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

Background: Dermatological manifestations affect 5% of patients with human T-lymphotropic virus (HTLV).

Methods: Thirteen patients with inflammatory or lymphoproliferative dermatological diseases, both HTLV-positive and HTLV-negative, were selected for treatment with ultraviolet B narrowband (UVB-NB) phototherapy. Clinical and histopathological evaluations were conducted before and after 120 d of phototherapy.

Results: All seven HTLV-positive patients evaluated were type 1. Clinical evaluation showed improvement in all 13 patients. In the histopathological examination, all patients with lymphoproliferative diseases and five with inflammatory diseases showed regression in most of the assessed parameters.

Conclusions: The present research suggests that UVB-NB phototherapy is a promising treatment for lymphoproliferative and inflammatory skin diseases in HTLV-1 patients.

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: Faecal microscopy is the mainstay of soil-transmitted helminth diagnosis and commonly completed on formalin-fixed samples when resources are insufficient to analyse fresh samples. This study assessed the diagnostic sensitivity of microscopic techniques using formalin-fixed samples.

Methods: Formalin-fixed faecal samples from 574 individuals were tested by the formalin-ethyl acetate concentration technique (FECT), Malachite smear, McMaster and McMaster2 methods. Agreement between tests was assessed by Kappa. Bayesian latent class models and a composite reference standard estimated the diagnostic sensitivity of each test.

Results: Moderate-to-good agreement between tests was observed for A. lumbricoides. Agreement was poorer for hookworm and Trichuris trichiura. The FECT (72.70%, credible interval [CrI]: 68.92-76.56%) and McMaster2 method (67.93%, 95% CrIs: 62.41-73.31%) had the highest sensitivities for A. lumbricoides. For hookworm, the McMaster2 method (70.56%, 95% CrIs: 64.10-76.96%) was more sensitive than all other tests. For T. trichiura, the McMaster (90.10%, 95% CrIs: 83.29-94.67%) and McMaster2 (89.3%, 95% CrIs: 82.28-94.52%) methods were the most sensitive.

Conclusions: The McMaster2 method is a viable alternative to FECT and provides important information on the intensity of infection. The effect of formalin-fixation on test performance may not be as great as previously assumed. This study reports formalin-fixed sensitivities similar to previous estimates using fresh samples.

Background: This study aimed to see if rifampicin susceptibility can be determined on repeat sampling in pulmonary tuberculosis with a trace call on the first GeneXpert Ultra report.

Methods: This retrospective cohort study included adults with a GeneXpert Ultra trace call in the first respiratory sample from January 2021 to June 2024.

Results: Of the 27 patients with repeat sampling done after the initial trace call, rifampicin susceptibility could be determined in 37% (n=10) of patients.

Conclusions: Repeating GeneXpert Ultra testing in patients with an initial trace call is valuable for determining rifampicin susceptibility.

Scrub typhus and leptospirosis are re-emerging zoonotic infections with significant morbidity and mortality rates in India. Overlapping aetiological and epidemiological patterns indicate a high possibility of their co-infection in India, which can be a diagnostic challenge due to non-specific clinical features. A systematic search of the PubMed/MEDLINE, Scopus and Embase databases was conducted to identify relevant studies published through 31 August 2023. Studies reporting co-infection of scrub typhus and leptospirosis among the Indian population were included. Data extraction, quality assessment and statistical analysis were performed in accordance with established guidelines. Six studies met the inclusion criteria, comprising a total of 58 co-infection cases. Pooled prevalence of scrub typhus-leptospirosis co-infection among acute undifferentiated febrile illness patients was 3.7% (95% confidence interval [CI] 0.00 to 0.126). Among scrub typhus patients, the prevalence of co-infection with leptospirosis was 13.7% (95% CI 0.027 to 0.304). Significant heterogeneity was observed among the included studies, highlighting the need for cautious interpretation of prevalence estimates. This meta-analysis underscores the clinical importance of scrub typhus-leptospirosis co-infection in India and emphasizes the need for enhanced clinical awareness, improved diagnostic strategies and targeted research efforts to address this emerging infectious disease threat.

Background: Without a cure, antiretroviral therapy (ART) continues to be the primary mode of managing HIV, transforming it from a formerly lethal disease to a less severe one. Adherence to ART can be impacted by several factors, including poor quality of care.

Methods: A quantitative cross-sectional study design was used to assess the factors that influence adherence to ART among adults receiving care at two health facilities in Accra. A structured interviewer-administered questionnaire was used to collect data on factors associated with medication adherence using a modified four-item Medication Adherence Rating from 255 people living with HIV (PLHIV). Descriptive statistics were used to summarise the data, while multiple binary logistic regression was used to assess the factors influencing adherence to ART.

Results: Adherence to HIV medication was 44.7% among PLHIV. Adherence was positively correlated with high client health service satisfaction (adjusted OR [AOR]: 26.59, 95% CI 7.46 to 94.82, p<0.001), increased privacy at the HIV clinics (AOR: 3.40, 95% CI 1.40 to 8.21, p<0.007) and among PLHIV who had been diagnosed with HIV for ≥5 y (AOR: 7.59, 95% CI 2.76 to 20.85, p<0.001).

Conclusions: Adherence to ART was significantly low among study participants. The study highlights the importance of maintaining privacy and confidentiality at the facility while ensuring client satisfaction with HIV care to promote adherence to ART.

Background: Mycetoma, a neglected tropical disease endemic to Sudan, is traditionally characterized as a painless condition. However, recent studies reporting painful mycetoma lesions have challenged this assumption. With limited reports in the medical literature regarding pain in mycetoma, this study was conducted to investigate the risk factors for painful mycetoma lesions in patients visiting the Mycetoma Research Centre (MRC) in Khartoum, Sudan.

Methods: This cross-sectional study aimed to identify the risk factors for painful mycetoma lesions. The study analyzed electronic records of 481 patients with confirmed mycetoma, seen between 1991 and 2020, using a systematic sampling approach.

Results: The study found that pain was more likely to occur in cases with bone destruction, secondary bacterial infection and actinomycete infection (OR=1.762, 1.815 and 1.259, respectively). Additionally, pain was more frequently observed in patients aged 45 y and older. Smaller mycetoma lesions, measuring less than 5 cm, were less likely to cause pain, and this was identified as a significant risk factor for painful mycetoma lesions (β coefficient=-1.294).

Conclusion: The findings suggested that pain in mycetoma is typically associated with the severity of the condition. Therefore, early initiation of appropriate treatment may help reduce pain. Furthermore, careful differentiation between actinomycetes and eumycetes is essential for the timely and accurate diagnosis of mycetoma.

Background: India experiences the highest snakebite burden globally, with 58 000 predicted deaths annually. The central Indian state of Madhya Pradesh is thought to have a substantial snakebite burden and provides compensation to families who can demonstrate by postmortem and hospital treatment reports that their relatives have died due to snakebite. This study represents the first report on the frequency of distribution of compensation for snakebite deaths in Madhya Pradesh.

Methods: Statewide snakebite death compensation data from 2020-2021 and 2021-2022, provided by the Madhya Pradesh health authorities, were analysed alongside interviews with 15 families that described the events that ultimately led to their compensation claims.

Results: Compensation was paid to a total of 5728 families, with a total value equating to 22 912 Lakhs (approximately US${$}$27.94 million). Families described commonly recognised snakebite risk factors and behaviours in the events that resulted in their relatives' deaths.

Conclusions: The snakebite burden in Madhya Pradesh is significant, both in terms of mortality and economic expenditure of the state. Sustained investment in preventative interventions, as well as monitoring of the rate of compensation payouts due to snakebite death as a measure of intervention effectiveness, should be considered to substantially reduce snakebite incidence and mortality.