American Journal of Tropical Medicine and Hygiene最新文献

This case report describes the use of photobiomodulation (PBM) as a complementary therapy in a 45-year-old patient with mammary tuberculosis (TB). The patient received conventional treatment, including antibiotic therapy and analgesics. Three months after the diagnosis, breast pain persisted (Visual Analog Scale [VAS] score: 8), and the mammary lesions had not healed. Adjuvant treatment with PBM (660 nm and 808 nm lasers, 100 mW, 3,333 mW/cm2, 20 J per session) was performed over 12 sessions in 38 days. After four PBM sessions, the patient reported no pain (VAS score: 0) and stopped using analgesics. Complete healing of the mammary lesions was observed after 12 sessions. The use of PBM was associated with improvements in tissue repair, pain control, and healing of lesions resulting from mammary TB.

Infectious diarrhea frequently occurs in children, and accurate diagnosis is essential for providing prompt treatment. Fecal calprotectin (FC) and procalcitonin (PCT) are useful in differentiating types of infectious diarrhea. Therefore, this study aims to assess the value of combining FC and PCT in the differential diagnosis of bacterial and viral diarrhea in children. As a retrospective study, convenience sampling was used to include 60 children with acute bacterial diarrhea (bacterial group) and 70 children with acute viral diarrhea (viral group) who were admitted to hospitals in China between October 2019 and October 2021. The demographic characteristics, medical history, and laboratory data of the children were collected and compared. The proportions of children with myocardial and liver damage were lower in the bacterial group than in the viral group, and the proportions of children with bloody stool and purulent stool were higher in the bacterial group than in the viral group (all P <0.001). The levels of FC, PCT, C-reactive protein (CRP), and white blood cells (WBCs) were elevated in patients in the bacterial group compared with those in the viral group (all P <0.05). The FC, PCT, CRP, and WBC count values are valuable in the differential diagnosis of bacterial and viral diarrhea, and the area under the curve of FC combined with PCT for the differential diagnosis was the largest at 0.933, with a 95% CI of 0.856-0.955. Fecal calprotectin is superior to PCT, CRP, and WBC count in terms of guiding the differential diagnosis. The combination of FC and PCT provides better guidance for differential diagnosis than each indicator used individually.

There have been significant reductions in the burden of trachoma worldwide. However, some districts have experienced persistently high trachoma prevalence despite many years of intervention. Here, we report the epidemiology of trachoma in Merhabete, Ethiopia, a district in the Amhara Region that has been receiving azithromycin mass drug administration (MDA) since 2009. Data were obtained from the baseline survey of a cluster randomized trial evaluating targeted treatment strategies for trachoma elimination. An enumerative census was conducted in February 2022 to generate lists of children aged 6 months to 9 years in 80 sentinel communities participating in the trial. All children in the sentinel communities who were included in the census were examined. Field grades and conjunctival swabs were collected to assess active trachoma (based on clinical assessment) and ocular chlamydia (based on polymerase chain reaction to identify Chlamydia trachomatis). A total of 5,935 children were examined in 80 communities. The prevalence of trachomatous inflammation-follicular (TF) was 46.6%, trachomatous inflammation-intense (TI) was 17.5%, and ocular chlamydia was 28.0%. The correlation between TF and ocular chlamydia (correlation coefficient 0.54, 95% CI 0.34-0.70) was similar to the correlation between TI and ocular chlamydia (correlation coefficient 0.49, 95% CI 0.30-0.65). The prevalence of ocular chlamydia remained high in this district, which had received more than 10 rounds of azithromycin MDA. Ocular chlamydia was moderately correlated with both TF and TI. Intensive interventions may be required to eliminate trachoma in settings with persistently high ocular chlamydia prevalence despite many years of intervention.

Scrub typhus is one of the common causes for acute febrile illness in monsoon and post-monsoon season in our region. It usually presents as fever, rash, and thrombocytopenia with or without multiorgan dysfunction syndrome (MODS). Infrequently, it can cause focal or symmetrical peripheral gangrene (SPG). Here, we report a 5-year-old female who presented with acute febrile illness with MODS and SPG in bilateral lower limbs. The diagnosis of scrub typhus was confirmed with positive scrub typhus IgM antibodies. She recovered completely after combination therapy with doxycycline and azithromycin, and organ supportive therapy (mechanical ventilation, vasoactive drugs, and continuous renal replacement therapy) in the pediatric intensive care unit.

Aerosolized pentamidine is Food and Drug Administration approved to treat Pneumocystis pneumonia via a route that does not lead to systemic absorption or toxicity. Because Leishmania is also susceptible to pentamidine and mucosal leishmaniasis is also an infection of the respiratory tract, we performed a pilot study of aerosolized pentamidine (300 mg for 10 days over approximately 4 weeks) for mucosal leishmaniasis caused by Bolivian Leishmania braziliensis with a 2-year follow-up. Of 15 patients, 6 of 7 patients with initially mild disease were cured, 3 of 4 patients with initially moderate disease relapsed at the 18- to 24-month follow-up visits, and 3 of 4 patients with initially severe disease failed early after treatment. This study suggests that inhaled pentamidine may be useful as a well-tolerated treatment of mild mucosal leishmaniasis and that to rule out relapse, mucosal leishmaniasis follow-up should extend to 2 years.

A critical impediment to efficient outbreak response is the availability of timely and complete data on cases and their linkage to care. To inform solutions to this issue, this study investigated the utility of self-testers reporting their coronavirus disease 2019 results using a mobile health platform. Our study has demonstrated that the mobile health platform is feasible; it achieved a 74.5% reporting rate, indicating a strong likelihood of data entry into the unstructured supplementary service data platform. Support from community health workers (CHWs) and healthcare professionals, particularly nurses, contributed to this success, especially among users with limited digital literacy. Specifically, 44.9% of self-test results were submitted by study participants themselves, 24.7% were submitted with the assistance of healthcare professionals, and 30.4% were submitted with the assistance of CHWs. The platform broadens the population base by increasing access and equity, allowing participation even among users without smartphones. Additionally, it integrates rapid antigen diagnostic tests with digital reporting, simplifying data processing and enabling standardized screening, real-time data capture, and effective patient follow-up. This technology also lays a foundation for pandemic preparedness in low- and middle-income countries by demonstrating the feasibility of fully integrating response loops for disease management and interventions. Future response loops could leverage artificial intelligence, machine learning, and integration with existing health surveillance systems, directly benefiting users through enhanced support.

Nerve destruction is central to the pathogenesis and clinical manifestation of leprosy reactions (LRs). However, pathological changes in dermal nerves in LRs have not been clearly elucidated. Hematoxylin and eosin (H&E) staining may fail to accurately identify fragmented nerves, and special stains may be required. We recruited 56 patients with clinically diagnosed LRs as cases and 30 patients with nonreactional leprosy as controls. Number and level of nerves, nerve edema, relation of granulomas to nerves, perineuritis, pattern of nerve involvement, and quantification of each nerve pattern were noted on H&E stain and S-100 immunostain on skin biopsy sections. Most of the cases were borderline tuberculoid (BT; 32.8%) and lepromatous leprosy (32.8%) types, whereas most controls were classified as BT (44.8%). We found greater dermal nerve infiltration, fragmentation, and destruction during reactions when compared with nonreactional leprosy (fragmented nerves on S-100: P <0.0001). Nerve fragmentation (P = 0.037), subcutaneous nerve involvement (P = 0.014), and severe nerve edema (P = 0.0005) were higher in type 2 reaction (T2R) compared with type 1 reaction (T1R; on S-100), mostly attributed to the higher number of severe T2Rs (n = 23/25) among our cases. Intact nerves were higher in downgrading T1R compared with upgrading T1R (P = 0.038 on H&E and P = 0.004 on S-100). Thus, the identification and quantification of different patterns of nerves using special stains, such as S-100, may shed more light on nerve fiber involvement and destruction in LRs and may help us predict the prognosis of such cases.

Hispaniola, which is shared by Haiti and the Dominican Republic, remains the last island in the Caribbean that is still endemic for malaria, with Haiti bearing the highest caseload. Few studies have examined the ecology of malaria vectors in Haiti. Five species of Anopheles have been described on the island, but the exophilic Anopheles albimanus (An. albimanus) is considered the primary vector of malaria in Haiti. Households recruited for a case-control study profiling risk factors for symptomatic Plasmodium falciparum (P. falciparum) infections were approached to participate in an entomological study. The goal was to determine the bionomics of anopheline mosquitoes around the 32 participating households across varying malaria transmission settings. We assessed the characteristics of the Anopheles population using ultraviolet-light traps and larval surveys. Anopheles albimanus was the most abundant mosquito species identified in the Grand'Anse. Its abundance was higher in outdoor traps than in indoor traps and in areas with relatively high positivity based on rapid diagnostic test results. A greater proportion of blood-fed mosquitoes were found in higher transmission areas. Anopheles albimanus samples were found to be infected with both P. falciparum and Plasmodium vivax sporozoites. As Haiti aims for the elimination of malaria, disrupting localized residual malaria transmission will increasingly rely on focal vector control strategies.