Tropical Medicine and Health最新文献

Introduction: Schistosome infections in early childhood can affect a child's growth and development, leading to lifelong consequences. Historically, monitoring and control of schistosomiasis have focused primarily on school-aged children leading to a knowledge gap on the magnitude of the prevalence of infections in younger age groups in many endemic countries. This study aimed to estimate the prevalence of schistosome infections among children under 2 years of age and describe its distribution in three regions of Madagascar endemic for Schistosoma mansoni, thereby informing public health strategies in the country.

Methods: A cross-sectional study was conducted on a sample of 2018 children under 2 years of age recruited from 42 primary health care centres in the regions of Itasy, Bongolava and Amoron'i Mania, Madagascar, from March 2020 to June 2021. Urine samples were collected to perform an up-converting reporter particle lateral flow circulating anodic antigen assay (UCP-LF-CAA) for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection, prevalence ratios with 95% CIs were estimated using mixed-effects Poisson regression.

Results: Among 2018 sampled children with an average age of 9.6 months (SD = 1.2), the prevalence of schistosome infection was 6.2% [CI95%: 5.0, 7.8]. The prevalence estimates were similar across all population subgroups. We observed no statistically significant associations of schistosome infections in children with maternal age (p-value = 0.4110), education (p-value = 0.1281), occupation (p-value = 0.3333), child sex (p-value = 0.3692), urbanisation (p-value = 0.8272) or region of residence (p-value = 0.7425).

Conclusion: Our results show that the prevalence of schistosome infection in children under 2 years of age in Madagascar is significant. Given the high burden and long-term consequences of early schistosome infection, integrated and inclusive public health interventions that combine treatment, caregiver health education, with improvements in sanitation and access to clean water, are needed for children under 2 years of age in endemic settings.

Background: Toxoplasmic encephalitis (TE) and tuberculoma are the leading causes of ring-enhancing brain lesions in patients with human immunodeficiency virus (HIV) infection. Because imaging findings of the two conditions overlap and cerebrospinal fluid (CSF) tests lack sensitivity, timely diagnosis is critical. Herein, we report the rare case of a patient with HIV infection and miliary tuberculosis who developed intracranial mass lesions after antiretroviral therapy (ART) initiation with high-dose prednisolone administration.

Case presentation: A 53-year-old Nepalese man who had been living in Japan was diagnosed with HIV infection (CD4 count, 146 cells/µL) and miliary tuberculosis. Four-drug rifabutin-based therapy was initiated. However, trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was discontinued because of a rash and replaced with monthly pentamidine. ART (dolutegravir/lamivudine) was initiated 3 weeks later. Prednisolone (60 mg/day) was administered for refractory tuberculous ascites, and the dose was tapered over 6 weeks. Eight weeks after ART, the patient developed a headache, and laboratory tests revealed a CD4 count of 384 cells/µL. Magnetic resonance imaging (MRI) revealed right frontal ring-enhancing lesions. CSF was acellular; polymerase chain reaction yielded negative results for several pathogens including Mycobacterium tuberculosis and positive results for Toxoplasma gondii. After a 5-day graded TMP-SMX desensitization, the patient received full-dose therapy for 6 weeks, followed by secondary prophylaxis. The patient's headache resolved, and repeat MRI after 2 weeks revealed marked regression of the lesions. No radiological relapse was observed 3 months after treatment completion.

Conclusions: TE can emerge during immune recovery at CD4 counts > 100 cells/µL when corticosteroid administration coincides with early ART. In patients receiving tuberculosis treatment who develop new brain lesions soon after ART, T. gondii polymerase chain reaction and prompt antiparasitic therapy should be pursued. Rifabutin permits concomitant use of dolutegravir, and TMP-SMX desensitization allows effective treatment and prophylaxis.

Diagnostic advances outpace bedside interpretation in tropical medicine. Two forces drive this gap: mimicry-infectious syndromes resembling noninfectious disease, and expansibility-epidemiology transcending geography, age, season, and host. The result is misclassification, mistargeted therapies (e.g., steroid-treated helminth infection), and wasted resources amid climate- and mobility-driven shifts. This correspondence proposes lightweight, locally led evidence circulation through structured case reviews, minimal essential data, and living, site-specific algorithms that integrate mimicry-aware red flags and calibrated pretest probabilities. Such networks transform tacit experience into auditable knowledge, improve day-to-day decision-making, and align technological advances with context, thereby strengthening equitable and sustainable care for tropical diseases.

Antimicrobial resistance (AMR) poses a severe and growing threat to public health in Africa, disproportionately affecting marginalised and vulnerable populations across communities and health systems. Current responses often prioritise technical measures, such as stewardship programmes and surveillance systems, with insufficient attention to the socioeconomic and cultural realities that drive resistance. AMR cannot be addressed in isolation, as its emergence and spread are closely linked to poverty, inadequate education, gender inequality, poor governance, limited access to healthcare, clean water, sanitation, and diagnostics, as well as weak supply chains for essential medicines. This commentary advocates for a people-centred approach to AMR that addresses the social determinants of health and fosters inclusive, community-driven solutions. Strengthening primary healthcare systems and improving access to affordable, quality-assured antimicrobials and diagnostics must be prioritised to empower both healthcare providers and patients. Local stakeholders are essential for raising awareness, promoting behaviour change, and ensuring cultural relevance through meaningful community engagement. Marginalised populations, including those in underserved regions or disproportionately exposed to infection due to displacement, disability, or comorbidities, should be central to the co-creation of AMR strategies. Embedding AMR initiatives within universal health coverage reforms, expanding preventive measures, such as vaccination, and tackling systemic challenges are also crucial for reducing antibiotic dependence and building equitable health systems. A coordinated, multisectoral response that connects human, animal, and environmental health, grounded in equity, community ownership, and interdisciplinary collaboration, is essential for sustainable AMR control efforts that leave no one behind.

Introduction: South Korea is experiencing an ageing population, coupled with a high prevalence of mental health issues among its older people. This study aimed to identify the variables that influence spiritual health (SH), seeking to provide a stronger theoretical foundation and practical guidance for designing interventions to improve purpose in life (PIL), ultimately improving spiritual health and overall quality of life in older adults.

Methods: This cross-sectional survey included 270 older adults (aged ≥ 65 years) from Wonju, Gangwon Province, and Yeoju, Gyeonggi Province, South Korea. The paper-based survey questionnaire included questions on demographic characteristics, health perceptions, and the PIL test. Descriptive statistics, Chi-square tests, and multivariate logistic regression analyses were performed using Stata 18.

Results: A total of 270 older adults (mean age = 73.8 ± 6.5 years) participated in the study, with women comprising the majority (62.6%). Among the participants, 79.6% (n = 215) reported low levels of purpose in life (PIL), while 20.4% (n = 55) reported moderate levels; no participants were classified as having high PIL. Educational attainment was significantly associated with PIL, as individuals with a university degree (p = 0.04) or graduate-level education (p = 0.01) were less likely to report moderate PIL compared to those with primary or junior high school education. In contrast, living with a care recipient was strongly and positively associated with moderate PIL (p = 0.001). Similarly, participants who reported strong religious faith demonstrated higher odds of moderate PIL (p < 0.01), whereas adherence to Shintoism was negatively associated with PIL (p = 0.03). Interestingly, engagement in volunteer activities was also inversely associated with PIL (p = 0.01).

Conclusion: The findings of this study suggest that PIL in older adults is shaped by a complex interplay between cultural, historical, and social factors. To address these issues, it is important to promote structured volunteer opportunities tailored to the preferences of older adults, strengthen caregiver support systems, and implement interventions that focus on alleviating social and economic difficulties. By doing so, it is expected that the sense of purpose in life among older adults will be enhanced, leading to an improvement in their overall well-being.

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections in humans, contributing to a substantial burden on both families and society. To date, no bibliometric studies have specifically addressed RSV pneumonia. We therefore employed bibliometric methods to analyze the top 100 most-cited articles in this field, aiming to construct a visual knowledge map and quantitatively identify current research hotspots and emerging trends.

Methods: We retrieved relevant publications from the Web of Science Core Collection (WoSCC) database. Using Microsoft Excel 2019, CiteSpace 6.2.R4, and VOSviewer 1.6.18, we performed a visual analysis of annual publication trends, countries, institutions, authors, journals, and keywords.

Results: The 100 most-cited articles received a total of 15,949 citations, with individual citation counts ranging from 46 to 2846 and a median of 74. The United States contributed the most publications, and the Centers for Disease Control and Prevention (CDC) was the most productive institution. The most prolific authors were Cohen, Cheryl; Graham, Barney S; Anderson, LJ; and Ramilo, O. The Pediatric Infectious Disease Journal published and received the most citations in this domain. "Bronchiolitis" was identified as the keyword with the strongest citation burst.

Conclusion: Current research on RSV pneumonia remains focused on pathogenesis, treatment, and prognosis. The development of new antiviral drugs and immunoprophylaxis strategies continues to be a central direction for future studies.

Background: Brucellosis, a zoonotic disease caused by Brucella species, remains a major public health and economic challenge in regions dependent on livestock farming. In Iran, particularly in the western provinces, the disease imposes a heavy burden on healthcare systems and households through medical costs and productivity losses. This study quantified the economic burden of brucellosis in western Iran to inform policy and resource allocation.

Methods: A cross-sectional cost-of-illness study was conducted among 427 brucellosis patients in Lorestan province. Data on direct medical costs (hospitalization, medications, diagnostics), direct non-medical costs (transportation, accommodation), and indirect costs (productivity losses) were collected using a bottom-up approach. All costs were expressed in 2024 USD, and sensitivity analyses were conducted at 0% and 5% discount rates. The catastrophic health expenditure (CHE) index was used to assess financial hardship.

Results: The mean total cost per patient was 1,060 USD, with direct medical costs representing 73.6% of the total. Hospitalization was the largest component (38%), followed by surgical interventions (26%) and medications (13%). Indirect costs accounted for 18.9% of the total burden. The CHE index reached 66.3%, indicating severe financial strain for affected households. Sensitivity analyses showed notable variability in medical and non-medical cost estimates.

Conclusion: Brucellosis imposes a substantial economic burden in western Iran, reflecting both healthcare and productivity losses. Effective control measures such as livestock vaccination, improved diagnosis, and expanded insurance coverage are essential to reduce financial hardship and support sustainable disease management.

Background: Opisthorchiasis, caused by Opisthorchis viverrini, is a major public health concern in Southeast Asia. Despite control programs, O. viverrini infection persists and contributes to severe liver diseases, including cholangiocarcinoma. This study aimed to assess seasonal variation in trematode prevalence and diversity, evaluate the susceptibility of Bithynia siamensis sensu lato lineages II and III to O. viverrini infection, and examine the phylogenetic and haplotype network of identified trematode and their snail hosts in Champasak Province, southern Lao PDR.

Methods: Snail samples were collected quarterly in 2024 (February, May, August, and November) from Khong and Mounlapamok Districts using handpicking and scooping. Trematode infections were detected by the crushing method, identified morphologically, and confirmed by molecular analysis. DNA barcoding of nuclear and mitochondrial genes was used to verify trematode species and snail lineages.

Results: Of 1,764 Bithynia snails examined, 169 (9.58%) were infected. Five cercarial types were identified: amphistome (3.40%), xiphidiocercariae (2.78%), monostome (2.61%), mixed monostome and amphistome (0.34%), cystophorous (0.28%), and O. viverrini (0.17%). Infection rates of O. viverrini did not differ between lineages II and III, but other trematodes were significantly more frequent in lineage III (76.67%).

Conclusions: Trematode infection rates and species diversity in B. s. goniomphalos show marked seasonal variation in Champasak Province, southern Lao PDR. These findings highlight the complexity of host-parasite interactions and the role of environmental factors shaping transmission, providing insights for targeted prevention and control.

Background: Urinary tract infections (UTIs) are a major public health concern, yet the burden in children remains poorly quantified. This study analyzed global, regional, and national trends in pediatric UTIs from 1990 to 2021.

Methods: Using Global Burden of Disease (GBD) 2021 data, we assessed incidence and disability-adjusted life years (DALYs) for individuals aged ≤ 14 years. Age-standardized incidence (ASIR) and DALY rates (ASDR), along with estimated annual percentage changes (EAPC), were calculated by age, sex, and region.

Results: From 1990 to 2021, the incidence of urinary tract infections and the global burden of associated diseases remained consistently higher among pediatric populations compared to the general population. Globally, there were 50,173,655 UTI cases in 2021, marking a 10% increase from 45,485,831 in 1990. The age-standardized incidence rate per 100,000 population decreased from 2,615.40 in 1990 to 2,493.89 in 2021, with an estimated annual percentage change of -17% (95% confidence interval [CI] -0.33 to -0.01). Additionally, the number of disability-adjusted life years associated with UTIs in pediatric populations decreased by 33%, from 827,127 in 1990 to 554,185 in 2021. The age-standardized disability rate also decreased from 0.53 per 100,000 in 1990 to 0.30 per 100,000 in 2021, with an EAPC of -1.36 (95% CI -1.51 to -1.21). The highest burden was in low-middle SDI regions, especially South Asia and Sub-Saharan Africa.

Conclusion: Despite a modest decline in age-standardized rates, the absolute burden of pediatric UTIs increased from 1990 to 2021. Disparities across SDI regions highlight the need for targeted, age- and region-specific public health strategies to reduce the global impact of pediatric UTIs.

Public policy denotes a government's formal intent to address specific issues in pursuit of defined objectives. The vision and mission of school feeding have progressively expanded. This study examined school feeding policy objectives across multiple countries, drawing on data from the Global Survey of School Meal Programs, and identified 23 relevant policies. The objectives were classified into five domains: health and nutrition, education, social protection, agriculture, and other areas. Japan is particularly notable for distinctive aims, including enhancing school life, fostering sociability and cooperation, promoting appreciation of nature, and cultivating respect for life and the natural world.