Tropical Medicine and Infectious Disease最新文献

Since the emergence of COVID-19, the epidemiological and seasonal patterns of respiratory pathogens have shifted, highlighting the need for ongoing surveillance. This study investigated the epidemiology, seasonal trends, and age-specific detection of respiratory viruses among patients with acute respiratory infections (ARIs) in Thailand from January to December 2024. Eight respiratory viruses were detected using multiplex real-time RT-PCR. Of 7853 samples, 60.8% (4777) tested positive. The most frequently detected pathogens were influenza virus (IFV, 24.8%), SARS-CoV-2 (21.5%), and human rhinovirus (HRV, 20.8%). IFV showed biannual peaks during the cold and rainy seasons, SARS-CoV-2 peaked in the warm months, and HRV circulated year-round. Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) were primarily detected during the rainy season (July-November), reflecting a return toward pre-COVID-19 seasonal patterns. Age-specific differences were notable: HRV was most prevalent in children < 5 years, IFV predominated among those aged 6-18 years, and adults ≥ 19 years were mainly positive for IFV and SARS-CoV-2. Co-infections were most frequent in children aged 3-5 years, often involving HRV. These findings provide updated insights into post-COVID-19 viral epidemiology, emphasize the importance of age- and season-specific surveillance, and support the development of effective public health strategies for ARI control.

In Brazil, public health programs have relied predominantly on chemical insecticides to control Aedes aegypti, Anopheles spp., Culex quinquefasciatus, triatomines, and phlebotomines. Rising vector-borne disease incidence and insecticide resistance (IR) call for a critical appraisal of historical and current control practices. This literature review compiles secondary data produced from 1901 to 2024 obtained from Medline/PubMed, Google Scholar, and governmental notes and reports. Brazil's vector control progressed from organochlorines (e.g., DDT) to organophosphates, carbamates, pyrethroids, insect growth regulators, microbial larvicides (Bti and Lsp), spinosad, and recently formulations with dual active-ingredient. Ae. aegypti showed widespread resistance to temephos and pyrethroids, decreased susceptibility to pyriproxyfen, and no documented Bti resistance. Anopheles spp. exhibited low to moderate resistance to pyrethroids. Cx. quinquefasciatus resistance is likely influenced by collateral exposure from Aedes control and domestic use. Regarding triatomines and phlebotomines, there was a predominant reliance on pyrethroids; most studies indicate their susceptibility to these compounds. In short, Brazil's century-long, insecticide-centric strategy has delivered episodic gains but fostered Aedes aegypti resistance. For other species, for which there is no dedicated program for a long period, data on resistance are scarce or nonexistent. Sustainable progress requires strengthened, nationwide IR surveillance and entomological mapping to coordinate cross-program actions.

Data on HIV prevalence in remote, rural communities of Cameroon are scarce despite the country's high HIV-1 group M diversity. This study assessed HIV seroprevalence and socio-demographic determinants in four regions of the equatorial rainforest location of the country. A cross-sectional survey was conducted among 5631 individuals in rural communities of the Centre, East, Littoral, and South regions. HIV testing was performed, and socio-demographic data were collected. Prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) were estimated using bivariate and multivariate analyses (negative log-binomial model with generalised estimating equations, GEEs). Overall, HIV prevalence was 3.4% (95% CI: 2.9-3.9%) in individuals aged 15-49 years and 4.9% in those aged ≥50 years. Women had higher prevalence than men (4.5% vs. 3.0%, aPR = 1.53, 95% CI: [1.12-2.08], p = 0.007) and also higher HIV prevalence among individuals aged 50-54 years compared to those aged 15-19 years (5.5% vs. 1.8%, aPR = 2.76, 95% CI: [1.24-6.15], p = 0.013). The South region recorded the highest prevalence (5.2%, aPR = 1.82, 95% CI: [1.04-3.18], p = 0.035) compared to the Centre region with the lowest (2.3%). Divorced/separated/widowed individuals (10.2%) had increased risk (aPR = 1.70, 95% CI: [0.80-3.58], p = 0.165) compared to single individuals (3.2%). HIV remains a significant public health concern in remote, rural Cameroon, with a disproportionate impact on older adults and women. Surveillance should extend beyond the traditional 15-49-year age range, and targeted prevention is needed for high-prevalence regions and older populations to curb ongoing transmission.

Malaria control in sub-Saharan Africa lies at the intersection of changing climate suitability and the scale-up of vector control and case management. Drawing on recent evidence from Kenya, we argue that climate variability already exerts effects on malaria outcomes comparable to, and sometimes stronger than, those of commonly measured interventions at local scales. Transmission dynamics display non-linear, lagged relationships with temperature and rainfall. As a result, climate change is expected to alter prevailing conditions and extremes, reshaping the geography and seasonality of malaria risk. At the same time, socio-economic development and vector control intervention such as insecticide-treated bed nets (ITNs) and timely case management continue to reduce malaria incidence and deaths, especially among young children. However, their population-level impact depends on when and where interventions are deployed relative to climate-favoured windows of transmission. We propose a practical agenda for "climate-smart" malaria control in Kenya advocating for dynamic targeting of interventions according to observed climate lags and thresholds, sustaining protection for the youngest, and innovating approaches for school-age reservoirs of infection. Access to effective care should be re-conceptualized as a climate-adaptation strategy, and short-term, locally tailored forecasts should be embedded into routine planning to support anticipatory and equitable malaria control.

Lung involvement in patients with leptospirosis is associated with a more complicated disease course. However, the demographic and clinical associations of lung involvement are incompletely defined, and its optimal management is uncertain. This retrospective study examined consecutive patients admitted to a referral hospital in tropical Australia, with laboratory-confirmed leptospirosis between January 2015, and June 2024. Lung involvement was defined as new lung parenchymal changes on chest imaging at any point during the patients' hospitalisation. The demographics, clinical findings and clinical course of the patients with and without lung involvement were compared. The median (interquartile range (IQR)) age of the 109 patients was 39 (24-56) years; 93/109 (85%) were male. Lung involvement was present in 62/109 (57%), 55 (89%) of whom had no documented comorbidities. Patients with lung involvement received antibiotics later in their disease course than those without lung involvement (after a median (IQR) of 5 (4-6) versus 3 (2-5) days of symptoms, p = 0.001). Lung involvement was frequently associated with multi-organ failure: patients with lung involvement were more likely to require intensive care unit admission than patients without lung involvement (41/62 (66%) versus 15/47 (32%), p < 0.001). Overall, 30/109 (28%) satisfied criteria for acute respiratory distress syndrome (ARDS) and 26/109 (24%) developed pulmonary haemorrhage. Patients with lung involvement received cautious fluid resuscitation, vasopressor support and prompt initiation of additional supportive care-including mechanical ventilation, renal replacement therapy and extracorporeal membranous oxygenation-guided by the patients' physiological parameters and clinical trajectory. All 109 patients in the cohort were alive 90 days after discharge. Life-threatening lung involvement was identified in the majority of individuals in this cohort and occurred in young and otherwise well individuals. However, in Australia's well-resourced health system excellent outcomes can be achieved using a standard contemporary approach to the management of a patient with undifferentiated infection while a confirmed diagnosis of leptospirosis is awaited.

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived from baseline psychosocial measures, including adherence self-efficacy, ART knowledge, HIV stigma, psychological distress (depression, anxiety, trauma), and social support. Linear mixed-effects models were used to examine psychosocial symptom outcomes at three timepoints (baseline, 12-weeks, and 24-weeks) and across groups with different adherence or viral load phenotypes. Using hierarchical clustering, four distinct clusters were identified, underscoring heterogeneity of psychosocial symptoms and patterns of ART and viral suppression. Findings from this analysis are among the first known characterizations of ART adherence phenotypes and psychosocial symptom clusters among AYAs with HIV. Heterogeneity in clusters underscores the need to examine other factors, such as resilience, not captured in the present study. Overall, these study findings contribute to improved understanding of the multi-level psychosocial influences of ART adherence and viral load suppression.

Background: Although antivenom is the standard treatment for snakebite envenoming, its efficacy may be impacted by geographic variation in venom composition, emphasizing the need for region-specific antivenom development. Methods: We report a case of snakebite envenoming, in which the patient was bitten on the hand by a captive Malayan pit viper (Calloselasma rhodostoma) with typical clinical manifestations following. Antivenom (produced in Thailand) was administered at 33 and 39 h post-bite. Venom from the causative individual snake was collected for compositional analysis via SDS-PAGE. Enzymatic activity of the venom was evaluated through the degradation of casein and phospholipid substrates, along with the assessment of enzymatic inhibition by two regionally specific antivenoms produced in Vietnam (AV. Cr. VN.) and Thailand (AV. Cr. TL.). Results: The patient showed good recovery, with complete normalization by day 7. SDS-PAGE profiling of the venom revealed five major enzymes, with SVSP, SVMP and PLA₂ being the most abundant (16.7%, 40.11% and 26.11%, respectively). Antivenom inhibition tests revealed remaining casein percentages of 67.43% (AV. Cr. VN) and 59.35% (AV. Cr. TL). Blood agar assays indicated that phospholipase activity was reduced to 21.01% by AV. Cr. VN. and 23.30% by AV. Cr. TL. Conclusions: Our results show that the Vietnamese antivenom generated greater inhibitory activity against proteinases compared to the Thai product, underscoring the importance of using regionally specific antivenoms that are more effective against the venom profiles of locality-matched snake populations.

Dengue fever typically presents as a febrile illness, and acute pancreatitis has been reported as a rare complication. Limited evidence exists regarding clinical features, imaging findings, and outcomes, particularly on the distinction between acute interstitial pancreatitis and acute necrotizing pancreatitis. This systematic review was therefore designed in accordance with PRISMA guidelines (PROSPERO ID: CRD420250631013) in order to characterize the clinical spectrum of dengue virus (DENV)-associated acute pancreatitis by recollecting available case reports from PubMed, EMBASE, Scopus, MedRxiv, and BioRxiv Case reports and case series, which were included if they described laboratory-confirmed DENV infection and met the diagnostic criteria for acute pancreatitis. Seventy cases of DENV-associated acute pancreatitis were identified, mostly from Asia (78.6%) and South America (17.1%). Patients were predominantly male (62.9%), with a mean age of 31.6 years. Acute interstitial pancreatitis was more common (65.7%) than acute necrotizing pancreatitis (34.3%). Acute necrotizing pancreatitis was associated with leukocytosis, pancreatic collections, multiorgan and respiratory failure, prolonged hospital stay, and higher mortality (25.0% vs. 4.3% for acute interstitial pancreatitis). Overall, the case fatality was 11.4%, and survival analysis demonstrated significantly worse outcomes for acute necrotizing pancreatitis. In summary, clinicians should maintain awareness of this complication, as early recognition and appropriate management may improve outcomes.

Dengue fever is one of the most important mosquito-borne diseases worldwide. The Association of Southeast Asian Nations (ASEAN) region is a high-incidence area for dengue fever and a primary source of imported cases in China. Based on the Global Burden of Disease (GBD) data, this study statistically analyzed the spatiotemporal distribution of the age-standardized incidence rate (ASR) of dengue fever in ten ASEAN countries from 1990 to 2021. Joinpoint regression was used to analyze long-term trends, and future trends from 2022 to 2031 were predicted. In 2021, the ASR of dengue fever varied widely among ASEAN countries. Singapore had the highest ASR (8715 cases per 100,000 persons). After 2000, countries, such as Brunei Darussalam, experienced short-term outbreaks. From 1990 to 2021, seven countries showed a significant upward trend in the ASR (AAPC > 0, p < 0.05). Predictions indicate that the Philippines will continue to see a rising ASR from 2022 to 2031, and the dengue fever situation in ASEAN countries is severe and heterogeneous. We recommend differentiated control measures according to the ASR level of the source country in China. The results can support the development of Sino-ASEAN collaborative strategies for dengue fever prevention and control.

The incidence and prevalence of nontuberculous mycobacterial (NTM) disease are rising. This narrative review examines the evolution of NTM disease trends over the past four decades, in Canada and globally, encompassing changing epidemiology, shifting treatment paradigms, and emerging antimicrobial resistance patterns. Challenges to NTM treatment are explored, and novel and investigational therapies are summarized. Key themes include a significant increase in NTM disease incidence, temporal shifts in the dominant species causing human infections, evolution from single-drug to multi-drug treatment approaches, and growing concerns regarding macrolide resistance. The substantial challenges with treatment tolerability, effectiveness, and access are outlined. This review synthesizes data from multiple sources, including peer-reviewed literature, clinical trials, and public health databases, to provide a comprehensive understanding of the changing NTM disease landscape in Canada and more broadly. There is a need for expanded surveillance, continued innovation, and a multidisciplinary approach to NTM management.