Tropical Medicine & International Health最新文献

Objectives: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) affect 340 million people worldwide and have a high impact on vulnerable populations. The aim of this systematic review and meta-analysis was to estimate the prevalence of these infections among inmates in Latin America and the Caribbean.

Methods: Searches were conducted in Medline, Embase, LILACS and Web of Science databases on 17 May 2024, without time or language restriction, according to PRISMA guidelines. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the bias risk in the selected studies. Meta-analysis was performed by using the random-effects model and heterogeneity between studies was assessed with I² statistic. Subgroup analyses and meta-regression were performed to investigate possible sources of heterogeneity.

Results: Seventy-nine studies were included, encompassing over 230,000 inmates. The estimated prevalences of HBV, HCV and HIV were 1.0% (95% CI: 0.0-1.0), 7.0% (95% CI: 6.0-8.0) and 4.0% (95% CI: 3.0-4.0), respectively. Subgroup analysis showed the following prevalences: HBV among females was 1.0% (95% CI: 0.0-3.0) and among males was 10.0% (95% CI: 3.0-17.0); HCV among females and males was 12.0% (95% CI: 7.0%-17.0%); and HIV among females was 10.0% (95% CI: 5.0-15.0) and among males was 8.0% (95% CI: 6.0-10.0).

Conclusions: A substantial proportion of inmates in Latin America and the Caribbean are infected with HBV, HCV or HIV, underscoring the need for viral infection testing, primary care for inmates and increased efforts to promote public health policies for the prison system.

Objectives: To investigate the differences in clinical, radiological and laboratory parameters between elderly and young patients with newly diagnosed smear-positive pulmonary tuberculosis in Vietnam.

Methods: This retrospective analysis included all patients hospitalised with newly diagnosed pulmonary tuberculosis with acid-fast bacilli-positive smear. Clinical symptoms, laboratory results and chest X-ray findings were collected using a standardised questionnaire. Elderly was defined as those patients aged 65 years and older.

Results: A total of 183 patients diagnosed with new acid-fast bacilli-positive pulmonary tuberculosis were included in this study, with a mean age of 56.2 ± 16.3 years (minimum = 18 and maximum = 87 years). Seventy-seven participants were aged ≥65 years, accounting for 42.1% of participants. A total of 147 (80.3%) patients were male, and the sex ratio of male/female was 4.1. Night sweats were statistically more frequent among younger patients (34.9% vs. 20.8%, p = 0.04), whereas muscle and joint pain were more predominant among the elderly (7.6% vs. 22.1%, p = 0.01). A proportion of 67.0% of younger patients and 63.6% of the elderly group were bilaterally affected. Cavitation lesions were significantly more frequent in the younger group (55.7% vs. 39.0%, p = 0.03), whereas pulmonary fibrosis occurred more frequently in elderly patients (29.3% vs. 45.4%, p = 0.02). No other significant differences in clinical symptoms, laboratory results and chest X-ray findings were observed.

Conclusion: These findings underscore the importance of considering age-related variations in the clinical and radiological presentation of tuberculosis, which can guide tailored approaches in diagnosis, management and treatment strategies for different age groups.

The resurgence of mpox, declared a Public Health Emergency of International Concern by the World Health Organization in 2024, highlights gaps in global preparedness, particularly for marginalised populations. While much of the focus has been on men who have sex with men, survivors of sex trafficking remain overlooked, despite being highly vulnerable to mpox transmission. These individuals face significant health disparities, including limited access to healthcare, exposure to violence and forced sexual encounters in unsafe conditions, which amplify their risk of infection. The clandestine nature of trafficking further complicates public health interventions like contact tracing and vaccination efforts, leaving survivors at heightened risk of infection and limited access to critical health resources. Addressing these inequities requires targeted interventions, such as confidential testing, outreach, culturally sensitive healthcare and integrating mpox awareness into existing survivor support programmes. Additionally, public health systems must ensure equitable vaccine distribution, enhance surveillance and collaborate with anti-trafficking organisations to improve prevention and care. A holistic approach that includes mental health support is crucial to address the unique challenges faced by trafficking survivors, ensuring they receive the protection and care needed during this global outbreak.

Background: Non-laboratory-based cardiovascular risk prediction tools are feasible alternatives to laboratory-based tools in low- and middle-income countries. However, their effectiveness compared to their laboratory-based counterparts has not been adequately tested.

Aim: We compared estimates from laboratory-based and non-laboratory-based risk prediction tools in a low- and middle-income country setting.

Methods: Using a cross-sectional design, residents of the Rishi Valley region, Andhra Pradesh, India, were surveyed from 2012 to 2015. Ten-year absolute risk was compared for laboratory-based and non-laboratory-based Framingham Risk Score (FRS), World Health Organization-Risk Score (WHO-RS) and risk prediction tool for global populations (Globorisk). An agreement was assessed using ordinary least-products (OLP) regression (for RS) and quadratic weighted kappa (κ_w, for risk band).

Results: Among 2847 participants aged 40-74 years, the mean age was 54.0 years. Cardiovascular RS increased with age and was greater in men than women in each age group. For all tools, regardless of whether laboratory or non-laboratory-based, over 80% of the participants were classified in the same risk band. There was strong agreement between laboratory-based and non-laboratory-based tools, greatest for the WHO-RS tools (OLP slope = 0.96, κ_w = 0.93) and least for the FRS (OLP slope = 0.84, κ_w = 0.88). The level of agreement was greater among women than men, less in those with hypercholesterolaemia or hypertension than those without, and was particularly poor among those with diabetes.

Conclusions: Non-laboratory-based Framingham, WHO-RS and Globorisk tools performed relatively well compared with their laboratory-based counterparts in rural India. However, they may be less useful for risk stratification when applied to individuals with diabetes.

Background: Sporotrichosis is a neglected tropical disease and the most common subcutaneous mycosis, mainly caused by Sporothrix species, particularly S. brasiliensis, S. schenckii and S. globosa, which exhibit varying biological behaviours and virulence. The epidemic of sporotrichosis in Brazil, initiated in Rio de Janeiro in the late 1990s, rapidly spread to other states, including Amazonas in 2021. This study aimed to identify the specific Sporothrix species responsible for the human sporotrichosis outbreak in the Brazilian Amazon.

Methods: A cross-sectional study was conducted by enrolling clinically suspected cases of sporotrichosis attended at a reference dermatologic centre, in Manaus (Brazil). Biological material was collected from their skin lesions for culture (Mycosel) and for species identification (qPCR).

Results: Sporothrix cultures were obtained from 150 cases. Sporotrichosis predominantly affected females (67.3%), aged 44.5 years on average, with lymphocutaneous lesions (72.7%). Sporothrix brasiliensis was identified in 89.3% of patients. Up to 83.3% of these patients reported contact with cats previously to the skin lesion, and the time-spatial progression of the human cases followed the notification of cases in cats, in the metropolitan region of Manaus.

Conclusion: Sporothrix brasiliensis is the dominant species in the zoonotic outbreak of human sporotrichosis in the Brazilian Amazon, with cats identified as the primary vectors. Effective sanitary control measures, education and responsible pet ownership are crucial to mitigating zoonotic sporotrichosis' impact in Brazil and preventing its spread to neighbouring Latin American cities.

Background: Acute febrile illness is a common reason for seeking healthcare in low- and middle-income countries. We describe the diagnostic utility of a TaqMan Array Card (TAC) real-time polymerase chain reaction (PCR) panel for pathogen detection in paediatric and adult inpatients admitted with febrile illness.

Methods: In this prospective cohort study, we screened medical admissions for a tympanic temperature ≥38.0°C or reported fever within 72 h and used a PCR panel to detect pathogens, including bacteria, viruses, fungi and protozoa, in 697 participants. We compared PCR results to conventional diagnostic methods and considered PCR detections as the cause of fever, except for Plasmodium spp. and Schistosoma spp. Participants for PCR testing was consecutively selected from the end of enrolment.

Results: Of 1132 participants enrolled in the cohort, 697 (61.6%) were tested by PCR. Median (IQR) age was 29.6 (4.6-46.4) years. Three hundred seventy-eight (54.2%) were male. The PCR method improved illness identification, increasing diagnostic yield from 73 (10.5%) by conventional methods to 124 (17.8%) of 697 participants. PCR detections included four viral pathogens: dengue (n = 1), enterovirus (n = 7), measles (n = 1) and Rift Valley Fever Virus (RVFV) (n = 3). Forty-six bacterial pathogens were detected in 44 (6.3%) participants, including fastidious bacteria such as Bartonella spp. (n = 2), Brucella spp. (n = 3), Coxiella burnetii (n = 2), Leptospira spp. (n = 1), M. tuberculosis (n = 7) and Rickettsia spp. (n = 9).

Conclusion: The PCR panel improved pathogen detection in febrile inpatients, providing clinically actionable results for fastidious bacteria and epidemiologically relevant findings like RVFV detections, when combined with conventional methods.

Background: Despite existing recommendations, there is still a scarcity of evidence on the impact of active case finding strategies versus passive case finding strategies, especially with regard to the mortality of tuberculosis patients. Therefore, our aim was to estimate the effect of case detection strategies on the prognosis of tuberculosis patients.

Methods: We conducted a retrospective cohort study of 160,384 new cases of tuberculosis patients diagnosed between 1 January 2010 and 31 August 2019 in the state of São Paulo, Brazil. We classified exposure into: passive case finding (emergency room, outpatient clinics or hospital settings) and active case finding (institutions, community or contact investigation). The primary outcome was all-cause mortality, and the secondary outcome was a composite outcome with treatment outcomes. We investigated associations using logistic regression, allowing for municipality-level random effects.

Results: Compared with outpatient passive case finding, passive case finding in the emergency room and in the hospital showed higher odds of death (adjusted odds ratio [OR] 3.69; 95% CI: 3.47-3.93 and 4.47; 95% CI: 4.22-4.74, respectively) and unfavourable treatment outcomes (1.92; 95% CI: 1.84-1.99 and 2.06; 95% CI: 1.98-2.14, respectively). By contrast, patients detected through community-based active case finding and contact investigation showed lower odds of death (0.77; 95% CI: 0.61-0.97 and 0.71; 95% CI: 0.54-0.92, respectively) and unfavourable treatment outcomes (0.85; 95% CI: 0.77-0.95 and 0.82; 95% CI: 0.74-0.91, respectively).

Conclusion: Community-based active case finding and contact investigation were associated with better prognosis than passive strategies in tuberculosis patients. Our results highlight the importance of strengthening active case finding as a fundamental part of mitigating the disease burden and controlling tuberculosis.

Background: Tuberculosis remains a significant public health issue, particularly among children who are in close contact with tuberculosis patients. India accounts for a large proportion of global tuberculosis cases. Despite global recommendations for Isoniazid Preventive Therapy to prevent latent tuberculosis infection from progressing to active disease, the initiation and adherence to Isoniazid Preventive Therapy remain suboptimal, especially in high-burden settings. Understanding the barriers to Isoniazid Preventive Therapy implementation is crucial to improving treatment outcomes and achieving tuberculosis elimination goals.

Objectives: This study aimed to quantify the uptake of isoniazid among children under 6 years who were started on Isoniazid Preventive Therapy and to identify the challenges from the perspectives of caregivers and healthcare providers.

Methods: The study was conducted in a slum in Mumbai, India, from June to December 2023, using a mixed-methods design. The quantitative phase involved a house-to-house survey, covering all 96 contacts started on Isoniazid Preventive Therapy in 2022, using a semi-structured questionnaire. The qualitative phase included key informant interviews with healthcare providers and in-depth interviews with caregivers. Quantitative data were analysed using Fisher's exact test and chi-square test, while qualitative data were analysed thematically.

Results: Of the 96 children, 11 (11.45%) completed therapy, with an average treatment duration of 2.5 months. Quantitative findings highlighted fear of side effects and family migration as major reasons for discontinuation. Completion of chemoprophylaxis was significantly associated with factors like male gender, support from extended family, home visits by tuberculosis health staff, and shorter travel time (under 30 min) to the tuberculosis unit. Qualitative data revealed challenges across themes of supply, staff, training, services, and adherence. Key challenges included lack of awareness, unavailability of isoniazid in syrup form, inadequate training for health workers, weak program monitoring, insufficient staffing, and fears related to tuberculosis exposure during outpatient department visits.

Conclusion: Effective counselling, regular follow-ups, availability of medications in syrup form, increasing staffing based on case burden, timely training of staff, strengthening program monitoring, and ensuring infection control in tuberculosis outpatient departments are critical to achieving successful completion of isoniazid preventive therapy.

Background: Ocular infections can harm the eye's anatomic structure on numerous levels. They are a global health issue. Endophthalmitis, a serious complication following cataract surgery, can result in substantial ocular morbidity and vision loss despite the administration of antibiotics. Bacterial ocular flora are the primary causative agents. This study aimed to assess the types of bacterial isolates on the external ocular surface and evaluate their antimicrobial susceptibility patterns in pre-operative cataract patients at Kafrelsheikh University Hospitals.

Methods: This cross-sectional study enrolled 691 patients scheduled for routine cataract surgery in the Department of Ophthalmology at Kafrelsheikh University Hospitals, Egypt. Each patient underwent a comprehensive assessment of medical history, including the use of traditional medicine, past eye trauma, and any prior eye surgeries, as well as ophthalmic clinical data such as visual acuity and ocular surface disorders. Conjunctival swabs were collected and processed using standard microbiological procedures to identify bacterial isolates and their respective antimicrobial susceptibility patterns.

Results: Among the 691 patients enrolled (median age 60 years, IQR 54-66), 59.8% were female. Conjunctival cultures yielded positive results in 38 cases (5.6%). The most frequently isolated organisms were Staphylococcus aureus, accounting for 52.6% of isolates, followed by Staphylococcus epidermidis at 15.8%. Notably, S. aureus demonstrated the highest resistance to erythromycin and vancomycin, with all 20 isolates showing resistance. In contrast, linezolid exhibited high efficacy, with 19 isolates showing sensitivity and only one displaying resistance.

Conclusion: This study indicated that ocular conditions such as dry eye syndrome, Meibomian gland dysfunction, and scaly blepharitis are strongly associated with the prevalence of culture-confirmed ocular infections. Regarding antibiotic susceptibility, most Staphylococcus species demonstrated the greatest sensitivity to linezolid and trimethoprim/sulfamethoxazole.

Objective: Opisthorchis viverrini and cholangiocarcinoma have been recognised by the World Health Organisation as critical public health concerns, particularly in northeastern Thailand, where Opisthorchis viverrini is a significant cause of cholangiocarcinoma. This study examines the factors influencing Opisthorchis viverrini and cholangiocarcinoma prevention within the One Health framework in Kanthararom District, Sisaket Province, Thailand.

Methods: A cross-sectional study was conducted among 327 residents aged 20 and above, utilising a structured questionnaire to assess knowledge, attitudes, perceived self-efficacy and prevention behaviours. Data were analysed using descriptive statistics, Pearson's product-moment correlation coefficient and multiple regression analysis to identify relationships and predictors within the dataset.

Results: The results showed that 53.52% of participants had moderate knowledge and attitudes towards prevention, while perceived self-efficacy was generally high. Positive correlations were found between income, knowledge, attitudes, self-efficacy and prevention behaviours. Key predictors of Opisthorchis viverrini and cholangiocarcinoma prevention behaviours included attitudes towards human health (β = 0.212), perceived self-efficacy in human health (β = 0.211), attitudes towards animal health (β = 0.205) and knowledge about human health (β = 0.138), accounting for 24.40% of the variance in prevention behaviours. These predictors were statistically significant at 0.05 (F = 25.95; p <0.001).

Conclusion: The findings suggest that enhancing knowledge, attitudes and self-efficacy is crucial to improving Opisthorchis viverrini and cholangiocarcinoma prevention. This study underscores the need for integrated public health strategies incorporating human, animal and environmental health to reduce the prevalence of Opisthorchis viverrini and cholangiocarcinoma in high-risk regions.