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

Background: Malaria is a serious public health issue in Pakistan. This study investigated the spatiotemporal patterns, seasonal dynamics, and molecular confirmation of malaria in District Malakand, Khyber Pakhtunkhwa, from 2011 to 2017.

Methods: Clinical data were collected from the District Headquarters Hospital over 7 y. A random sample of 120 patients from 2017 was used for microscopic and molecular identification. Spatial-temporal patterns were analysed using ArcGIS (Environmental Systems Research Institute (Esri), Redlands, California, United States). Statistical analyses were performed using SPSS (IBM Corporation, Armonk, New York, United States) and R software (R Foundation for Statistical Computing, Vienna, Austria).

Results: Of 41 863 tests, 6246 were positive, yielding an overall test positivity rate of 14.92%. Males (58.89%) were more affected than females. The highest proportion of cases was in the 1-20-y age group. The annual test positive rate declined from 32.97% in 2011 to 10.77% in 2017. Seasonally, autumn had the highest case proportion (46.73%); winter the lowest (7.09%). Spatial analysis identified Gharhi, Dargai and Haryankot as high-burden areas. Inverse distance weighting highlighted these as hotspots for potential transmission. PCR confirmed microscopy-based species identification.

Conclusions: Malaria in Malakand peaks in autumn, affecting males and individuals aged <20 y most. Neighbouring villages are at risk from hyper-endemic areas. Microscopy remains a dependable diagnostic tool here.

Background: Herein we characterize the factors associated with the hospitalization and deaths of patients with chikungunya from 2017 to 2023 in Brazil.

Methods: We used a retrospective case series using chikungunya virus records with suspected case criteria and positive laboratory tests according to the Ministry of Health guidelines. A 95% confidence interval was considered for all statistical tests.

Results: Factors associated with hospitalization or death outcomes were fever, leucopenia, diabetes, chronic kidney disease, hypertension, emesis and autoimmune disease.

Conclusions: The analysed data indicate that the described clinical profile should be used to adopt preventive measures aimed at reducing hospitalizations or deaths in patients with chikungunya virus.

Measles remains a leading vaccine-preventable cause of viral pneumonia worldwide. In people with advanced human immunodeficiency virus (HIV) its course is often atypical, lacking the hallmark rash and progressing rapidly to respiratory failure. We report a case of measles virus-associated acute respiratory distress syndrome in a profoundly immunosuppressed woman with HIV and chronic hepatitis B who failed to respond to ribavirin. This case underscores the diagnostic challenge of rash-less measles in acquired immunodeficiency syndrome, the narrow therapeutic window for antivirals and the urgent need to integrate adult measles screening and vaccination into HIV care.

Background: Aedes-borne diseases represent an increasing public health problem in Sudan. There is a lack of knowledge of Aedes mosquitoes that breed in natural habitats, especially tree-holes. The current study describes Aedes mosquitoes' fauna in tree-holes of different tree species in Sennar state.

Methods: Larval surveys were carried out to determine the presence and abundance of tree-hole mosquitoes in three study sites during the rainy season.

Results: A total of 253 trees with holes containing water were inspected and 99 (39.10%) trees were positive for Aedes mosquito larvae. Eight Aedes mosquito species were identified from 798 collected larval specimens: Aedes luteocephalus (45.5%), Aedes furcifer (17.2%), Aedes unilineatus (15.4%), Aedes metallicus (9.6%), Aedes aegypti formosus (6.6%), Aedes africanus (4.5%), Aedes taylori (0.6%) and Aedes adersi (0.5%). Tree-holes of Psidium guajava and Mangifera indica contained higher numbers of Aedes species in terms of diversity and density compared with other types of trees.

Conclusions: The predominance of sylvatic Aedes species in these areas raises concerns as many are known or potential vectors of arboviruses. These species could sustain the transmission of arboviruses within and around natural reserves and should be taken into consideration as part of the control framework for arboviral infections.

Background: Leprosy is described as a curable infectious disease but is considered a stigmatizing disease due to the damage it causes to the skin and nerves. The stigma associated with leprosy promotes social isolation and reinforces maladaptive behaviours. This study aims to investigate long-term emotional brain changes in the amygdala and cortex insular of treated leprosy patients using psychometric scales and a multimodal neuroimaging approach.

Methods: Fourteen treated leprosy patients and fourteen paired healthy controls were evaluated by magnetic resonance imaging (MRI) using two approaches, functional connectivity analyses and brain volume morphometry. During the functional MRI exam, the participants underwent an implicit emotional recognition task comprising aversive emotional stimuli.

Results: The patient's group showed greater connectivity between the amygdala and supramarginal gyrus. Granger causality analysis revealed that the patient group connectivity was bidirectional while in the control group it was unidirectional with left amygdala activity being predicted by the left supramarginal gyrus. Also, there was a positive correlation between this connectivity and anxiety scores. Leprosy-treated patients also showed a smaller bilateral amygdala volume.

Conclusions: The changes in brain connectivity and brain morphometry in the present study may represent a cumulative neurobiological effect of their mental suffering in their stigmatizing leprosy-related condition.

Schistosoma japonicum infection can cause severe hepatic complications associated with portal hypertension, which may lead to death by bleeding from esophageal varices. Ultrasonography (US) enables the identification of two different types of liver fibrosis characteristic for S. japonicum infection: interseptal fibrosis (ISF) and portal fibrosis (PF). To date, these two forms of liver fibrosis have not been sufficiently investigated with regard to their potential to cause portal hypertension. Among the 121 reports published, only 56 (46.3%) distinguish between ISF and PF. In 31/56 (55.4%) of these publications, patients with only ISF, two (3.6%) with only PF, as well as 23 (41.1%) with concomitant ISF and PF, are reported. US signs of portal hypertension are reported in 10/25 (40.0%) of publications reporting PF, of which 2/2 (100%) of publications report PF alone and 8/23 (34.8%) of publications report concurrent PF and ISF. Also, 2/31 (6.5%) of publications report that ISF alone is associated with portal hypertension. Thus, PF appears to be the main risk factor for portal hypertension. Future studies need to assess the exact nature of liver fibrosis caused by S. japonicum in a standardized way to clarify the individual contributions of PF and ISF to morbidity.

Background: Drug-combination therapies are needed to combat treatment refractory giardiasis. However, data describing the activity of combinations of currently used drugs against Giardia duodenalis are unavailable.

Methods: The in vitro activity of combinations of currently used antigiardial drugs were investigated against G. duodenalis.

Results: Combinations of metronidazole with albendazole or quinacrine, and quinacrine with nitazoxanide, behaved additively, whereas combinations of metronidazole with nitazoxanide, albendazole or quinacrine behaved synergistically. Combinations of albendazole with nitazoxanide behaved antagonistically.

Conclusions: While combinations of metronidazole with nitazoxanide, or albendazole with quinacrine, may be effective treatments of giardiasis, combinations of albendazole with nitazoxanide are likely to result in negative pharmacodynamic interactions.

Background: Tuberculosis (TB) active case-finding (ACF) among high-risk populations is recommended to detect the missing people with TB. In Rajasthan, India, a state with a high TB prevalence:notification ratio, leveraging digital annual health survey data could enhance ACF by targeting villages with a high burden of TB risk factors.

Methods: We conducted an ecological study across 19 districts of Rajasthan using data from the digital annual health survey. High-risk villages were identified based on three factors: multidimensional poverty index (MDPI), high proportion (>60%) of socially marginalized populations and geographic access (distance to primary health centre >7 km).

Results: The survey covered 24.6 million individuals across 20 803 villages. Thirty-five percent of individuals belonged to socially marginalized populations. At the household level, 39% used solid fuels, indicating potential exposure to indoor air pollution. Nine percent of villages had high poverty (MDPI >0.21) and 25% had a high proportion (>60%) of socially marginalized populations. Approximately 34% of villages had at least one of the three high-risk factors.

Conclusions: This study demonstrates the potential of existing digital annual survey data for targeted ACF. Further research is being planned to assess the yield of ACF in identified high-risk villages and to advocate for similar data-driven interventions in other settings.

Background: Chagas disease (CD) affects approximately 300 000 individuals in the USA. However, its impact on heart failure (HF) hospitalizations in the USA as non-endemic setting remains poorly characterized. We aimed to assess the clinical profile and acute clinical outcomes of HF hospitalizations in patients with CD compared with those without CD in the USA.

Methods: The National Inpatient Sample (2002-2021) was queried for adult hospitalizations with a primary diagnosis of HF. Multivariable regression models assessed the association between CD diagnosis and in-hospital mortality, length of stay and total healthcare costs.

Results: Among 2 990 959 HF hospitalizations, 154 (0.005%) had a CD diagnosis. After adjustment, CD was associated with longer length of stay (β=5.94 d, 95% CI 4.92 to 6.97) and higher total healthcare costs (β=US$94 886, 95% CI 79 282 to 110 490), but not differential mortality (OR=0.63, 95% CI 0.19 to 2.11). Sex-stratified analyses revealed longer hospitalizations in females (β=8.58 vs 3.75 d), but higher healthcare costs in males (β=US$106 667 vs 80 089) with CD compared with their non-CD counterparts.

Conclusions: In the USA, HF hospitalizations with CD are characterized by increased healthcare utilization, despite similar mortality compared with non-CD admissions. Sex-specific differences in outcomes highlight the need for targeted approaches to care delivery. Larger studies focused on CD cases detection are needed to have a better understanding of the burden of this neglected disease in non-endemic settings.