Tropical Medicine and Infectious Disease最新文献

The occurrence of hepatitis E virus (HEV) in patients with Schistosomiasis mansoni (SM) is still poorly understood in Brazil. The objective of this study was to estimate the seroprevalence of anti-HEV IgG in patients with SM and its association with the periportal fibrosis (PPF), assessed by serum markers and ultrasound criteria. This cross-sectional study was carried out in an endemic area in Pernambuco, Brazil, with schistosomal patients who underwent coproscopic survey. Anti-HEV antibody IgG were evaluated by using ELISA (Euroimmun^®, Lübeck, Germmany). In positive cases, HEV-RNA was tested by using real-time PCR. Among the 286 patients (60.8% women; 56% 18-44 years), 116 (40.6%) had advanced PPF (Niamey pattern D/E/F). Anti-HEV IgG was positive in 15 (5.24%), and all were HEV-RNA negative. Anti-HEV IgG was more frequent in patients with an advanced PPF (D/E/F) pattern (p = 0.034) and those with the largest spleen diameter (p = 0.039). In this study, the occurrence of anti-HEV IgG in patients with SM was higher than described in the same region and more frequent among patients with evidence of advanced liver fibrosis.

Malaria remains a significant public health problem in India. Although temperature influences Anopheline mosquito feeding intervals, population density, and longevity, the reproductive potential of the Plasmodium parasite and rainfall influence the availability of larval habitats, and evidence to correlate the impact of climatic factors on the incidence of malaria is sparse. Understanding the influence of climatic factors on malaria transmission will help us predict the future spread and intensification of the disease. The present study aimed to determine the impact of temporal trend of climatic factors such as annual average maximum, minimum, mean temperature, and rainfall on the annual incidence of malaria cases in India for a period of 61 years from 1961 to 2021 and relative humidity for a period of 41 years from 1981 to 2021. Two different analyses were performed. In the first analysis, the annual incidence of malaria and meteorological parameters such as annual maximum, minimum, and mean temperature, annual rainfall, and relative humidity were plotted separately in the graph to see if the temporal trend of climatic factors had any coherence or influence over the annual incidence of malaria cases. In the second analysis, a scatter plot was used to determine the relationship of the incidence of malaria in response to associated climatic factors. The incidence of malaria per million population was also calculated. In the first analysis, the annual malaria cases showed a negative correlation of varying degrees with relative humidity, minimum, maximum, and mean temperature, except rainfall, which showed a positive correlation. In the second analysis, the scatter plot showed that the rainfall had a positive correlation with malaria cases, and the rest of the climatic factors, such as temperature and humidity, had negative correlations of varying degrees. Out of the total 61 years studied, in 29 years, malaria cases increased more than 1000 square root counts when the minimum temperature was at 18-19 °C; counts also increased over a period of 33 years when the maximum temperature was 30-31 °C, over 37 years when the mean temperature was 24-25 °C, over 20 years when the rainfall was in the range of 100-120, and over a period of 29 years when the relative humidity was at 55-65%. While the rainfall showed a strong positive correlation with the annual incidence of malaria cases, the temperature and relative humidity showed negative correlations of various degrees. The increasing temperature may push the boundaries of malaria towards higher altitude and northern sub-tropical areas from the southern peninsular region. Although scanty rainfall reduces the transmission, increases in the same would increase the malaria incidence in India.

PAVON has developed a malaria microscopy competency training scheme to augment competency in malaria microscopy. Here, data accrued from training activities between 2020 and 2023 in Botswana are presented. Three trainings were done for 37 central and peripheral level technicians for a two-week period. The scheme consisted of basic theory on Plasmodium parasites, malaria epidemiology and diagnosis. The practicals focused on standard slide preparation, staining, parasite detection, speciation and counting. Scores were assessed by the Wilcoxon signed rank test. Participants who excelled joined the WHO External Competency Assessment for Malaria Microscopy (ECAMM). The median competency scores for the three trainings were detection: 100 (IQR = 94-100), 100 (IQR = 94-100) and 92 (IQR = 92-100), respectively, from pre-test scores of 40 (IQR = 27-54), 44 (IQR = 32-52) and 20 (IQR = 10-40) (z = 2.937, p < 0.003, z = 3.110, p = 0.002 and (z = 2.251, p = 0.024), respectively. Speciation: 93 (IQR = 86-96), 81 (IQR = 73-96) and 88, (IQR = 88-100) from pre-test scores of 50 (IQR = 30-50), 36 (IQR = 20-45) and 17 (IQR = 17-50) (z = 2.936, p < 0.003, z = 3.152, p = 0.002 and z = 3.237, p = 0.001). The competency scores achieved in the ECAMM were 98/98 and 97/98 for sensitivity and specificity pre- and post-tests detection. The training was effective in raising the competency skills of participants and is open to NMPs (National Malaria Programs) for critical capacity building.

Kaposi sarcoma-associated herpes virus (KSHV), also known as human herpes virus 8 (HHV-8), is the primary etiologic cause of Kaposi sarcoma (KS) and KSHV Inflammatory Cytokine Syndrome (KICS). Patients with KICS demonstrate symptoms of systemic inflammation, high KSHV viral load, elevation of inflammatory markers, and increased mortality. Management requires rapid diagnosis, treatment of underlying HIV, direct treatment of KS, and addressing the hyperimmune response. While a case definition based on clinical presentation, imaging findings, laboratory values, KSHV viral load, and lymph-node biopsy has been proposed, some of the required investigations are frequently unavailable in resource-constrained settings. Due to these challenges, KICS likely remains underdiagnosed and undertreated in these settings. We report a case of a 19-year-old woman living with HIV, and intermittent adherence to her ART, who presented with hypotension and acute hypoxemic respiratory failure. She was found to have high KSHV and HIV viral loads, low CD4 count, anemia, thrombocytopenia, hypoalbuminemia, and elevated inflammatory markers. On bedside ultrasound, she was found to have bilateral pleural effusions, ascites, an enlarged spleen, and hyperechoic splenic lesions. The diagnosis of KICS was made based on this constellation of findings. Weighing the risk and benefits of steroid administration in KS patients, the patient was successfully treated by the continuation of ART and the initiation of paclitaxel chemotherapy and steroids. We propose an adapted case definition relevant to the resource-constrained context. Due to the dual burden of KSHV and HIV in sub-Saharan Africa, additional cases of KICS are likely, and this syndrome will contribute to the burden of early mortality in newly diagnosed HIV patients. Addressing the diagnostic and therapeutic challenges of KICS must be a part of the overall management of the HIV pandemic.

Objective: Staphylococcus aureus (SA), including methicillin-resistant strains (MRSAs), is a major cause of skin and soft tissue infections (SSTIs) in military populations. This study investigated SSTI incidence and SA carriage in a military training site over 16 weeks using a prospective observational cohort design.

Methods: Two training cohorts provided pre- and post-training self-collected swabs for bacterial carriage, and environmental swabs from accommodations, personal items, and training facilities. Hygiene awareness and practices were assessed through questionnaires. Bacteria were identified using culture, mass spectrometry (MALDI-TOF), and genomic sequencing.

Results: Nasal carriage of SA increased from 19% to 49% by the end of training. SSTIs requiring treatment occurred in 16% of participants. Steam cleaning reduced but did not eliminate SA on personal bed linen. Additionally, 40% of participants had poor knowledge of antibacterial cleaning practices and wound management.

Conclusions: Increased SA carriage was linked to human-to-human transmission in close-quarter military training environments.

Implications for public health: Improved personal hygiene training, wound management education, and monitored cleaning protocols are essential to mitigate SSTI risks in communal military training environments.

Agricultural pesticides may play a crucial role in the selection of resistance in field populations of mosquito vectors. This study aimed to determine the susceptibility level of An. gambiae s.l. to pyrethroids and neonicotinoids in vegetable farms in northern Benin, in West Africa, and the underlying insecticide resistance mechanisms. A survey on agricultural practices was carried out on 85 market gardeners chosen randomly in Malanville and Parakou. Anopheles gambiae s.l. larvae were collected, reared to adult stages, and identified to species level. Susceptibility was tested with impregnated papers (WHO bioassays) or CDC bottles according to the insecticides. Synergists (PBO, DEM, and DEF) were used to screen resistance mechanisms. Allelic frequencies of the kdr (L1014F), kdr (L1014S), N1575Y, and ace-1R G119S mutations were determined in mosquitoes using Taqman PCR. Fertilizers and pesticides were the agrochemicals most used with a rate of 97.78% and 100%, respectively, in Malanville and Parakou. Anopheles coluzzii was the predominant species in Malanville, while An. gambiae was the only species found in Parakou. Bioassays revealed a high resistance of An. gambiae s.l. to pyrethroids and DDT, while a susceptibility to bendiocarb, pyrimiphos-methyl, malathion, and clothianidin was recorded. Resistance to acetamiprid was suspected in mosquitoes from both localities. A lower resistance level was observed when mosquitoes were pre-treated with synergists, then exposed to insecticides. The kdr L1014F mutation was observed in both locations at moderate frequencies (0.50 in Malanville and 0.55 in Parakou). The allelic frequencies of N1575Y and G119S were low in both study sites. This study confirmed the resistance of An. gambiae s.l. to insecticides used in agriculture and public health. It reveals a susceptibility of vectors to bendiocarb, pyrimiphos-methyl, malathion, and clothianidin, thus indicating that these insecticides can be used as an alternative in Benin to control malaria vectors.

Key populations are particularly vulnerable to human immunodeficiency virus (HIV) infection. Nearly half of Tajikistan's gross domestic product (GDP) originates from labor migrant transfers. While not officially designated as a key population, over 300,000 migrants return to Tajikistan every year at increased risk for HIV due to absence or interruption of treatment, change in risky behaviors, and other factors. We analyzed cross-sectional data from the national registry system operated by the Tajikistan Ministry of Health and Social Protection of individuals (n = 10,700) who had been diagnosed with HIV from 1 January 2010 to 30 May 2023. Individual HIV cases resided in five regions: Districts of Republican Subordination (DRS), Dushanbe (Tajikistan's capital city), Gorno-Badakhshan Autonomous Oblast (GBAO), Khatlon, and Sughd. We developed logistic regression models to investigate the relationships between key population status and demographic characteristics. GBAO has the largest proportion of labor migrants (49.59%), which is much larger than that of the other regions (<32%). In contrast to other key populations, there was a larger proportion of HIV cases in rural areas that were labor migrants (23.25%) in comparison to urban areas (16.05%). In multivariable analysis, the odds of being a labor migrant were 6.248 (95% CI: 4.811, 8.113), 2.691 (95% CI: 2.275, 3.184), and 1.388 (95% CI: 1.155, 1.668) times larger if a case was residing in GBAO, Sughd, or DRS, compared to Dushanbe, respectively. Our research contributes to the field by proposing to expand the definition of key population to include labor migrants in Central Asia who should be emphasized as a vulnerable population at high risk of HIV. We encourage policy action to provide designated HIV funding for labor migrants, increase international attention, and promote potential modifications of national regulations and/or laws regarding prevention and treatment of HIV among non-citizen populations.

Phlebotomus pedifer is a vector of Leishmania aethiopica, the causative agent of cutaneous leishmaniasis. This study assessed the abundance and distribution of P. pedifer in different habitats and human houses situated at varying distances from hyrax (reservoir host) dwellings, in Wolaita Zone, southern Ethiopia. Sandflies were collected from January 2020 to December 2021 using CDC light traps, sticky paper traps, and locally made emergence traps. Sampling was performed in human houses, peri-domestic areas, farmlands, and hyrax dwellings. Houses 200 m and 400 m from hyrax dwellings were selected to study whether distance affects indoor sandfly abundance. A total of 2485 sandflies were captured, with P. pedifer accounting for 86.1% of the catch and Sergentomyia spp. comprising the remaining 13.9%. The abundance of P. pedifer was highest in human houses (72.3%) and lowest in farmlands (4.0%). Temperature showed a positive correlation with sandfly abundance (r = 0.434, p = 0.000), while rainfall (r = -0.424, p = 0.001) and humidity (r = -0.381, p = 0.001) were negatively correlated with abundance. Houses near hyrax dwellings had significantly higher P. pedifer abundance compared to those further away. Soil-emergence trapping yielded only a few P. pedifer specimens, primarily from hyrax dwellings. The findings highlight the increased presence of P. pedifer indoors, particularly in houses close to hyrax habitats, emphasizing the need for targeted indoor vector control strategies to mitigate the risk of cutaneous leishmaniasis transmission.

Recently malaria and micronutrient deficiencies have become a major worldwide public health problem, particularly in Africa and other endemic countries with children under 5 years old being the most vulnerable. Apart from nutritional problems that cause micronutrient deficiencies, studies have also reported that parasitic infections like malaria can affect the levels of micronutrients. Thus, this research was aimed at assessing the serum levels of micronutrient biomarkers and their association with malaria infection in children under 5 years old in the Buea Health District. Method: This cross-sectional study recruited 80 participants from February to April 2024. The micronutrient biomarkers levels were measured using a Q-7plex Human Micronutrient Measurement Kit. Results: There were changes in serum micronutrient biomarkers levels between malaria infected and healthy children. Ferritin was higher in sick children (23.53 μg/L ± 7.75) than in healthy children (19.07 μg/L ± 3.87), significantly (p < 0.002). The same trend was observed with the soluble transferrin receptor being higher (p < 0.049) in sick children (3.74 mg/L ± 1.92) compared to healthy ones (3.08 mg/L ± 0.64). In addition, the levels of retinol-binding protein 4 and thyroglobulin levels were not significantly different between the sick and healthy children. Therefore, this study revealed that malaria causes alterations in the serum levels of micronutrient biomarkers and consequently affects micronutrient levels in children below the age of 5 in the Buea Health District.

Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs.