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

Background: This study aimed to map the cumulative evidence on pre-hospital non-medical helping behaviours and interventions attempted for snakebites.

Methods: The scoping review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: This review included 158 articles representing research conducted across 41 countries. Respective studies encompassed 83 317 snakebite cases. Visits to traditional healers and the use of traditional medicine represented the most common patterns of behaviour in response to snakebites, occurring with median rates of 21.7% and 38.7%, respectively. Particular helping actions were classified into 92 categories. The most prevalent non-evidence-based measures included washing the bite site (median occurrence rate 53.3%), use of a tourniquet (34.2%), application of herbal products through an unspecified route or various routes (20.2%), ingestion of herbs (12.0%) and incisions to the bite site (9.9%). Multiple studies confirmed an adverse influence of the guidelines-discordant helping actions on health outcomes. For low-income and lower-middle-income countries, the pooled median estimate of the occurrence of improper helping actions was significantly higher (15.0%) than for high-income and upper-middle-income countries (5.9% and 7.1%, respectively; p≤0.001).

Conclusions: Improper help-seeking behaviour and helping practices constitute a global health threat with disproportionately higher vulnerability of inhabitants of resource-limited regions of the world. Further research and widespread public awareness campaigns communicating the guidelines-recommended evidence-based methods of first aid response to snakebites are urgently needed.

Background: Serological assays and conventional PCR used for detecting Rickettsia and Orientia are time-consuming. Given that therapeutic approaches for these infections overlap, early molecular detection significantly enhances timely clinical management. This study evaluates the utility of real-time PCR for the detection of Rickettsia and Orientia compared with ELISA and the Weil-Felix test.

Methods: A total of 243 patients (92 females and 151 males) were enrolled. The Weil-Felix test and ELISA were performed to detect the spotted fever group, the typhus group and Orientia. Molecular testing included Pan-Rickettsial PCR targeting Pan antigen and real-time PCR for Orientia targeting 47 kDa. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated.

Results: Real-time PCR exhibited a sensitivity, specificity, PPV, NPV and accuracy of 88.5-95.0%, 83.25-96.0%, 81.91-96.0%, 89.42-95.0% and 85.68-95.0%, respectively. The ELISA showed a sensitivity, specificity, PPV, NPV and accuracy of 81.05-96.0%, 89.45-95.0%, 88-95.0%, 83.18-96.0% and 85.68-95.8%, respectively. The Weil-Felix test demonstrated a sensitivity, specificity, PPV, NPV and accuracy of 20.3-28%, 71-96.6%, 13-57%, 76.3-89% and 65-67%, respectively. Serological tests showed a positivity of 30-75% in convalescent-phase samples, whereas real-time PCR proved superior during the acute phase with a detection rate of 66.7-72.4%.

Conclusions: This study highlights the utility of real-time PCR as a rapid and effective tool for detecting Rickettsia and Orientia, reducing the turnaround time and simplifying the workflow.

We describe challenges and opportunities during the mpox virus animal reservoir surveillance expedition to the Mkpot community in Nigeria, a remote enclave in the heart of the Cross River rainforest that is replete with viral and ecological footprints. Anecdotal evidence of mpox in Mkpot and adjoining villages, and the absence of domestic animals where wild animal hunting and consumption is intense, suggests potential spillover of infections at the human-animal interface, requiring active surveillance and monitoring.

Malaria is a complex disease and transmission can be prevented in multiple ways. A range of interventions to achieve this became widely available from the year 2000, and cases continually declined, but progress has plateaued since 2015. This review aims to cover the population-level prevention strategies responsible for this and those that could continue this progress, focussing on how they can be successfully integrated. Insecticide-treated nets (ITNs) made the most substantial contribution to reducing malaria mortality, but their distribution, access and use remains suboptimal while development of insecticide resistance requires continuous adaptation. Chemoprevention provides protections to tens of millions of people, primarily children in sub-Saharan Africa, but is also threatened by the emergence and spread of drug resistance. These strategies may have reached a point of saturation for reducing morbidity and mortality, thus calling for innovative developments to build upon more basic approaches such as accurate early diagnosis, appropriate treatment and improved housing. The R21/Matrix-M vaccine is a significant improvement over the RTS,S/AS01 vaccine, with greater efficacy, lower cost and scalable mass production. Field trials of current monoclonal antibodies (mAbs) suggest that next-generation mAbs could be a promising tool for seasonal chemoprophylaxis. Furthermore, gene drives may have the potential to eradicate entire populations of malaria-transmitting mosquitoes. A multifaceted approach combining these new strategies with traditional approaches (ITNs and chemoprevention) offers a framework to reinvigorate progress towards malaria elimination.

This study aimed to investigate the prevalence of Toxoplasma gondii DNA in cancer tissue samples and explore potential associations with different cancer types. A total of 338 paraffin blocks from patients diagnosed with nine different cancers, including brain, lung, colon, breast, testis, prostate, uterus, ovary and eye, were analysed. The age distribution of the patients ranged from ≤30 to >70 y. The analysed sample consisted of 204 female and 134 male subjects. The molecular analysis revealed an overall prevalence of T. gondii DNA presence in 9.75% (33 cases) of the cancer tissue samples: 19 lung tissue samples, 6 colon samples, 5 breast samples and 1 sample each from the testis, prostate and uterus. Conversely, no T. gondii DNA was detected in the brain, ovary and eye samples. Statistical analysis using the χ2 test indicated a significant association between T. gondii and the type of cancer tissue, with a higher frequency in lung and colon tissues (p<0.001). However, there was no significant correlation observed between T. gondii infection and age or gender. These findings highlight potential links between T. gondii infection and specific cancer types, suggesting a need for further research to elucidate the underlying mechanisms and implications for cancer pathogenesis. Understanding the role of T. gondii in cancer development may offer new insights into preventive strategies and targeted treatments for T. gondii-associated malignancies. Further investigations are warranted to validate these associations, expand the sample size and explore the clinical significance of T. gondii infection in cancer patients.

Background: India accounts for two-thirds of the malaria burden in Southeast Asia. We described the lab-confirmed malaria cases under the Integrated Disease Surveillance Programme in Chhattisgarh, India, from 2015 to 2023.

Methods: We conducted a surveillance data analysis by abstracting the lab-confirmed malaria cases from five regions of Chhattisgarh from January 2015 to December 2023. We estimated the annual parasite incidence (API) by region and year. We estimated the incidence rate ratio (IRR) with a 95% CI over the years using a generalized estimating equation in Stata 16.0.

Results: A total of 391 387 malaria cases were reported from 2015 to 2023. API ranged from 0.4-3.2 per 1000 population with an annual decline of 25% (IRR:0.75; 95% CI 0.71 to 0.79). Cases peaked in July (monsoon season) and November. Incidence was consistently higher in Chhattisgarh's Bastar (IRR:12.5; 95% CI 3.7 to 43.0) and Surguja regions (IRR:7.4; 95% CI 2.0 to 27.4) compared with the central region.

Conclusions: Southern districts of Chhattisgarh consistently documented increased incidence over the years. We recommend strengthening the implementation of the vector control measures starting in May. Further research should be conducted to identify the reasons for the high malaria incidence in southern Chhattisgarh.

Background: In Honduras, Central America, human infection with Leishmania (L.) infantum chagasi can lead to the clinical manifestation known as non-ulcerated cutaneous leishmaniasis (NUCL) and visceral leishmaniasis. This study evaluates the dynamics of human infection with L. (L.) infantum chagasi, focusing on the NUCL form, atypical and rare clinical form of disease.

Methods: A cohort of 576 individuals from Amapala, southern Honduras, was followed for 2 y with clinical, parasitological and immunological tests: ELISA-IgG/IgM and delayed-type hypersensitivity (DTH) tests were conducted at 12 and 24 mo.

Results: The prevalence was 82% asymptomatic and 18% symptomatic, with only NUCL cases. Among asymptomatic individuals, 44.9% with an indeterminate profile (DTH-/ELISA+) evolved to a final asymptomatic infection profile (DTH+/ELISA-). Among symptomatic individuals, 43% had an early symptomatic profile (DTH-/ELISA-) and evolved to a final symptomatic infection profile (DTH+/ELISA-). Notably, none of the NUCL cases developed visceral disease during the study.

Conclusions: The results suggest that L. (L.) infantum chagasi infection in southern Honduras is generally benign, as most infected individuals evolved to DTH+ and none of them developed visceral disease.

Background: Bangladesh's health system is largely financed through out-of-pocket (OOP) payments. We aimed to quantify the direct OOP expenditure incurred by hospitalised patients with dengue during the 2023 epidemic.

Methods: A cross-sectional study was conducted among 428 hospitalised adult patients with dengue at a major public hospital during the 2023 epidemic, collecting detailed OOP expenditure data.

Results: The median total OOP expenditure was US$51 per patient, with medical costs comprising 56% and non-medical costs 44%. Laboratory investigations and travel expenses were the largest contributors.

Conclusions: Hospitalisation with dengue imposes a substantial financial burden on patients in public facilities.