epilepsy presented with clinical signs of onchocerciasis including blindness (53.2%), compared to persons without epilepsy (32.5%) (p = 0.0007).

Conclusion: Despite years of CDTI, the main causes of blindness in Raga County remain onchocerciasis-related blindness observed in 22.6% and cataract observed in 9.3% of the study participants. The study confirmed an epidemiological association between onchocerciasis and epilepsy.

Purpose: The rate of moderate-to-severe hearing loss in Southeast Asia is 5.8%, among the world's most prevalent. However, it is difficult to measure for people whose healthcare access is limited by the ongoing civil war. Therefore, a cross-sectional study of the impacts of hearing loss was incorporated with ongoing vision/cataract clinics along the Thai-Burma border.

Patients and methods: In this cross-sectional observational study, culturally sensitive informed consent was obtained from patients presenting to a regionally promoted hearing clinic in Karen State, Burma (Myanmar) with a chief complaint of hearing loss. They were then administered a standardized survey derived from the Hearing Handicap Inventory for Adults/Elderly (HHI), then assessed based on history, otoscopy, Weber and Rinne testing, and portable audiometry.

Results: Twenty-two adults and children presented with a chief complaint of hearing loss, and 26 others came seeking vision care needing cataract surgery. HHI survey showed 41% had mild-to-moderate, and 34% had moderate-to-severe hearing impairment. On a 0-4 Likert scale, prominent complaints due to hearing loss were feeling upset (2.4 ± 1.8), limited social life (2.2 ± 1.6), using the phone less (2.1 ± 1.8) and needing to be warned of the danger by others (2.1 ± 1.9). Seventy-three percent had no prior hearing care. Access was limited due to financial (59%), limited travel (50%), and military conflict (41%). Pure-tone averages were 55.3 + 22.1 dB and 67.9 + 14.5 dB for the right and left ears, respectively. Pure tone averages are negatively correlated with HHI survey score (R = -0.53). Chicken feathers were a common mechanism of ear drum trauma. Twenty patients received Solar Ear hearing aids.

Conclusion: Ongoing military conflict in the Karen State leaves the internally displaced people with high prevalence of hearing loss and fear of additional injury due to inability to hear danger. Surveys such as this appear more useful to assess the individual impact of hearing loss rather than severity. Efforts by regional medics to provide hearing care should be supported.

We present the case of an HIV-positive man diagnosed with multicentric Castleman disease (MCD) associated with human herpesvirus 8 (HHV8) infection, complicated by renal failure. This subtype of an otherwise rare disease is a complication of HIV and HHV8 infection. The diagnosis and management of HHV8-MCD in the developing world is challenging-in part due to its rarity, but largely due to the limited access to histology and other laboratory services. Our case presented with a confusing constellation of symptoms and was diagnosed with MCD on histology. Here we discuss the epidemiology, pathogenesis, diagnosis, and treatment of HHV8-MCD in the context of HIV infection in a resource-limited setting, in the hope that greater awareness will lead to more prompt recognition.

Background: Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome.

Methods: This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed.

Results: 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%).

Conclusion: Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up.

Background: Ascaris lumbricoides is a common infectious parasite of the gastrointestinal tract worldwide, but the invasion of the pleural cavity is rare.

Case report: A 45-year-old man from Eastern Sudan presented to the emergency department complaining of breathlessness, cough stained with blood, and chest pain one month before his presentation. Also, he complained of high-grade fever for two weeks associated with sweating. Diagnosis of hydropneumothorax was made and a chest tube was inserted, two days later we found three adult A. lumbricoides worms in the chest drain.

Conclusion: The patient was treated with Albendazole 200 mg, orally twice, daily for seven days, he improved and was referred to a cardiothoracic surgeon for more assessment. Our study highlights that internal medicine specialists should know about pleural ascariasis when patients present with respiratory signs and symptoms, especially in A. lumbricoides endemic regions like Eastern Sudan.