Infectious Diseases of Poverty最新文献

Background: Artificial intelligence (AI) remains poorly understood and its rapid growth raises concerns reminiscent of dystopian narratives. AI has shown the capability of producing new medical content and improving management through optimization and standardization, which shortens queues, while its complete reliance on technical solutions threatens the traditional doctor-patient bond.

Approach: Based on the World Economic Forum's emphasis on the need for faster AI adoption in the medical field, we highlight current gaps in the understanding of its application and offer a set of priorities for future research. The historic review of AI and the latest publications point at barriers like complexity and fragmented regulations, while assisted analysis of big data offers new insights. AI's potential in healthcare is linked to the breakthrough from rule-based computing, enabling autonomy through learning from experience and the capacity of reasoning. Without AI, protein folding would have remained unsolved, as emphasized by the Nobel-honored AlphaFold2 approach. It is expected that AI's role in diagnostics, disease control, geospatial health and epidemiology will lead to similar progress.

Conclusions: AI boosts efficiency, drives innovation, and solves complex problems but can also deepen biases and create security threats. Controlled progress requires industry collaboration leading to prompt acceleration of proper incorporation of AI into the health sphere. Cooperation between governments as well as both public and private sectors with a multi-actor approach is needed to effectively address these challenges. To fully harness AI's potential in accelerating healthcare reform and shorten queues, while maintaining the compassionate essence of healthcare, a well-coordinated approach involving all stakeholders is necessary.

Background: Naegleria fowleri, a pathogenic free-living amoeba, causes primary amoebic meningoencephalitis (PAM), a rare but devastating disease with acute onset, rapid progression, and > 95% mortality. Despite its rarity, the catastrophic outcomes associated with this infection underscore the critical importance of prevention. In this report, we present a rare pediatric fatality caused by PAM in China, highlighting the challenges of diagnosis and treatment.

Case presentation: A 6-year-old child from Lushan County, Henan Province, developed persistent high fever, headache, vomiting, and altered mental status on December 5, 2024. After receiving ineffective local treatment, the child was transferred to the Eastern District of Henan Children's Hospital on December 7 for further evaluation and management. Upon admission, cerebrospinal fluid was collected for laboratory analysis, and antimicrobial therapy, including amphotericin B, fluconazole, and rifampicin, was promptly initiated. Despite these interventions, the patient's condition deteriorated rapidly, and the child succumbed to the infection on December 9.

Conclusions: Clinical and laboratory findings strongly suggest that the child was infected with N. fowleri, resulting in PAM. Epidemiological investigation suggests possible exposure at a public bathhouse. Given the survival characteristics of the N. fowleri and potential habitat expansion due to global warming, this sporadic case underscores PAM's lethal potential. With mortality exceeding 95%, early recognition and prompt intervention are crucial. Clinicians should maintain high suspicion for PAM in patients with compatible symptoms, especially in regions with warm freshwater exposure.

Background: HIV/AIDS, hepatitis B, and tuberculosis (TB) are chronic infectious diseases prioritized by the United Nations Sustainable Development Goals (SDGs) and China's "Healthy China Initiative (2019-2030)," posing persistent challenges to global and Chinese public health systems. This study analyzed mortality trends and regional/urban-rural disparities of these three diseases among Chinese elderly individuals aged 60 years and older from 2004 to 2021 to identify priority areas for targeted prevention strategies.

Methods: Data were sourced from the "China Cause-of-Death Surveillance Dataset (2004-2021)" published by the Chinese Center for Disease Control and Prevention. The study population comprised Chinese elderly individuals aged 60 years and older from 2004 to 2021. Joinpoint 4.9.0.1 software was used for joinpoint regression analysis to characterize dynamic mortality trends, calculating average annual percentage change (AAPC), annual percentage change (APC), and 95% confidence intervals (CIs).

Results: From 2004 to 2021, 100,934 deaths from the three chronic infectious diseases occurred among Chinese elderly. The overall age-standardized mortality rate (ASMR) decreased from 51.00 to 13.37 per 100,000 (AAPC: - 7.54%, 95% CI: - 9.38%, - 5.67%). Notably, the ASMR for HIV/AIDS increased from 0.11 to 0.85 per 100,000 population, while the ASMR for hepatitis B declined from 17.96 to 6.84 per 100,000 population and TB declined from 32.92 to 5.68 per 100,000 population. The three chronic infectious diseases collectively demonstrated the most significant ASMR reduction in central China (AAPC: - 7.85%, 95% CI: - 12.11%, - 3.39%), followed by eastern China (- 7.57%, 95% CI: - 9.02%, - 6.09%) and western China (- 7.10%, 95% CI: - 9.52%, - 4.62%). Rural areas experienced substantially steeper ASMR declines compared to urban areas (AAPC: - 7.81%, 95% CI: - 9.40%, - 6.18% vs. AAPC: - 6.05%, 95% CI: - 8.20%, - 3.85%).

Conclusion: China achieved a continuous decline in the overall ASMR for the three chronic infectious diseases among elderly populations during 2004-2021, suggesting initial success in prevention efforts. However, the rising ASMR for HIV/AIDS necessitates disease-specific strategies. Notable regional disparities persist: hepatitis B and TB remain concentrated in western/rural areas, while the ASMR for HIV/AIDS is higher in urban regions. Future efforts should tailor resource allocation to local contexts to enhance intervention outcomes and protect elderly health.

Background: A "trace" result from the Xpert Ultra molecular tuberculosis test indicates Mycobacterium tuberculosis DNA detection but may not always signify tuberculosis disease. Little is known about the experiences of individuals with trace results who are not immediately treated. We surveyed patients with trace results to better understand their experiences and preferences related to their uncertain tuberculosis status.

Methods: We enrolled adults and adolescents with trace Xpert Ultra sputum results, plus individuals with positive (at a semiquantitative level greater than trace) results ("positive controls") and with negative results ("negative controls"), from community-screening and clinic settings in Kampala, Uganda between February 2021 and December 2024. After an extensive clinical, laboratory, and radiographic evaluation, participants not recommended to start tuberculosis treatment immediately were closely monitored with interval reassessments. Starting in September 2021, surveys captured participants' perceptions and preferences related to their uncertain tuberculosis status at baseline and one and six months later. We compared categorial variables using Pearson's chi-squared test or Fisher's exact test with a significance level of 0.05.

Results: A total of 329 people with trace sputum (PWTS), 241 positive controls, and 279 negative controls were enrolled. Among PWTS surveyed, 22% (28/129) and 23% (30/129) thought they were likely to have or develop tuberculosis, respectively, and most reported low associated anxiety initially (80%, 263/329) and during follow-up. While 53% (174/329) would have favored treatment at baseline if not in the study, only 30% (41/136) of those who remained untreated were inclined toward treatment at six months. Participants chose a sensitive hypothetical test, even with high false-positivity risk, over one with lower sensitivity.

Conclusions: Most PWTS in our study reported a low self-perceived likelihood of having or developing tuberculosis and low anxiety during follow up. Deferring treatment for PWTS is acceptable to most patients when sufficient testing and monitoring are available; in other contexts, upfront treatment may be preferable.

Background: The sterile insect technique (SIT) requires distinguishing sterile from wild male mosquitoes to evaluate male qualities and maintain an appropriate release ratio for efficient population suppression. Current dye/powder marking methods have limitations and may affect SIT effectiveness, necessitating alternative discrimination strategies. Aedes albopictus naturally harbors two Wolbachia infections (wAlbA/wAlbB), which can be eliminated via tetracycline. Although Wolbachia removal minimally affect host fitness, its impact on microbiota remains unclear. Characterizing post-elimination microbial communities is the first step to identify novel endogenous biomarkers for SIT monitoring.

Methods: We analyzed the bacterial diversity and composition of two strains of wild-type GUA (Wolbachia-infected) and GT (Wolbachia-free) mosquitoes using the 16S rRNA V3-V4 region sequencing. qPCR was employed to confirm the relative abundance of four major bacterial genera, while PCR was used to validate selected biomarkers for distinguishing factory-reared sterile males from wild males. Kruskal-Wallis or Mann-Whitney test was used to analyze the comparable parameters between GUA and GT strains.

Results: Five-day-old GUA and GT females showed similar microbial diversity/composition, while young males shared diversity but differed in composition. The core microbiota in both strains consisted of Proteobacteria (64.27%), Firmicutes (16.09%), Actinobacteriota (11.22%), and Bacteroidota (4.96%). Asaia was dominant in both strains (GUA: 47.33%; GT: 32.69%), whereas Enterococcus increased in GT males with aging. Wolbachia was absent in GT mosquitoes, and Elizabethkingia was undetected in GUA males. qPCR further confirmed these trends. PCR analysis revealed that wAlbB exhibited higher stability in differentiating factory-reared GT males from their wild counterparts (96.7% infection in field males, n = 60) compared to wAlbA (61.7%, n = 60) or Enterococcus (65.8%, n = 120). The mark-release-recapture experiment further confirmed the detectability using wAlbB biomarker.

Conclusions: Without obvious fitness costs observed previously in the Ae. albopictus GT strain compared to GUA strain, the removal of Wolbachia significantly changes the microbial composition in male mosquitoes in this study. Wolbachia wAlbB is recommended as a reliable biomarker for distinguishing sterile males from wild males when using GT strain in SIT programs targeting Ae. albopictus.

Background: Malaria is a major worldwide health concern that impacts many individuals worldwide. P. falciparum is Africa's main malaria cause. However, P. vivax share a large number in Ethiopia than any other countries in Africa, followed by the closest countries. This research aims to examine the spatiotemporal trends in the risk of malaria caused by P. falciparum and P. vivax in Ethiopia and other countries that share borders between 2011 and 2020.

Methods: This study was carried-out in seven East African countries in 115 administration level 1 (region) settings. We used secondary data on two plasmodium parasites, P. falciparum, and P. vivax, between 2011 and 2020 from the Malaria Atlas Project. This study used a Bayesian setup with an integrated nested Laplace approximation to adopt spatiotemporal models.

Results: We analyzed P. falciparum and P. vivax malaria incidence data from 2011 to 2020 in 115 regions. Between 2011 and 2020, all of South Sudan's areas, Ethiopia's Gambella region, and Kenya's Homa Bay, Siaya, Busia, Kakamega, and Vihita regions were at a higher risk of contracting P. falciparum malaria than their neighbors in seven East African nations. However, the Southern Nations, nationalities, and people, as well as the Oromia, Harari, Afar, and Amhara areas in Ethiopia, and the Blue Nile in Sudan, are the regions with a higher risk of P. vivax malaria than their bordering regions. For both P. falciparum and P. vivax, the spatially coordinated main effect and the unstructured spatial effect show minimal fluctuation across and within 115 regions during the study period. Through a random walk across 115 regions, the time-structured effect of P. falciparum malaria risk shows linear increases, whereas the temporally structured effect of P. vivax shows increases from 2011 to 2014 and decreases from 2017 to 2020.

Conclusions: The global malaria control and eradication effort should concentrate particularly on the South Sudan and Ethiopia regions to provide more intervention control to lower the risk of malaria incidence in East African countries, as both countries have high levels of P. falciparum and P. vivax, respectively.

Lowndes County is a predominantly Black rural county in Alabama, in the United States, which has a historical and current legacy of racial discrimination, creating inequitable infrastructure access and adverse health impacts. Over 80% rely on on-site sanitation infrastructure and most are failing. A community assessment of exposure to untreated sewage was conducted using samples from residential drinking water, surface swabs, and soil combined with environmental water and soil samples using culture-based and quantitative polymerase chain reaction (qPCR) methods. Testing varied slightly across samples, due to difficulty of access or availability. Of 43 households, 68% and 55% of houses had detectable presence of human fecal matter indicator in their soils and on their doorsteps, respectively, and 0% had detectable amounts of culturable Escherichia coli in their drinking water. Of 40 houses sampled, 88% tested positive for E. coli in soil samples. Of 39 residences, 31% had positive presence of environmental and zoonotic parasites in soil, but none for Necator americanus, Cryptosporidium species, or Giardia intestinalis. Of the 18 sampled environmental surface waters, 100% tested positive for culturable E. coli, 50% had detectable human fecal matter indicator present, and 27% tested positive for anthropogenic parasites. This work sheds light that there is presence of culturable E. coli, human fecal matter, and anthropogenic parasites in residential soil samples of all sanitation types (municipal, septic tank, and straight piping) and in environmental surface waters throughout the sampled areas. Our findings support the narrative that sanitation infrastructure of all types in Lowndes County, Alabama are compromised and highlights residential and environmental exposure to raw wastewater.

Background: Visceral leishmaniasis (VL) an 'infectious disease of poverty', caused by the Leishmania donovani complex, remains a significant public health threat in endemic regions of South Asia, East Africa, and Brazil. Early and accurate diagnosis is critical to prevent the disease's potentially fatal outcomes. However, due to the nonspecific nature of clinical symptoms, diagnosis often relies on serological tests. This study aims to assess the diagnostic potential of the L. donovani activated C kinase (LACK), a highly conserved antigen essential for parasite survival and host establishment, in VL-endemic regions such as India and Brazil.

Methods: We conducted a multi-center study with serum samples from India (n = 184) and Brazil (n = 59), along with non-invasive urine samples from India (n = 132). Clinical samples from India were collected from the endemic regions of Bihar and West Bengal between 2016-2024, while those from Teresina, Brazil, were collected between 2008 and 2009. Following preliminary immunoblot analysis, we validated the diagnostic utility of LACK through enzyme-linked immunosorbent assays (ELISA) and dipstick tests. Results were analyzed and area under a Receiver Operating Characteristic (ROC) curve (AUC) values were calculated via the Mann-Whitney U test. Additionally, sensitivity, specificity, and confidence intervals were assessed to evaluate diagnostic performance.

Results: The ELISA results revealed that LACK antibodies exhibited 100% sensitivity in both Indian [95% confidence intervals (CI): 94.80-100%] and Brazilian (95% CI: 91.24-100%) patient samples, with specificity of 97.33% for Indian controls and 94.74% for Brazilian controls. Urine samples from Indian patients also demonstrated perfect sensitivity and specificity (100%). Notably, LACK showed minimal reactivity with follow-up patient samples. Dipstick assays confirmed these findings, offering a simple, rapid, and field-friendly diagnostic alternative.

Conclusion: LACK is a promising diagnostic marker for VL, showing high sensitivity across regions and has potential to distinguish active infections from cured or relapsed cases, though larger studies are needed for confirmation.

Background: Nigeria's Federal Capital Territory (FCT) launched annual mass drug administration (MDA) in its four lymphatic filariasis (LF)-endemic councils in 2011, achieving sustained high coverage and pre-transmission assessment survey success. This study aimed to confirm transmission interruption in Bwari and Gwagwalada and to evaluate post-MDA surveillance efficacy in Abaji and Kuje.

Methods: Transmission Assessment Surveys (TAS) were systematically conducted in four distinct evaluation units (EUs) within the FCT. TAS 1 was carried out in Bwari and Gwagwalada EUs that had recently achieved pre-TAS thresholds indicating potential interruption of transmission, whereas TAS 2 was conducted in Abaji and Kuje EUs, where MDA had been discontinued since 2021 following successful TAS 1 evaluations. Abbott Filarial Test Strips (FTS) were employed to test children aged 6-7 years attending selected schools. Data collection adhered to standardized WHO guidelines, utilizing both paper-based and electronic data-capture tools to enhance accuracy and reduce human error.

Results: A total of 6,448 children participated in surveys across the four EUs, with gender distribution closely balanced (53% male, 47% female). In TAS 1 (Bwari and Gwagwalada), no LF-positive cases were identified well below the WHO-defined critical cutoff of 18 cases. In TAS 2 (Abaji and Kuje), a single LF-positive case was detected in Abaji, still below the critical threshold. Participant refusal rates were minimal, reflecting strong community support and engagement.

Conclusions: The findings provide compelling evidence of significant progress toward LF elimination in Nigeria's FCT; however, the single positive case in Abaji underscores the continued importance of vigilant surveillance and integrated vector-management strategies to maintain elimination status and guard against residual transmission.