Tropical Medicine and Infectious Disease最新文献

Tuberculosis preventive therapy (TPT) for people living with HIV (PLHIV) has been recommended by Indonesia's National TB Program since 2014 but has seen limited implementation. This study describes TB screening and TPT initiation from 2019 to 2022 among eight healthcare facilities supported by the Zero TB Yogyakarta (ZTB) project. ZTB assigned a dedicated nurse to assist with active TB screening among PLHIV and recommended the immediate initiation of TPT as an innovation implemented. Data were obtained from the national HIV program reporting system, routinely reported by ART clinics from 2019 to 2022. We conducted a descriptive analysis, comparing the pre-intervention and intervention periods. During the intervention, there was a significant increase in PLHIV visits to healthcare facilities where TPT eligibility was assessed. At health centers, TB screening coverage for PLHIV decreased toward the end of the baseline period but recovered during the intervention. The number of PLHIV starting TPT also rose during the intervention. While the direct impact of ZTB is difficult to measure, the changes observed indicate progress in integrating TB/HIV services and enhancing TB prevention among PLHIV. Ongoing support, training, and supervision of healthcare facilities are crucial for improving TB screening and TPT provision.

Dengue fever is caused by four common serotypes of the dengue virus (DENV-1, DENV-2, DENV-3, and DENV-4). Patients infected with one serotype may develop lifelong serotype-specific protective immunity. However, they remain susceptible to reinfection with the other serotypes, often increasing the risk of severe forms of dengue. This cross-sectional study investigates the prevalence of the four dengue serotypes in patients who presented with dengue fever at Makkah hospitals between April 2023 and May 2024. Data were collected from the medical records of the Regional Laboratory in Makkah, Saudi Arabia. The 238 positive dengue samples included 185 samples (77.73%) from male patients. The average age of the patients was 37.65 years (SD = 15.05). Dengue type 2 was the most common serotype, followed by type 1, type 3, and type 4. Most of the dengue patients were Saudi nationals, followed by Egyptians. There were 11 dengue-positive samples that were not diagnosed with any of the four dengue serotypes. Since Makkah receives numerous international travelers, these samples might contain novel dengue serotypes circulating in different parts of the world. This study underscores the need for the continuous monitoring of dengue serotypes to predict potential outbreaks and mitigate the risk of severe dengue in susceptible populations.

Globalization in the 21st century has posed several challenges. In particular, the spread of multidrug-resistant bacterial strains, especially Gram-negative bacteria, which are prevalent in certain regions of the world, is one of the most critical issues. This raises concerns about the risks associated with the booming tourism industry and migratory flows. In fact, even transient colonization with multidrug-resistant strains can present significant challenges to individual, family, and public health. Understanding the epidemiology and mechanisms of resistance, associated risk factors and prevention policies is therefore essential to ensure that strategies are in place to limit the global spread of high-risk bacterial clones and thereby protect public health.

Antimicrobial resistance (AMR) in Campylobacter species, particularly C. jejuni and C. coli, poses a significant public health threat. These bacteria, which are commonly found in livestock, poultry, companion animals, and wildlife, are the leading causes of foodborne illnesses, often transmitted through contaminated poultry. Extensive exposure to antibiotics in human and veterinary medicine creates selection pressure, driving resistance through mechanisms such as point mutations, horizontal gene transfer, and efflux pumps. Resistance to fluoroquinolones, macrolides, and tetracyclines complicates treatment and increases the risk of severe infections. Drug-resistant Campylobacter is transmitted to humans via contaminated food, water, and direct contact with animals, highlighting its zoonotic potential. Addressing this challenge requires effective interventions. Pre-harvest strategies like biosecurity and immune-based methods reduce bacterial loads on farms, while post-harvest measures, including carcass decontamination and freezing, limit contamination. Emerging approaches, such as bacteriocins and natural antimicrobials, offer chemical-free alternatives. Integrated, multidisciplinary interventions across the food chain are essential to mitigate AMR transmission and enhance food safety. Sustainable agricultural practices, antimicrobial stewardship, and innovative solutions are critical to curbing Campylobacter resistance and protecting global public health. Our review examines the dynamics of antimicrobial resistance in Campylobacter and presents current strategies to mitigate Campylobacter-related AMR, offering valuable insights for antimicrobial control in the poultry industry.

HIV remains a significant health issue, especially in sub-Saharan Africa. There are 39 million people living with HIV (PLWH) globally. Treatment with ART improves patient outcomes by suppressing the HIV RNA viral load. However, not all patients treated with ART suppress the HIV RNA viral load. This research paper explores the potential predictors of VL suppression in ART-treated PLWH. We used retrospective data from the 4820 ART-treated participants enrolled through population-based surveys conducted in Zambia and Malawi. We applied several machine learning (ML) classifiers and used the top classifiers to identify the predictors of VL suppression. The age of participants ranged from 15 to 64 years, with a majority being females. The predictive performance of the various ML classifiers ranged from 64% to 92%. In our data from both countries, the logistic classifier was among the top classifiers and was as follows: Malawi (AUC = 0.9255) and Zambia (AUC = 0.8095). Thus, logistic regression was used to identify the predictors of viral suppression. Our findings indicated that besides ART treatment status, older age, higher CD4 T-cell count, and longer duration of ART were identified as significant predictors of viral suppression. Though not statistically significant, ART initiation 12 months or more before the survey, urban residence, and wealth index were also associated with VL suppression. Our findings indicate that HIV prevention programs in the region should integrate education on early ART initiation and adherence in PLWH.

Background: Chronic schistosomiasis can lead to significant morbidity. Serology is highly sensitive; however, its role in assessing treatment response is controversial. This study aimed to analyze serological values following treatment of chronic imported schistosomiasis.

Methods: A retrospective observational study was performed including patients treated for chronic imported schistosomiasis from 2018 to 2022 who had at least one serological result at baseline and during follow-up. Demographic, clinical, and laboratory data were evaluated. Generalized estimating equation (GEE) models and Kaplan-Meier curves were used to analyze the evolution of serological values.

Results: Of the 83 patients included, 72 (86.7%) were male, and the median age was 26 years (IQR 22-83). Most patients, 76 (91.6%), were migrants from sub-Saharan Africa. While 24 cases (28.9%) presented with urinary symptoms, the majority (59; 71.1%) were asymptomatic. Schistosoma haematobium eggs were observed in five cases (6.2%). Eosinophilia was present in 34 participants (40.9%). All patients had an initial positive Schistosoma ELISA serology, median ODI 2.3 (IQR 1.5-4.4); the indirect hemagglutination (IHA) test was positive/indeterminate in 34 cases (43.1%). Following treatment with praziquantel, serology values significantly decreased: -0.04 (IC95% -0.073, -0.0021) and -5.73 (IC95% -9.92, -1.53) units per month for ELISA and IHA, respectively. A quarter of patients (25%) had negative ELISA results 63 weeks after treatment. All symptomatic cases were clinically cured.

Conclusions: Serial serological determinations could be helpful for monitoring chronic schistosomiasis in non-endemic regions. The ideal timing for these follow-up tests is yet to be determined. Further research is needed to determine the factors that influence a negative result during follow-up.

Background: Rocky Mountain spotted fever (RMSF) is a challenge for physicians because the disease can mimic other endemic febrile illnesses, such as dengue and COVID-19. The comparison of their main clinical and epidemiological manifestations in hospitalized children can help identify characteristics that improve empirical suspicion and timely therapeutic interventions.

Methods: A cross-sectional study was conducted on a series of patients aged 0 to 18 years, hospitalized between 2015 and 2022, with a diagnosis of RMSF, dengue, or COVID-19. Data were retrieved from medical records. Subjects were categorized as patients with RMSF (group I) and patients with dengue and COVID-19 (group II). Descriptive statistics were used, and differences were evaluated using Student's t-test and the chi-squared test.

Results: A series of 305 subjects were studied, with 252 (82.6%) in group I. Subjects in both groups presented fever, myalgias, arthralgias, and rash, but exposure to ticks distinguished group I. The fatality rate (21.0%) in group I was higher than in group II (3.8%).

Conclusions: Although fever, myalgias, arthralgias, and rash are common in all three illnesses, they are more prevalent in hospitalized patients with RMSF. In the presence of such symptoms, a history of tick exposure can guide clinical decisions in regions where all three diseases are endemic.

Accurate rapid diagnostic tests (RDTs) are needed to diagnose lymphatic filariasis (LF) in global elimination programmes. We evaluated the performance of the new STANDARD Q Filariasis Antigen Test (QFAT) against the Bioline Filariasis Test Strip (FTS) for detecting W. bancrofti antigen (Ag) in laboratory conditions, using serum (n = 195) and plasma (n = 189) from LF-endemic areas (Samoa, American Samoa and Myanmar) and Australian negative controls (n = 46). The prior Ag status of endemic samples (54.9% Ag-positive) was determined by rapid test (ICT or FTS) or Og4C3 ELISA. The proportion of samples testing positive at 10 min was similar for QFAT (44.8%) and FTS (41.3%). Concordance between tests was 93.5% (kappa 0.87, n = 417) at 10 min, and it increased to 98.8% (kappa 0.98) at 24 h. The sensitivities of QFAT and FTS at 10 min compared to the prior results were 92% (95% CI 88.0-96.0) and 86% (95% CI 80.0-90.0), respectively, and they increased to 97% and 99% at 24 h. Specificity was 98% for QFAT and 99% for FTS at 10 min. Both tests showed evidence of cross-reaction with Dirofilaria repens and Onchocerca lupi but not with Acanthochilonema reconditum or Cercopithifilaria bainae. Under laboratory conditions, QFAT is a suitable alternative RDT to FTS.

The causative agent of Lyme disease, Borrelia burgdorferi, is endemic to Canada, the northeastern United States, northern California, and temperate European regions. It is rarely associated with a travel-related exposure. In this report, we describe a resident of southern Ontario, Canada who developed rash, fever, and cranial nerve VII and XII palsies following a 12 day trip to Ecuador and the Galapagos islands approximately four weeks prior to referral to our center. Comprehensive microbiological work-up was notable for reactive Borrelia burgdorferi serology by modified two-tier testing (MTTT), confirming a diagnosis of Lyme disease. This case highlights important teaching points, including the classic clinical presentation of acute Lyme disease with compatible exposure pre-travel in a Lyme-endemic region of Ontario, initial manifestations during travel following acquisition of arthropod bites in Ecuador, and more severe manifestations post-travel. Given the travel history to a South American country in which Lyme disease is exceedingly uncommon, consideration of infections acquired in Ecuador necessitated a broad differential diagnosis and more comprehensive microbiological testing than would have been required in the absence of tropical travel. Additionally, cranial nerve XII involvement is an uncommon feature of Lyme neuroborreliosis, and therefore warranted consideration of an alternative, non-infectious etiology such as stroke or a mass lesion, both of which were excluded in this patient through neuroimaging.

Integrated serological surveillance (serosurveillance) involves testing for antibodies to multiple pathogens (or species) simultaneously and can be achieved using multiplex bead assays (MBAs). This systematic review aims to describe pathogens studied using MBAs, the operational implementation of MBAs, and how the data generated were synthesised. In November and December 2023, four databases were searched for studies utilising MBAs for the integrated serosurveillance of infectious diseases. Two reviewers independently screened and extracted data regarding the study settings and population, methodology, seroprevalence results, and operational implementation elements. Overall, 4765 studies were identified; 47 were eligible for inclusion, of which 41% (n = 19) investigated multiple malaria species, and 14% performed concurrent surveillance of malaria in combination with other infectious diseases (n = 14). Additionally, 14 studies (29%) investigated a combination of multiple infectious diseases (other than malaria), and seven studies examined a combination of vaccine-preventable diseases. Haiti (n = 8) was the most studied country, followed by Ethiopia (n = 6), Bangladesh (n = 3), Kenya (n = 3), and Tanzania (n = 3). Only seven studies were found where integrated serosurveillance was the primary objective. The synthesis of data varied and included the investigation of age-specific seroprevalence (n = 25), risk factor analysis (n = 15), and spatial analysis of disease prevalence (n = 8). This review demonstrated that the use of MBAs for integrated surveillance of multiple pathogens is gaining traction; however, more research and capabilities in lower- and middle-income countries are needed to optimise and standardise sample collection, survey implementation, and the analysis and interpretation of results. Geographical and population seroprevalence data can enable targeted public health interventions, highlighting the potential and importance of integrated serological surveillance as a public health tool.