Tropical Medicine and Infectious Disease最新文献

Limited research has examined the possible synergistic interrelationships between serious bacterial infections (SBIs) of the heart (i.e., endocarditis), bone, spine, brain, or joints (e.g., osteomylelitis) and hepatitis C virus (HCV) infections. We examined whether syndemic interactions existed between SBI, HCV, and substance-use-related factors in rural communities, hypothesizing that injection-mediated risks elevated the likelihood for both SBIs and HCV infections, which could be exacerbated by synergistic biological-biological or biological and social interactions. We calculated the prevalence ratios (PRs) of past-year SBI associated with each risk factor in separate models. Effect modification among significant risk factors was assessed using multiplicative interaction. Among 1936 participants, 57% were male and 85% White, with a mean age of 36 years. Eighty-nine participants (5%) reported hospitalization for an SBI in the year prior to the survey. More than half tested HCV-antibody-positive (58%); 62 (5.6%) of the participants with a positive HCV antibody result reported past-year hospitalization with an SBI. Injection behaviors were correlated with other SBI risk factors, including multiple injections in the same injection event (MIPIE), injection equipment sharing, and fentanyl use. In adjusted models, MIPIE (PR: 1.79; 95% confidence interval [CI]: 1.03, 3.11) and fentanyl use (PR: 1.68; 95% CI: 1.04, 2.73) were significantly associated with past-year SBI. Our analyses pointed to co-occurring epidemics of SBI and HCV, related to the cumulative health effects of fentanyl use contributing to frequent injections and MIPIE. Both the SBI and HCV epidemics present public health challenges and merit tailored interventions.

Toxoplasma gondii (T. gondii), a globally distributed obligatory intracellular opportunistic parasite that has infected one third of the world population, has different transmission routes including via organ transplantation. The liver has emerged as a frequent transplanted organ in which the transmission of T. gondii can occur between seropositive donors and seronegative recipients. Allied with immunosuppressive therapy, the presence of latent infection in recipients elevates the risk of severe toxoplasmosis. The goal of this study was to evaluate the demographic, clinical, epidemiological, and anti-T. gondii antibody profiles in liver transplant recipients. All demographic, clinical, epidemiological, and serological data were obtained from the electronic medical records of liver transplant recipients from the Liver Transplantation Service of the Hospital de Base in São José do Rio Preto, Brazil, from 2008 to 2018. Data from 48 eligible recipients (females: n = 17; males: n = 31) were evaluated. The recipients were grouped according to their T. gondii serological profiles (G1: IgM-/IgG-; G2: IgM-/IgG+; G3: IgM+/IgG+; G4: IgM+/IgG-). The overall mean age was 55.3 (±15.3) years; the age difference between women (42.7 ± 17 years) and men (62.2 ± 10.9 years) was statistically significant (p-value > 0.0001). The percentages of the serological profiles were 20 (n = 41.7%), 26 (n = 54.1%), and 2 (n = 4.2%) for G1, G2, and G3, respectively. No recipient had a serological profile for G4. Hepatosplenomegaly (47.9%), fever (35.4%), encephalopathy (20.8%), and headache (16.7%) were commonly observed symptoms. No statistically significant differences were observed between the serological group and clinical data (p-value = 0.953). The percentages of coinfection by T. gondii with hepatitis A, B, and C were 47.9%, 20.8%, and 12.5%, respectively. About 41.7% of the recipients later died. The data demonstrate that infection by T. gondii is common in liver transplant recipients, and it is not associated with the analyzed demographic, clinical, and epidemiological data.

Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10-15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts.

Dengue infection has been associated with oxidative stress (OS) induction; however, whether such a response predicts the development of complications remains unknown. We conducted a case-control study (1:2 ratio) nested within a cohort of febrile patients with a presumptive or confirmed diagnosis of dengue. Incident cases were patients who developed hypotension or severe bleeding during the follow-up, whereas controls did not. Total antioxidant status (TAS), superoxide dismutase (SOD), and glutathione peroxidase activity (GPx) were quantified in serums obtained ≤96 h from disease onset. The association between each biomarker and complications was evaluated by estimating adjusted odds ratios (ORs) using logistic regression. We evaluated 132 patients (median age: 19.0 years; 58.2% males). TAS and SOD were higher among cases than controls (2.1 versus 1.7 mM and 6.7 versus 6.0 U/mL, respectively), and the opposite was observed for GPx (128.1 versus 133.7 mmol/min/mL); however, none of these contrasts reached statistical significance. In the multivariate analysis, higher levels of TAS and SOD were associated with a higher likelihood of complications up to 3.5 mM (OR = 2.46; 95%CI: 1.10-5.53) and 8.0 U/mL (OR = 1.69; 95%CI: 1.01-2.83), respectively. GPx did not show an association with hypotension or severe bleeding. Our results suggest that the induction of OS during the acute phase of dengue infection might be a prognostic factor of hypotensive and hemorrhagic complications.

Reproducibly assessing malaria exposure is critical for force health protection for military service members deployed to malaria-endemic regions as well as for civilians making public health decisions and evaluating malaria eradication efforts. However, malaria disease surveillance is challenged by under-reporting, natural immunity, and chemoprophylaxis, which can mask malaria exposure and lead to an underestimation of malaria prevalence. In this study, we determined the feasibility of using a serosurveillance-based approach to measure Anopheles vector exposure, Plasmodium sporozoite exposure, and blood-stage parasitemia using a multiplex serological panel. We tested post-deployment samples obtained from U.S. service members returning from regions with malaria risk to assess the potential of this serosurveillance panel. The results identified that some service members had anti-CSP antibody levels comparable to those found in endemic populations, suggesting exposure to sporozoites while those individuals were on chemoprophylaxis. We also observed isolated cases of anti-MSP1 levels that were as high as those observed in endemic populations and in CHMI studies, suggesting possible cases of clinical or subclinical parasitemia. The study demonstrated the feasibility of implementing a multiplex serology approach for conducting serosurveillance for Anopheles vector exposure and Plasmodium parasite exposure in samples collected following military deployments and its potential to support public health policies.

This study aimed to determine the prevalence of co-infection with malaria and intestinal parasites and assess its association with anemia in school-aged children from rural and urban settlements in Gabon. This cross-sectional study involved afebrile school children recruited at schools between May and June 2021. Blood and stool samples were collected from participants whose parents or legal guardians provided informed consent to participate in the study. Hemoglobin concentration (Hb) was measured using a HemoCue photometer (HemoCue 201, HemoCue, Angelholm, Sweden). Giemsa-stained blood films were examined to detect malaria parasites and any filarial infections, while the merthiolate-iodine concentration (MIC) method was used to identify intestinal parasitic infections (IPI). A total of four hundred and seventy (470) school-aged children were successfully enrolled in this study. The observed prevalence values were as follows: malaria infection at 69.6%, IPIs at 19.1%, filaria at 5.1%, Schistosoma infection at 15.0%, and anemia at 29.0%. Co-infections of malaria with IPIs, filaria, and Schistosoma were present in 12.3%, 4.7%, and 6.6% of the children, respectively. Malaria and filaria infections were associated with residing in Lastourville city (p < 0.05) and were also correlated with age (p < 0.05), whereas IPIs were associated with male gender and living in the city of Lastourville. Anemia was linked to malaria infection (p < 0.05) and was more prevalent among children living in rural areas. The findings of this study indicate that malaria, IPIs, and Schistosoma infections continue to pose a significant public health problem in the study area, even though only malaria infection appeared to be associated with anemia. Nevertheless, these results highlight the need for implementing control measures to reduce the prevalence of malaria, IPIs, filaria, and Schistosoma, particularly in Lastourville.

Brazilian garimpeiros are a highly hard-to-reach and mobile population, with little access to basic hygiene and health services, and have been crossing the border to work irregularly in gold mines in French Guiana since the 1990s. This study aimed to characterize this population and identify their main health problems. A cross-sectional study was carried out in the municipality of Oiapoque-AP, with two surveys: before (2018) and after (2019) the implementation of Malakit. Individuals were recruited from resting places and given a questionnaire regarding demographic variables, history and knowledge of malaria, and health issues in the mines. Simultaneously, a clinical evaluation was performed. The garimpeiros were mainly men from Maranhão, Pará, and Amapá, with a low educational level and who had worked on average for 10 years in the mining sites. The study population mentioned numerous health problems: malaria, followed by leishmaniasis, flu, body aches, headaches, and digestive problems. Other diseases mentioned were skin diseases, bat bites, hepatitis, and HIV infection. This vulnerable population is constantly subjected to heavy routines and exposed to different diseases and infections that can spread across borders. Knowledge of this is essential for developing public health policies that can be integrated into specific epidemiological situations.

Tuberculosis is no longer confined to developing nations; it persists as a significant contributor to illness and death on a global scale. The subtle clinical manifestation and association with human immunodeficiency virus infection poses obstacles for early diagnosis and management. Tuberculosis manifesting at extrapulmonary sites is relatively rare. We herein present the case of a 26-year-old patient from Cameroon with a history of pleuropulmonary tuberculosis treated in 2008, who had been taking pre-exposure prophylaxis (PrEP). The patient presented with right shoulder pain of an inflammatory type. The case was diagnosed as tuberculous osteomyelitis of the scapular spine, complicated by a deltoid abscess. Diagnosis was confirmed using computed tomography and the MTB/RIF GeneXpert test on the abscess puncture. This rare form of tuberculosis with an exceptional site revealed a HIV infection with profound immunosuppression. The patient was initiated on anti-tubercular treatment according to Moroccan recommendations.

Rabies is a fatal infectious disease that can be prevented with vaccination. The aim of this study was to evaluate the level of rabies knowledge among medical faculty students. This cross-sectional study included students in the medical faculty of a university hospital. The level of rabies knowledge was evaluated with a questionnaire evaluating 70 parameters. A total of 892 students participated in this study. Medical students knew that dogs and cats transmit rabies at high rates (96.9% and 87.4%, respectively) but understood less about other animals. Pregnancy (45.2%), being >65 years of age, having a chronic disease, and being immunosuppressed were indications for rabies vaccine, with rates between 31.4 and 37.4%. In total, 64.3% of respondents stated that the nearest health center should be approached to seek medical care, without first touching the wound. While indications for vaccination were correctly reported to be high after bites or scratches (74.2-94.6%), such indications were considered to be lower for other types of contact (46.2-66.6%). Indications for rabies immunoglobulin administration were correctly recognized at rates between 15.9% and 57.8%. Overall, the mean rabies knowledge level was 41.82 (Max. score 70). There was a statistically significant relationship between the total and subgroup rabies knowledge scores and class level, having taken a rabies course, a history of dog bites among the respondents or their family members, and possessing information about rabies. It was determined that the rabies knowledge levels among the students were insufficient. Having received lessons about rabies or a history of being bitten by an animal with suspected rabies were found to be important factors for increased knowledge about rabies.