Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

Background: Haematological parameters and CD4+ T-cell count are used as indicators of disease severity and treatment response. Ethiopia is one of the cutaneous leishmaniasis (CL)-endemic countries. There is a scarcity of data on the haematological and CD4+ T-cell profiles of patients with CL in Ethiopia.

Methods: A cross-sectional study was conducted from April to July 2022. This study was conducted at Nefas Mewcha Hospital Leishmaniasis Treatment Centre. Patients with different clinical presentations of CL were recruited. The controls were from a non-CL endemic area and had neither symptoms nor history of CL. Demographic data were collected by a standardised questionnaire. Complete blood cell and CD4+ T-cell counts were determined by a MicroCC-20 Plus automated haematology analyser and BD FACSPresto, respectively. The data were analysed using SPSS-23 and Graphpad Prism 9.4.1. Statistical difference was considered at p<0.05.

Results: A total of 48 adult patients (41.7% female; median age: 28 [18-45] y) with CL and 31 controls were recruited. Most patients (62.5%) had localised CL. Whole blood levels, haematological parameters and CD4+ T-cell count were significantly lower in patients than controls. The median value of CD4+ counts was 734.5/mm³ in CL vs 867.0/mm³ in controls. There was no significant difference in all parameters between patients with different clinical forms.

Conclusions: Patients with CL had significantly lower levels of haematological parameters and CD4+ T-cell count.

Background: Gastrointestinal parasitic infections remain a major health burden in low- and middle-income countries (LMICs).

Methods: Overall, 1238 faecal samples (548 from healthcare-seeking children [Cohort 1] and 690 from children from the community [Cohort 2]) were examined by microscopy for Giardia duodenalis and Entamoeba species, and by PCR for G. duodenalis, Entamoeba histolytica, Entamoeba dispar and Cryptosporidium spp. Associations between symptoms, microscopy intensity and PCR cycle threshold (Ct) values were analysed. Children were matched by age, gender and residence.

Results: Giardia duodenalis was the most common, detected by PCR in 56.2% (Cohort 1) and 63.0% (Cohort 2) (p≤0.05), 2.5 times more often than by microscopy. Microscopy overestimated E. histolytica prevalence by 23% compared with PCR, due to non-pathogenic species. Four E. histolytica infections and one Cryptosporidium infection were PCR-confirmed. Ct values correlated with microscopy intensity (p<0.01), but detection was not linked to symptoms. The only cohort difference was water source: 48% in Cohort 2 vs 23% in Cohort 1 had private water posts.

Conclusions: Children in Bissau carry a high asymptomatic burden of G. duodenalis. Microscopy overestimates E. histolytica, while PCR improves specificity. Selective molecular testing with clinical assessment is recommended for rational treatment in high-endemic, resource-limited settings.

Leprosy is a public health concern in India, with significant social stigma and exclusion faced by affected individuals. Social participation is a critical component of rehabilitation and overall well-being, yet limited evidence has been synthesized regarding the associated factors. Therefore, this systematic review aimed to provide an overview of the social participation of people affected by leprosy from the existing literature in India. Scopus, PubMed and InfoLep databases were searched to identify the articles for the systematic review, which only includes studies conducted in India. The critical appraisal tool of cross-sectional studies-AXIS-was used to assess the study quality and risk of bias. The search identified 458 articles; 23 full-text articles were considered for eligibility, six of which were included in the review. All studies used the Participation Scale to assess social participation in individuals with leprosy. Findings showed associations between older age, female gender, lower socioeconomic status, longer disease duration and the multibacillary form of leprosy with participation restrictions. To overcome the restrictions on the social activities of people affected by leprosy, a comprehensive approach, consisting of health promotion activities, early accessible healthcare and improved rehabilitation services, is needed.

Malaria vaccines are crucial for advancing public health and achieving malaria elimination. Currently, pre-erythrocytic vaccines like RTS, S/AS01 and R21/Matrix-M are in use, but their effectiveness is limited. Ongoing research on blood-stage vaccine candidates such as RH5, MSP1 and MSP3 has shown promising results. Incorporating a blood-stage vaccine could greatly enhance malaria control by targeting the symptomatic phase of the infection, providing additional protection alongside pre-erythrocytic vaccines and other control methods. Understanding the structural biology and immunological interactions of blood-stage antigens is essential for developing effective vaccines. Combining pre-erythrocytic and erythrocytic-stage vaccines could lead to better protection, improved public health outcomes and significant progress toward malaria elimination.

Background: This study was conducted to assess the correlation between baseline waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), triceps skinfold thickness (TSFT) and subscapular skinfold thickness (SSFT) with body mass index (BMI) at follow-up and to identify the anthropometric parameters accounting for the highest proportion of the BMI variation among junior high school students in Ho Chi Minh City.

Methods: This was a 5-y prospective cohort study; 761 students were followed annually. Data collected included height, weight, WC, TSFT and SSFT. Pearson correlation coefficients were calculated to investigate the correlations between baseline anthropometric parameters with BMI at follow-up. Multilevel mixed-effect models with linear regression analyses and Poisson regression were used to assess the relationship between all listed variables with BMI changes as well as the risk of being overweight/obesity.

Results: BMI, WC, TSFT, SSFT, WHtR, the sum of four skinfold thicknesses and % body fat at baseline were all strongly correlated with BMI at follow-up (p<0.001). Among multiple linear regression models, the models with WC or WHtR accounted for the highest variation in BMI changes (approximately 74.5%) (p<0.001), while the model with WHR explained only 22.7% of the variation in BMI changes.

Conclusion: WC is a simple anthropometric indicator, which can be easily used to assess adiposity and is significantly associated with BMI changes over time.

Background: Anisakis simplex is a parasitic zoonosis associated with consuming raw or undercooked fish. Despite its global relevance, data from Africa are scarce. This study assessed the seroprevalence and risk factors of A. simplex infection among primary schoolchildren (PSC) in Makoko, an urban slum in Lagos, Nigeria.

Methods: A cross-sectional study was conducted from November 2013 to March 2014 involving 196 PSC from three government schools. Serodiagnosis was performed using enzyme-linked immunosorbent assay (ELISA) with recombinant Ani s 1 and Ani s 7 allergens. Stool samples were examined for soil-transmitted helminths (STHs) using the Kato-Katz method. Structured questionnaires gathered demographic and dietary information.

Results: The overall seroprevalence of A. simplex infection was 12.25%. No significant association was found with gender or raw fish consumption. However, parental education and occupation influenced seropositivity. Interestingly, co-infection with STHs was inversely associated with A. simplex seropositivity. ELISA demonstrated high specificity with minimal cross-reactivity to STHs.

Conclusions: This study provides the first seroepidemiological data on A. simplex in Nigerian children. Public health interventions, particularly fish-handling education, are warranted. Further research is needed to understand the clinical relevance of A. simplex sensitization in African settings.

Background: Leprosy relapse remains a challenge to Brazil's elimination efforts, particularly in regions where Mycobacterium leprae persists in the environment. While multidrug therapy (MDT) is effective, patients exposed to ongoing transmission may develop reinfections over time. This study investigates whether proximity to pilgrimage sites influences leprosy relapse in the Cariri region.

Methods: Leprosy relapses in the Cariri region (2010-2022) were georeferenced based on patients' residences. A geostatistical model assessed relapse proximity to pilgrimage sites, classifying cases (2-18 km) and controls (18-102 km) by spatial dependence. Logistic regression assessed relapse odds near pilgrimage sites, comparing reinfections (≥5 y) to insufficient therapy (<5 y), adjusted for age, gender, cure outcome, disease severity and patient mobility.

Results: A total of 337 leprosy relapses were identified across 45 municipalities in the Cariri region. Spatial analysis indicated that individuals living near pilgrimage sites had nearly twice the odds of experiencing a relapse ≥5 y after MDT treatment (OR=1.76, 95% CI 1.09 to 2.85), supporting the hypothesis that pilgrimage sites may act as transmission hotspots.

Conclusions: Leprosy elimination in Brazil requires context-dependent measures. Pilgrimage sites, where individuals seek healing but may contribute to transmission, should be prioritized for active surveillance and targeted interventions.

Background: Few attempts have been made to explore the drug-resistant tuberculosis (DR-TB) outcomes and associated factors among underprivileged communities. This study aimed to determine DR-TB treatment outcomes and associated factors in the Saharia tribal group (TGs), a community with a high TB burden in Madhya Pradesh, India.

Methods: TB cases were detected through active case finding and were treated under the National Tuberculosis Elimination Programme. All the patients who were initiated on DR-TB treatment and had outcomes at the end of treatment were included in the study. The DR-TB treatment outcomes and associated factors were recorded.

Findings: Of 323 patients included in the analysis, 216 patients (66.8%) had successful treatment outcomes, including 70 (21.7%) who were cured and another 146 (45.2%) who completed treatment. Among the rest, 36 (11.1%) died, 66 (20.4%) were lost to follow-up and 5 (1.5%) had treatment failure. A total of 83% of patients were rifampicin resistant (RR)/multidrug resistant (MDR).

Conclusions: Although the program's recommended target of >75% could not be achieved, the treatment success rate in the study is still admirable in a hard-to-reach high-TB-risk tribal area. The findings show that with community-based approaches, favourable treatment outcomes can be achieved in DR-TB patients from resource-poor settings.